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Objective To investigate the dynamic changes of uterine artery and umbilical artery in the first, second, and third trimester of normal pregnancy and hypertensive disorders in pregnancy (HDP).Methods A multi-center prospective study was conducted on 1098 women with normal singleton pregnancies at the first prenatal visit in the Second West China Hospital of Sichuan University, First Affiliated Hospital with Nanjing Medical University, Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical University, Wuhan Union Hospital Affiliated to Medical School of Huazhong University of Science and Technology and Renji Hospital Affiliated to Medical School of Shanghai Jiao Tong University from April 2005 to July 2006, with the average age of (28. 3±3.3). The pulsatility indices (PI),resistance indices (RI) and systolic to diastolic velocity ratios (S/D) of uterine artery and umbilical artery were measured for all subjects in the first (10th -14th gestationa] weeks), second (20th-26th gestational weeks) and third trimester(30th -36th gestational weeks), respectively. In this longitudinal study, women who developed HDP were classified into HDP group, and the rest into normal pregnancy group. Results (1) Among the 1098 pregnant women, 44 developed HDP during the index pregnancy, including 20 gestational hypertension, 15 mild pre-eclampsia and 9 severe pre-eclampsia, giving an incidence of 4.17%,and the rest 1054 were normal until delivery.(2) In the normal pregnancy group, the RI, PI and S/D of uterine artery were decreased with the progress of pregnancy (RI: 0. 64, 0. 57, 0. 50; PI: 1.24, 0. 98,0. 80; S/D: 3.26, 2. 58, 2. 20; P<0.01). However, the above indices showed an increasing trend with the increase of gestations in the HDP group (RI: 0. 55, 0. 67, 0. 64; PI: 1.22, 1.36, 1.20; S/D: 3.18,3.41,3.05; P <0. 01). In the second and third trimester, the RI, PI and S/D of uterine artery in the HDP group were higher than those in the normal pregnancy group (P<0.01). (3) In the normal pregnancy group, the RI, PI and S/D of the umbilical artery decreased from the secondto the third trimester (RI:0. 71 and 0. 58; PI: 1.16 and 0. 87; S/D: 3.58 and 2. 48; P<0.01). However, no significant difference was found in the RI, PI and S/D value of umbilical artery in the second and third trimester between the normal and HDP group (RI:0.71 and 0.63; PI: 1.20 and 0.95; S/D: 3.71 and 2.69; P>0.05,respectively), despite the decreasing trend in the HDP group. Conclusions In uncomplicated pregnancies,the blood flow resistance of uterine artery decreases and the end-diastolic blood flow of uterine artery increases with the progress of pregnancy. However, in pregnant women with HDP, the blood flow resistance of uterine artery increases significantly with the increase of gestations which shows significant difference to that in normal pregnancies. The blood flow resistance of umbilical artery decreases in both normal and HDP pregnant women with the increasing gestational age.
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Objective To evaluate the efficacy and safety of motherwort (herbs leonuri/leonurus heterophyllus sweet) injection for preventing postpartum hemorrhage after caesarian section. Methods The prospective study was designed as a randomized and single blind multi-center research matched with positive agent as controls from Apt 2007 to Aug 2007. 440 women underwent caesarian section (CS) indicated by obstetric factors were enrolled from 15 teaching hospitals in China and assigned into three groups: group of motherwort: 147 cases were administered by motherwort 40 rag uterine injection during CS and 20 mg intramuscular injection per 12 hours 3 times after CS; group of motherwort + oxytocin : 144 cases were administered by motherwort 40 mg and oxytocin 10 U uterine injection during CS and motherwort 20 mg intramuscular injection per 12 hours 3 times after CS and group of oxytocin: 149 cases were administered by oxytocin 10 U uterine injection and oxytocin 10 U + 5% glucose 500 nd intravenously injection during operation and oxytocin 10 U intramuscular injection per 12 hours 3 times after CS. The following clinical parameter were collected and analyzed: (1) The amount of blood loss during operation, at 2, 6, 12, 24, 48 hours after operation. (2) The total amount of blood loss in 24 hours after CS and the incidence of postpartum hemorrhage. (3) The change of level of hemoglobin (Hb) and counting of red blood cell ( RBC ) from prepartum to postpartum. (4) Adverse reaction. Results (1) The mean amount of blood loss during operation were (368±258) ml in group of motherwort, (255±114) mi in group of motherwort + oxytocinand (269±141 ) ml in group of oxytocin, which exhibited significant difference among three groups ( P<0.01 ). Meanwhile, no statistical different amount of blood loss among three groups were observed at 2,6,12, 24, 48 hours after CS. (2)The amount of blood loss of postpartum at 24 hours were (480±276)ml ingroup of motherwort, (361±179) ml in group of motherwort + oxytocin, (381±179) nd in group of oxytocin, which showed significant difference among 3 groups(P <0.01 ). (3) The incidence of postpartum hemorrhage were 32.0% (47/147) in group of motherwort, 11.1% (16/144) in group of motherwort + oxytocin, and 18.8% in (28/149) in group of oxytocin. When comparing the lowest rate of postpartum blood loss in group of motherwort + oxytocin and the highest rate in group of motherwort, it displayed statistical difference (P<0.01). (4) The decreased level of RBC and Hb were shown that RBC(0.3±0.5)×10<'12<‘/L and Hb(9±13)g/L in group of motherwort, RBC (0.2±0.4)×10<'12/L and Hb ( 6±10) g/Lin group of motherwort + oxytocin and RBC (0.2±0.4)×10<'12/L and Hb(7±30) g/L in group of oxytocinrespectively. However, the comparison of different value of RBC and lib in group of oxytocin and motherwort +oxytocin showed significant difference (P<0.05 ). (5) Two cases with allery reaction was observed.Conclusion It is safe and efficacious that combined use of motherwort injection and oxytocin was to preventpostpartum hemorrhage during or after caesarian section.
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Objective To studythe effect of CD+4CD+25 regulatory T(Tr)cells on dendric cells(DC)in peripheral blood and deciduas from unexplained recurrent spontaneous abortion(URSA)patients.Methods Four URSA patients(abortion group)and 4 normal early pregnant women(control group)were enrolled in this study.Tr cells and DC in the peripheral blood and deciduas were isolated using Ficoll density gradient centrifugation and magnetic cell sorting(MACS).DC were cultured alone(DC alone)or in combination with Tr cells(DC+Tr)for 6 days,during which the release of interferon(IFN)-γandinterleukin(IL)-10 in the medium was subsequently measured by enzyme linked immunoadsorbent assay (ELISA).Results(1) Peripheral blood:there was no significant difference in IFN-γlevel between DCalone(23.2±0.7)ng/L and DC+Tr(22.5±3.0)ng/L in abortion group(P>0.05).The similar level of IL-10 was observed between DC alone(37±7)ng/L and DC+Tr(35±4)ng/L in abortion group(P>0.05).IL-10 level,but not IFN-γ,was significantly hisber in DC alone(54±20)ns/L than that in DC+ Tr(36±9)ng/L in control group(P<0.01).(2)Deciduas:there was no significant difference in IFN-γlevel between DC alone(23.4±2.6)ng/L and DC+Tr(24.4±2.5)ng/L in abortion group(P>0.05).Moreover,Similar IL-10 level was found between DC alone(28±7)ng/L and DC+Tr(25±5)ng/L in abortion group(P>0.05).IFN-γlevel in CD alone(30.7±4.6)ng/L was significantly higher than that in DC+Tr(22.6±3.8)ng/L in control group(P<0.01);whereas IL-10 level was much lower in DC alone (27±6)ng/L than that in DC+Tr(31±9)ng/L in control group(P<0.05).Conclusion The decreasing of immunosuppressive funetion of Tr eell of URSA patients affect its regulation on DC.resulting in imbalance of Th1/Th2 and abnormality of maternal-fetal jmmuno-tolerence in URSA.
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Recurrent spontaneous abortion (RSA), which affects 1% to 5% of women of reproductive age, is difficult to treat in the clinical setting. In the investigations of iramunopathogenesis, diagnosis and treatment of RSA since the late 1980s, it was found that RSA was associated with abnormal maternal local or systemic immune response, the pathogenesis of autoimmune RSA was mainly associated with antiphosphlipid antibody (APA), while that of alloimmune RSA was due to the disturbance of maternofetal immunological tolerance. Systemic etiological screening process and diagnosis systems of RSA with immune type were developed, and anticardiolipin (ACL) + β_2-GP1 combining multiple assay for effective diagnosis of RSA with immune type was initially established. According to dynamic monitoring clinical parameters before and during gestation, low-dose, short-course and individual immunosuppressive therapy and lymphocyte immunotherapy for RSA. With immune type were initiated. The outcomes of the offsprings of patients with RSA were followed up, and the safety and validity of the therapies were confirmed. The research achievement leads to great progress in the diagnosis and treatment of RSA in China.
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Objective To study the changes in the percentage of CD+4 CD+25 regulatory T (Tr) cells in peripheral blood and deciduas in unexplained recurrent spontaneous abortion (URSA) patients, normal non-pregnant and pregnant women respectively. Methods The percentage of CD+4 CD+25 Tr cells in deciduas and peripheral blood from 25 URSA patients, 22 normal non-pregnant (NNP) women, and 34 normal early pregnant (NP) women were measured by double-staining followed by flow cytometric analysis. Results (1) The percentage of CD+4 CDbright25 T cells in peripheral blood in both URSA and NP [ ( 1.55±0.77 ) %, (2. 65±1.10)%, respectively] women were increased significantly than that in NNP women [ (0. 39± 0.14)% P<0.05]. The percentage of CD+4 CDbright25 T cells in peripheral blood in URSA women was significantly lower than that in NP women (P<0.05 ). (2) The percentage of CD+4 CDbright25 T cells in decidua in URSA women was significantly lower than that in NP women [ ( 0. 59±0. 23 ) %, ( 1.24 ± 0. 55)%, respectively, P <0. 01 ]. There was no significant difference in the percentage of CD+4 CDdim25 T cells in decidua between URSA women and NP women [ (4. 23±1.52)%, (3.75±1.88)%, respectively, P>0.05]. (3) The proportion of CD+4 CDbright25/CD+4 cells in deeiduas was significantly higher than that in peripheral blood in NP women [(13. 10±10. 25 ) %, ( 5.59±2.62 ) %, respectively, P < 0. 05 ] . However, a significant difference in the proportion of CD+4 CDbright25/CD+4 between decidua and peripheral blood was not found in URSA patients [ (5. 16±2. 83 ) %, ( 4. 64±2. 07 ) %, respectively, P>0.05)].Conclusions The number of CD+4 CD+25 Tr cells is increased in normal pregnancy and decreased in URSA. Therefore, CD+4 CD+25 Tr cells may play an important role in maintaining maternal-fetal tolerance and may be involved in the pathogenesis of URSA.
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Objective To investigate T cell receptor(TCR)variable β(BV)chain usage at the maternal-fetal interface and explore the relationship between the skewed TCR BV usage and unexplained recurrent spontaneous abortion(BSA).Methods Eighteen cases with unexplained RSA,together with matched 41 women with normal pregnancies in first trimester from Renji Hospital,Shanghai Jiao Tong University were studied.A high-resolution spectrum typing analysis of complementarity-determining region 3 (CDR3)was used to detect and compare the degree and frequency of TCR BV family expression in deciduas between RSA patients and normal controls.Results(1)The expression degree of BV19(0.029±0.031 vs.0.013±0.010,P=0.038)in RSA group showed a higher usage,while BV5.2(0.040±0.035 vs.0.067±0.052,P=0.046)showed a significantly lower usage when compared with normal controls.No significant difference in the expression of the other TCR BV families between RSA and controls were observed(P>0.05).(2),TCR BV2,3,6,and 7 were the four most common BV families in deciduas of patients with RSA and normal controls,whose frequencies were all mors than 50%.In RSA group,higher frequencies of BV15 (33.3%vs.7.3%,P=0.018),BV19(38.9%vs.14.6%,P=0.049)and BV20(33.3%vs.7.3%,P=0.018)were observed;meanuhile lower frequencies of BV4(33.3%vs.65.9%,P=0.026)and BV7 (66.7%vs.92.7%.P=0.018)distributions were observed.The other TCR BV families did not display significantly different freqencies of distribution(P>0.05).Conclusions It is suggested that a significant skewed TCR BV family occurs at the maternal-fetal interface in patients who undergo abortion.The specific skewed usages of TCR BV might be associated with the susceptibility to unexplained pregnancy loss.
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Objective:To investigate the changes of interleukin(IL)-4 and IL-12 following active immunotherapy of women with unexplained habitual abortion(UHA) .Metbods:The expression of IL-4 and IL-12 mRNA was measured by semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR) in peripheral blood mononuclear cells(PMBC) . The samples were taken from 30 non-pregnant(NNP) women and 30 UHA women before and three weeks after active immunotherapy.Results: (1)IL-4 mRNA expression was lower significantly ( P
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0 05) Conclusion The results suggested that pregnancy immunological tolerance can be induced efficiently and the ELR can be decreased significantly by oral administration of proper dosage antigens of OVA and TMA2
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Objective To investigate the changes of serum T helper cell (TH)1/TH2 type cytokines after the active immunotherapy in unexplained habitual abortion (UHA) women. Methods Concentrations of interleukin (IL) 2, IL 12, interferon (IFN) ?, IL 4, IL 10 and transforming growth factor (TGF) ?1 were measured by enzyme linked immunosorbant assay (ELISA) method in sera from thirty three cases of unexplained habitual abortion (UHA) women before and after active immunotherapy. Thirty normal non pregnancy (NNP) women and thirty normal pregnancy (NP) women were taken as control. Results (1) Serum concentrations of IL 2 and IL 12 were higher significantly (P
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Objective To investigate the relationship between CD + 4CD + 25 regulatory T cells (CD + 4 CD + 25 Tr)and unexplained recurrent spontaneous abortion (URSA) Methods The expression rate of CD + 4CD + 25 Tr in peripheral blood was determined by double label flow cytometric analysis The samples were taken from 20 normal non pregnancy women, 17 URSA women and 20 normal pregnancy women Results The expression frequency of CD + 4CD + 25 Tr cells was decreased significantly( P 0 05) Conclusion The results suggest that downregulation of CD + 4CD + 25 Tr may be associated with URSA
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Objective To investigate the role of KiSS-1 and matrix metalloproteinase(MMP)9 in trophoblasts in the pathogenesis of preeclampsia and their relation to perinatal outcome of neonates. Methods RT-PCR and western blot analyses were used to detect the MMP-9 and KiSS-1 expression levels in trophoblast of 40 patients with preeclampsia (15 cases of mild and 25 cases of severe preeclampsia)(preeclampsia group) and 20 cases of term pregnancy (normal pregnancy group) and their correlations with symptoms and perinatal outcome of neonates were analyzed. Results (1) The KiSS-1mRNA and metastin expression levels in trophoblasts of preeclampsia group were 1.73?0.24 (A value) and (78.4?8.0) ?g/ 100 ?g total protein separately,those of mild preeclampsia were (1.50?0.15) and (72.4?6.9) ?g/ 100 ?g total protein , and severe preeclampsia were (1.87?0.20) and (83.52?3.57) ?g/100 ?g total protein , which were all significantly higher than those of normal pregnancy group [1.24?0.25, P
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Objective:To investigate if DQB1 promotor allele polymorphism is associated with the susceptibility to unexplained habitual abortion (UHA).Methods:Polymerase chain reaction-sequence specific oligonucleotide (PCR-SSO) genotyping method was performed to detect HLA-DQB1 promotor (QBP) alleles in 32 cases of unexplained habitual abortion and 53 women with normal pregnancy history.Results:The frequency of QBP alleles was not different between two groups. The frequency of QBP6 2-DQB1*0604/0605 haplotype was 12 5% in patients group and 2 83% in control group, which got statistical significance. Meanwhile, six new haplotypes were first observed in Chinese population.Conclusion:No direct association was found between QBP polymorphism and UHA, but QBP-DQB1 haplotype might play a role in the susceptibility to UHA.
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39 cases of normal pregnancy,26 cases of pregnancy-induced hypertension syndrome (PIHs) and 23 cases of nonpregnant woman were observed on the changes in B lymphocyte and T lymphocyte subpopulations.B lymphocyte were detected by direct immunofluorescent technique and T lymphocyte subpopulations were identified by rosette forming cell(RFC)treated with adnosine. Compared with the nonpregnant women,the results showed that the significant cha-nges of T lymphocyte subpopulations during pregnancy were observed including the in-crease of adenosine sensitive(AS)cells,the decrease of adenosine resistent(AR)cells,and the icrease of AS/AR ratio. Furthermore in the cases of PIHs,compared with the late pregnant women,AScells,AR cells and AS+AR cells were significantly reduced(all P value