Early warning of low maternal unconjugated estriol level by prenatal screening for fetus with X-linked ichthyosis / 中华妇产科杂志

Objective:To analyze the characteristic of prenatal serological screening in fetus with X-linked ichthyosis (XLI), and to explore the relationship between unconjugated estriol (uE 3) levels and XLI. Methods:A total of 56 fetuses with Xp22.31 microdeletion indicated by prenatal diagnosis and 70 fetuses diagnosed with trisomy 21 and 26 fetuses with trisomy 18 in Henan Provincial People's Hospital and Affiliated Hospital of Weifang Medical College from September 2016 to June 2021 were collected. The multiples of median (MoM) values of uE 3, alpha-fetoprotein (AFP), and human chorionic gonadotropin (hCG) during the second trimester of pregnancy were retrospectively analyzed. Prenatal diagnosis was made by amniotic fluid karyotype analysis and genome copy number variant analysis, parent genetic verification and pathogenicity analysis were performed, and maternal and infant outcomes were followed up. Results:Of 56 pregnant women with fetal Xp22.31 microdeletion, 43 underwent serological screening during the second trimester of pregnancy, of which 42 were abnormal (39 male fetuses and 3 female fetuses). The median uE 3 MoM value of 39 male fetuses [0.06 (0.00-0.21)] was lower than the normal value and significantly lower than that of fetuses with trisomy 21 [0.71 (0.26-1.27)] and fetuses with trisomy 18 [0.36 (0.15-0.84)], the difference was statistically significant ( Z=99.96, P<0.001). While the MoM values of AFP and hCG were all within the normal range. Among the 56 fetuses carrying Xp22.31 microdeletion, 45 were male fetuses and 11 were female fetuses, and the deletion fragments all involved STS gene. Eighty-nine percent (50/56) were inherited from mother (49 cases) or father (1 case), and 11% (6/56) were de novo mutations. Follow-up showed 48 live births (38 males and 10 females) and 8 chose to terminate pregnancy (7 males and 1 female). Among the 38 male newborns, 37 presented with scaly skin changes from 1 to 3 months of age, and one had no clinical manifestations until 4 months after birth. Ten female newborns had no obvious clinical manifestations. Conclusions:The decrease levels of uE 3 MoM on maternal serological screening is closely related to the higher risk of XLI in male fetuses. For pregnant women with low uE 3 in serological screening or with family history of ichthyosis, in addition to chromosomal karyotype analysis, joint detection of genomic copy number variant analysis should be recommended.

Impacto da estrogenização vaginal no seguimento de citologia oncótica de significado indeterminado na pós-menopausa / Impact of vaginal estrogenization in follow-up of oncotic cytology of undetermined significance in postmenopausal women

Avaliar a estrogenização tópica vaginal no seguimento de citologia oncótica de significado indeterminado, tipo ASC-H, na pós-menopausa. Estudo, tipo caso-controle, que avaliou mulheres menopausadas com diagnóstico de ASC-H, divididas em dois grupos, com e sem uso de estrogênio tópico vaginal (GE e GNE). Foi calculada razão de chance a partir de tabelas de contingência construídas com variação robusta. Foram analisados 128 prontuários, sendo 27% de pacientes do GNE e 72% do GE. Houve aumento de diagnósticos ASC-H no GNE. No GE, aproximadamente 68 vezes menos colposcopias inadequadas e diminuição do número de colposcopias e Cirurgia de Alta Frequência (CAF), com evidência na redução em 21 e 12,5 vezes, respectivamente. Diminuição do número de colposcopias com melhor adequação ao exame, número de biópsias inalterado e diminuição do número de cirurgias de alta frequência, no grupo com uso de estrogênio tópico vaginal durante o seguimento.

Current paper evaluates topic vaginal estrogenization following oncotic cytology of undetermined significance, type ASC-H, in postmenopausal women. A case-control study evaluated menopausal women diagnosed with ASC-H, divided into two groups, with and without the use of topic vaginal estrogen (GE and GNE). Odds ratios were calculated from contingency tables built with robust variation. 128 medical records were analyzed, 27% of which were from the GNE and 72% from the GE. There was an increase in ASC-H diagnoses in GNE. In GE, approximately 68 times less inappropriate colposcopies and a decrease in the number of colposcopies and High Frequency Surgery (HFS), with a reduction of 21 and 12.5 times, respectively. Decrease in the number of colposcopies with better adaptation to the exam, unchanged number of biopsies and decrease in the number of high-frequency surgeries, in the group using topic vaginal estrogen during the follow-up.

Efectividad y seguridad del policresuleno en el tratamiento del síndrome genitourinario de la menopausia. Estudio controlado y aleatorizado / Effectiveness and safety of polyresullen in the treatment of menopausal genitourinary syndrome. Controlled and randomized study

Objetivo: evaluar la efectividad y seguridad del policresuleno frente al estriol y el lubricante vaginal, en el tratamiento del síndrome genitourinario de la menopausia en mujeres de Armenia (Quindío, Colombia). Materiales y métodos: en mujeres diagnosticadas con síndrome genitourinario de la menopausia, se hizo un ensayo clínico controlado aleatorizado y triple ciego. Se asignaron tres grupos (estriol, n=86, lubricante vaginal, n=83 y policresuleno, n=82). El principal parámetro indicador de efectividad fue la elevación de la puntuación del índice de salud vaginal (ISV), mejoría de la función sexual de acuerdo al índice de Función Sexual Femenina Abreviado-6 (IFSFA-6), porcentaje de mejoría de la sintomatología e incidencia de efectos adversos.Resultados: la efectividad fue mayor con el uso del estriol, seguida del policresuleno y menor con el lubricante vaginal (92,82%, 75,69% y 63,74%, respectivamente, p =0,012); también se encontraron diferencias en la mejoría de la función sexual, según los puntajes del IFSFA-6 [29,29 ± 6,23 (estriol), 28,66 ± 6,12 (policresuleno) y 25,38 ± 6,27 (lubricante vaginal), p = 0,021], con diferencias en el porcentaje tanto de la mejoría de la sintomatología como en la presentación de efectos adversos (p = 0,001). Conclusiones: el policresuleno tiene una significativa efectividad en el tratamiento del síndrome genitourinario de la menopausia, superior frente al lubricante vaginal,pero inferior comparado con el estriol. Es evidente la presencia de efectos adversos, mayores con el estriol, seguido del policresuleno y luego del lubricante vaginal, sin cuestionar el notable perfil de seguridad del policresuleno..Au

Objective: to evaluate the effectiveness and safety of policresulen against estriol and vaginal lubricant in the treatment of menopausal genitourinary syndrome in women from Armenia (Quindío, Colombia). Materials and methods: in women diagnosed with genitourinary menopausal syndrome, a randomized, three-blind, controlled clinical trial was conducted. Three groups were assigned (estriol, n = 86, vaginal lubricant, n = 83 and policresulen, n = 82). The main indicator parameter of effectiveness was the elevation of the vaginal health index (ISV) score, improvement in sexual function according to the Abbreviated Female Sexual Function Index-6 (IFSFA-6), percentage of improvement in symptoms and incidence of adverse effects. Results: the effectiveness was greater with the use of estriol, followed by policresulen and less with the vaginal lubricant (92.82%, 75.69% and 63.74%, respectively, p = 0.012); Differences were also found in the improvement of sexual function, according to IFSFA-6 scores [29.29 ± 6.23 (estriol), 28.66 ± 6.12 (policresulen) and 25.38 ± 6.27 (vaginal lubricant), p = 0.021], with differences in the percentage of both improvement in symptoms and in the presentation of adverse effects (p = 0.001). Conclusions: polycresullen has a significant effectiveness in the treatment of genitourinary syndrome of menopause, superior compared to vaginal lubricant, but inferior when compared to estriol. The presence of adverse effects is evident, greater with estriol, followed by policresulen and then vaginal lubricant, without questioning the remarkable safety profile of polyresulin..Au

Compare the efficacy, safety and compliance of oral estradiol and vaginal estriol for urogenital problems in post-menopausal women

Background: Menopause is recognised to have occurred after 12 months of amenorrhoea for which there are no obvious pathological and physiological causes, it is retrospective diagnosis. Objective of this study was to compare the efficacy, safety and compliance of oral estradiol and vaginal estriol for urogenital problems in post-menopausal         women.Methods: A total of 100 postmenopausal women having urogenital symptoms were selected for the prospective study. The selected patients were randomly allocated in 2 groups. Group A received 2 mg of estradiol OD for 4 weeks and then evaluated after 4 weeks. Group B received 0.5 mg of vaginal estriol cream continuously for 4 weeks at night and then evaluated after 4 weeks. Patients were followed after 1,3 and 6 months. Inclusion criteria were postmenopausal women, vaginal symptoms, urogenital symptoms. exclusion criteria were all patients having estrogen dependent neoplasia and comorbidities.Results: For urinary complaints, symptomatic relief was assessed by AUA Score in which after 6 months; in Group A the difference in mean from baseline was 19.64±1.63 and in Group B it was 21±2.52 and was statistically insignificant from each other. For genital complaints, symptomatic relief was graded as 1, 2, 3, 4 in which grade 4 means complete relief. After 6 months of therapy 88.2% got complete relief in Group A and   91.1% in Group B. In vaginal cytological smears; in both groups, parabasal cells were reduced and superficial cells were increased after 6 months of therapy and both groups were statistically insignificant from each other. After 6 months of therapy, increase in mean value of KPI from the baseline is 24.54±10.1 in Group A and 28.6±10.11 in Group B and both groups were statistically insignificant. Endometrial thickness remained unchanged in both the groups after 6 months of therapy.Conclusions: Both drugs were equally effective in alleviating the urogenital symptoms with no significant side effects.

Study of changes in levels of salivary estriol and progesterone in preterm labor in comparison to normal pregnancy

Background: This prospective research was designed to evaluate changes in levels of salivary Estriol and Progesterone in preterm labor in comparison to normal pregnancy. Spontaneous onset of labor at term is produced by definite increase in estriol and fall in progesterone. This rise in free estrogen should precede the onset of labor according with the known effect of estrogen and progesterone on myometrial activity. Concentration of steroid in saliva reflect unbound unconjugated and biologically active fraction.Methods: The present study was carried for duration of one year enrolling 115 antenatal women between 28 and < 37 weeks of gestation with or without labour pains attending the antenatal clinic in KGMU, Lucknow and those admitted in Queen Mary’s Hospital Lucknow. 5 ml of saliva was collected in cryovials from each patient to estimate estriol and progesterone. The estimation of saliva progesterone and estriol was done by immunoenzymatic colorimetric method of the supernatant of sample.Results: In our study mean value of saliva progesterone levels of pregnant women with preterm delivery (study group IIA) was lower than the control group (Group l) but the difference was not significant (3814.46±751.14 pg/ml versus 3945.16±577.11 pg/ml, p = 0.351). Mean value of estriol study group who delivered preterm (3512.85±586.16 pg/ml) was higher as compared to the mean value of control group (2691.72±681.08 pg/ml) and difference was significant (p value < 0.001).Conclusions: Thus, there is significant rise in level of saliva estriol, it can be used as a predictor for detecting symptomatic and asymptomatic women at risk for preterm birth.

Serum estriol and placenta growth factor levels in pregnant women with subclinical hypothyroidism after thyroxine therapy / 中华全科医师杂志

Sixty four pregnancy women with mildly raised TSH level (2.5-4.5 mU/L) in the 1st trimester were divided into two groups:only the thyroid function was monitored in study Ⅰ group (n =32),while levothyroxine therapy was given in study Ⅱ group (n =32);45 normal pregnant women with TSH level ＜2.5 mU/L served as control group.Serum unconjugated estriol(uE3) and placenta growth factor (PlGF) levels in 3rd trimester were measured in all subjects.The incidence of adverse events in control group,study groups Ⅰ and Ⅱ were 22.2％,40.6％ and 31.3％,respectively (P ＞0.05).The serum levels of uE3 (7.34 μg/L) and PlGF (76.3 ng/L) were elevated in study group Ⅱ;and the uE3 level was close to that in the control group (6.61 μg/L),while PlGF level was lower than that in the control group (169.1 ng/L).When TPO antibody was positive,the uE3 level in the study group Ⅰ (logarithmic value 0.37 ±0.31) was lower than those in other two groups (logarithmic value 0.81 ± 0.37,0.56 ± 0.27),while there was no significant difference in PlGF levels among three groups.The results suggest that levothyroxine may improve placental function to some extent and TPO antibody might be one of the regulators in the expression of uE3.

Estriol vs estrógenos conjugados de origen equino en el tratamiento del síndrome genitourinario de la menopausia / Estriol vs. Conjugated estrogens of equine origin in the treatment of the genitourinary syndrome of menopause

Resumen OBJETIVO Comparar la efectividad y seguridad del estriol vs estrógenos conjugados de origen equino en el tratamiento del síndrome genitourinario de la menopausia. MATERIALES Y MÉTODOS Ensayo clínico multicéntrico, doble ciego, controlado, con asignación al azar, efectuado en tres clínicas de Colombia entre los meses de julio de 2015 y septiembre de 2017. Criterio de inclusión: mujeres con síndrome genitourinario de la menopausia tratadas con estrógenos tópicos. Las pacientes se asignaron al azar a dos grupos: A (estriol) y B (estrógenos conjugados de origen equino). Variables de estudio: concentraciones séricas de estradiol, testosterona total, globulina fijadora de hormonas sexuales, porcentaje de satisfacción al disminuir los síntomas y tiempo hasta su desaparición. También se consideraron: pH vaginal menor de 4.5, puntuación del índice de maduración vaginal, intensidad de la sequedad vaginal, necesidad de terapia hormonal sistémica, medición del endometrio, comportamiento sexual y coexistencia de efectos secundarios. RESULTADOS Se estudiaron 387 mujeres: 192 del grupo A, que recibió estriol y 195 del grupo B tratadas con estrógenos conjugados de origen equino. El porcentaje de efectividad en el grupo A fue de 90.6% y en el grupo B de 89.2%; (p = 0.507). Las mujeres del grupo A experimentaron menos efectos secundarios (26.5%) que las del grupo B (38.4%). En las otras variables no se encontraron diferencias. CONCLUSIONES El estriol y los estrógenos conjugados de origen equino son igual de efectivos y seguros para tratar el síndrome genitourinario de la menopausia; sin embargo, el estriol ofrece mayores ventajas porque disminuye más rápidamente los síntomas y origina menores efectos secundarios.

Abstract OBJECTIVE To compare the effectiveness and safety of estriol vs. conjugated estrogens of equine origin in the treatment of the genitourinary syndrome of menopause. MATERIALS AND METHODS Multicentric, double-blind, controlled, randomized clinical trial conducted in three clinics in Colombia between July 2015 and September 2017. Inclusion criteria: women with menopausal genitourinary syndrome treated with topical estrogens. The patients were randomly assigned to two groups: A (estriol) and B (conjugated estrogens of equine origin). Study variables: serum levels of estradiol, total testosterone, sex hormone-binding globulin, percentage of satisfaction with decreasing symptoms and time to disappearance. The following were also considered: vaginal pH lower than 4.5, vaginal maturation index score, intensity of vaginal dryness, need for systemic hormonal therapy, measurement of the endometrium, sexual behavior and coexistence of side effects. RESULTS We studied 387 women: 192 of group A, who received estriol and 195 of group B treated with conjugated estrogens of equine origin. The percentage of effectiveness in group A was 90.62% and in group B it was 89.23%; (p = 0.507). In women in group A there were fewer side effects (26.56%) than in group B (38.46%). No differences were found in the other variables. CONCLUSIONS Estriol and conjugated estrogens of equine origin are equally effective and safe in the treatment of the genitourinary syndrome of menopause.

Association between adverse obstetric outcomes and abnormal maternal serum markers in the second trimester screening / 上海交通大学学报（医学版）

Objective · To evaluate the association between the abnormal maternal serum markers of alpha fetoprotein (AFP), human chorionic gonadotrophin (hCG) and unconjugated estriol (uE3) in the second trimester screening and the adverse obstetric outcomes other than trisomy 21 (T21),trisomy 18 (T18) and open neural tube defects (ONTD), and to provide local data for supporting evidence based clinical managements. Methods · A retrospective cohort study was performed in the women who received second trimester maternal serum screening in the International Peace Maternal and Child Health Hospital between 2012 and 2014, with naturally conceived singleton pregnancies. Obstetric outcomes were followed up by searching electronic medical records within the hospital. Abnormal level of marker was defined as a MOM value ≥ 99th (P99) or ≤ 1st percentile (P1) of the overall screened population. Incidence of an adverse obstetric outcome was compared between the groups with abnormal markers and the control with all markers in normal. Results · ① A total of 25616 pregnancies were included in this study, in which 4526 were identified as having various adverse obstetric outcomes. Among them 4143 pregnancies were with isolated and 383 pregnancies were with co-occurring two or more adverse outcomes. ② When compared to pregnancies with normal levels of all three serum markers, pregnancies with decreased AFP or decreased hCG did not show associations with any adverse obstetric outcomes. However, pregnancies with increased AFP, increased hCG or decreased uE3 were at increased risk for a variety of abnormal pregnancy outcome. In 18 pregnancies with an outcome of fetal chromosomal abnormalities other than T21 and T18, 9 presented with either increased AFP, increased hCG or decreased uE3, with relative risk ratios of 13.33、35.00 and 59.00, respectively. ③ The performance of those markers tended to be improved in a subset of adverse obstetric outcomes, including low birth weight

Effect of lipidemia on time-resolved fluoroimmunoassay for determination of unconjugated estriol / 国际检验医学杂志

Objective To investigate the effect of different degree lipidemia on time-resolved fluoroimmunoassay(TRFIA)for determination of unconjugated estriol(uE3).Methods Mixed serum was prepared by collecting different levels of lipidemia samples which were normal and chylous appearance from male and by mixing with definite value serum of uE3.The levels of uE3 in the sam-ples were measured by TRFIA and the effect of lipidemia on TRFIA for determination of uE3 was evaluated.Results For the ap-pearance of chylous specimens,mild lipidemia increased uE3,mid-or hiper-lipidemia samples reduced uE3 and the effect of both was considerable.Conclusion The chylous lipidemia has variant degree of influence to TRFIA for determination of uE3,then the results effect accuracy of Down′s screening.

Effect of estriol and placenta prolactin on fetal growth / 国际检验医学杂志

Objective To discuss the determination of estriol and placenta prolactin levels for fetal grow th and development and provide theoretical basis for doctors to improve the rate of eugenic and superior nurture .Methods The pregnant women treated in the hospital from August 2014 and February 2015 were divided into two groups :pregnant women with fetal growth restriction were as the observation group(n=59) ,who with normal fetal development were as control group(n=256) .Estriol and placenta prolactin levels of two groups tested ,and the data obtained were statistically analyzed .Results Estriol level of the observation group was (13 .36 ± 2 .57)ng/mL ,which of the control group was (21 .34 ± 3 .48)ng/mL ,and the level of the observation group was lower than the control group significantly(P<0 .05) .Placenta prolactin concentration of the observation group was (3 .28 ± 0 .84)ng/mL , taht of the control group was (5 .27 ± 1 .24) ng/mL ,and the level of the observation group was lower than the control group signifi‐cantly(P<0 .05) .Estriol positive rate of observation group was 40 .68% (24/59) ,placenta prolactin positive rate was 37 .29%(22/59) ,and the positive rate of combined detection was 71 .19% (42/59) .Conclusion Examination the estriol and placenta prolac‐tin levels of pregnant female can evaluate fetal placental function .

Clinical Significance of determination of unconjugated estriol and human placental lactogen in preeclampsia / 国际检验医学杂志

Objective To explore the relationship between serum levels of unconjugated estriol (uE3)and human placental lacto-gen (hPL)and preeclampsia.Methods 123 cases of pregnant women diagnosed as preeclampsia were enrolled into observational group,and 1 50 cases of healthy pregnant women were enrolled into control group.Blood specimen were collected from the two groups in 28-<32 gestational weeks and 32-36 gestational weeks.Serum levels of uE3 and hPL were determined and compared between the two groups.Results The pregnancy outcomes of the control group were better than those of the observation group. With the increase of gestational age,there was increasing trend of serum levels of uE3 and hPL in the two groups.However,com-pared with the observation group,the serum levels of uE3 and hPL were higher in the control group,and the differences were statis-tically significant(P <0.05).Conclusion The decrease of serum levels of uE3 and hPL in pregnant women with preeclampsia may be associated with the pregnancy outcomes.

Serological prenatal screening results of sIUFD when twin pregnancy / 中华检验医学杂志

Objective To study whether there was significant difference between pregnant women , data and the results of prenatal screening of single intrauterine fetal death ( sIUFD) when twin pregnancy and singleton pregnancy for guiding the clinical prenatal screening and risk consulting .Methods By comparative study, 56 cases of sIUFD when twin pregnancy were recorded from 2011 to 2014 in Ningbo Prenatal Diagnosis Center , all were natural pregnancy , the sistens gestational weeks were less than 14 weeks , and 4 993 natural singleton pregnancy .The pregnant women , data and the results of serological prenatal screening between sIUFD and singleton pregnancy were analyzed by t-test and rank sum test .Separately , the 56 cases of prenatal screening , risk value was calculated according to the twins and singleton , then the difference were analyzed combined with the results of follow-up.Results Pregnant women , data of two groups were analyzed, there were no statistically significant difference between sIUFD and singleton pregnancy .The age of sIUFD and singleton was (27 ±3)year-old and (27 ±3)year-old respectively, t=2.56, P>0.05; the weight of sIUFD and singleton was (55.2 ±10.23 ) kg and (56 ±10.34) kg, t=4.268, P>0.05.The gestational weeks of sIUFD and singleton were (39.21 ±0.78)weeks and (39.1 ±0.91) weeks, t=1.3, P>0.05;the weight of newborn was (3.38 ±0.41) kg and (3.31 ±0.43) kg, t=1.9, P>0.05.The AFP multiple of median (AFPMOM) of sIUFD and singleton was 1.41(0.99,1.83) and 1.02(0.84,1.24), Z=5.337, P0.05;unconjugated estriol multiple of median of sIUFD and singleton was 1(0.79,1.16) and 1.01(0.85,1.21), Z=1.334, P>0.05.Trisomy 21 risk of sIUFD and singleton was 7 750(2 200,28 000) and 5 300(2 000,12 000), Z=2.093, P<0.05, that had significant difference.The 56 cases of prenatal screening risk value was calculated according to the twins and singleton , among whom 42 cases had the same conclusion , 14 cases had the different conclusion .Among them, according to singleton calculation , 3 cases for high risk, according to the twin calculation of high risk for 17 cases,χ2 =12.1, P <0.05.According to follow-up, all newborns were normal.Conclusions For the natural pregnancy , sIUFD when twin pregnancy , if the sistens gestational weeks less than 14 weeks, the risk of prenatal screening results calculated according to singleton will be more reasonable , as for the prenatal screening for twin pregnancy , the method needs further exploration .

Accuracy of Combined Maternal Serum Interleukin-8 and Salivary Estriol in Prediction of Preterm Labor.

Aim: To assess the accuracy of combined maternal serum interleukin and maternal salivary estriol levels in prediction of preterm labor in Egyptian pregnant females. Study Design: Case control study. Place and Duration of Study: It was conducted in El-Shatby University Hospital of Gynecology and Obstetrics, Alexandria, Egypt between 1st Jan to 30th September in the year 2012. Methodology: We included 80 pregnant females of gestational age 28-36 weeks (40 females with preterm labor and 40 pregnant not in labor). Both groups were matched for the women's age and the gestational age. A questionnaire was completed; abdominal and vaginal examinations were done. Maternal serum and saliva were collected for measuring the serum interleukin-8 and salivary estriol levels using ELISA technique. Results: Using ROC curve analysis, the overall diagnostic accuracy of Salivary Estriol alone at cut off point 200 pg/ml in prediction of preterm labor was 58% (0.46-0.71). Sensitivity and specificity were 82.5% and 32.5% respectively. The diagnostic accuracy of combined Salivary Estriol and serum interleukin-8 in prediction of preterm labor was 68% (0.56-0.79). Sensitivity and specificity were 75%% and 60% respectively. Lastly, the maternal serum interleukin-8 had the following accuracy measures for prediction of preterm labor at cut off point 965 pg/ml. (Overall accuracy: 79% (0.69-0.89), sensitivity 92.5% and specificity 42.5%). Conclusion: The maternal serum interleukin-8 is an effective and relatively non invasive and more accurate strategy for prediction of preterm labor at cut off point 965 pg/ml than salivary estriol. (Overall accuracy: 79%, sensitivity 92.5% and specificity 42.5%).

Application of serum alpha-L-fucosidase in monitoring the function of placenta / 国际检验医学杂志

Objective To investigate the application of maternal serum α-L-fucosidase to the placental function monitoring. Methods Comparative analysis of the changes of serum α-L-fucosidase between 120 patients with advanced placental dysfunction, pregnant women with different stages of gestation and 80 healthy non-pregnant woman was performed,and the correlation of the se-rum α-L-fucosidase of 120 cases with advanced placental dysfunction with UE3 and HPL was analyzed.Results The level of serumα-L-fucosidase of patients with placental dysfunction was lower than that of normal pregnant women,and the difference was statisti-cally significant (P <0.05 ).The serum α-L-fucosidase was correlated with UE3 and HPL which were the indicators of placental function monitoring (r=0.534 and 0.587,P <0.05).Conclusion Serum α-L-fucosidase can serve as the conventional biochemical indicator for monitoring placental function.

Predictive value of abnormal second-trimester maternal serum triple screening markers for adverse pregnancy outcomes / 中华妇产科杂志

Objective To investigate the predictive value of abnormal multiples of the median (MoM) of second trimester maternal serum triple screening (STMSTS) markers for adverse pregnancy outcomes.Methods 16 000 singleton pregnancies at 15+0 to 20+6 weeks' gestation who underwent STMSTS between July 2010 and January 2013 in the First Hospital of Jilin University were recruited.Maternal serum AFP,free β-hCG (F-β-hCG) and unconjugated estriol (uE3) levels were measured using time-resolved fluoroimmunoassay,and then convened to MoM.LifeCycle 3.2 software was used to calculate risk,and a risk value greater than 1 in 270 or 1 in 350 was considered as high risk for trisomy 21 syndrome (Down syndrome,DS) and trisomy 18 syndrome (Edwards syndrome,ES),respectively.MoM of AFP more than 2.5was considered high risk for open neural tube defect (ONTD).Amniocentesis and karyotyping,ultrasound screening were advised for high risk women.AFP,F-β-hCG higher than 2.0 MoM or uE3 lower than 0.5MoM was considered as abnormal,respectively.The MoM of STMSTS marker between women with adverse pregnancy outcome and with normal outcome was compared.Results (1) The median MoM of AFP,F-β-hCG and uE3 was 0.91 MoM,0.94 MoM and 1.05 MoM,respectively.Of the 16 000 pregnant women,there was no statistical difference in the median MoM of triple screening marker at different weeks of gestation (P＞0.05).The positive rate of DS,ES and ONTD in women ≤35 years old (n=14 972) was 4.03％ (603/14 972),0.36％(54/14 972) and 0.29％(44/14 972) respectively.And in women＞35 years old(n=1 028),the positive rate was 24.51％ (252/1 028),1.95％ (20/1 028) and 0.78％ (8/1 028),respectively.There was a statistically significant difference of positive rate between the two groups(P＜0.05).(2) 9 cases of DS,1 case of ES and 1 ease of ONTD were found in the high risk group,and 2 cases of DS in the low risk group.The detection rate of DS,ES and ONTD was 9/11,1/1 and 1/1 respectively; and the positive predictive value was 1.05％(9/855),1.35％(1/74) and 1.92％(1/52),respectively.(3)The incidence of adverse outcome (group 1) was 1.49 ％(239/16 000).7 760 pregnant women in this study were healthy during pregnancy,so were their fetuses (group 2).There were significant differences in the age at delivery,body weight and markers' MoM of STMSTS between the two groups(P＜0.01).(4) In group 1,the rate of abnormal MoM of AFP or F-β-hCG was 7.95％(19/239) and 23.85％ (57/239),and the abnormal rate of MoM of uE3 was 4.18％(10/239).The rate of two abnormal MoM of markers was 5.02％(12/239); the rate that all three MoM were abnormal was 0.84％(2/ 239).However,in group 2,the rate of two abnormal MoM of markers was 0.14 ％(11/7 760); and the rate that all three MoM were abnormal was 0.There was a significant difference of abnormal MoM of maternal serum marker between the two groups (P＜0.01).Conclusions There is a relationship between abnormal marker of STMSTS and adverse outcomes.STMSTS show a high value in the detection of DS,ES and ONTD.

Maternal serum median levels of alpha-foetoprotein, human chorionic gonadotropin & unconjugated estriol in second trimester in pregnant women from north-west India.

Background & objectives: Triple test as prenatal screening procedure does not form a part of routine health care of pregnant women in India. Hence, median values of triple test biomarkers are lacking for Indian population. This study was undertaken to establish population-specific medians for biomarkers viz. alpha-foetoprotien (AFP), human chorionic gonadotropin (hCGβ), and unconjugated estriol (uE3) for detection of Down’s syndrome, Edward’s syndrome and neural tube defects (NTDs) in pregnant women in north-west India. Methods: Serum biomarker values were derived from 5420 pregnant women between 15-20 wk of gestation who were enrolled for triple test investigations at Department of Gynecology and Obstetrics, Government Medical College and Hospital, Chandigarh, India, between January, 2007 to December, 2009. Median values were calculated for rounded weeks using database comprising pregnancies with normal outcomes only. Simple statistical analysis and log-linear regression were used for median estimation of the biomarker values. Results: The levels of the three biomarkers were found to be ranging from 1.38 to 187.00 IU/ml for AFP, 1.06 to 315 ng/ml for hCGβ, and 0.25 to 28.5 nmol/l for uE3. The age of women ranged from 18 to 47 yr and mean weight was 57.9 ± 9.8 kg. Data revealed that AFP, hCGβ and uE3 medians in our study population were not significantly different from those reported from other countries or when compared ethnically. Interpretation & conclusion: The population-specific median values for the three biomarkers (AFP, hCGβ, uE3) may be used as reference values during prenatal screening in Indian pregnant women.

Maternal serum progesterone, estradiol and estriol levels in successful dinoprostone-induced labor

Hormone-mediated quiescence involves the maintenance of a decreased inflammatory responsiveness. However, no study has investigated whether labor induction with prostanoids is associated with changes in the levels of maternal serum hormones. The objective of this study was to determine whether labor induction with dinoprostone is associated with changes in maternal serum progesterone, estradiol, and estriol levels. Blood samples were obtained from 81 pregnant women at term. Sixteen patients had vaginal birth after spontaneous labor, 12 required cesarean section after spontaneous labor and 16 underwent elective cesarean. Thirty-seven patients had labor induction with dinoprostone. Eligible patients received a vaginal insert of dinoprostone (10 mg) and were followed until delivery. Serum progesterone (P4), estradiol (E2) and estriol (E3) levels and changes in P4/E2, P4/E3 and E3/E2 ratios were monitored from admission to immediately before birth, and the association of these measures with the resulting clinical classification outcome (route of delivery and induction responsiveness) was assessed. Progesterone levels decreased from admission to birth in patients who underwent successful labor induction with dinoprostone [vaginal and cesarean birth after induced labor: 23% (P < 0.001) and 18% (P < 0.025) decrease, respectively], but not in those whose induction failed (6.4% decrease, P > 0.05). Estriol and estradiol levels, P4/E2, P4/E3 and E3/E2 ratios did not differ between groups. Successful dinoprostone-induced labor was associated with reduced maternal progesterone levels from induction to birth. While a causal relationship between progesterone decrease and effective dinoprostone-induced labor cannot be established, it is tempting to propose that dinoprostone may contribute to progesterone withdrawal and favor labor induction in humans.

Maternal serum markers for Down syndrome screening in second-trimester and its relations with adverse pregnant outcomes / 中华围产医学杂志

Objective To investigate the relationship between abnormalities of maternal serum markers in Down syndrome screening in second trimester and adverse pregnancy outcome.Methods Totally,1935 pregnant women were screened for Down syndrome with maternal serum tri marker with time-resolved fluorescence assay,including alpha fetoprotein (AFP),free β-human chorionic gonadotropin (β-hCG) and unconjugated estriol (uE3),between 15 and 20+6 gestational weeks at Peking Union Hospital from January 1,2009 to January 31,2011,and were followed up till delivery.The relationship between incidence of adverse pregnancy outcomes and women with normal or abnormal levels of serum markers in Down syndrome screening was investigated.T-test or Chi-square test were applied for statistical comparison.Results (1) Among the 1935 pregnant women,normal levels of serum markers were found in 1255(normal group) and 680 were abnormal(abnormal group),in which 577 with only one abnormal serum marker,89 with two and 14 with three abnormal serum markers.According to the serum marker level,the 577 women with one abnormal serum marker were further divided into five groups,including high AFP group (n=17),low AFP group (n=114),high β-hCG group (n=242),low β-hCG group (n=139) and low uE3 group (n=65).The birth weight of infants in lower AFP group and the gestational age at delivery in low β-hCG group were greater than those in normal group [(61.3±9.1) kg vs (59.5±8.3) kg,(272.6±11.8) d vs (274.4±10.1) d,t=2.21 and 1.99,both P＜0.01].(2) The incidence of adverse pregnancy outcome in normal group was 42.8％(537/1255),while comparing with the abnormal group(43.7％,297/680),no statistical significance was shown (RR =1.02,P =0.71).While comparing with the normal group,the incidences of placenta previa [25.5％ (32/1255) vs 2/17,RR=4.61,P＜0.05] and abnormal placental morphology were higher in high AFP group [4.1％ (51/1255) vs 5/17,RR=7.24,P＜ 0.05],the incidence of gestational diabetes mellitus (GDM) was higher in low AFP group [8.1％ (101/1255) vs 14.4％(16/114),RR=1.74,P＜0.05],the incidence of placenta and membrane retention was higher in high β-hCG group [3.5％ (44/1255) vs 6.2％(15/242),RR=1.77,P＜0.05],the incidence of pre-eclampsia was higher in low β-hCG group [1.7％ (21/1255) vs 6.5％ (9/ 139),RR=3.87,P＜0.05].(3) There were 89 women with two abnormal serum markers.Comparing with the normal group,the incidences of small for gestional age (SGA) infants,oligohydramnios,abruptio placenta were higher in women with low AFP but high β-hCG [SGA infants:6.9％(2/29) vs 1.8％(22/1255),RR=3.94; oligohydramnios:20.7％(6/29) vs 6.4％(80/ 1255),RR=3.24; both P＜0.05],the incidences of oligohydramnios was higher in women with both low AFP and low uE3[3/14 vs 6.4％(80/1255),RR=3.36,P＜0.05],the incidence of premature birth and GDM were higher in women with both low β-hCG and low uE3 [premature birth:2/6 vs 4.3％(54/1255),RR=7.75; GDM:3/6 vs 8.0％ (101/1255),RR=6.21; both P＜0.05].(4) There were 14 women with three abnormal serum markers.The relationship between adverse outcome and abnormal serum markers did not show any statistical significance.Conclusions The abnormality of serum markers of Down syndrome screening is closely related to adverse pregnancy outcomes,and women with abnormal serum markers should be carefully monitored during pregnancy.

The relationship between hypertensive disorder complicating pregnancy and serum free estriol and its impact on pregnancy outcomes / 中国基层医药

Objective To research the relationship between hypertensive disorder complicating pregnancy and serum free estriol 3 (FE3) and explore its impact on pregnancy outcome.Methods Clinical data of 117 hypertensive disorder complicating pregnancy and 165 normal pregnant women were retrospectivly analyzed.Chemiluminescence immunoassay determination of maternal serum FE3 also had been conducted.Then analyzing the correlation between hypertensive disorder complicating pregnancy and FE3 and its impact on pregnancy outcomes.Results LDL cholesterol and the level of creatinine of observation group were significantly lower than the control group(t =3.129,9.372,all P ＜ 0.05),while blood pressure,triglycerides,HDL,and 24-hour urinary protein content were significantly higher than control groug(t =7.361,2.398,2.833,all P ＜ 0.05).The FE3 level of the observation group were significantly lower than the control group (t =2.913,P ＜ 0.05).There was a significant positive correlation between the FE3 level of normal pregnant women and their gestational age (r =0.937,P ＜ 0.05).The probabilities of premature birth,premature rupture of membranes,postpartum hemorrhage,and neonatal asphyxia of observation group were significantly higher than amtrol group (x2 =3.912,3.879,4.267,6.935,all P ＜ 0.05).Conclusion There is a significant correlation between hypertensive disorder complicating pregnancy and FE3,which has an important significance on monitoring the health status of pregnant women and the fetal-placental function.

Tratamento da atrofia urogenital com a administração local de estrogênios: um estudo randomizado, controlado em mulheres no climatério e na pós-menopausa / Treatment of urogenital atrophy with the local administration of oestrogens: a randomized, controlled study in climateric and postmenopausal women

Objetivo: Avaliar a eficácia, segurança e aceitabilidade de cremes vaginais contendo promestriene (Colpotrofine®, Laboratórios Teva do Brasil) ou estriol (Ovestrion®, MSD, Brasil), em mulheres no climatério e na menopausa. Método: Estudo prospectivo, randomizado, aberto, de grupos paralelos e controlado. Locais: Instituto de Ginecologia da Universidade Federal do Rio de Janeiro e Faculdade de Medicina da Valença. Material: 80 mulheres na menopausa ou climatério, para quem o tratamento com creme vaginal de estrogênio foi indicado. Intervenção(s): As pacientes aplicaram 1g do creme vaginal, respectivo, a cada noite por 20 dias e depois uma aplicação semanal durante seis meses consecutivos. As pacientes foram distribuídas aleatoriamente sucessivamente numa proporção de 1:1, de acordo com a sua ordem de chegada: as pacientes ímpares foram designadas para receber promestriene e as com números pares foram designadas para receber estriol. Principal medida de desfecho(s): A variável de resposta primária foi a maturação do epitélio vaginal, avaliada pela citologia vaginal e medida pelo índice de Frost. Ambos os tratamentos melhoraram significativamente o trofismo do epitélio vaginal. Resultado(s): Uma melhoria acentuada (94,1%) foi indicado para pacientes do grupo promestriene por três meses, culminando na melhoria de 100% em 6 meses (p <0,0001). Houve clara melhoria dos sintomas da menopausa para ambos os grupos, sendo os tratamentos seguros e bem tolerados. Pacientes do grupo promestriene foram significativamente (p <0,038) mais satisfeitas (100%) com seu tratamento em comparação ao grupo estriol (73,33%). Conclusão(s): Ambos os tratamentos reverteram a atrofia vaginal, levando a um epitélio vaginal saudável, com destaque estatisticamente significativo para o promestriene, o que condicionou a uma melhoria da qualidade de vida.