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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has spread worldwide and threatened human's health. With the passing of time, the epidemiology of coronavirus disease 2019 evolves and the knowledge of SARS-CoV-2 infection accumu-lates. To further improve the scientific and standardized diagnosis and treatment of maternal SARS-CoV-2 infection in China, the Chinese Society of Perinatal Medicine of Chinese Medical Association commissioned leading experts to develop the Recommendations for the Diagnosis and Treatment of Maternal SARS-CoV-2 Infection under the guidance of the Maternal and Child Health Department of the National Health Commission. This recommendations includes the epidemiology, diagnosis, management, maternal care, medication treatment, care of birth and newborns, and psychological support associated with maternal SARS-CoV-2 infection. It is hoped that the recommendations will effectively help the clinical management of maternal SARS-CoV-2 infection.
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Objective:To investigate the molecular mechanism for regulation of trophoblast invasion by piR-3127964, which is differentially expressed in placental tissues of preeclamptic and healthy pregnant women.Methods:Placenta samples of healthy (control group, n=12) and preeclamptic pregnant (PE group, n=10) women who delivered by caesarean section and chorionic villi specimens of patients undergoing artificial abortion were collected in the Department of Obstetrics of the First Affiliated Hospital of Chongqing Medical University during November 2020 to August 2021. Total RNA was extracted from placenta samples and sequenced and the expression of piR-3127964 in different tissues was determined by real-time quantitative-polymerase chain reaction (qRT-PCR). The expressions of PIWI proteins including PIWIL-1, PIWIL-2 and PIWIL-3 in different tissues were detected by Western blot. The expressions of two candidate targets, guanine nucleotide-binding protein-like 3-like (GNL3L) mRNA and sialophorin (SPN) mRNA were evaluated by qRT-PCR after exogenous treating HTR-8/SVneo cells with mimics, inhibitor or negative control of piR-3127964, respectively. qRT-PCR was also used to detect the relative expression of GNL3L and SPN at mRNA level in placentas of all women. The interactions between GNL3L/SPN and piR-3127964 were analyzed by double luciferase reporter gene detection. The localization of piR-3127964 and SPN in chorionic villi was detected by fluorescence in situ hybridization and immunofluorescence. Transwell assay was performed to analyze the influence of piR-3127964 on the invasion of HTR-8/SVneo cells and the possible mechanism. Independent sample t-test, analysis of variance, and LSD post test were used for analysis Results:(1) Enrichment pathways of candidate targets predicted by differentially expressed piR-3127964 were associated with cell motility. There were statistically significant differences in piR-3127964 expression in villi, healthy and preeclamptic placentas (2.950±0.853 vs 1.036±0.303 vs 0.254±0.155, F=27.35, P<0.05), and piR-3127964 was predominantly expressed in extravillous cytotrophoblasts (EVTs). (2) The expression of PIWIL-3 protein in placentas of preeclamptic patients was significantly lower than that in healthy placentas and villi (0.810±0.400 vs 3.175±0.429 and 6.843±1.379, F=49.36, P<0.05). (3) Compared with the control group, exogenous piR-3127964 mimics (piR-mimics) and inhibitors (piR-inhibitor) significantly affected the expression of SPN mRNA (0.971±0.045 vs 0.732±0.010, F=6.50; 1.076±0.073 vs 1.293±0.092, F=7.58; both P<0.05), while the expression of GNL3L mRNA had no significant correlation with piR-3127964 level. (4) The luciferase activity of wild-type SPN (SPN-WT) plasmids was significantly affected by piR-mimics (1.010±0.049 vs 0.645±0.047, t=9.34, P<0.05) and piR-inhibitor (1.035±0.058 vs 1.397±0.015, t=－10.60, P<0.05). (5) SPN mRNA was significantly upregulated in placentas of preeclamptic patients than in healthy placentas (2.097±0.239 vs 1.305±0.290, t=－4.22, P<0.05), but no significant difference in the expression of GNL3L mRNA was observed. Immunofluorescence experiment showed that SPN was expressed in EVTs. (6) The invasive potential of HTR8/SVneo cells treated with piR-inhibitor was significantly inhibited, but this effect could be reversed by SPN knockdown (160.714±53.860 vs 371.667±103.061 and 344.333±120.267, F=9.76, both P<0.05). Conclusions:piR-3127964 expression is abnormally downregulated in placentas of preeclamptic patients, resulting in inhibition of trophoblasts invasion through upregulation of SPN expression, which may be related to the pathogenesis of preeclampsia.
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Objective:To evaluate the mixed team-based learning (TBL) teaching method in the practical teaching of critical obstetric diseases.Methods:A total of 72 undergraduate students majoring in "5+3" clinical medicine who practiced in The First Affiliated Hospital of Chongqing Medical University from April to June 2019 were selected in the study. The typical cases of obstetric critical illness were selected, and the students were taught by TBL teaching combined with flipped classroom. After the class, a questionnaire survey was conducted to evaluate the teaching effect.Results:Totally 72 questionnaires were recovered and the results showed that all the students thought this kind of mixed TBL teaching method was helpful to develop clinical thinking ability, and the process of "group discussion" and "extra-curricular preparation" was very helpful to understand the learning. A percentage of 93 (67/72) of the students liked this teaching mode, while 28% (20/72) of the students thought this learning mode was very stressful.Conclusion:This mixed TBL teaching method is effective and feasible in the practical teaching of critical obstetric diseases.
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Objective:To investigate the predictive value of cerebroplacental ratio (CPR) for adverse perinatal outcomes of induction of labor in prolonged pregnancy.Methods:This retrospective study recruited 315 singleton pregnant women who had induced labor due to prolonged pregnancy (≥41 gestational weeks) in the First Affiliated Hospital of Chongqing Medical University from January 1, 2019 to April 30, 2020. Based on the occurrence of adverse perinatal outcomes (emergency delivery due to persistent abnormal fetal heart rate monitoring, umbilical artery blood pH at birth <7.2, 5 min Apgar scores<7, transferring to neonatal intensive care unit after birth, chorioamnionitis and vaginal delivery converted to cesarean section), they were divided into two groups: case group ( n=76) and normal group ( n=239). Clinical features and umbilical artery blood flow, middle cerebral artery (MCA) flow and CPR measured in the last ultrasound scan before induction were compared between the two groups using student's t-test, Mann-Whitney U test and Chi-square test. Receiver operating characteristic (ROC) curve was used to analyze the predictive values of umbilical artery blood flow, MCA flow and CPR for the adverse perinatal outcomes. Multivariate logistic regression analysis was used to screen the meaningful predictors. Results:Compared with the normal group, the umbilical artery pulsatility index (PI) (0.9±0.1 vs 0.8±0.1, t=-5.458, P<0.001) and the percentage of abnormal CPR (<1.0) increased significantly [21.1%(16/76) vs 6.3%(15/239), χ2=14.190, P<0.001] in the case group, while the MCA-PI and CPR decreased significantly (1.1±0.2 vs 1.3±0.3, t=5.658, P<0.001; 1.2±0.3 vs 1.6±0.5, t=8.940, P<0.001). The areas under the ROC curves of umbilical artery PI, MCA-PI and CPR for predicting adverse perinatal outcomes were 0.71, 0.71 and 0.77, respectively. CPR had the highest sensitivity (0.74) compared with umbilical artery PI (0.68) and MCA-PI (0.71), but the specificity of them were similar (0.67, 0.66 and 0.66). Multivariate logistic regression analysis showed that only CPR was the independent risk factor for adverse perinatal outcomes ( OR=0.028, 95% CI: 0.010-0.080, P<0.001). Conclusions:As an indicator for early prediction of adverse perinatal outcomes of induction of labor in prolonged pregnancy, CPR was more sensitive but less specific.
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Objective:To compare the preterm birth rate among different age groups and analyze relative high-risk factors of preterm birth.Methods:A retrospective analysis was conducted on clinical data of single pregnant women ≥28 gestational weeks from January 2013 to May 2019 in the First Affiliated Hospital of Chongqing Medical Hospital. All involved women were divided into three groups according to age, Group 1 (aged<35 years), Group 2 (aged 35-39 years), and Group 3 (aged ≥40 years). The preterm birth rate among 3 groups was compared and their high-risk factors were analyzed.Results:There were 48 288 singleton pregnancies during the study period, of which 3 351 were preterm births， preterm birth rate was 6.94% (3 351/48 288). In Group 1, there were 42 020 women, of which 2 699 were preterm births (6.42%, 2 699/42 020); in Group 2, there were 5 061 women, of which 491 were preterm births (9.70%, 491/5 061); and in Group 3, there were 1 207 women, of which 161 were preterm births (13.34%, 161/1 207). Comparing the spontaneous preterm birth rates among the three groups, Group 1 was the lowest one and Group 3 was the highest one (3.72% vs 4.51% vs 5.88%); comparing the medical preterm birth rates among the three groups, Group 1 also was the lowest one and Group 3 also was the highest one (2.70% vs 5.20% vs 7.46%); the differences were statistically significant ( P<0.05). The incidence of spontaneous and medical preterm birth according gestational weeks were compared among three groups and there were no significant differences ( P>0.05). Comparing and analyzing the high-risk factors of medical preterm birth, the incidence of intrahepatic cholestasis of pregnancy and fetal distress in Group 1 were higher than those in Group 2 and 3; the incidence of placenta praevia were significantly higher in Group 2 and 3 than that in Group 1; the differences were statistically significant ( P<0.05). Conclusions:Maternal age is a significant high-risk factor of both spontaneous preterm birth and medical preterm birth, and the risk of preterm birth increases with age. For medical preterm birth, compared with right-age pregnant women, placenta praevia is the high-risk factor for women in advanced maternal age(AMA), which have great effect on medical preterm birth rate of AMA.
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Objective:To analyze the cerebroplacental blood flow distribution characteristics in monochorionic-diamniotic(MCDA) twin pregnancies with stageⅠ-Ⅱof twin-twin transfusion syndrome (TTTS), and investigate the predictive value of cerebroplacental ratio (CPR) in the stageⅡ of TTTS.Methods:The cerebroplacental blood flow distribution were analyzed retrospectively in 68 cases from June 2017 to June 2019 in the First Affiliated Hospital of Chongqing Medical University (34 cases for each stage) with TTTS, including the umbilical artery pulsatility index (UA-PI), middle cerebral artery peak systolic velocity (MCA-PSV), middle cerebral artery pulsatility index (MCA-PI), CPR, and their discordances(UA-PI disc, MCA-PSV disc, MCA-PI disc and CPR disc). Results:The differences of UA-PI, MCA-PI, and CPR between donors and recipients in TTTS Ⅱ were statistically significant (all P<0.05), the differences of UA-PI disc, MCA-PI disc and CPR disc between TTTS Ⅰ and TTTS Ⅱ were statistically significant (all P<0.05). Multivariate Logistic regression analyses showed that only CPR disc was independently associated with the stage Ⅱ of TTTS( P<0.05), and it had moderate predictive accuracy for the stage Ⅱ of TTTS with an area under the curve of 0.766, a sensitivity of 64.71% and a specificity of 82.35%( P<0.001). Conclusions:More cerebroplacental blood flow discordances are observed and CPR disc is closely related to stageⅡof TTTS.
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Corona Virus Disease 2019 (COVID-19) occurred in Wuhan in December, 2019, with the number of the infected cases gradually increasing. The pregnant women are susceptible to the virus due to their specific immune tolerance. Both the maternal and fetal safety will be imperiled if the pregnant women were infected with COVID-19. Therefore, antenatal care and perinatal management are crucial for guaranteeing the safety of the pregnant women infected with COVID-19.
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OBJECTIVE@#To explore the pathogenesis and genetic characteristics of a fetus with a der(X)t(X;Y)(p22.3;q11.2) karyotype.@*METHODS@#G-banding karyotyping analysis, BoBs (BACs-on-Beads) assay, and single nucleotide polymorphism array (SNP-array) were used to delineate the structural chromosomal aberration of the fetus. The parents of the fetus were also subjected to karyotyping analysis.@*RESULTS@#The fetus and its mother were both found to have a karyotype of 46,X,add(X)(p22), while the father was normal. BoBs assay indicated that there was a lack of Xp22 but a gain of Yq11 signal. SNP-array confirmed that the fetus and its mother both had a 7.13 Mb deletion at Xp22.33p22.31 (608 021-7 736 547) and gain of a 12.52 Mb fragment at Yq11.221q11.23 (16 271 151-28 788 643).@*CONCLUSION@#The fetus was determined to have a karyotype of 46,X,der(X)t(X;Y)(p22.3;q11.2)mat. The combined use of various methods has facilitated delineation of the fetal chromosomal aberration and prediction of the risk prediction for subsequent pregnancy.
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Female , Humans , Male , Pregnancy , Chromosome Banding , Chromosome Deletion , Chromosomes, Human, X/genetics , Chromosomes, Human, Y/genetics , Fetus , Karyotyping , Prenatal Diagnosis , Translocation, GeneticABSTRACT
Objective@#To investigate the efficacy and safety of radiofrequency ablation for fetal reduction in monochorionic twin pregnancies at gestational age over 26 weeks.@*Methods@#A retrospective study was performed based on the clinical data of 51 patients who underwent fetal reduction by radiofrequency ablation in the First Affiliated Hospital of Chongqing Medical University from May 2013 to July 2018. Clinical data including basic information, surgical data (such as ablation duration, power and the number of cycles), perinatal complications and pregnancy outcomes were collected. Differences in pregnancy outcomes were compared between the group with gestational age >26 weeks (n=17, group A) and that ≤26 weeks (n=34, group B) using t-test, rank-sum test and Chi-square test or Fisher's exact test.@*Results@#(1) The indications of fetal reduction were malformation in one of the twins, twin-to-twin transfusion syndrome, twin reversed arterial perfusion sequence and selective intrauterine growth restriction [45.1% (23/51), 15.7% (8/51), 19.6% (10/51) and 19.6% (10/51)]. The differences in the proportion of different indications between group A and B were statistically significant [12/17, 1/17, 0/17, 4/17 vs 32.4% (11/34), 20.6% (7/34), 29.4% (10/34), 17.7% (6/34), P=0.009]. Those in the group A required longer operation duration than the group B [M(min-max), 20(7-40) vs 15(3-29) min, Z=2.550, P=0.011]. (2) The gestational age of the 51 patients was (23.7±4.7) weeks (15+1-32+6 weeks), the overall survival rate of the remaining fetuses was 86.3% (44/51) and the preterm birth rate was 50.0% (22/44). The gestational age at operation was (28.9±2.5) weeks (26+1-32+6 week) in group A and (21.1±3.1) weeks (15+1-25+2 weeks) in group B. The survival rate of the remaining fetuses and the preterm birth rate in group A were significantly higher than those in group B [17/17 vs 79.4% (27/34), P=0.046; 12/17 vs 37.0% (10/27), χ2=4.697, P=0.030].@*Conclusions@#Fetal reduction at gestational age >26 weeks, of which the main surgical indication is malformation in one of the twins, may increase the risk of preterm birth, but can improve the overall survival rate of the remaining fetuses without increasing the maternal and infant morbidity. Therefore, radiofrequency ablation is a safe and effective procedure for twin pregnancies >26 weeks of gestation.
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Objective@#To analyze the cerebroplacental blood flow distribution characteristics in monochorionic-diamniotic (MCDA) twin pregnancies with selective fetal growth restriction (sFGR), and investigate the relationship between co-twin cerebroplacental blood flow discordances and co-twin birth weight discordances (BWdisc).@*Methods@#The cerebroplacental blood flow distribution characteristics and their discordances were analyzed retrospectively in 52 MCDA twin pregnancies with normal growth (control group) and 52 with sFGR (case group), including the umbilical artery pulsatility index (UA-PI), middle cerebral artery peak systolic velocity (MCA-PSV), middle cerebral artery pulsatility index (MCA-PI), cerebroplacental ratio (CPR), and their discordances (UA-PIdisc, MCA-PSVdisc, MCA-PIdisc and CPRdisc).@*Results@#Compared to the control group, UA-PIdisc, MCA-PIdisc and CPRdisc increased significantly (all P<0.01). UA-PIdisc, MCA-PIdisc and CPRdisc were related positively to BWdisc as shown by correlation analyses (r=0.488, 0.414, 0.592; all P<0.001), and they had moderate predictive accuracy for sFGR with area under the curves of 0.743, 0.662 and 0.778, with sensitivity of 48.08%, 67.31% and 71.15%, and specificity of 92.31%, 59.62% and 78.85% (all P<0.01). Multivariate Logistic regression analyses showed that only CPRdisc were independently associated with sFGR (P<0.05).@*Conclusions@#More cerebroplacental blood flow discordances are observed in MCDA twin pregnancies with sFGR. Co-twin cerebroplacental blood flow discordance is related to BWdisc.
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Objective@#To investigate the mechanism of wild-type p53-induced phosphatase (Wip1) in regulating p53-dependent apoptosis of trophoblasts for further understanding the etiology of preeclampsia (PE).@*Methods@#Placenta tissues were collected from normal (n=15) and PE (n=13) gravidas who underwent caesarean section in the First Affiliated Hospital of Chongqing Medical University from June 2017 to December 2018. Chorionic villus and decidua tissues were collected from another 10 women who aborted in early pregnancy. Two in vitro trophoblastic hypoxia cultures were established by subjecting human chorionic trophoblast cells (HTR8/SVneo) to either hypoxia intervention in incubator (HII) or simulated ischemic buffer (SIB). Wip1 expressions at the transcriptional and protein levels were determined by real-time quantitative polymerase chain reaction and Western blotting, respectively. The localization of Wip1 in placental tissues and HTR8/SVneo cells was determined by immunohistochemistry and immunofluorescence. Cell apoptosis was assessed by flow cytometry after viral infection and hypoxia. And the changes of pathway-related molecules including p53, phospho-p53 (p-p53), mouse double minute 2 homolog (Mdm2) and cleaved caspase3 (cl-cas3) were measured by Western blotting. The impact of Wip1 on Mdm2-p53 interaction was examined by co-immunoprecipitation. NVP-CGM097, an Mdm2-p53 specific inhibitor, was administered in PE cell models to verify the regulation of Wip1 on trophoblastic apoptosis through Mdm2-p53 pathway. Independent student's t-test, Welch's t-test and one-way analysis of variance were used as statistical methods.@*Results@#(1) Wip1 expression, which was mainly in trophoblast cells, was significantly elevated in human PE placentas (mRNA: 1.711±0.141 vs 0.860±0.126, t=4.496; protein: 0.449±0.027 vs 0.192±0.019, t=7.902) and in both in vitro trophoblastic PE models (protein in HII: 1.376±0.086 vs 0.977±0.114, t=2.792; SIB: 1.243±0.057 vs 0.381±0.045, t=11.910) compared with the corresponding control groups (all P<0.05). (2) Compared with corresponding control groups, overexpression of Wip1 suppressed the hypoxia-induced upregulation of p53 (HII: 0.185±0.024 vs 0.572±0.072; SIB: 0.400±0.067 vs 0.803±0.064), cl-cas3 (HII: 0.243±0.034 vs 0.529±0.072; SIB: 0.179±0.011 vs 0.368±0.025) and p-p53/p53 protein expression (HII: 1.326±0.129 vs 2.100±0.187; SIB: 0.473±0.028 vs 0.925±0.036) and also reduced the apoptosis rate [HII: (8.925±1.092)% vs (17.610±1.980)%; SIB: (13.910±1.886)% vs (24.650±1.622)%], which in turn promoted Mdm2-p53 binding (all P<0.05). However, knockdown of Wip1 gene expression in HTR8/SVneo cells brought about opposite effects (all P<0.05). (3) Neither overexpression nor knockdown of Wip1 influenced p53 or cl-cas3 expression when Mdm2-p53 interaction was blocked by NVP-CGM097.@*Conclusions@#Mdm2-p53 interaction promoted by Wip1 upregulation could compensate for the trophoblastic p53 accumulation in response to hypoxia, while exogenous upregulation of Wip1 in trophoblasts may reverse hypoxia-induced apoptosis. Therefore, this might provide a new therapeutic target for PE.
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Objective To investigate the mechanism of wild-type p53-induced phosphatase (Wip1) in regulating p53-dependent apoptosis of trophoblasts for further understanding the etiology of preeclampsia (PE). Methods Placenta tissues were collected from normal (n=15) and PE (n=13) gravidas who underwent caesarean section in the First Affiliated Hospital of Chongqing Medical University from June 2017 to December 2018. Chorionic villus and decidua tissues were collected from another 10 women who aborted in early pregnancy. Two in vitro trophoblastic hypoxia cultures were established by subjecting human chorionic trophoblast cells (HTR8/SVneo) to either hypoxia intervention in incubator (HII) or simulated ischemic buffer (SIB). Wip1 expressions at the transcriptional and protein levels were determined by real-time quantitative polymerase chain reaction and Western blotting, respectively. The localization of Wip1 in placental tissues and HTR8/SVneo cells was determined by immunohistochemistry and immunofluorescence. Cell apoptosis was assessed by flow cytometry after viral infection and hypoxia. And the changes of pathway-related molecules including p53, phospho-p53 (p-p53), mouse double minute 2 homolog (Mdm2) and cleaved caspase3 (cl-cas3) were measured by Western blotting. The impact of Wip1 on Mdm2-p53 interaction was examined by co-immunoprecipitation. NVP-CGM097, an Mdm2-p53 specific inhibitor, was administered in PE cell models to verify the regulation of Wip1 on trophoblastic apoptosis through Mdm2-p53 pathway. Independent student's t-test, Welch's t-test and one-way analysis of variance were used as statistical methods. Results (1) Wip1 expression, which was mainly in trophoblast cells, was significantly elevated in human PE placentas (mRNA: 1.711±0.141 vs 0.860±0.126, t=4.496; protein: 0.449±0.027 vs 0.192±0.019, t=7.902) and in both in vitro trophoblastic PE models (protein in HII: 1.376±0.086 vs 0.977±0.114, t=2.792; SIB: 1.243±0.057 vs 0.381±0.045, t=11.910) compared with the corresponding control groups (all P<0.05). (2) Compared with corresponding control groups, overexpression of Wip1 suppressed the hypoxia-induced upregulation of p53 (HII: 0.185±0.024 vs 0.572±0.072; SIB: 0.400±0.067 vs 0.803±0.064), cl-cas3 (HII: 0.243±0.034 vs 0.529±0.072; SIB:0.179±0.011 vs 0.368±0.025) and p-p53/p53 protein expression (HII: 1.326±0.129 vs 2.100±0.187; SIB:0.473±0.028 vs 0.925±0.036) and also reduced the apoptosis rate [HII: (8.925±1.092)% vs (17.610±1.980)%;SIB: (13.910±1.886)% vs (24.650±1.622)%], which in turn promoted Mdm2-p53 binding (all P<0.05). However, knockdown of Wip1 gene expression in HTR8/SVneo cells brought about opposite effects (all P<0.05). (3) Neither overexpression nor knockdown of Wip1 influenced p53 or cl-cas3 expression when Mdm2-p53 interaction was blocked by NVP-CGM097. Conclusions Mdm2-p53 interaction promoted by Wip1 upregulation could compensate for the trophoblastic p53 accumulation in response to hypoxia, while exogenous upregulation of Wip1 in trophoblasts may reverse hypoxia-induced apoptosis. Therefore, this might provide a new therapeutic target for PE.
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Objective To analyze the cerebroplacental blood flow distribution characteristics in monochorionic‐diamniotic ( MCDA ) twin pregnancies with selective fetal grow th restriction ( sFGR ) ,and investigate the relationship between co‐twin cerebroplacental blood flow discordances and co‐twin birth weight discordances ( BWdisc ) . Methods The cerebroplacental blood flow distribution characteristics and their discordances were analyzed retrospectively in 52 MCDA twin pregnancies with normal grow th ( control group) and 52 with sFGR ( case group) ,including the umbilical artery pulsatility index ( U A‐PI) ,middle cerebral artery peak systolic velocity ( MCA‐PSV ) ,middle cerebral artery pulsatility index ( MCA‐PI ) , cerebroplacental ratio ( CPR ) ,and their discordances ( U A‐PIdisc ,MCA‐PSVdisc ,MCA‐PIdisc and CPRdisc ) . Results Compared to the control group ,UA‐PIdisc ,MCA‐PIdisc and CPRdisc increased significantly ( all P ＜0 .01) . U A‐PIdisc ,MCA‐PIdisc and CPRdisc were related positively to BW disc as show n by correlation analyses ( r＝0 .488 ,0 .414 ,0 .592 ;all P ＜ 0 .001) ,and they had moderate predictive accuracy for sFGR with area under the curves of 0 .743 ,0 .662 and 0 .778 , with sensitivity of 48 .08% ,67 .31% and 71 .15% , and specificity of 92 .31% ,59 .62% and 78 .85% ( all P ＜ 0 .01 ) . M ultivariate Logistic regression analyses showed that only CPRdisc were independently associated with sFGR ( P ＜ 0 .05 ) . Conclusions More cerebroplacental blood flow discordances are observed in MCDA twin pregnancies with sFGR . Co‐twin cerebroplacental blood flow discordance is related to BW disc .
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Objective To investigate the efficacy and safety of radiofrequency ablation for fetal reduction in monochorionic twin pregnancies at gestational age over 26 weeks. Methods A retrospective study was performed based on the clinical data of 51 patients who underwent fetal reduction by radiofrequency ablation in the First Affiliated Hospital of Chongqing Medical University from May 2013 to July 2018. Clinical data including basic information, surgical data (such as ablation duration, power and the number of cycles), perinatal complications and pregnancy outcomes were collected. Differences in pregnancy outcomes were compared between the group with gestational age >26 weeks (n=17, group A) and that ≤26 weeks (n=34, group B) using t-test, rank-sum test and Chi-square test or Fisher's exact test. Results (1) The indications of fetal reduction were malformation in one of the twins, twin-to-twin transfusion syndrome, twin reversed arterial perfusion sequence and selective intrauterine growth restriction [45.1% (23/51), 15.7% (8/51), 19.6% (10/51) and 19.6% (10/51)]. The differences in the proportion of different indications between group A and B were statistically significant [12/17, 1/17, 0/17, 4/17 vs 32.4% (11/34), 20.6% (7/34), 29.4% (10/34), 17.7% (6/34), P=0.009]. Those in the group A required longer operation duration than the group B [M(min-max), 20(7-40) vs 15(3-29) min, Z=2.550, P=0.011]. (2) The gestational age of the 51 patients was (23.7±4.7) weeks (15+1-32+6 weeks), the overall survival rate of the remaining fetuses was 86.3% (44/51) and the preterm birth rate was 50.0% (22/44). The gestational age at operation was (28.9±2.5) weeks (26+1-32+6 week) in group A and (21.1±3.1) weeks (15+1-25+2 weeks) in group B. The survival rate of the remaining fetuses and the preterm birth rate in group A were significantly higher than those in group B [17/17 vs 79.4% (27/34), P=0.046; 12/17 vs 37.0% (10/27), χ2=4.697, P=0.030]. Conclusions Fetal reduction at gestational age>26 weeks, of which the main surgical indication is malformation in one of the twins, may increase the risk of preterm birth, but can improve the overall survival rate of the remaining fetuses without increasing the maternal and infant morbidity. Therefore, radiofrequency ablation is a safe and effective procedure for twin pregnancies >26 weeks of gestation.
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Infants with fetal growth restriction (FGR) who did not achieve full in utero growth potential because of environmental factors are at increased risk of morbidity and mortality compared with those with normal in utero growth.Diagnosis and management of FGR are becoming more standardized as clinical guidelines sponsored by academic societies and governments are emerging.However,how to accurately identify FGR fetus and manage the pregnancies appropriately remain controversial.Early prevention of FGR and standardized administration of prenatal glucocorticoids and magnesium sulfate are urgently needed to be addressed with more evidences.
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Objective To investigate the current status of uterine rupture in pregnant women in China and analyze the impacts of different surgical histories on the pregnancy outcomes of pregnant women with uterine rupture. Methods The clinical records and pregnancy outcomes of 84 uterine rupture cases were collected and analyzed retrospectively. All cases came from 21 hospitals of 13 provinces (or municipality) in China, dated from January 1st 2014 to December 31st 2015. The total deliveries were 283 614 during the period. For 84 pregnant women with symptomatic uterine rupture, the impacts of different surgical histories on pregnancy outcomes were compared and the results were statistically analyzed.Results (1) Totally, 84 cases of uterine rupture were with symptoms and diagnosed. The median age, median gestational age were 32.5 years old (23.0-44.0 years old) and 35.7 weeks (9.3-41.0 weeks), respectively. The incidence of uterine rupture was 0.03%(84/283 614). The proportion of patients with cesarean section history was 66.7% (56/84). The proportion of patients with other gynecological surgery history was 20.2%(17/84). (2)Compared with the group of cesarean section history, the group with other gynecological surgery history had a significant increase in complete uterine rupture (16/17 vs 66.1%, P<0.05). Meanwhile, regarding the massive blood transfusion (red blood cell transfusion≥1 000 ml) in the treatment of uterine rupture, patients with other gynecological surgery history had significant more cases than the group with cesarean section history (9/17 vs 23.2%, P<0.05). There was no statistical difference for the other outcomes. Compared with the patients with cesarean section history, the rate of hysterectomy was higher in the group without major surgery history when uterine rupture happened (4/11 vs 7.1%, P<0.05). The incidence of postpartum hemorrhage significantly increased in patients without major surgery history, compared with those with cesarean section (8/11 vs 28.6%, P<0.05). There were no statistic difference for other outcomes.(3) Patients with uterine rupture in the non-abdominal pain group had a significantly increased risk of massive blood transfusion (5/8 vs 27.6%, P<0.05),and the incidence of neonatal asphyxia and hypoxic ischemic encephalopathy (4/7 vs 22.2%, P<0.05) were significantly increased. There were no significant difference between two groups regarding the other outcomes, such as preoperative diagnosis, complete rupture of uterus, hysterectomy, postpartum hemorrhage, shock, intrauterine fetal death or neonatal death, admission to neonatal ICU. Conclusions In addition to considering cesarean section history as one of the known risk factors, patients with non-cesarean section uterine surgery history should also be considered. The management of these patients should be strengthened during their pregnancy and delivery. There might be much more dangerous maternal and neonatal outcomes for the patients with uterine rupture who does not have any abdominal pain during pregnancy and delivery. To reduce the incidence of severe complications, uterine rupture should be diagnosed earlier. The early recognition and diagnosis of uterine rupture helps to improve maternal and neonatal outcomes.
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Objective To evaluate the risk factors and sonographic findings of pregnancies complicated by placenta increta or placenta percreta. Methods Totally, 2219 cases were retrospectively analyzed from 20 tertiary hospitals in China from January 2011 to December 2015. The data were collected based on the original case records. All cases were divided into two groups, the placenta increta (PI) group (79.1％, 1755/2219) and the placenta percreta (PP) group (20.9％, 464/2219), according to the degree of placental implantation. The risk factors and sonographic findings of placenta increta or percreta were analyzed by uni-factor and logistic regression statistic methods. Results The risk factors associated with the degree of placental implantation were age, gravida, previous abortion or miscarriage, previous cesarean sections, and placenta previa (all P<0.05), especially, previous cesarean sections (χ2=157.961) and placenta previa (χ2=91.759). Sonographic findings could be used to predict the degree of placental invasion especially the boundaries between placenta and uterine serosa, the boundary between placenta and myometrium, the disruption of the placental-uterine wall interface and loss of the normal retroplacental hypoechoic zone(all P<0.01). Conclusions Previous cesarean sections and placenta previa are the main independent risk factors associated with the degree of placenta implantation. Ultrasound could be used to make a prenatal suggestive diagnosis of placenta accreta spectrum disorders.
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Objective · To investigate the effects of growth arrest and DNA damage 45 alpha (Gadd45α) on the migration and invasion function of human extravillous trophoblast cells under hypoxia/re-oxygenation (H/R). Methods · Human extravillous trophoblast cells were infected by shRNA lentivirus targeting Gadd45α gene, to knock down Gadd45α gene expression. Then the oxidative stress model of preeclampsia was used in vitro to observe the changes of cell biological functions. The experiments were divided into 4 groups, nontreated group, hypoxia/re-oxygenation group, shRNA Gadd45α+H/R group and shRNA negative control+H/R group. Human villous explant experiments were used to determine the effects of silencing Gadd45α on human extravillous trophoblast cell under oxidative stress. Protein expression of Gadd45α was identified by Western blotting. Changes of cell migration and invasion were detected by transwell migration and Matrigel invasion assay. Gelatin zymography was used to detect the expression of matrix metalloproteinase (MMP) -2/9 in culture medium. Results · Hypoxia/re-oxygenation can increase the expression of Gadd45α in HTR8/SVneo cells and damage the trophoblast cell migration and invasion. Knocking down Gadd45α can increase the activities of MMP2/9, which can increase the cell migration and invasion. Conclusion · Knockdown of Gadd45α gene has promoted cell migration and invasion function of human extravillous trophobalst cells under oxidative stress.
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At present, the particularity and importance of ethical consciousness in the teaching of clinical obstetrics and Gynecology has become increasingly prominent while the education of medical students in the ethics and social responsibility is relatively weak. This study explored a series of practical methods under WEIGHT guide through the real cases, conducting clinical training and sides debate, com-bining multimedia and interview form, in order to strengthen the cultivation of medical students' moral quality and improve the students' comprehensive ability.
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Objective · To investigate the effects of a p38 mitogen-activated protein kinase (p38 MAPK) inhibitor SB203580 on biological function changes of human extravillous trophoblast cells induced by hypoxia/re-oxygenation (H/R). Methods · In-vitro cultured early pregnancy villus explants and human extravillous trophoblast cell line HTR8/SVneo were assigned to 4 groups according to different interventions, i.e. control group, SB203580 group (p38 MAPK inhibition), H/R group (simulation of preeclampsia by the oxidative stress model), and SB203580+H/R group. The effects of SB203580 on biological functions of human extravillous trophoblast cells under oxidative stress in early pregnancy villus explants were observed. Protein expression and phosphorylation of p38 MAPK in HTR8/SVneo cells were measured with Western blotting. Cell migration and invasion were observed with Transwell migration and Matrigel invasion assay, respectively. Gelatin zymography was used to measure the activity of matrix metalloproteinase (MMP) -2/9 in supernatant. ELISA was used to detect the levels of soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (sEng). Results · SB203580 could promote the exogenous migration of human extravillous trophoblast cells in early pregnancy villus explants under oxidative stress. H/R could decrease the migration and invasion of HTR8/SVneo cells , and increase the phosphorylation level of p38 MAPK in HTR8/SVneo cells and the secretion of sFlt-1 and sEng. SB203580 could increase the activity of MMP2/9 in supernatant and cell migration and invasion, decrease the phosphorylation level of p38 MAPK in HTR8/SVneo cells under oxidative stress and the secretion of sFlt-1 and sEng. Conclusion · SB203580 can protect biological functions of human extravillous trophobalst cells under oxidative stress.