Perinatal outcome of different approaches for second-trimester multifetal pregnancy reduction in women with dichorionic triamniotic triplet pregnancies / 中华围产医学杂志

Objective:To explore the effects of different approaches for second-trimester multifetal pregnancy reduction on pregnancy outcome in women with dichorionic triamniotic (DCTA) triplet.Methods:A retrospective study was performed on 51 women with DCTA triplet pregnancies who were referred to Guangdong Women and Children Hospital for second-trimester multifetal pregnancy reduction from January 2014 to January 2020. All participants were divided into either preventive group ( n=39) or treatment group ( n=12) according to the indication for multifetal pregnancy reduction, and they were further allocated to three subgroups based on different reduction methods, which were reduction to dichorionic twin by radiofrequency ablation (RFA) (RFA subgroup), reduction to monochorionic singleton (KCl-singleton subgroup) or monochorionic twin (KCl-twin subgroup) by cardiac injection of potassium chloride. Pregnancy loss rate, neonatal birth weight, gestational age at delivery, incidence of intrauterine death, and neonatal death were compared and analyzed between different groups using t-test, analysis of variance, Chi-square test, Fisher's exact test and Bonferroni correction. Results:(1) The mean gestational week at operation in the treatment group was significantly later than that in the preventive group [(18.5±3.1) vs (15.0±2.3) weeks, t=-4.209, P<0.001]. In the preventive group, the mean gestational week at operation in the RFA subgroup was later than the KCl-singleton and KCl-twin subgroup[(17.2±1.6) vs (13.8±1.5) and (12.7±1.0) weeks, t=6.630 and 3.875, respectively, both P<0.05]. (2) The postoperative pregnancy loss rate in the preventive group was decreased compared with the treatment group [10.3%(4/39) vs 5/12, Fisher's exact test, P<0.05], and the live birth ratio was increased [ 85.7%(48/56) vs 10/18, χ2=5.640, P=0.018]. No live birth infants with birth weight <1 500 g was reported in the KCl-singleton subgroup in preventive group, and the statistical significance was observed in the intra-group differences ( P<0.05) rather than the pairwise comparison differences in the preventive group. For the proportion of live births, there was a statistically significant difference in the intra-group comparison in the treatment group, which was higher in the RFA subgroup than that in the KCl-twin subgroup (6/6 vs 1/6, P=0.045). No significant difference was revealed among pregnancy loss rate, gestational weeks at delivery, the mean birth weight, premature delivery <32 gestational weeks, and full-term birth rate among three different approaches within the two groups. (3) No monochorionic twin complications or perinatal death occurred in any RFA or KCl-singleton subgroups in the two groups. In the KCl-twin subgroups including five cases with ten fetuses, including three live birth, four miscarriage, three intrauterine death occured, while no neonatal death was reported. One case with selective fetal uterine growth restriction in the preventive group delivered two live births, and one case with twin-to-twin transfusion syndrome in the treatment group had intrauterine death in one fetus and one survival neonate. Conclusions:The pregnancy outcome of multifetal pregnancy reduction to dichorionic diamniotic twins by RFA or reduction to singleton by cardiac injection of potassium chloride are comparative in women with DCTA triplet, regardless of whether it is a preventive or therapeutic reduction.

Perinatal outcomes and influencing factors following radiofrequency ablation in multiple pregnancies / 中华妇产科杂志

Objective@#To assess the effectiveness of radiofrequency ablation (RFA) in the treatment of multiple pregnancies.@*Methods@#In this retrospective study, 84 cases (total 174 fetuses) of complex monochorionic pregnancies treated with RFA for selective fetal reduction were analyzed. All cases were managed in the Guangdong Women and Children Hospital from January 2015 to January 2018. Indications for offering RFA, details of the procedure and pregnancy outcomes were collected and analyzed.@*Results@#(1)The rate of miscarriage and fetal intrauterine death was 21% (18/84), termination of pregnancy because of fetal malformation or oligohydramnion occurred in 10% (8/84) of cases. Total live birth rate was 69% (58/84) and the gestation age at delivery was (35.0±3.0) weeks. (2) The live birth rate of twin reversed arterial perfusion sequence (TRAPS) was the lowest (6/11), followed by twin to twin transfusion syndrome (TTTS; 66%, 27/41), structural or genetic abnormalities of one fetus in monochorionic twin pregnancy (10/14), triplet pregnancy reduction (4/6) and selective intrauterine growth restriction (sIUGR) (11/12). (3) The live birth rate was 67% (20/30) in stage Ⅲ of TTTS and 7/11 in the stage Ⅳ of TTTS (P>0.05). The average gestational age was (33.6±3.0) weeks in stage Ⅲ of TTTS compared with (36.5±2.4) weeks in the stage Ⅳof TTTS (P<0.05).@*Conclusions@#RFA appears to be a reliable option for selective fetal reduction in monochorionic multiple pregnancies. The indication of RFA is an influencing factor on its pregnancy outcomes. Type Ⅱand type Ⅲ sIUGR may choose this technique as a priority. Compared with stage Ⅲ of TTTS, the live birth rate and the gestation age at delivery in stage Ⅳ of TTTS, there are no significant differences.

Combined chromosomal microarray analysis and fluorescence in situ hybridization for prenatal diagnosis of two cases with Pallister-Killian syndrome / 中华医学遗传学杂志

OBJECTIVE@#To carry out prenatal diagnosis for two cases of Pallister-Killian syndrome (PKS) using combined chromosomal microarray analysis (CMA) and fluorescence in situ hybridization (FISH).@*METHODS@#Umbilical cord blood was sampled from the two fetuses and subjected to G-banding chromosomal karyotyping, CMA and FISH assay.@*RESULTS@#Chromosomal karyotyping showed that the two fetuses were mos 47,XX,+i(12)(p10)[3]/46,XX[197] and mos 47,XY,+i(12)(p10)[5]/46,XY[95], respectively. CMA showed that both had carried duplication of 12p. The results of interphase FISH confirmed mosaicism of 12p tetrasomy. Combined with ultrasonographic findings, both fetuses were diagnosed as PKS.@*CONCLUSION@#Prenatal ultrasound examination, karyotype analysis of umbilical cord blood, G-banded chromosomal analysis, CMA and FISH may be used in conjunct for the prenatal diagnosis of PKS.

The effect of occupational and environmental factors on the pregnancy for Down's syndrome / 中国职业医学

OBJECTIVE: To investigate the influence of occupational and environmental factors on the pregnancy for Down's syndrome. METHODS: By systematic sampling method,97 pregnant women who had been diagnosed as Down's syndrome by Giemsa staining on fetal chromosomes in chorionic villus sampling,amniocentesis,or umbilical cord blood sampling were selected as the case group,while 373 non-Down's syndrome pregnant women after same examinations during the same period in the same hospital were selected as the control group. The history of exposure before pregnancy to occupational and environmental factors was analyzed. RESULTS: The pregnant women aged over 35 years had higher risk of Down's syndrome than those aged under 35 years( P < 0. 01). The pregnant women with occupational exposure to organic solvents containing benzene had higher risk of Down's syndrome than those without occupational exposure history to hazardous substances( P < 0. 01). The pregnant women using estrogenic drugs before pregnancy or during early pregnancy had higher risk of Down's syndrome than those without drug use( P < 0. 05). The pregnant women living in newly-decorated houses or using the new furniture had higher risk of Down's syndrome than those without new decoration( P < 0. 01). The pregnant women with pre-pregnancy intake of folic acid had lower risk of Down's syndrome than those without any intake of folic acid supplement( P < 0. 05). CONCLUSION: The age,occupational exposure to benzene solvents and taking estrogenic drugs were the major leading factors of development of Down's syndrome.

Acellular porcine aorta matrix as a novel tissue engineered vascular scaffold / 中国组织工程研究

BACKGROUND: The key of tissue engineered blood vessel research depends on the appropriate scaffolds. The porcine vascular tubes have frequently been used as candidates for tissue engineering vessel construction, but high immunogenicity and poor mechanical strength limit its application for tissue engineering scaffolds.OBJECTIVE: To prepare a novel tissue engineered vascular scaffold with good mechanical properties and biocompatibility using acellular porcine aorta matrix.METHODS: Porcine aorta was decellularized and modified by thermal cross-linking to improve the mechanical strength and biodegradation properties and to prepare acellular porcine aorta matrix scaffolds. Hematoxylin-eosin staining of histological sections and biomechanical tests were performed to assess the decellularization effects and the mechanical strength of the vascular matrix respectively. Vascular endothelial cells from human umbilical cord veins were isolated and seeded on the acellular matrix scaffolds and cultured in vitro. The biocompatibility was evaluated. RESULTS AND CONCLUSION: After the porcine aorta was treated by 1% Triton X-100 solution for 84 hours, the vessel was fully decellularized, and the architecture of matrix was well preserved. The acellular vascular matrix demonstrated improved biomechanical properties after modification by thermal cross-linking under vacuum at 120 °C for 12 hours. Its tensile strength reached 1.70 MPa. After 7 days of in vitro culture, the seeded endothelial cells formed a typical vascular endothelial layer structure on the surface of acellular matrix, as observed by scanning electron microscopy. Results proved that acellular vascular matrix of porcine aorta could maintain the morphology and structure of natural vessels, its mechanical strength could be greatly improved after successive freeze-drying and thermal cross-linking. A good compatibility between the acellular matrix and endothelial cells of umbilical vein is also achieved.

Reconstruction of tissue engineering blood vessel via acellular matrix / 中国病理生理杂志

AIM:To reconstruct the tissue engineering blood vessel by using acellular matrix of porcine thoracic aorta tissue as the scaffold, and by inoculability of vascular endothelial cells (EC) from human umbilical cord vein. METHODS: The porcine thoracic aorta was treated with 1% Triton X-100 for preparing acellular vessel matrix, and the mechanical characterization was in succession modified by freeze-drying and thermal cross-linking techniques. Meanwhile, the mechanics capability of the vessel was measured. The endothelial cells isolated from umbilical cord vein were seeded on the acellular matrix scaffolds by tissue culture in vitro. The structure of acellular matrix was analyzed by light microscopy and scanning electron microscopy. RESULTS: By treatment with 1% Triton X-100 for 84 h, the cells of thoracic aorta were fully come off and the three-dimensional structure of the matrix still remained. After modification by freeze-drying for 24 h and then thermal cross-linking under vacuum at 120 ℃ for 12 h, the tensile strength of the acellular matrix remarkable increased and reached the maximum breaking strength of 1.70 MPa. It was also showed that cultured endothelial cells grew on the surface of acellular matrix for 7 days and the typical structure of vessel-like intimal formation was observed under scanning electron microscopy. CONCLUSION: The acellular matrix and endothelial cells have favorable compatibility. The modified acellular matrix could be a good candidate scaffold for rebuilding the tissue engineering blood vessel.