Factors influencing success of external cephalic version and their clinical significance / 中华围产医学杂志

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.

Role of microRNA in complications of offspring born to mothers with gestational diabetes mellitus / 中华围产医学杂志

Gestational diabetes mellitus (GDM) can lead to adverse pregnancy outcomes and epigenetic changes in offspring due to exposure to a high-glucose intrauterine environment, resulting in related short- and long-term complications. MicroRNA (miRNA)-mediated post-transcriptional regulation, a gene expression regulation mechanism that has gained much attention in recent years, may play a role in morbidity in offspring born to mothers with GDM, such as macrosomia, heart development, neurodevelopment, and long-term metabolic diseases. This article reviews the progress of miRNA in GDM and associated complications in the offspring.

Effects of interpregnancy interval on pregnancy outcomes of subsequent pregnancy: a multicenter retrospective study / 中华妇产科杂志

Objective:To explore the effects of interpregnancy interval (IPI) on pregnancy outcomes of subsequent pregnancy.Methods:A multicenter retrospective study was conducted in 21 hospitals in China. Information of age, height, pre-pregnancy weight, IPI, history of diseases, complications of pregnancy, gestational age of delivery, delivery mode, and pregnancy outcomes of the participants were collected by consulting medical records of pregnant women who had two consecutive deliveries in the same hospital during 2011 to 2018. The participants were divided into 4 groups according to IPI:<18 months, 18-23 months, 24-59 months and ≥60 months. According to the WHO′s recommendation, with the IPI of 24-59 months group as a reference, to the effects of IPI on pregnancy outcomes of subsequent pregnancy were analyzed. Stratified analysis was further carried out based on age, history of gestational diabetes mellitus (GDM), macrosomia, and premature delivery, to explore the differences in the effects of IPI on pregnancy outcomes among women with different characteristics.Results:A total of 8 026 women were included in this study. There were 423, 623, 5 512 and 1 468 participants in <18 months group, 18-23 months group, 24-59 months group and ≥60 months group, respectively. (1) The age, pre-pregnancy body mass index (BMI), history of cesarean section, GDM, gestational hypertension and cesarean section delivery rate of <18 months group, 18-23 months group, 24-59 months group and ≥60 months group were gradually increased, and the differences were statistically significant ( P<0.05). (2) After adjusting for potential confounding factors, compared with women in the IPI of 24-59 months group, the risk of premature delivery, premature rupture of membranes, and oligohydramnios were increased by 42% ( OR=1.42, 95% CI: 1.07-1.88, P=0.015), 46% ( OR=1.46, 95% CI: 1.13-1.88, P=0.004), and 64% ( OR=1.64, 95% CI: 1.13-2.38, P=0.009) respectively for women in the IPI≥60 months group. No effects of IPI on other pregnancy outcomes were found in this study ( P>0.05). (3) After stratified by age and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would significantly increase the risk of oligohydramnios for women with advanced age ( OR=2.87, 95% CI: 1.41-5.83, P=0.004); and <18 months could increase the risk of premature rupture of membranes for women under the age of 35 ( OR=1.59, 95% CI: 1.04-2.43, P=0.032). Both the risk of premature rupture of membranes ( OR=1.58, 95% CI: 1.18-2.13, P=0.002) and premature delivery ( OR=1.52, 95% CI: 1.07-2.17, P=0.020) were significantly increased in the IPI≥60 months group. After stratified by history of GDM and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would lead to an increased risk of postpartum hemorrhage for women with a history of GDM ( OR=5.34, 95% CI: 1.45-19.70, P=0.012) and an increased risk of premature rupture of membranes for women without a history of GDM ( OR=1.44, 95% CI: 1.10-1.90, P=0.009). After stratified by history of macrosomia and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months could increase the proportion of cesarean section for women with a history of macrosomia ( OR=4.11, 95% CI: 1.18-14.27, P=0.026) and the risk of premature rupture of membranes for women without a history of macrosomia ( OR=1.46, 95% CI: 1.12-1.89, P=0.005). After stratified by history of premature delivery and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would significantly increase the risk of premature rupture of membranes for women without a history of premature delivery ( OR=1.47, 95% CI: 1.13-1.92, P=0.004). Conclusions:Both IPI≥60 months and <18 months would increase the risk of adverse pregnancy outcomes in the subsequent pregnancy. Healthcare education and consultation should be conducted for women of reproductive age to maintain an appropriate IPI when they plan to pregnant again, to reduce the risk of adverse pregnancy outcomes in the subsequent pregnancy.

Comparative analysis of high risk factors between early-onset pre-eclampsia and late-onset pre-eclampsia / 中华妇产科杂志

Objective:To explore the difference of high-risk factors between early-onset and late-onset pre-eclampsia, and to further understand high-risk factors of pre-eclampsia.Methods:Clinical data of pre-eclampsia pregnant women in 160 medical institutions in China in 2018 were retrospectively analyzed, including 8 031 cases of early-onset pre-eclampsia and 12 969 cases of late-onset pre-eclampsia. The proportion of high-risk factors, different body mass index (BMI) and age stratification between early-onset group and late-onset group were compared.Results:(1) Univariate analysis of high-risk factors: the proportions of high-risk factors in early-onset group and late-onset group were compared, and the differences were statistically significant (all P<0.05). Among them, the proportions of primipara and multiple pregnancy in early-onset group were lower than those in late-onset group, while the proportions of pregnant women with advanced age, irregular antenatal examination, obesity, family history of hypertension, pre-eclampsia, diabetes, kidney diseases, immune system diseases and assisted reproductive technology were higher than those in late-onset group. (2) Hierarchical analysis of BMI: the proportion of pregnant women with BMI≥24 kg/m 2 in early-onset group [48.2% (2 828/5 872) vs 45.5% (4 177/9 181), respectively; P=0.001] and the proportion of pregnant women with BMI ≥28 kg/m 2 in early-onset group [19.5% (1 143/5 872) vs 18.0% (1 656/9 181), respectively; P=0.028] were significantly higher than those in late-onset group. (3) Age stratification analysis: the proportion of pregnant women aged 35-39 years in the early-onset group [21.8% (1 748/8 023) vs 17.5% (2 110/12 068), respectively; P<0.01], the proportion of pregnant women 40-44 years old [6.8% (544/8 023) vs 5.4% (648/12 068), respectively; P<0.01], and the proportion of pregnant women ≥45 years old [0.7% (58/8 023) vs 0.5% (57/12 068), respectively; P=0.021] were significantly higher than those in the late-onset group. (4) Multivariate analysis: advanced age (≥35 years old), multiple pregnancy, irregular antenatal examination or transfer from other hospitals, family history of hypertension (including paternal, maternal and parental lines), previous history of pre-eclampsia, kidney diseases, immune system diseases (systemic lupus erythematosus, antiphospholipid antibody syndrome) and assisted reproductive technology pregnancy were the risk factors affecting the severity of pre-eclampsia (all P<0.05). Conclusion:Pregnant women with high risk factors such as age ≥35 years old, BMI ≥24 kg/m 2 before pregnancy, family history of hypertension, history of pre-eclampsia, chronic kidney diseases, immune diseases (mainly including systemic lupus erythematosus and antiphospholipid syndrome) and assisted reproductive technology are more likely to have early-onset pre-eclampsia.

Clinical analysis of risk factors and pregancy outcomes of fetal growth restriction in the third trimester / 中国医师杂志

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.

Progress in role of iron in pathogenesis of preeclampsia / 中华围产医学杂志

Iron plays an important role in maintaining normal physiological functions of oxygen transportation and electron transfer in the body. However, excessive iron intake will induce the generation of oxygen radicals through Fenton reaction and result in free radical chain reactions, causing lipid peroxidation and DNA damage. Oxidative stress is also known as one of the causes of preeclampsia. Therefore, the correlation between iron overload and preeclampsia has attracted more attention. Relevant publications were reviewed to discuss the potential mechanisms of iron overload under oxidative stress in the pathogenesis of preeclampsia.

Study of coenzyme Q10 in the liver of preeclampsia pregnant rats / 中华妇产科杂志

Objective To investigate the protective effect of coenzyme Q10 (CoQ10) in the liver of preeclampsiapregnant rats and the potential etiology. Methods Fifty pregnant SD rats were equally divided into the normal pregnant (NP) group (n=10) and the preeclampsia (PE) group (n=40) randomly. The PE rats (n=40) were equally divided into four groups randomly,distilled water(DW)group,CoQ10 group, CoQ10 combined magnesium(CM) group and magnesium (Mg) group were established by treating the preeclampsia rats on day 15 to 21 of gestation with different measures. As for all the 50 rats, systolic blood pressure (SBP) of rat tail was detected on day 10, 15 and 21 of gestation respectively, 24 hours proteinuria analysis were detected on day 10, 15 and 21 of gestation respectively, levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) in blood andsuperoxide dismutase (SOD), glutathione peroxidase (GSH-PX), malondialdehyde (MDA), caspase-3, Bcl-2 and Bax protein expression in liver tissue were detected by western blot assay on day 21 of gestation. Results (1)SBP and 24 hours proteinuria analysis:there was no statistic difference among all the five groups on day 10 of gestation (P>0.05). Whereas, SBP and 24 hours proteinuria analysis were significantly higher in CoQ10 group, CoQ10 combined CM group, CM group and DW group than that in NP group on day 15, 21 of gestation (P<0.05). And SBP and 24 hours proteinuria analysis were significantly lower in CoQ10 group, CoQ10 combined CM group and CM group than that in DW group on day 21 of gestation (P<0.05). (2) Liver function: among CoQ10 group, CoQ10 combined CM group, CM group, DW group and NP group, serum levels of ALT were respectively(52±7),(34±9),(49±10), (70 ± 19),(30 ± 7)U/L;and serum levels of AST were respectively(169 ± 25),(84 ± 11),(159 ± 20),(281 ± 26)and(78±18)U/L. ALT and AST serum levels were significantly higher in CoQ10 group, CM group and DW group than that in NP group (P<0.05). ALT and AST serum levels were significant lower in CoQ10 combined CM group than those in CoQ10 group, CM group and DW group, respectively (P<0.05). ALT and AST serum levels were significant lower in CoQ10 group and CM group than that in DW group, respectively (P<0.05). (3) SOD, GSH-PX, MDA, caspase-3, Bcl-2 and Bax expression in liver tissue of rats: SOD expression was significant higher in CoQ10 group, CoQ10 combined CM group than thoes in CM group, DW group and NP group(P<0.05);SOD expression was significant lower in CM group, DW grouo than thoes in NP group(P<0.05);and SOD expression was significant higher in CM group than that in DW group(P<0.05). Compared with CoQ10 group, CoQ10 combined CM group, CW group and DW group respectively, the GSH-PX and Bcl-2 protein expressions were significant higher in NP group(P<0.05), while MDA, caspase-3 and Bax protein expressions were significant lower in NP group(P<0.05);compared with CoQ10 group, CoQ10 combined CM group and CW group respectively, the GSH-PX and Bcl-2 protein expressions were significant lower in DW group (P<0.05), while MDA, caspase-3 and Bax protein expressions were significant higher in DW group (P<0.05). Conclusions Oxidative stress and apoptosis levles were upregulated in PE pregnant liver tissues. CoQ10 could effectively protect the liver by improving the liver functions and decreasing the apoptosis of liver cells in PE pregnant rats, and markedly decrease the oxidative stress and apoptosis in the livers. The protective roles of CoQ10 in liver might through its function of anti-oxidative stress and inhibiting cell apoptosis by regulating the balance of Bcl-2/Bax.

Relationship between vascular endothelial growth factor and microvessel density in placenta and placenta increta / 中华围产医学杂志

Objective To investigate the relationship between the expression level of vascular endothelial growth factor (VEGF) and microvessel density (MVD) in placenta tissue and placenta increta.Methods Thirty singleton pregnant women who received antenatal care and underwent cesarean section in Fujian Maternity and Child Health Hospital between November 2013 and August 2014,were enrolled in this study.They were divided into placenta previa group,placenta increta group and control group,with ten patients in each group.Placenta tissue was collected from each patient.Expressions of VEGF and its mRNA were detected by immunohistochemistry,Western blot,and real-time polymerase chain reaction.MVD in placenta tissue was measured by immunohistochemistry.Rank sum test,t test,Kruskal Wallis test,one-way ANOVA and Spearman correlation test were used for statistical analysis.Results (1) Gestational age at admission and delivery in placenta previa and placenta increta groups was lower than in control group (all P＜0.05).Compared with control group,the placenta previa and placenta increta groups had more blood loss,and longer operating duration and hospital stay (all P＜0.05).(2) The expression levels of VEGF and its mRNA in placenta increta and placenta previa groups were higher than in control group (VEGF:0.691±0.032,0.695 ± 0.027 and 0.518±0.025,respectively,F=373.401;VEGF mRNA:1.667±0.661,1.832±0.678 and 0.767±0.269,respectively,F=27.399;both P＜0.05).But there was no significant difference between placenta previa and increta groups.(3) There was no significant difference of VEGF expression in increta location,border site and normal site in placenta increta group,but its mRNA was decreasing (2.519± 0.116,1.482 ± 0.232 and 1.000± 0.000,respectively,F=240.827,P＜0.05).(4) Expression level of VEGF at the attachment of umbilical cord,upper and lower margin of placenta in placenta previa group was higher than in control group (0.702 ± 0.026 vs 0.528± 0.020,t=12.302;0.698 ± 0.026 vs 0.519±0.035,t=12.715;and 0.685±0.029 vs 0.509±0.010,respectively,t=17.891;all P＜0.05).Expression of VEGF mRNA in placenta previa group was higher than in control group (2.080± 0.539 vs 1.024±0.272,t=8.093;1.587±0.757 vs 0.546±0.083,t=2.401;1.828±0.704 vs 0.731 ±0.157,t=4.259;all P＜0.05).(5) MVD in placenta increta group and placenta previa group was higher than in control group (171.2± 14.7,155.7± 14.6 vs 147.8±12.3,respectively,F=7.277,P＜0.05).(6) Expression level of VEGF in placenta increta group and control group was positively associated with MVD (r=0.825,P＜0.05).Conclusions There may be some common mechanisms in the occurrence of placenta previa and placenta increta.Overexpression of VEGF in placenta and abnormal formation of villous vessels may be important factors in the pathogenesis of placenta increta.

Relationships between concentrations of free fatty acid in serum and oxidative-damage levels in placental mitochondria and preeclamupsia / 中华妇产科杂志

Objective To investigate the relationships between concentrations of free fatty acid (FFA) in maternal serum and oxidative damage levels in placental mitochondria and preeclampsia ( PE)-Methods A total of 60 women with PE and 60 normal pregnant women as control participated in this study.All were admitted to Fujian Maternity and Child Health Hospital for delivery from August 2010 to May 2011.Patients with PE were divided into early-onset group ( n =30,presented at ＜ 34 weeks of gestation ) and late-onset group ( n =30,presented at ≥ 34 weeks of gestation),with 30 normal pregnant women as early control group ( ＜ 34 weeks of gestation ) and 30 as late control group ( ≥34 weeks of gestation).Improved copper agent colorimetry was used to detect FFA in maternal serum Ultraviolet colorimetry was used to detect glutathione peroxidase (GPX) and catalase (CAT) activity in maternal placenta and malondialdebyde (MDA) and permeability transiton (PT) pore in placental mitochondria.Total superoxide dismutase (SOD) assay kit-WST was used to detect SOD activity in placenta.Real-time fluorescent quantitative PCR was used to detect mitochondrial DNA (mtDNA) expression in placenta.Results ( 1 ) Maternal serum FFA was ( 1.6 ±0.5 ) mmol/L in early-onset PE group and ( 1.5 ± 0.4) mmol/L in lateonset PE group,significantly elevated as compared to ( 1.0 ± 0.5 ) mmol/L in early control group and (0.9 ±0.5) mmol/L in late control group (P ＜ 0.05 ). However,no significant difference was found between early-onset and late-onset PE groups (P ＞ 0.05 ).(2) The mean placental GPX,CAT and SOD activity were significantly decreased in the early-onset PE group [ (47 ±6),( 19 ±5),(62 ± 13) U/mg]and late-onset PE group [ (67 ±6),(20 ±4),(96 ± 17) U/mg] as compared to late control group [ (80 ±3),(55 ± 3 ),( 123 ± 19 ) U/mg],respectively ( P ＜ 0.05 ).(3) The mean placental mitochondria MDA was significantly elevated in the early-onset PE group [ (115 ± 22) nmol/mg] and late-onset PE group [(90±17) nmol/mg] as compared to late control group [(52 ± 11) nmol/mg,P ＜0.05].The mean absorption value that present the permeability of placental mitochondria PT pore was significantly elevated in the early-onset PE group (0.086 ±0.013) and late-onset PE group (0.069 ±0.014) as compared to late control group (0.052 ± 0.0 12,P ＜ 0.05 ).The mean placental mtDNA expression was significantly elevated in the early-onset PE group (3.0 ±0.7) and late-onset PE group (2.8 ±0.7) as compared to late control group ( 2.6 ± 0.6,P ＜ 0.05 ).( 4 ) The mean placental mitochondria MDA concentration correlated positively with the concentrations of FFA in maternal serum in the early-onset PE group ( r =0.703,P ＜0.05 ) and late-onset PE group (r =0.457,P ＜ 0.05 ),and negatively with placental antioxidant enzyme in the early-onset PE group ( r =- 0.652,- 0.787,- 0.952 ; P ＜ 0.05 ) and late-onset PE group ( r =-0.378,-0.689,-0.854; P＜0.05).Conclusions Increased FFA in maternal serum and high levels of oxidative damage in placental mitochondria may be involved in the pathogenesis of preeclampsia.Increased FFA in serum and decreased activity of antioxidant enzyme in placenta may contribute to oxidative damage levels in placental mitochondria in women with PE.

Expression and significance of adipocyte fatty acid-binding protein in placenta, serum and umbilical cord blood in preeclampsia / 中华妇产科杂志

Objective To investigate the change of adipocyte fatty acid-binding protein(FABP4) in maternal serum and umbilical cord blood and FABP4 mRNA placental expression in patients with preeclampsia(PE). Methods A total of 60 women with PE and 60 normal pregnant women as control participated in this study. All are admitted to Fujian Maternity and Children Health Hospital for delivery from December 2008 to October 2009. Patients with PE were divided into early-onset group (n = 30, presented at ≤34 weeks of gestation) and late-onset group(n = 30, presented at > 34 weeks of gestation), with 30 normal pregnant women as early control group(≤34 weeks of gestation) and 30 as late control group(>34 weeks of gestation). Enzyme-linked immunosorbent assay (ELISA) was used to detect FABP4,fasting serum glucose,fasting insulin(FINS) in maternal serum and FABP4 in umbilical cord blood. Real-time fluorescent quantitative revere transcription PCR was used to detect placental FABP4 mRNA expression. Furthermore,clinical and biochemical parameters were recorded, such as body mass index(BMI), systolic pressure(SP),diastolic pressure (DP), mean arterial pressure (MAP), total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL), high density lipoprotein (HDL), creatinine (Cr), uric acid (UA) , glomerular filtration rate (GFR), 24 hours urine protein in pregnant women and neonatal weight. Results (1) Maternal serum FABP4 was (176 ± 9) ng/L in early-onset PE group and (170 ± 9) ng/L in late-onset PE group, significantly elevated as compared to (81 ± 13) ng/L in early control group and (94 ± 15) ng/L in late control group. (2) Mean maternal FINS, homeostasis model of assessment for insulin resistence index (HOMA-IR) were significantly elevated in the early-onset PE group and late-onset PE group as compared to control groups, respectively. (3) Mean placental FABP4 mRNA expression were significantly elevated in the early-onset PE group and late-onset PE group as compared to late control group. However, no significant difference was found in placental FABP4 mRNA expression between early-onset and late-onset PE groups.(4) Mean umbilical cord blood FABP4 concentrations were significantly decreased in the early-onset PE group and late-onset PE group as compared to late control group. Furthermore, umbilical cord blood FABP4 concentration correlated negatively with maternal serum FABP4 level and placental FABP4 mRNA expression, but positively with neonatal weight. (5) Mean maternal serum FABP4 concentrations correlated positively with placental FABP4 mRNA expression,TG, FINS, HOMA-IR, Cr, UA; and negatively with HDL, GFR. Conclusions Increased FABP4 expression in maternal serum and placenta may be involved in the pathogenesis of preeclampsia. Increased FABP4 mRNA expression in placenta may contribute to high serum FABP4 level in women with PE.

Multi-center study of motherwort injection to prevent postpartum hemorrhage after caesarian section / 中华妇产科杂志

Objective To evaluate the efficacy and safety of motherwort (herbs leonuri/leonurus heterophyllus sweet) injection for preventing postpartum hemorrhage after caesarian section. Methods The prospective study was designed as a randomized and single blind multi-center research matched with positive agent as controls from Apt 2007 to Aug 2007. 440 women underwent caesarian section (CS) indicated by obstetric factors were enrolled from 15 teaching hospitals in China and assigned into three groups: group of motherwort: 147 cases were administered by motherwort 40 rag uterine injection during CS and 20 mg intramuscular injection per 12 hours 3 times after CS; group of motherwort + oxytocin : 144 cases were administered by motherwort 40 mg and oxytocin 10 U uterine injection during CS and motherwort 20 mg intramuscular injection per 12 hours 3 times after CS and group of oxytocin: 149 cases were administered by oxytocin 10 U uterine injection and oxytocin 10 U + 5% glucose 500 nd intravenously injection during operation and oxytocin 10 U intramuscular injection per 12 hours 3 times after CS. The following clinical parameter were collected and analyzed: (1) The amount of blood loss during operation, at 2, 6, 12, 24, 48 hours after operation. (2) The total amount of blood loss in 24 hours after CS and the incidence of postpartum hemorrhage. (3) The change of level of hemoglobin (Hb) and counting of red blood cell ( RBC ) from prepartum to postpartum. (4) Adverse reaction. Results (1) The mean amount of blood loss during operation were (368±258) ml in group of motherwort, (255±114) mi in group of motherwort + oxytocinand (269±141 ) ml in group of oxytocin, which exhibited significant difference among three groups ( P<0.01 ). Meanwhile, no statistical different amount of blood loss among three groups were observed at 2,6,12, 24, 48 hours after CS. (2)The amount of blood loss of postpartum at 24 hours were (480±276)ml ingroup of motherwort, (361±179) ml in group of motherwort + oxytocin, (381±179) nd in group of oxytocin, which showed significant difference among 3 groups(P <0.01 ). (3) The incidence of postpartum hemorrhage were 32.0% (47/147) in group of motherwort, 11.1% (16/144) in group of motherwort + oxytocin, and 18.8% in (28/149) in group of oxytocin. When comparing the lowest rate of postpartum blood loss in group of motherwort + oxytocin and the highest rate in group of motherwort, it displayed statistical difference (P<0.01). (4) The decreased level of RBC and Hb were shown that RBC(0.3±0.5)×10<'12<‘/L and Hb(9±13)g/L in group of motherwort, RBC (0.2±0.4)×10<'12/L and Hb ( 6±10) g/Lin group of motherwort + oxytocin and RBC (0.2±0.4)×10<'12/L and Hb(7±30) g/L in group of oxytocinrespectively. However, the comparison of different value of RBC and lib in group of oxytocin and motherwort +oxytocin showed significant difference (P<0.05 ). (5) Two cases with allery reaction was observed.Conclusion It is safe and efficacious that combined use of motherwort injection and oxytocin was to preventpostpartum hemorrhage during or after caesarian section.

Maternal serum level of adiponectin and expression of adiponectin mRNA in subcutaneous and omental adipose tissues in women with preeclampsia / 中华妇产科杂志

creased maternal serum adiponectin level may be involved in the pathogenesis of pre-eclampsia and also may contribute to the reduced expression of adiponectin in the omental adipose tissue.

Real time contrast-enhanced ultrasound in diagnosis of liver localized fatty deletion and fatty infiltration / 中国介入影像与治疗学

Objective To explore the clinical value of real time contrast-enhanced ultrasound in diagnosis of liver localized fatty deletion and fatty infiltration which couldn't be confirmed by conventional ultrasonography. Methods Contrast-enhanced ultrasound was performed on 94 patients with liver localized diseases confirmed by baseline sonography, among them 34 patients with liver localized fatty deletion and fatty infiltration were enrolled. Results Contrast-enhanced ultrasonography didn't show apparent occupancy nidus in 34 patients. Enhancement mode of lesions was the same as liver parenchyma, which was distinctly different from liver occupancy diseases. Conclusion Real time contrast-enhanced ultrasound can display typical signs of liver localized fatty deletion and fatty infiltration and has significant value in diagnosis and differentiating diagnosis of them.