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Objective:To compare the maternal and fetal outcomes of women with cervical insufficiency (CI) undergoing McDonald cerclage (MC) and laparoscopic cervicoisthmic cerclage (LCC), so as to provide evidence for the selection of cerclage methods.Methods:A retrospective trial was carried out in the First Affiliated Hospital of Sun Yat-sen University from January 2010 to December 2020. A total of 221 women who underwent the prophylactic cerclage were divided into MC group ( n=54), LCC with MC history group ( n=28) and LCC without MC history group ( n=129) by the mode of operation and whether the pregnant women who underwent LCC had MC history. General clinical data, pregnancy complications and pregnancy outcomes were compared between the three groups. Results:(1) General clinical data: the proportion of women accepted cervical cerclage during pregnancy in MC group, LCC with MC history group and LCC without MC history group were 100.0% (54/54), 7.1% (2/28) and 27.1% (35/129), respectively ( P<0.001). The indications of the three groups showed statistical significance ( P=0.003), and the main indication was the history of abortion in the second and third trimester [75.9% (41/54) vs 89.3% (25/28) vs 84.5% (109/129)]. (2) Pregnancy complications: the incidence of abnormal fetal position [7.8% (4/51) vs 17.4% (4/23) vs 19.8% (24/121)], placenta accrete [5.9% (3/51) vs 13.0% (3/23) vs 11.6% (14/121)], uterine rupture [0 vs 4.3% (1/23) vs 5.8% (7/121)] in the MC group were all lower than those in LCC with MC history and LCC without MC history groups. However, there were no statistical significances (all P>0.05). Intrauterine inflammation or chorioamnionitis [15.7% (8/51) vs 0 vs 0.8% (1/121)] and premature rupture of membrane [23.5% (12/51) vs 4.3% (1/23) vs 0] were both significantly higher in MC group than those in LCC with MC history and LCC without MC history groups (all P<0.001). (3) Pregnancy outcomes: the cesarean section rate was significantly lower in MC group (41.2%, 21/51) than that in LCC with MC history group (100.0%, 23/23) and LCC without MC history group (100.0%, 121/121; P<0.001). MC group was associated with lower expenditure than LCC with MC history and LCC without MC history groups (12 169 vs 26 438 vs 27 783 yuan, P<0.001). The success rates of live birth cerclage did not differ significantly in MC (94.4%, 51/54), LCC with MC history (82.1%, 23/28) and LCC without MC history (93.8%, 121/129) groups ( χ2=5.649, P=0.059). There was no significant difference in neonatal intensive care unit occupancy, neonatal birth weight and neonatal asphyxia between the three groups (all P>0.05). Conclusions:Both LCC and MC are the treatment choice for women with CI, which may get similar liver birth. However, MC has the advantages of low cesarean section rate, economical and easy operation. Therefore, MC is recommended as the first choice for CI patients, and LCC is for women with failed MC.
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This paper takes the establishment of the College of Basic Gynecology and Obstetrics in the First Affiliated Hospital of Sun Yat-sen University as an example, and through reviewing its establishment background, organizational system (including organizational structure, regulation construction, platform construction and teacher construction) and curriculum system (including curriculum goals and principles, curriculum format, specific curriculum settings, assessment system and evaluation feedback system), so that we can understand the development of the Basic College of Obstetrics and Gynecology and its role in the standardized residency training. This general hospital specialized college model focuses on training comprehensive, professional, applied medical talents and clinically competent physicians, which plays an important role in the standardized residency training, and improves the theoretical knowledge and technical skills of the residents. Running of the college has been widely recognized by peers, This college model is worthy of further promotion.
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Cholesterol-lowing statins such as pravastatin have been contraindicated in pregnant women for a long time, but recent clinical evidence has demonstrated its safety. Studies have found that pravastatin can correct the imbalance in angiogenesis, reduce vascular inflammation and improve the conditions in patients with placental and maternal vascular dysfunction-related diseases, such as preeclampsia, fetal growth restriction and antiphospholipid syndrome. However, universal administration of pravastatin in pregnancy still requires more evidence on its safety from human clinical trials with larger sample sizes. This article reviews the current situation and prospect of pravastatin in pregnancy.
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Insulin analogues can reduce gestational hyperglycemia more safely and effectively because their molecular structure and metabolic characteristics are more consistent with the characteristics of gestational glucose metabolism. However, the safety and effectiveness of some insulin analogues in pregnancy remain unclear. At present, only a few insulin analogues, insulin aspart, insulin lispro and insulin detemir, have been approved for use during pregnancy in China. As for misuse or off-label insulin analogues during pregnancy, clinicians should make adjustments based on published clinical safety data. In this review, the safety and progress in the management of gestational hyperglycemia with rapid- and long-acting insulin analogues and insulin degludec/insulin aspart are reviewed to provide reference for insulin therapy during pregnancy.
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Rh alloimmunization can lead to serious fetal complications, such as hemolysis, anemia, edema, and even intrauterine death. However, there is no domestic clinical guideline for prophylaxis and management of Rh alloimmunization. This review aims to interpret the key points from international clinical guidelines, consisting of the timing of routine antibody screening and anti-Rh(D) immunoglobulin prophylaxis strategies for Rh-negative pregnant women, possible sensitization events and anti-D prophylaxis of Rh alloimmunization, and postpartum prophylaxis for unsensitized Rh-negative pregnant women.
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Objective:To study the risk factors for abnormal glucose metabolism in pregnant women with a history of gestational diabetes mellitus (GDM).Methods:A retrospective analysis was performed on pregnant women who had two consecutive deliveries and were was complicated by GDM in the previous pregnancy at the First Affiliated Hospital of Sun Yat-sen University from January 2011 to May 2019. Clinical data of both pregnancies were collected, including general information, fasting blood glucose in early pregnancy and 75 g oral glucose tolerance test (OGTT) results, glycosylated hemoglobin A1c and blood lipid profile at 24-28 gestational weeks. The incidence and risk factors of abnormal glucose metabolism in these cases during the present pregnancy were analyzed. Analysis of variance, Kruskal-Wallis test, SNK- q or LSD- t-test, and Chi-square test were used for data analysis. Single-factor logistic regression analysis was used to analyze the high-risk factors, and multifactor logistic regression analysis was performed to fit the model. Variable collinearity diagnosis was performed using the coldiag2 command. Results:(1) A total of 455 cases were enrolled in the study. According to the fasting glucose level in the first trimester and the OGTT results in the present pregnancy, they were divided into three groups: normal OGTT group ( n=240), GDM group ( n=189), and pre-gestational diabetes mellitus group (PGDM, n=26). The incidence of abnormal glucose metabolism in these patients during the present pregnancy was 47.2% (215/455). (2) Those with a history of GDM had higher pre-pregnancy weight, lower weight gain, higher cesarean section rate, smaller gestational age at delivery, and higher neonatal birth weight in the present pregnancy than those in the previous pregnancy [(55.6±8.5) vs (53.3±7.9) kg, t=-4.059; (11.2±4.2) vs (12.5±4.4) kg, t=4.435; 47.9% (218/455) vs 33.0% (150/455), χ2=20.481; (38.6±1.3) vs (38.8±1.3) weeks, t=2.288; (3 177±463) and (3 114±460) g, t=-2.044; all P<0.05]. (3) In the PGDM group, the 2-h plasma glucose level after 75 g OGTT was higher than that in the previous pregnancy [(11.4±1.1) vs (9.9±1.7) mmol/L, t=-3.299, P=0.002]. (4) In the present pregnancy, the PGDM group had the highest fasting blood glucose in early pregnancy, followed by the GDM group and the normal OGTT group [4.6 mmol/L (4.2-7.6 mmol/L), 4.3 mmol/L (4.0-4.6 mmol/L) and 4.1 mmol/L (3.8-4.4 mmol/L), χ2=34.498, P<0.001]. The PGDM group had the least postpartum weight retention, followed by the normal OGTT group and the GDM group [(1.2±3.9), (1.6±3.9), and (2.6±4.9) kg, F=3.086, P<0.05]. (5) Multivariate logistic regression analysis showed postpartum weight retention and the 1-h and 2-h plasma glucose levels after 75 g OGTT in the previous pregnancy were independent risk factors for abnormal glucose metabolism in pregnant women with a history of GDM (postpartum weight retention: OR=1.054, 95% CI: 1.005-1.106; 1-h plasma glucose: OR=1.284, 95% CI: 1.087-1.516; 2-h plasma glucose: OR=1.272, 95% CI: 1.071-1.511). Conclusions:The incidence of abnormal glucose metabolism is higher in subsequent pregnancy in women with GDM history, which may be related to various factors, such as postpartum weight retention and plasma glucose after 75 g OGTT in the previous pregnancy.
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Objective:To investigate and analyze disease status and risk factors of venous thromboembolism (VTE) during pregnancy and puerperium in our country.Methods:Clinical datas were collected from 575 patients diagnosed with VTE during pregnancy and puerperium and hospitalized in nine medical institutions in our country from January 1, 2015 to November 30, 2019, and retrospectively analyzed it′s disease status and risk factors.Results:(1) The proportion of VTE in pregnancy and puerperium was 50.6% (291/575) and 49.4% (284/575), respectively. Four patients died, the mortality rate was 0.7% (4/575). The cause of death was pulmonary embolism. (2) The location of VTE during pregnancy and puerperium was mainly in the lower limb vascular (76.2%, 438/575), followed by pulmonary vessels (7.1%, 41/575). (3) In the risk factors of VTE, cesarean section accounted for 32.3% (186/575), maternal advance age accounted for 27.7% (159/575), braking or hospitalization during pregnancy accounted for 13.6% (78/575), other risk factors accounted for more than 5% were previous VTE, obesity, preterm birth, assistant reproductive technology conception and so on, pre-eclampsia and multiple pregnancy accounted for 4.9% (28/575) respectively. In addition, some patients with VTE did not have any of the above risk factors, and the incidence rate was as high as 23.1% (133/575).Conclusions:The occurrence of VTE during pregnancy and puerperium is related to multiple risk factors, and could lead to matemal death, It is very necessary to screen VTE risk factors for all pregnant women, to make corresponding prevention and control measures.
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Current guidelines recommend that women with high risk factors for preeclampsia should take low-dose aspirin between 12 to 34 weeks of gestation (preferably before 16 weeks of gestation), in order to effectively reduce the risk of preeclampsia. The mechanism of aspirin in preventing preeclampsia includes lowering the ratio of thromboxane A 2 over prostacyclin; decreasing the plasma level of soluble Fms-like tyrosine kinase-1; increasing the proliferation and invasion of trophoblast, whilst inhibiting trophoblast apoptosis; and anti-inflammatory effects. This article reviews the progress on research regarding its mechanism.
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Objective To analyze labor progression characteristics among nulliparas and provide reference to labor progress management. Methods A retrospective study was conducted on 1089 women who went for vaginal delivery at the First Affiliated Hospital, Sun Yet-San University from January 1st, 2015 to May 31th, 2016. The duration of cervical dilation from 1.0 cm to the next and the process of initial cervical dilation (2.0 cm or 3.0 cm) to full cervical dilation of nulliparas were analyzed. Results The cervical dilation speed was accelerating with the progress of labor. The rate of cervical dilation changed fastest between 5.0-6.0 cm dilation, which was more than 3.0 cm/hour. With regard to labor curves, at admission of 2.0 cm cervical dilation, it rose dramatically from 5.0 cm dilation. At admission of 3.0 cm dilation, it presented approximately linear rising before 5.5 cm dilation, then became steeper. Conclusions The cervical dilation speed is fast. Both labor curves of initial cervical dilation (2.0 cm or 3.0 cm) to full cervical dilation show obvious acceleration stage with steep slope.
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Objective To investigate obstetric outcomes of multiparous pregnancies with advanced maternal age in different inter-pregnancy intervals.Methods A retrospective study was performed in 222 multiparous pregnancies with advanced maternal age from January 1 st 2016 to December 31 st 2016.According to the inter-pregnancy intervals,all cases were divided into four groups:Group A (1-3 years),group B (4-6 years) group C (7-9 years) and group D (≥10 years).The clinical characteristics,complications during pregnancy,maternal and fetal outcomes and duration of labor were compared and analyzed in the four groups.Results The average age of groups was significantly different (P ≤ 0.001).But there was no significant difference in the rate of oxytocin (P =0.465),incidence of gestational diabetes mellitus (P =0.698),pregnancy-induced hypertension (P =0.158),premature rupture of membrane (P =0.542)and postpartum hermorrhege (P =0.124) among the four groups.A total of 212 pregnancies underwent vaginal delivery.In group A,the first stage of labor last (239.16 ± 137.63) min,which was significantly shorted than that in group B [(296.36 ± 124.56) min],group C [(332.81 ± 181.01) min] and group D [(337.19 ±224.02)min,P =0.030].However,the interval of delivery did not prolong the second (P =0.137) and third stage of labor (P=0.079).The neonatal birth weight (P =0.276) and the neonatal sex (P =0.918),as well as admission of neonatal intensive care unit (NICU,P =0.103),were similar among three groups.The rate of neonatal asphyxia in group A and group D was higher than that in group B and group C (P =0.021).Conclusions Although the second and third stage were similar among multiparous pregnancies with advanced maternal age,the first stage of labor last longer in the longer inter-pregnancy interval.Furthermore,the risk of neonatal asphyxia was higher in women with inter-pregnancy interval ≤ 3 years or ≥ 10 years.
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Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance of variable severity with onset or first recognition during pregnancy.Short-and long-term effects of GDM on both mother and child depend on the severity of the condition and blood sugar level.Currently,relatively standardized guidance on management of GDM in China has greatly improved maternal and infant outcomes.Moreover,standardized postpartum management and monitoring are also essential for the prevention of long-term complications in this population.The guidelines issued by America Diabetes Association (ADA) and American College of Obstetricians and Gynecologists (ACOG) in 2018 recommended that GDM patients should be followed up at 4-12 weeks postpartum for a 75 g oral glucose tolerance test.For those who is normal at the first postpartum follow up,it is necessary to have their blood glucose tested once every 1-3 years.However,for those who is abnormal,medication should also be initiated when necessary in addition to more frequent follow-ups and nutritional intervention and physical exercise.
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Objective To investigate the morbidity, diagnostic profile and perinatal outcome of pregestational diabetes mellitus (PGDM) in 15 hospitals in Guangdong province. Methods A total of 41338 women delivered in the 15 hospitals during the 6 months,195 women with PGDM(PGDM group) and 195 women with normal glucose test result(control group)were recruited from these tertiary hospitals in Guangdong province from January 2016 to June 2016. The morbidity and diagnostic profile of PGDM were analyzed. The complications during pregnancy and perinatal outcomes were compared between the two groups. In the PGDM group, pregnancy outcomes were analyzed in women who used insulin treatment (n=91) and women who did not (n=104). Results (1)The incidence of PGDM was 0.472%(195/41338). Diabetes mellitus were diagnosed in 59 women (30.3%, 59/195) before pregnancy, and 136 women (69.7%,136/195) were diagnosed as PGDM after conceptions. Forty-six women (33.8%) were diagnosed by fasting glucose and glycohemoglobin (HbA1c) screening. (2) The maternal age, pre-pregnancy body mass index (BMI), prenatal BMI, percentage of family history of diabetes, incidence of macrosomia, concentration of low density lipoprotein were significantly higher in PGDM group than those in control group (all P<0.05). Women in PGDM group had significantly higher HbA1c concentration((6.3±1.3)% vs (5.2±0.4)%), fasting glucose [(6.3±2.3) vs (4.8±1.1) mmol/L], oral glucose tolerance test(OGTT)-1 h glucose((12.6±2.9) vs (7.1± 1.3) mmol/L)and OGTT-2 h glucose [(12.0±3.0) vs (6.4±1.0) mmol/L] than those in control group (P<0.01). (3)The morbidity of preterm births was significantly higher (11.3% vs 1.0%, P<0.01), and the gestational age at delivery in PGDM group was significantly smaller [(37.6±2.3) vs (39.2±1.2) weeks, P<0.01]. Cesarean delivery rate in the PGDM group (70.8% vs 29.7%) was significantly higher than the control group (P<0.01). There was significantly difference between PGDM group and control in the neonatal male/female ratio (98/97 vs 111/84, P=0.033). The neonatal birth weight in PGDM group was significantly higher((3159±700) vs (3451±423) g, P<0.01). And the incidence of neonatal hypoglycemia in the PGDM group was higher than the control group (7.7% vs 2.6%, P=0.036).(4)In the PGDM group, women who were treated with insulin had a smaller gestational age at delivery [(36.9±2.9) vs (37.9±2.5) weeks, P<0.01], and the neonates had a higher neonatal ICU(NICU)admission rate (24.2% vs 9.6% , P<0.01). Conclusions The morbidity of PGDM in the 15 hospitals in Guangdong province is 0.472%. The majority of PGDM was diagnosed during pregnancy; HbA1c and fasting glucose are reliable parameters for PGDM screening. Women with PGDM have obvious family history of diabetes and repeated pregnancy may accelerate the process of diabetes mellitus. Women with PGDM have higher risk for preterm delivery and neonatal hypoglycemia. Unsatisfied glucose control followed by insulin treatment may increase the need for NICU admission.
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[Objective]To investigate the influence of different pre-pregnancy body mass index(BMI)on blood glucose and serum lipid and pregnancy outcome during pregnancy.[Methods]Clinical records of 1115 singleton pregnant women who underwent obstetric examination and delivered in the first affiliated hospital of Sun Yat-sen University between January 1,2013 and December 31,2013 were collected. The patients were divided into 3 groups based on pre-pregnancy BMI,underweight(G1):BMI 0.05). By Pearson analysis,TG had significantly positive relationship with pre-pregnancy BMI(P < 0.05),but TC,LDL-C, HDL-C had negative relationship with pre-pregnancy BMI(P<0.05).(4)With the increase of pre-pregnancy BMI,the weight and head circumference of the newborn was gradually rising(P < 0.05). The average weight of the newborn among groups were(3.03 ± 0.42),(3.18 ± 0.45),(3.30 ± 0.46)kg,the head circumference were(32.98 ± 1.59),(33.43 ± 1.64),(33.87 ± 1.60)cm,there was statistical difference among groups(P<0.05). The shoulder circumference of the newborn of G1 was obviously lower than that of G2 and G3 group(P<0.05). Pearson analysis showed that the weight,body length,head circumference,shoulder circumference of the newborn had positive relationship with pre-pregnancy BMI(P < 0.05).[Conclusion]With the increase of pre-pregnancy BMI, the blood glucose at each time point,serum lipid and growth index of the newborn was gradually rising. We suggest that overweight and obese women should lose weight before pregnancy.
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Objective]To investigate the influence of induced before or after the expected date of childbirth on maternal and neonatal outcome in patients with gestational diabetes mellitus which blood glucose well controlled.[Methods]We retrospectively analyzed 238 cases with mild gestational diabetes mellitus who had delivered in this hospital. Mild gestational diabetes mellitus cases were those who only need diet control,exercise therapy,no drug treatment. There were 120 cases who induced in 40 ~ 40+6 weeks was the research group,and 118 cases who induced in 39~39+6 weeks was the control group.[Results]The cesarean section rate be?tween the two groups was no difference(49.2%vs 55.9%,P=0.528);Postpartum hemorrhage rate of the two groups was no differ?ence(10.0%vs14.4%,P=0.299)Birth weight between the two groups was no difference(3.26 ± 0.33)kg vs(3.22 ± 0.34)kg,P =0.448). The incidences of the two groups including fetal distress,large for gestational age infants,neonatal pathological jaundice, neonatal hypoglycemia were no difference(P > 0.05).[Conclusion]Pregnant women with mild gestation diabetes mellitus induced before after 40 completed gestation weeks did not increase cesarean section rate. Pregnancy outcome between the two groups were no difference.It would be better to select the appropriate induction time according to the patient′s condition.
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Objective To investigate the relationship between time and mode of delivery and gestational outcomes in uncomplicated twin pregnancies.Methods A total of 347 women with uncomplicated twin pregnancies who gave birth in First Affiliated Hospital of Sun Yat-Sen University between November 2012 and June 2015 were reviewed retrospectively,including 291 dichorionic diamniotic twin pregnancies (DCDA) and 56 monochorionic diamniotic twin pregnancies (MCDA).The general information,gestational complications,time and mode of delivery,gestational outcomes were recorded and the relationship between time and mode of delivery and gestational outcomes in DCDA and MCDA groups were analyzed.Ttest,Chi-square,Fisher's exact test and logistic regression analysis were used for statistical analysis.Results (1) The incidence of adverse neonatal outcomes in DCDA group [49.1％ (281/572)] was significantly lower than in MCDA group [75.5％ (83/110)] (x2=25.698,P＜0.05).In DCDA group,women delivered at 36-36+6 weeks,37-37+6 weeks and 38 38+6 weeks had lower rates of admission to neonatal intensive care unit (NICU),neonatal respiratory distress syndrome (NRDS) and other neonatal diseases than those delivered at ＜34 weeks,34-34+6 weeks and 35-35+6 weeks (all P＜0.05),while those delivered at 38-38+6 weeks had a higher incidence of pathological jaundice (2/8) than at 36-36+6 weeks and 37-37+6 weeks (3.1％ and 1.9％) (x2=10.133 and 13.510,both P＜0.05).In MCDA group,the rate of admission to the NICU decreased gradually from 100.0％ (30/30) (＜35 weeks) to 3/12 (37-37+6 weeks) (P＜0.05).In DCDA group,the odds ratio (OR) and 95％ confidence interval(95％CI) of adverse neonatal outcomes in 35-35+6,36-36+6 and 37-37+6 weeks were 0.237(0.116-0.482),0.056(0.029-0.108) and 0.054(0.026-0.112),respectively (all P＜0.05).In MCDA group,OR (95％CI) of adverse neonatal outcomes in 34 34+6 and 35-35+6 weeks were 38.894 (3.084-490.552)and 18.858 (1.538-231.222),respectively (both P＜0.05).(2) With regard to mode of delivery,ten cases of DCDA and two cases of MCDA had vaginal deliveries.In DCDA group who gave birth at less than 34 weeks,the incidence of neonatal pathological jaundice in vaginal delivery group (8/14) was higher than that in cesarean delivery group [22.7％ (15/66)] (x2=5.104,P=0.024).Conclusions The optimal time of delivery for uncomplicated twins is 36-37+6 weeks.The appropriate mode of delivery should be determined by the status of both the mother and the twins.
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Objective To determine the effects of adiponectin on high glucose induced BeWo cell proliferation in vitro. Methods BeWo cells were seeded in 96-well plates at the appropriate density. After treatments with high glucose (25 mmol/L), western blot analysis of cyclin D1 and a colorimetric assay (cell counting kit-8, CCK-8) were used to analyse BeWo cells′proliferation, and western blot was used to detect the expression of adiponectin. Moreover, we added adiponectin (20μg/ml) in the culture medium and three methods were utilized for cell proliferation analysis: CCK-8, cell cycle analysis (by flow cytometry) and proliferating cell nuclear antigen (PCNA) immunocytochemical staining. Results Compared to BeWo cells cultured by normal glucose and high mannitol, the proliferation of BeWo cells treated by high glucose increased (P<0.05). Compared with BeWo cells cultured by high mannitol, the expression of adiponectin in BeWo cells treated by high glucose decreased. After added adiponectin in the culture medium, the proliferation of BeWo cells treated by adiponectin+high glucose decreased than that of cells treated by high glucose (0.770±0.050 versus 0.990±0.070, P<0.05);the proportion of G2+S phases of BeWo cells treated by adiponectin+high glucose decreased than that of cells treated by high glucose [(40.7±2.1)%versus (44.9± 3.9)%, P<0.05];the rate of PCNA positive cell in BeWo cells treated by adiponectin+high glucose decreased than that of cells treated by high glucose [(28 ± 5)% versus (44 ± 5)%, P<0.05]. Conclusion Adiponectin could inhibit proliferation of high glucose induced BeWo cells in vitro.
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ObjectiveTo investigate the risk factors of preterm birth, as well as the clinical characteristics in dichorionic diamniotic (DCDA) twins and monochorionic diamniotic (MCDA) twins. MethodsA retrospective study was conducted on 290 premature cases out of 363 twin pregnancies who delivered alive babies in the First Affiliated Hospital, Sun Yat-sen University from September 2012 to March 2015. The selected cases, including 219 cases of DCDA and 71 cases of MCDA,were divided into three groups according to their gestational age at delivery: 28-31+6, 32-33+6 and 34-36+6 weeks. The clinical features, causes and risk factors were described between these three groups. Analysis of variance,Chi-square test and multi-variant Logistic regression were used for statistical analysis.ResultsThe incidence of premature delivery in twin pregnancies was 79.9% (290/363), while this figure was lower in DCDA twins than in MCDA [76.3%(219/287) vs 93.4%(71/76),χ2=10.955,P=0.001]. The three leading causes of preterm birth in DCDA twins were gestational age≥36 weeks (33.8%, 74/219), preterm labor (30.6%, 67/219) and preterm premature rupture of membrane (PPROM) (8.7%, 19/219), while in MCDA twins were preterm labor (31.0%, 22/71), selective intrauterine growth restriction (21.1%, 15/71) and gestational age≥36 weeks (19.7%, 14/71). Logistic regression analysis showed that the independent risk factors of preterm birth in twins at 28-31+6 weeks was PPROM (OR=2.390, 95%CI: 1.006-5.872,P=0.043), and for those twins at 32-33+6 weeks, the independent risk factors were MCDA (OR=2.758, 95%CI: 1.243-6.118,P=0.013), preeclampsia (OR=12.176, 95%CI:4.685-31.642,P=0.000), PPROM (OR=5.348, 95%CI: 2.151-13.294,P=0.000) and preterm labor (OR=3.274, 95%CI:1.453-7.375,P=0.004). MCDA (OR=3.666, 95%CI: 1.364-9.585,P=0.010) and preeclampsia (OR=8.086, 95%CI:1.044-62.617,P=0.045) were the risk factors in the group of 34-36+6 weeks.ConclusionsAlthough preterm birth in MCDA and DCDA twins is due to different reasons, the former has a higher incidence than the latter. The risk factors of premature delivery at different gestations are also different.
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Objective To investigate gene expression profile in peripheral leucocytes of patients with severe preeclampsia (SPE) during 16-20 gestational weeks to see if there are different expression between normal pregnancy and SPE, and to provide the evidence for predicting the pathogenesis of preeclampsia in the future. Methods Eight hundred primipara who accepted pregnancy examination at the First Affiliated of Hospital SUN YAT-SEN University from August 2008 to December 2008 were selected into this study. The gestational age of all objects were confirmed as 16-20 weeks by ultrasonography. And they were followed up until delivered. Six patients developed severe preeclampsia (SPE group); and 40 pregnant women without any complications were chosen as the control. Human genome complementary DNA (cDNA) single-fluorescent chip were used to detect the different gene expression in peripheral leucocytes between normal pregnancy and SPE at 16-20 gestation weeks. Results There were different expressions in 983 genes between SPE group and control group, among which 719 genes were up-regulated and 264 genes were down-regulated in the SPE group. Up-regulating genes mainly involved in immunity, coagulation and fibrinolysis, signal transduction, cell adhesion, transcription and protein synthesis; and the expression of platelet and T cell activation antigen 1 (PTA1/CD226), bactericidal/permeability increasing protein (BPI), interleukin-8 (IL-8), protein kinase C (PKC), lymphocyte antigen 75 (LY-75), mucoprotein and EGFR pathway substrate 8 (EPS8) were significantly increased in SPE patients. Down-regulating genes mainly involved in apoptosis, calcium metabolism, lipid metabolism and cell transformation; and the expression of adrenomedullin (ADM), killer cell immunoglobulin-like receptors (KIR), vitamin D receptor (VDR), adipose differentiation-related protein (ADRP), parathyroid hormone (PTH) and mitogen-activated protein kinase kinase 4 (MKK4) were significantly decreased in SPE patients. Conclusions The gene expressions of peripheral leucocytes in pre-eclampsia patients were different from those of normal pregnant women during 16-20 gestational weeks. Gene CD226, BPI, IL-8, PKC, ADM, KIR and VDR might participate in the pathogenesis of SPE which should be further investigated.
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Objective To investigate whether no asphyxia neonates with intrauterine distress are complicated with myocardial injury and determine the sensitive biochemical diagnostic parameters. Methods A total of 89 neonates born in the First Affiliated Hospital of Sun Yat-sen University from July 2009 to December 2009 were enrolled. Fifty-three fetal distress cases with Apgar score ＞ 7 at 1 and 5 minites were enrolled in the study group; while the rest 36 healthy neonates, whose Apgar score = 10 at 1 and 5 minites, were the control group. Umbilical artery blood samples of all cases were collected for blood gas analysis and biochemical measurement. Results(1)pH(7.23±0.07) and BE [(-4.8±3.0)mmol/L] in the study group were significantly lower than pH (7.31 ±0.03) and BE [(-2.1±1.5)mmol/L] in the control group (P＜0.05).The lactic acid of study group [(5.2±2.3)mmol/L] was higher than that of the control group [(2.3±1.1)mmol/L], and the difference was significant (P＜0.01). However, there was no significant difference between the two groups in PaO2[(16.2±7.9)mm Hg(1 mm Hg=0.133 kPa) vs. (17.5±6.7)mm Hg] and PaCO2[(54.0±11.2)mm Hg vs. (48.5±5.4) mm Hg; P＞0. 05]. (2) The level of CK-MB in neonates with fetal distress[(48 ±59) U/L] was significantly higher than that of healthy neonates [(36±27)U/L]. However, no significant difference was found in CK [(194±73)U/L vs. (162±95) U/L]and BNP levels[(519±309)ng/L vs.(481±216)ng/L;P ＞ 0.05]. (3) Spearman rank correlation analysis showed that CK-MB level was negatively correlated with pH(r=-0.296, P＜0.05) and BE (r=-0.318,P＜0.05) of umbilical artery blood,while BNP level was positively correlated with umbilical lactic acid (r=0.278, P＜0.05). No correlation was found between other parameters (P＞0.05).Conclusions Intrauterine distress without neonatal asphyxia had effect on fetal myocardial injury. CK-MB can be used as a sensitive parameter for monitoring the development of myocardial injury. The severity of myocardial injury was related to fetal acidosis.
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[Objective]To establish a novel noninvasive fluorescent animal model for endometriosis in vitro and in vivo.[Methods]Adenovirus encoding enhancing green fluorescent protein(Ad-eGFP)was used to transfect endometrial glandular cells and stromal cells(cells transfection and injection,Method No.1),and fragments(tissues transfection and injection,Method No.2).Transfection efficiencies were compared between the two methods in vitro.Then GFP transfected glandular cells and stromal cells suspension were injected into nude mice subcutaneously(Method No.1),taking Method No.2 as a comparison.In vivo observation last for 25 days,and positive rates and duration times of fluorescent lesions were calculated.Histological examination was used to confirmed lesion formation.[Results]On the fifth day after injection,lesion positive rate of Method No.1 was 88.9%,which was statistically significantly higher than that of Method No.2(22.2%),P=0.015＜0.05.The fluorescent positive duration of Method No.1 and No.2 were 12 ± 8 days and 7±4 days.The structures of lesions were all identified as human original endometrium by histological examination,including HE staining and immunofluoresceney.[Conclusion]Noninvasive animal model of endometriosis can be built up by subcutaneously injection of Ad-EGFP transfected endometrial glandular cells and stromal cells suspension with higher positive rate and longer observation time