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The condition known as spontaneous hemoperitoneum in pregnancy (SHiP) is characterized by an accumulation of fluid in the abdominal cavity and a vague collection of symptoms. Specifically, intrauterine pregnancy increases the chance of death for both the mother and the fetus, making SHiP a potentially lethal illness when it coexists. Here, we discuss two cases of spontaneous hemoperitoneum in pregnancy that resulted from placenta accreta spectrum and endometriosis, and happened in the second and third trimesters, respectively.
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Background: Placenta previa is a serious and life-threatening pregnancy complication characterized by bleeding originating from the placental site located in the lower uterine segment. This condition typically occurs during the latter half of pregnancy when the lower uterine segment undergoes stretching.Methods: This study is a retrospective observational study of total 30 cases of placenta previa from October 2022 to February 2024 at the department of obstetrics and gynecology at SVP Hospital, tertiary center, western Ahmedabad. All women with placenta previa included in this study except patients suffering from any other bleeding disorder. These women were analyzed with age, parity, gestational age, past history of bleeding, clinical features at presentation, blood transfusion, period of gestation at time of delivery, mode of delivery and perinatal outcome.Results: In present study 30 cases were taken. Majority were registered 66.7% (20), age group between 21 to 30 year patients 87% (26), multiparous 73.4% (22) patients. Most common risk factor is caesarean section 20% (6) followed by D&E 16.6% (5). Common complications include 33.33% (10) postpartum haemorrhage.Conclusions: Placenta previa is a major risk factor for adverse maternal and perinatal outcome. Good antenatal care, early diagnosis, availability of emergency obstetrics services with senior obstetricians, blood bank facility, ICU care and nicu services can improve maternal and neonatal outcome in high risk cases.
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A retained placenta is suspected when there is failure of expulsion of the placenta even after 30 minutes of delivery of the fetus. Retained placenta is a common cause of PPH and, hence, a significant cause of maternal mortality and morbidity in developing countries. Thus, early intervention is necessary to prevent this post-delivery of the baby. We present a case of retained placenta in a young primigravida with oligohydramnios with fetal horse horseshoe-shaped kidney and a foetal echogenic bowel loop. Her clinical findings and investigations were not significant at the time of admission. She was induced with dinoprostone gel intra-cervically and delivered via vaginal route. There was failure of expulsion of the placenta even after 30 minutes of delivery of the baby. Inj. syntocin 5 units were given via the umbilical cord. In the event of this failure, the patient was shifted inside the OT, and manual removal of the placenta was done under general anaesthesia f/b evacuation retained bits of placental membranes with ovum forceps under USG guidance. Retained placenta can lead to severe PPH and its consequences in the postpartum period. Thus, it requires timely intervention to prevent PPH and reduce maternal mortality and morbidity. Cases of retained placenta can occur even in the absence of any known identified risk factors and should be managed in a tertiary care centre with OT facilities.
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Abstract Objective: To study the association between placental efficiency with anthropometry and nutritional phenotypes in full-term newborns from a birth cohort. Method: This was a secondary cross-sectional analysis of data obtained in a cohort study (Brazilian RibeirãoPreto and São Luís Birth Cohort Studies - BRISA), whose deliveries were performed between 2010 and 2011. Standardized questionnaires were applied to mothers, and placentas and newborns were evaluated shortly after delivery. Placental efficiency was assessed using the ratio between birth weight and placental weight (BW/PW ratio); values below the lower quartile (25th percentile for gestational age) were considered to have low placental efficiency. Newborn phenotypes were small and large for gestational age, stunted and wasted, evaluated using the INTERGROWTH-21 growth standard. To identify the confounding variables theoretical model was constructed using Directed Acyclic Graphs, and unadjusted and adjusted logistic regression were performed. Placental measurements were obtained blindly from pregnancy and delivery data. Results: 723 mother-placenta-child triads were studied. 3.2 % of newborns were small-for-gestational-age (SGA), 6.5 %large-for-gestational-age (LGA), 5.7 %had stunting, and 0.27 % wasting. A significantly higher risk was found between low placental efficiency and SGA (OR 2.82;95 % CI 1.05-7.57), stunting (OR 2.23; 95 % CI 1.07-4.65), and wasting (OR 8.22; 95 % CI 1.96-34.37). No relationship was found between LGA and placental efficiency. Conclusions: Low placental efficiency was associated with increased risk for small-for-gestational-age, stunting, and wasting. Placental morphometry can provide valuable information on intrauterine conditions and neonatal health, helping to identify newborns at higher risk of future comorbidities.
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En la práctica, es muy frecuente asociar las gestaciones gemelares monocoriales (MC) con embarazos complejos o complicados, utilizando ambos términos en forma intercambiable. Sin embargo, no lo son; el dinamismo es protagonista en los sistemas complejos, pero no en los complicados. Para entender a la embarazada con una gestación MC como un sistema complejo, primero se desarrollarán las características principales de los embarazos MC; su placenta es una de las principales responsables de los problemas. Luego se analizará el embarazo MC desde la complejidad, identificando las características del sistema y sus complicaciones como propiedades emergentes.
In practice, it is very common to associate monochorionic (MC) twin pregnancies with complex or complicated pregnancies, using both terms interchangeably. However, these are not synonyms; dynamism is the protagonist in complex systems, but not in complicated ones. In order to understand a MC pregnancy as a complex system, it is necessary to first look into its main characteristics. The placenta is one of the main sources of problems. Then, the MC pregnancy has to be analyzed from the perspective of complexity, identifying the system characteristics and its complications as emergent properties.
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Humans , Female , Pregnancy , Twins, Monozygotic , Pregnancy, Twin/psychology , Placenta , Pregnancy Complications , ChorionABSTRACT
When the placenta does not expel after 30 minutes of delivery of fetus it is said to be retained. It can be a cause of post-partum haemorrhage. It may result from poor uterine contractions. The most common source of a trapped placenta is from a partial closure of the cervix and/or a contracted lower uterine segment. We present an unusual case of a retained placenta trapped in a myometrial sacculation at the left angular region of the uterus.
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Placenta accreta spectrum (PAS) is a potentially life-threatening obstetric condition that requires a multidisciplinary approach to management. The main complication of PAS is due to it抯 massive obstetric haemorrhage which leads to maternal morbidity and mortality. The incidence of placenta accreta spectrum increases day by day due to an alarming increase in caesarean section rates. Depending on the range of invasiveness, The Placenta accreta spectrum is classified as placenta accreta, placenta increta and placenta percreta. We report here a series of 5 cases of placenta accreta spectrum and their management at our centre. With all due pre-op preparedness and anticipation of complications. All 5 cases had good maternal and fetal outcome. In 3 cases hysterectomy was required and 2 cases uterus could be preserved.
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Introducción: El amniocele es una hernia del saco amniótico a través de un defecto en la pared del útero, el cual puede deberse a ruptura uterina, secundario a daños preexistentes, anomalías uterinas o en un útero sin cicatrices. Caso clínico: Presentamos el caso de una paciente de 37 años, con antecedente de dos partos por cesárea, a quien en la semana 25,5 de embarazo se le diagnostica por ecografía amniocele en la pared anterior de útero contenido por la vejiga, además de signos ecográficos de acretismo placentario. La posterior realización de resonancia magnética confirma el diagnóstico. Se realiza manejo expectante con estancia continua intrahospitalaria estricta. Resolución obstétrica a las 34 semanas por cesárea, con extracción fetal por fondo uterino sin complicaciones, con posterior realización de histerectomía con placenta in situ. Conclusiones: Este reporte de caso ilustra la importancia de la identificación temprana de esta condición por ser una complicación infrecuente, pero de grave pronóstico fetomaterno en ausencia de atención inmediata.
Introduction: Amniocele is a hernia of the amniotic sac through a defect in the uterine wall, which can be caused by uterine rupture secondary to preexisting damage, uterine anomalies, or a scarless uterus. Case report: We present a case of a 37-year-old patient with a history of two previous cesarean deliveries. At 25.5 weeks of gestation, the diagnosis of amniocele in the anterior uterine wall, contained by the bladder, along with ultrasound signs of placenta accreta, was confirmed through ultrasound. Subsequent magnetic resonance imaging further confirmed the diagnosis. Expectant management with strict continuous intrahospital stay was implemented. Obstetric resolution was achieved at 34 weeks through cesarean delivery, with uncomplicated fetal extraction through the uterine fundus. Subsequently, a hysterectomy was performed with the placenta left in situ. Conclusions: This case report illustrates the importance of early identification of this condition due to its infrequent but serious feto-maternal prognosis in the absence of immediate attention.
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Humans , Female , Pregnancy , Adult , Placenta Accreta/diagnostic imaging , Ultrasonography, Prenatal , Placenta Accreta/surgery , Uterine Rupture , Magnetic Resonance Imaging , Cesarean Section , Amnion , Hernia/diagnostic imaging , HysterectomyABSTRACT
Background: Caesarean section is one of the major oldest surgical procedure that has been performed all over world to save life of mother and fetus. The steadily increasing global rates of caesarean section have become one of the most debated topics in maternity care, as its prevalence has increased alarmingly in recent years. The aim is to assess the indications and complications of primary caesarean section in primigravida and multigravida.Methods: A cross sectional study carried out over a period of 1 year from April 2022 to March 2023, among 300 pregnant women from labour room in Mata Kaushalya District Hospital, Patiala by simple random sampling method.Results: Majority 54.7% of cesarean section were of primigravida and 45.3% were of multigravida. Maximum number of caesareans was between 26-30 yrs of age group. 68% women underwent emergency caesarean section and 32% underwent elective caesarean section. 6% underwent caesarean section at <37 weeks gestational age, maximum 83%caesarean section were at 37- 40 weeks gestational age and 11% caesarean section were at >40 weeks gestational age. Among primigravida, majority 35%were fetal distress, 24.29% CPD, malpresentation and malposition were 6.77%, 5.08% NPOL, 3.38% were placenta previa, 2.25% were IUGR, 3/177 (1.69%), severe oligohydroamnios 1.69%, preeclampsia and 1/177 (0.56%) were abruptio placenta. Among multigravida women 41.46% had most common indication was fetal distress, 2.43% had non progress of labour, 14.63% had malpresentations and malpositions.Conclusions: The proportion of primigravida undergoing primary Caesarean delivery was much more than multigravida. However, complications related to primary CS was much higher in multigravida.
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Objetivo: Comparar la evolución de la cicatrización en pacientes en quienes se aplicó amnios con cobertura antibiótica, con otro grupo en que no se aplicó, posterior a la realización de conización cervical en la consulta de patología cervical del Hospital Central de San Cristóbal, entre febrero y mayo de 2023. Métodos: Estudio experimental, comparativo, aleatorizado, longitudinal. Incluyó 66 pacientes, aleatorizadas en dos grupos: grupo 1 (control): no se aplicó el amnios (n = 30/45,5 %) y grupo 2 (experimental): se aplicó el amnios tratado con antibióticos (n = 36/54,5 %). La investigadora preparó, en quirófano, el amnios de placentas obtenidas por cesárea o parto vaginal. Se obtuvo consentimiento informado de donantes y receptoras. Resultados: Al día 14, ninguna paciente del grupo 1 presentaba epitelización. En el grupo 2, una paciente (2,7 %) tenía 50 % de epitelización y 35 (94,6 %) habían alcanzado el 100 % (p < 0,001). La epitelización fue total en 13,3 % del primer grupo y 94,6 % del segundo (Odds Ratio de 227 (IC 95 %: 24,0 a 2157,0; p < 0,001). No hubo ningún caso de infección cervical. Cinco pacientes (16,7 %) del grupo 1 y una del grupo 2 (2,8 %) presentaron ectopias (p = 0,051). No hubo asociación entre epitelización completa o parcial y características clínicas (p Ë 0,05). Conclusión: El amnios con cobertura antibiótica se asocia a mejor evolución de la cicatrización en pacientes con conización cervical. Se comprobó su eficacia como terapéutica médica al ser aplicada sobre la herida operatoria(AU)
Objective: To compare the evolution of healing in patients in whom amnion with antibiotic coverage was applied, with another group in which it was not applied, after cervical conization performed in cervical pathology consultations of the San Cristobal Central Hospital, between February and May 2023. Methods: Experimental, randomized, longitudinal comparison. It included 66 patients, randomly divided into two groups. Group 1: in which amnion was applied (n = 36/54.5 %); Group 2: no treatment (n = 30/45.5%). The researcher prepared the amnions of placentas obtained by cesarean section or vaginal delivery, in the operating room. Informed consent was obtained from both donors and recipients. Results: On day 14, none of the patients in the group 1 had epithelialization. In the group 2, one patient (2.7%) had 50% epithelialization and 35 (94.6%) had reached 100% (p < 0.001). Epithelialization was total in 13.3% of the first group and 94.6% of the second group (Odds Ratio of 227 (95% CI: 24.0 to 2157.0; p < 0.001). There were no cases of cervical infection. Five patients (16.7%) in the group 1 and one in the group 2 (2.8%) had ectopias (p = 0.051). There was no association between complete or partial epithelialization and clinical characteristics (p Ë 0.05). Conclusion: Amnion with antibiotic coverage is associated with better healing outcomes in conized patients. Its effectiveness as a medical therapy was proven when placed on the surgical wound(AU)
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Humans , Female , Pregnancy , Adult , Middle Aged , Conization , Amnion , Anti-Bacterial Agents , Uterine Neoplasms , PapillomaviridaeABSTRACT
Background: Emergency peripartum hysterectomy is a vital surgical procedure performed at the time of vaginal or caesarean delivery or in the immediate postpartum period in cases of intractable postpartum haemorrhage unresponsive to other conservative measures. Such hemorrhage may be due to atonic uterus, uterine trauma, coagulation disorders, abnormal placentation, not treatable by conservative measures.Methods: This study was conducted for a time period of 1.5 years from March 2016 to September 2017, in the department of Obstetrics and Gynecology, GMC Srinagar, Jammu and Kashmir, India. All such patients in our hospital were included in this study. The incidence, risk factors, age, parity, gestational age, indications for performing hystrectomy, pre and post-operative complications were studied.Results: The incidence was 3.2/1000 deliveries. The average age of the patients in our study was 31.18±2.80 years. Most patients were delivered at gestation of 37-38 weeks (61.17%). Among the patients undergoing peripartum hysterectomy 87.38% had caesarean delivery and 12.62% had vaginal delivery. The commonest indication of peripartum hystrectomy in our study was abnormal placentation (67.96%) with accreta accounting for most of these cases (53.40%).Conclusions: The incidence of peripartum hystrectomy in our centre has increased with time, which can be accounted by increase in the rate of caesarean sections over time which has led to the emergence of morbidly adherent placentation as the commonest risk factor for peripartum hysterectomy.
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La membrana amniótica (MA), ubicada en el lado interno de la placenta fetal, ha sido objeto de múltiples investigaciones para intentar dilucidar su papel embriológico y su potencial celular terapéutico. Actualmente las limitaciones del estudio en fetos humanos hacen que parte de su funcionamiento sea una incógnita, sin embargo algunos estudios clínicos y básicos nos dan luz sobre su papel en la médica moderna. Se realizó una revisión bibliográfica de la literatura desde 1960 hasta 2022, empleando bases de datos como PubMed, SciELO y Scopus, siendo incluidos un total de 50 artículos y dos textos de embriología. El objetivo de esta revisión narrativa fue sintetizar la información sobre la angiogénesis y su importancia clínica. La información recopilada permitió evidenciar que las propiedades de curación de la piel del feto se deben a factores intrínsecos del feto, y a que las células epiteliales amnióticas humanas poseen una diferenciación similar a las células madre embrionarias, con la capacidad de diferenciación similar al de las células mesenquimales, resaltando su importancia clínica por sus características regenerativas. En conclusión, el desarrollo embrionario humano sigue siendo relativamente inexplicable, pero su conocimiento ha permitido grandes avances, que podrían ser útiles en terapias de regeneración, reparación de tejidos y órganos lesionados.
The amniotic membrane, located on the inner side of the fetal placenta, has been the subject of multiple investigations to try to elucidate its embryological role and its therapeutic cellular potential. Currently, the limitations of the study in human fetuses mean that part of its functioning is unknown, however, some clinical and basic studies shed light on its role in modern medicine. A bibliographic review of the literature was carried out from 1960 to 2022, using databases such as PubMed, SciELO and Scopus, including a total of 50 articles and two embryology texts. The objective of this narrative review was to synthesize information on angiogenesis and its clinical importance. The information collected made it possible to show that the healing properties of the fetal skin are due to intrinsic factors of the fetus, and that human amniotic epithelial cells have a differentiation similar to embryonic stem cells, with the differentiation capacity similar to that of mesenchymal cells, highlighting their clinical importance due to their regenerative characteristics. In conclusion, human embryonic development remains relatively inexplicable, but its knowledge has allowed great advances, which could be useful in regeneration therapies, repair of injured tissues and organs.
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Humans , Female , Placenta/embryology , Amnion/embryology , Fetal DevelopmentABSTRACT
Fundamento la placenta humana es un misterio. El diagnóstico anatomopatológico cobra importancia en la búsqueda de factores en los que se pueda trabajar para evitar las muertes fetales. Objetivo determinar las alteraciones macroscópicas y microscópicas de la placenta y sus anejos en especímenes procedentes de muertes fetales. Métodos se realizó un estudio descriptivo, retrospectivo y trasversal, en el Hospital Dr. Gustavo Aldereguía Lima, de Cienfuegos, en el período comprendido entre 2021 y 2023. Fueron analizadas 58 placentas y sus anejos, recibidos en el departamento de Anatomía Patológica. Se estudiaron las alteraciones macroscópicas y microscópicas de la placenta. Resultados tuvieron mayor representación las placentas y cordones anormalmente pequeños (24,14 % y 63,79 % respectivamente); la inserción marginal del cordón (36,21 %), las rupturas, las torciones (8,62 %), los quistes (6,90 %), el edema (77,59 %), la necrosis fibrinoide (72,41%), las vellosidades inmaduras, la villitis (43,10 %), el excesivo número de nudos sincitiales (3,48 %), la esclerosis fibromuscular (20,69 %), la presencia de fibrina (82,76 %), la funisitis (29,31%), la esclerosis fibromuscular (20,69 %) y la corioamnionitis (31,03 %). Conclusiones los resultados evidenciaron predominio de las alteraciones microscópicas, como son la fibrina, la necrosis fibrinoide y el edema. Teniendo en cuenta estos factores, se podrán tomar las medidas necesarias para evitar una muerte fetal.
Foundation the human placenta is a mystery. The anatomopathological diagnosis becomes important in the search for factors that can be worked on to avoid fetal deaths. Objective to determine the macroscopic and microscopic alterations of the placenta and its annexes in specimens from fetal deaths. Methods a descriptive, retrospective and cross-sectional study was carried out at the Dr. Gustavo Aldereguía Lima Hospital, in Cienfuegos, from 2021 to 2023. 58 placentas and their annexes, received in the Pathological Anatomy Department, were analyzed. Macroscopic and microscopic alterations of the placenta were studied. Results abnormally small placentas and cords were more represented (24.14 % and 63.79 % respectively); marginal cord insertion (36.21 %), ruptures, twists (8.62 %), cysts (6.90 %), edema (77.59 %), fibrinoid necrosis (72.41 %), immature villi, villitis (43.10 %), excessive number of syncytial knots (3.48 %), fibromuscular sclerosis (20.69 %), the presence of fibrin (82.76%), funisitis (29.31 %), fibromuscular sclerosis (20.69 %) and chorioamnionitis (31.03 %). Conclusions the results showed a predominance of microscopic alterations, such as fibrin, fibrinoid necrosis and edema. Taking these factors into account, the necessary measures can be taken to avoid fetal death.
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With a rise in number of caesarean sections we are also seeing an increase in the adherent placenta that form a part of placenta accreta spectrum. Early identification and appropriate management and monitoring is very important in these patients as they can have hemorrhage that can cause significant maternal and fetal morbidity and mortality. This is a case of conservative management of a woman with placenta accreta spectrum, use of uterine artery balloon ligation to decrease the intra-operative blood loss, leaving placenta in situ, methotrexate therapy and follow up of the patient that ultimately led to hysterectomy. It highlights the importance of managing these women in adequately equipped center with the required expertise and intensive care support and multidisciplinary management to improve patient care leading to good maternal and fetal outcome.
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Background: Placenta accreta spectrum disorder (PASD) is a complex obstetric condition associated with significant maternal and fetal morbidity and mortality. Despite its increasing global prevalence, there is limited research focusing on the fetal outcomes of PASD patients, particularly in Asian populationsMethods: This observational study was conducted at Cumilla medical college hospital over 18 months, starting from January 2022. A total of 60 patients diagnosed with PASD were included, following specific inclusion and exclusion criteria. Data were collected on sociodemographic characteristics, antenatal care, presenting complaints, and fetal outcomes.Result: The study found that 90% of the participants had live births, while 10% experienced intrauterine death. Among the live births, there was a nearly equal distribution between low and normal birth weights. The sociodemographic distribution was diverse, with the majority of participants falling within the age range of 21-30 years. Half of the participants received regular antenatal care, and antepartum hemorrhage was the most common presenting complaint.Conclusions: The study provides valuable insights into the fetal outcomes of PASD patients, with a notably high rate of live births. The findings also highlight the importance of regular antenatal care and early diagnosis in managing PASD effectively. The study serves as a foundation for future research aimed at improving both maternal and fetal outcomes in PASD.
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Background: Obstetric hysterectomy is a lifesaving procedure in a setting of life-threatening obstetrical hemorrhage. There is and increasing need of obstetric hysterectomy due to rising cases of caesarean sections and morbidly adherent placenta. We aimed to study the incidence, indications and fetomaternal outcome of obstetric hysterectomy. Various risk factors are discussed which may be helpful in reducing maternal and neonatal morbidity.Methods: A one year hospital based retrospective study involving detailed medical records of patients who underwent obstetric hysterectomy between 1st April 2022 and 31st march 2023.Results: The overall incidence of obstetric hysterectomy was 0.2% in this study with majority of patients in the 20-25-year age group, and patients who were 2nd and 3rd para comprised of the maximum number. The indication identified in this study were morbidly adherent placenta followed by atonic PPH and caesarean scar ectopic. The major risk factors noted were previous LSCS in 60% and morbidly adherent placenta in 53.3% patients. Of the 15 patients, 60% underwent total while 40% underwent subtotal hysterectomy. ICU admission, fever and coagulopathy were the leading post op complications. There was one case of maternal death noted and one case each of intrauterine death and perinatal mortality.Conclusions: Obstetric hysterectomy is the last resort to intractable bleeding and hence an important lifesaving procedure. The feto-maternal outcome depends on timely decision, surgical techniques and stringent post op monitoring of these patients.
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RESUMEN Introducción: El embarazo ectópico es toda gestación, en la que el sitio de implantación del óvulo fecundado se localiza fuera de la cavidad endometria y representa el 1.4 % de estos. Caso clínico: Paciente de 28 años con dos cesáreas previas, sometida a salpingoclasia durante la última intervención. La paciente ingresó al hospital con presión arterial de 180/130 mm Hg, no respondió a tratamiento médico y presentó falla en la progresión de trabajo de parto, por lo que se decidió interrupción por operación cesárea. Durante la cirugía, se observó un pequeño útero con embarazo extrauterino adherido a la serosa del ciego, el colon ascendente y el apéndice. Se obtuvo un producto femenino pretérmino vivo; la madre cursó con evolución favorable y sin complicaciones posoperatorias. Conclusión: La presentación del embarazo abdominal ectópico es rara, por lo que un control prenatal adecuado por personal capacitado puede orientar a la sospecha diagnóstica. La madre y la recién nacida no presentaron ninguna complicación, a pesar de ser un embarazo abdominal avanzado y la inserción multifocal de la placenta. Se resalta la importancia del manejo oportuno y multidisciplinario cuando se enfrentan embarazos con curso anormal para la mejor evolución de la madre y del producto.
ABSTRACT Introduction: Ectopic pregnancy is any gestation in which the implantation site of the fertilized egg is located outside the endometrial cavity. Abdominal ectopic pregnancy represents 1.4% of these. Case report: 28-year-old patient with two previous cesarean sections; bilateral tubal obstruction during the last operation. The patient was admitted to the hospital with blood pressure of 180/130 mm Hg that did not respond to medical treatment and not progression to labor so it was decided to interrupt the pregnancy by cesarean section. During surgery, a small uterus with extrauterine pregnancy was observed adhered to the serosa of the cecum, ascending colon, and appendix. A live preterm female product was obtained; the mother had a favorable evolution and no postoperative complications. Conclusion: Ectopic pregnancies are rera. An adequate prenatal control by well trained personnel is essential for an accurate diagnosis. The mother and the newborn did not present any complication. It is very important to have and accurate an opportune diagnosis so trained personnel can offer an adequate management.
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Objective:To evaluate the efficacy of cerebral-placental-uterine ratio(CPUR)in predicting late-on-set fetal growth restriction(FGR).Methods:From May 2020 to May 2021,1255 women with singleton pregnancy who underwent prenatal examinations at the University of Hong Kong Shenzhen Hospital were selected for fetal growth and Doppler measurements at 35-37 +6 weeks of gestation.Pregnant women with birth weight of newbo-rns<the 10th percentile were the FGR group.The pulsatility index(PI)of uterine artery(UtA),umbilical artery(UA)and fetal middle cerebral artery(MCA)were analyzed separately and in combination.ROC curve was used to analyze the cerebral-placental-uterine ratio(CPUR),cerebral-placental ratio(CPR),cerebral-uterine ratio(C-UtA)for predicting late-onset FGR;and to evaluate the sensitivity,positive and negative predictive value and of CPUR in the prediction of late-onset FGR.Results:The area under the curve(AUC)of CPUR,CPR,C-UtA and mean UtA-PI for FGR grope were 0.88,0.86,0.84 and 0.72.Under certain cut-off values and 87% specificity,the specificity of CPUR,CPR,C-UtA and mean UtA-Pifor predicting FGR group was 43.2%,46.6%,39.8% and 23.9%,respectively.The positive predictive values of CPUR,CPR,C-UtA and mean UtA-PI,UA-PI for predicting FGR group were 90.5%,71.9%,83.3%,63.6%and 5.2%,respectively.Conclusions:CPUR is more effective in predicting late onset FGR than CPR,C-UtA and mean UtA-PI.It can effectively increase the detection rate of fetal growth restrictionand reduce the FGR risk.
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Objective:To investigate the influencing factors of post-traumatic stress disorder(PTSD)in hospitalized patients with placenta previa.Methods:A total of 110 hospitalized patients with placenta previa admitted to our hospital from Oct 2019 to Jan 2023 were selected,and the occurrence of PTSD during hospitalization was evaluated by using Post-Traumatic Stress Disorder Checklist-Civilian Version(PCL-C),and relevant data were collected.Multivariable logistic regression analysis was used to analyze the influencing factors of PTSD in these patients.Results:Among 110 patients,41 cases developed PTSD(37.27% ).Univariable analysis showed that the type of pregnant women(primigravida),optimistic tendency,family support,psychological resilience and personality traits were associated with PTSD in hospitalized patients with placenta previa(P<0.05).Other information such as age,gestational age,parity,unplanned pregnancy and education level were not associated with PTSD(P>0.05).Multivariable logistic regression analysis showed that primiparas and introversion were risk factors for PTSD(OR>1,P<0.05),and higher optimism tendency,higher degree of family support and higher psychological resilience were protective factors for PTSD in hospitalized patients with placenta previa(OR<1,P<0.05).Conclusions:The incidence of PTSD is higher in hospitalized patients with placenta previa.The risk factors of PTSD are primiparas,low level of optimistic tendency,low degree of family support,low psychological resilience and introversion.
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Objective To investigate the expression of lncRNA SNHG8 in placenta accrete(PA)and its effect on trophoblast invasion and migration.Methods qRT-PCR was used to detect the expression of lncRNA SNHG8 in placenta tissue of 30 cases in PA group and 30 cases in control group,and the correlation between lncRNA SNHG8 expression and prenatal ultrasound score of 30 cases in PA group was analyzed.Transwell and scratch assay were used to detect the effect of lncRNA SNHG8 interference on the invasion and migration of human chorionic trophoblast cells(HTR8/SVneo cells),and western blot was used to detect the expression of MMP-2 and MMP-9.The downstream targets of lncRNA SNHG8 were predicted by StarBase software,and the expression of lncRNA SNHG8 was detected in placental tissues of the two groups.Dual luciferase reporter assay was used to detect the targeting relationship between lncRNA SNHG8 and miR-542-3p.Results Compared with that of the control group,the expression of lncRNA SNHG8 was up-regulated in the placenta tissue of the PA group(P<0.05),and it was positively correlated with prenatal ultrasound score.Interference with lncRNA SNHG8 inhibited the invasion and migration of trophoblast cells(P<0.05);the protein expression of MMP-9 and MMP-2 also decreased signifi-cantly(P<0.05).Biological prediction indicates that miR-542-3p had a binding site with lncRNA SNHG8,and miR-542-3p expression was down-regulated in PA placental tissue(P<0.05).Dual luciferase reporter assay confirmed that lncRNA SNHG8 could target miR-542-3p.Compared with si-SNHG8+inhibitor-NC,co-transfection of si-SNHG8 and miR-542-3p inhibitor enhanced the invasion and migration ability of trophoblast cells(P<0.05).Conclusion lncRNA SNHG8 is highly expressed in PA and is related to the severity of PA.LncRNA SNHG8 promotes the invasion and migration of trophoblast by regulating the level of miR-542-3p.The study suggests that lncRNA SNHG8 plays an important role in the invasion and migration of PA trophoblast cells,which is expected to be a clinical diagnostic biomarker and therapeutic target.