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Preeclampsia is a kind of idiopathic disease during pregnancy. Its pathogenesis may involve many factors, such as mother, placenta and fetus. The study found that the abnormal metabolism of blood glucose and blood lipid during pregnancy may be closely related to the onset of preeclampsia. This paper reviews the research progress of abnormal glycolipid metabolism in preeclampsia at home and abroad in order to better guide the management of related aspects during pregnancy.
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Objective:To analyze the factors influencing the success rate of external cephalic version (ECV) and to create a preoperative scoring scale for stratified management of pregnant women who were preparing for ECV.Methods:This prospective study was conducted on singleton pregnant women who underwent ECV without anesthesia in Fujian Maternity and Child Health Hospital from January 1, 2017, to December 31, 2019. Univariate (two independent samples t-test, Mann-Whitney U test, and Chi-square test) and multivariate logistic regression were used to screen the clinical characteristics affecting the success of ECV, and receiver operating characteristic (ROC) curve was used to determine the cut-off value and convert quantitative variables into dichotomous variables. The independent variables were scored according to the regression coefficient in multivariate logistic regression analysis, and then a preoperative scoring scale was created. The ROC curve was used to calculate the cut-off value for the scoring scale. The subjects were divided into low and high score groups according to the cut-off value. The area under the ROC curve was used for evaluating the effectiveness of the scale in predicting the success of ECV. The success rate of ECV, difficulty of the operation and mode of delivery were compared between the two groups. Results:A total of 1 338 pregnant women met the inclusion criteria during the study period. After the exclusion of 885 women, 165 refused ECV in favor of direct cesarean section, 27 spontaneously converted to cephalic position before ECV, 261 who voluntarily accepted ECV were finally enrolled. ECV succeeded in 202 cases and failed in 59. (1) Favorable factors for ECV without anesthesia were the distance between the fetal breech and ischial spine <－3.5 cm ( OR=0.177, 95% CI: 0.071-0.438, P=0.009), the sum of the fundal height and the station of the fetal breech based on the ischial spine <30.25 cm ( OR=0.225, 95% CI: 0.094-0.537, P=0.001), amniotic fluid index ≥12 cm ( OR=0.399, 95% CI: 0.164-0.969, P=0.042), the surgeon's ability to hold the fetal head or breech with one hand ( OR=0.241, 95% CI: 0.098-0.589, P=0.002; OR=0.219, 95% CI: 0.087-0.546, P=0.001), and the fetal head located on the right or left upper abdomen of the mother ( OR=0.184, 95% CI: 0.059-0.568, P=0.003; OR=0.253, 95% CI: 0.084-0.760, P=0.014). (2) The area under the ROC curve of the preoperative score for predicting the success of ECV was 0.881 (95% CI: 0.821-0.941) and the cut-off value was 5.5. The subjects were divided into low (0-5 scores) and high (6-11 scores) score groups and the area under the ROC curve for predicting the success of ECV by grouping was 0.843 (95% CI: 0.774-0.912). Compared with the low score group, the high score group had a shorter ECV duration [2.0 min (0.5-10.0 min) vs 10.0 min (0.9-25.8 min), Z=－6.83, P<0.001], less attempts [1.0 times (1.0-4.0 times) vs 3.0 times (1.0-5.0 times), Z=－8.41, P<0.001], higher success rate [92.7% (190/205) vs 21.4% (12/56), χ2=127.64, P<0.001], higher rate of vaginal birth [75.4% (147/195) vs 18.5% (10/54)] and lower cesarean section rate [24.6% (48/195) vs 81.5% (44/54)] ( χ2=58.70, P<0.001). Conclusions:Preoperative scoring based on the factors influencing the success rate of ECV (the distance between the fetal breech and ischial spine, the sum of the fundal height and the station of the fetal breech based on the ischial spine <30.25 cm, amniotic fluid index ≥12 cm, the surgeon's ability to hold the fetal head or breech with one hand, and the fetal head locating on the right or left upper abdomen of the mother) is conducive to the individualized evaluation of the difficulty and the success rate of ECV as well as the success rate of vaginal delivery after ECV, which can provide a reference for clinical stratified management of ECV patients.
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Preeclampsia is a multiple system disease in obstetrics, which often leads to adverse pregnancy outcome.Twin pregnancy is a high-risk pregnancy.When preeclampsia occurs, the condition is very serious, and the complications of mother and child are increasing.The pathogenesis of preeclampsia is diversified.The high risk factors of twin pregnancy with preeclampsia are bichorionic, assisted reproductive technology pregnancy, primipara, and advanced age.The timing of termination of pregnancy should be selected according to chorionic nature, and the indications of cesarean section should be relaxed to reduce the adverse pregnancy outcomes.Clinical studies mostly use comprehensive indicators combined with screening to predict preeclampsia.How to prevent preeclampsia still needs further clinical and basic research.
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Objective:The aim of this study is to analyze risk factors and perinatal outcomes of fetal growth restriction (FGR) in the third trimester to improve pregnancy outcomes.Methods:The retrospective study collected 676 fetus, included 338 FGR and 338 appropriate for gestational infants. All samples were collected between January 1st 2014 and January 1st 2016 from Fujian Provincial Maternity and Children's Hospital. Multivariate logistic regression analysis was used to analyze the risk factors and pregnancy outcomes of fetal growth restriction between FGR and control group.Results:⑴ Multivariate logistic regression analysis showed that the independent risk factor of FGR was severe preeclampsia for 28-33 + 6 weeks FGR. The independent risk factors of 37-40 + 6 weeks FGR were severe preeclampsia, oligohydramnios, velum attachment of cord and cord around neck. ⑵ Compared with the control group of the same gestational week, the fetal distress rate, 1 minute asphyxia rate of newborn and cesarean section rate of FGR in the 28-33 + 6 gestational week group were all higher than those in the same gestational week group ( P<0.05). ⑶ The fetal distress in FGR group was more than in cesarean delivery that in vaginal delivery at 28-33 + 6 weeks of gestation, and that in FGR group was more than that in vaginal delivery at 34-36 + 6 weeks of gestation ( P<0.05). Conclusions:Severe preeclampsia, oligohydramnios, velum attachment of umbilical cord and cord around the neck are the independent risk factors of FGR in the third trimester. During pregnancy, early intervention such as screening in high risk pregnant women and fetal intrauterine monitoring should be carried out to improve the perinatal outcome.
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Objective To explore the risk factors of twin preeclampsia,so as to provide evidence for early identification,early warning and prognosis,and better guide clinical work.Methods The clinical data of 236 cases of twin pregnancy with preeclampsia and 200 cases of preeclampsia in the same period in Beijing Haidian District maternal and child health care hospital were analyzed retrospectively.The clinical epidemiology of patients in two groups was conducted in a cohort study to analyze the risk of disease,and to explore the risk factors for twin pregnancy and preeclampsia.Results The preeclampsia incidence of multipara (OR =2.275,95％ CI:1.404-3.686) increased compared with the primipara.The risk of preeclampsia increased in elderly patients (≥35 years old) (OR =1.412,95％ CI:0.917-2.174).The preeclampsia incidence of double chorionic twins was 1.946 times that of monochorial twins (OR =1.946,95％ CI:1.321-2.868).The preeclampsia incidence of assisted reproductive technology pregnancy was 2.063 times that of natural pregnant women (OR =1.946,95％ CI:1.321-2.868).Overweight and obesity were closely related to preeclampsia (OR =3.482,95％ CI:2.064-5.874;x2 =23.498,P ＜ 0.001) and excessive weight gain during pregnancy increased the risk of preeclampsia.Conclusions Primipara,advanced age,double chorionic twins,assisted reproductive technology pregnancy,overweight or obesity and excessive weight gain during pregnancy were all risk factors of preeclampsia in twin pregnancy women.Age,chorionicity and assisted reproductive technology were independent risk factors for preeclampsia.In order to reduce the incidence of preeclampsia and improve the prognosis in twin pregnant women,high risk factors should be identified as early as possible and more perinatal health care should be taken in clinical work.
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Purpose To quantitatively evaluate the severity of brain damage in the acute phase of CO poisoning using intravoxel incoherent motion imaging.Materials and Methods MRI scans were performed in 26 patients with CO intoxication of acute stage and 18 healthy controls with matched age and gender.The difference of D value,D* value and f value in different ROIs between the poisoning and the control groups were compared,and the best cut-off values were determined.The correlation between the consciousness state and the D value as well as f value in the vulnerable area of the brain (globus pallidus) was analyzed.Results Compared with control group,the D and F value of the poisoning group were decreased in multiple ROIs,of which statistical significance was observed in the f values in the centrum semiovale,globus pallidus and thalamus,and the D values in the centrum semiovale,lateral ventricle,globus pallidus and corpus callosum splenium (P＜0.05).The best cut-off value,sensitivity and specificity were as follows:fcs=51％,77％,73％;fga=61％,77％,83％;ft=80％,85％,64％;D,=0.69×10-3 mm2/s,85％,83％;Dlv=0.65× 10-3 mm2/s,73％,89％;Dga=0.68× 10-3 mm2/s,62％,83％;Dccs=0.70× 10-3mm2/s,81％,89％.The disturbance of consciousness was positively correlated with decrease of D value and f value (rD=0.828,rf=0.745,P＜0.05).Conclusion The D and f values of intravoxel incoherent motion imaging can quantitatively evaluate the brain damage severity in acute CO poisoning.
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Objective The expressions of PI3K in invasive squamous cell carcinoma of cervix and their clinical significance were investigated .Methods The expressions of PI3K ,Ki‐67 and CD34 protein in 28 cases of normal cervical epithelium (NCE) ,36 cases of cervical intraepithelial neoplasm (CIN) and 68 cases of squamous cell carcinoma of cervix (SCC) were detected by immunohisto‐chemistry SP method .Results The positive expression rates of PI3K in NCE ,CIN and SCC were 25 .00% ,55 .56% and 85 .29% , respectively .The positive expression rates of PI3K increased remarkably from NCE and CIN to SCC(P0 .05) .In the cases with FIGO staging Ⅱ ,poorly differentiated tissue and pelvic lymph node metasta‐sis ,The positive expression rate of PI3K significantly higher than those in the cases without them(P<0 .05) .Conclusion The o‐ver‐expression of PI3K may lead to up regulation of tumor angiogenesis and cancer cell proliferation in SCC ,and may promote tumor Metastasis and progress of SCC .