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Objective:To explore and compare the reference ranges of four coagulation tests in normal pregnant women during early and late pregnancy and the influence of age.Methods:Values of four coagulation tests from 4 974 pregnant women, who gave single birth at Peking University First Hospital, Obstetrics and Gynecology Hospital of Fudan University, West China Second University Hospital, Peking University Third Hospital and Shengjing Hospital of China Medical University from February 2017 to July 2020, were measured and analyzed in this study, including prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib) and thrombin time (TT). The four normal reference ranges of coagulation during early and late pregnancy phases were expressed as P2.5- P97.5. The difference of two pregnancy phases was compared by non-parametric test of two related samples. And the difference between pregnant women of advanced and non-advanced age in the same pregnancy phase was compared by independent sample non-parametric test. Chi-square test was used to compare the incidence of pregnancy complications in different coagulation reference ranges. Results:The reference ranges of PT of normal pregnant women′s early and late pregnancy were 10.0-13.9 s and 9.6-12.3 s, the reference ranges of APTT were 22.6-35.3 s and 22.4-30.9 s, the reference ranges of Fib were 2.4-5.0 g/L and 3.0-5.7 g/L, the reference ranges of TT were 12.0-19.0 s and 11.5-18.4 s. Compared with early pregnancy, PT, APTT and TT shortened significantly, while the Fib significantly increased in late pregnancy (all P<0.001). PT, APTT and TT of advanced and non-advanced age pregnant women were significantly different (all P<0.01). Compared with the ranges of non-pregnant population, more pregnant women were included in the normal pregnant reference ranges of PT in early pregnancy and APTT in the early and late pregnancy, while the incidence of pregnancy complications had no significant differences (all P>0.05). The incidence of fetal distress was higher and the incidence of preterm birth was lower in the reference range of PT in late pregnancy. The incidence of gestational diabetes mellitus was higher in the early and late gestational Fib reference ranges, and the incidence of hypertensive disorders in pregnancy was higher in the late gestational Fib reference range (all P<0.05). Conclusions:The coagulation function of pregnant women increases significantly with the growth of pregnancy, and there is a significant difference between advanced significantly and non-advanced age pregnant women. The recommended ranges of normal pregnant women′s early and late pregnancy PT are 10.0-13.9 s and 9.6-12.3 s, the recommended ranges of APTT are 22.6-35.3 s and 22.4-30.9 s, the recommended ranges of TT are 12.0-19.0 s and 11.5-18.4 s. The appropriate ranges of normal pregnant women′s early and late pregnancy Fib still need further exploration.
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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.
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Objective To evaluate the risk factors and sonographic findings of pregnancies complicated by placenta increta or placenta percreta. Methods Totally, 2219 cases were retrospectively analyzed from 20 tertiary hospitals in China from January 2011 to December 2015. The data were collected based on the original case records. All cases were divided into two groups, the placenta increta (PI) group (79.1％, 1755/2219) and the placenta percreta (PP) group (20.9％, 464/2219), according to the degree of placental implantation. The risk factors and sonographic findings of placenta increta or percreta were analyzed by uni-factor and logistic regression statistic methods. Results The risk factors associated with the degree of placental implantation were age, gravida, previous abortion or miscarriage, previous cesarean sections, and placenta previa (all P<0.05), especially, previous cesarean sections (χ2=157.961) and placenta previa (χ2=91.759). Sonographic findings could be used to predict the degree of placental invasion especially the boundaries between placenta and uterine serosa, the boundary between placenta and myometrium, the disruption of the placental-uterine wall interface and loss of the normal retroplacental hypoechoic zone(all P<0.01). Conclusions Previous cesarean sections and placenta previa are the main independent risk factors associated with the degree of placenta implantation. Ultrasound could be used to make a prenatal suggestive diagnosis of placenta accreta spectrum disorders.
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Objective To study the changes in cesarean delivery rate (CSR) and indications against the background of two-child policy. Methods Maternal information and indications for cesarean delivery were retrospectively obtained from medical records of 62007 women who delivered at the Obstetrics and Gynecology Hospital of Fudan University between January 2013 and December 2016. Indications for cesarean section were divided into 16 categories, such as maternal or fetal indication, repeat cesarean section, maternal request, labor arrest disorders, fetal distress, and so on. Changes in CSR and the proportion of cesarean delivery for each indication were evaluated. One-way analysis of variance, Chi-square or Fisher's exact test were used for statistical analysis. The average annual percent change (AAPC) in cesarean delivery rate was calculated by Joinpoint Analyses software. Relative contribution of each indication to the overall increase or decrease in CSR was analyzed using the data of the years of 2013 and 2016. Results The CSR dropped from 45.2％ (6683/14798) in 2013 to 38.3％ (6546/17104) in 2016. The rate of cesarean delivery due to maternal request and labor arrest disorders decreased significantly (χ2=49.402 and 14.617, both P<0.05) .The rate of cesarean delivery due to labor arrest disorders in all cases decreased sharply from 14.7‰ in 2013 to 0.9‰ in 2016 at an annual decrease of 48.0％ (95％CI: - 67.6％- - 21.5％). It was also worth noting that the rate of cesarean delivery on maternal request in all cases decreased from 119.3 ‰ in 2013 to 40.7 ‰ in 2016 at an average annual decrease of 30.1％ (95％CI: - 31.3％- - 28.9％). Despite of a limited number of cesarean delivery cases for uterine scar caused by leiomyoma resection, its rate increased from 1.4 per 1000 deliveries in 2013 to 2.9 per 1000 deliveries in 2016 with the highest average annual increase of 32.3％ (95％CI: 10.1％-60.9％), followed by the rate of cesarean delivery due to maternal pyrexia, increasing from 6.6 per 1000 deliveries in 2013 to 16.4 per 1000 deliveries in 2016 at an average annual increase of 27.4％ (95％CI: 11.0％-46.5％), and the rate of cesarean delivery due to repeat cesarean section, increasing from 67.6 per 1000 deliveries in 2013 to 113.9 per 1000 deliveries in 2016 at an average annual increase of 19.0％ (95％CI: 5.0％-34.6％). The first two positive contributors to the total decrease of CSR were maternal request and labor arrest disorders (144.2％ and 27.7％, respectively), while the first two negative contributors were repeat cesarean section and maternal pyrexia (-102.3％ and -18.9％, respectively). Conclusions The CSR is reduced after the implementation of two-child policy through active control on maternal request and application of new partogram.
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Objective To summarize the experience of multidisciplinary consultation for prenatal fetal deformity, and to explore the mode suitable for China. Methods The Obstetrics and Gynecology Hospital of Fudan University and Children's Hospital of Fudan University established a joint multidisciplinary consultation center, including obstetrics, pediatrics, pediatric surgery, ultrasound and other departments. A total of 3 378 pregnant women visited the consultation center from July 31, 2003 to August 1, 2013. After consultation, treatment was divided into three classes:pregnancy termination, pregnancy continuation and perinatal treatment. Follow-up was made through correspondence and telephone communication. Retrospective analysis on reasons for consultation, fetal structural abnormalities of the classification system, chronological order of abnormalities, gestational weeks of diagnosis, maternal-related factors, treatment and prognosis was performed. Results (1) Reasons for consultation:Among 3 378 women undertaking prenatal multidisciplinary consultation, 3 243 (96.00%) were due to fetal factors, and 135 (4.00%) were due to maternal factors. (2) Classification of fetal structural abnormalities:Among the 3 243 cases undertaking consultation with fetal factors, fetal abnormality was found in 80.85%(2 622/3 243). The most common were neurological abnormalities(23.19%, 608/2 622), followed by urinary tract malformation (20.25%, 531/2 622) and cardiovascular malformation (15.48%, 406/2 622). These were followed by digestive system malformation, limb deformities and space-occupying lesions. There were 156 cases of multiple malformations. (3) Average gestational weeks for diagnosis of fetal deformity:The 2 622 cases of fetal deformity were diagnosed at a mean (26.7± 2.1) of gestational weeks (21.1–30.4 weeks). Urinary tract malformations were detected at (24.0±0.7) weeks, whereas digestive system malformations were detected at (28.3±2.6) weeks. (4) Induced labor:Induced labor cases accounted for 35.66% (935/2 622), among which, 92 cases were fetal intrauterine death and 843 cases were active choice. The several highest induced labor rates resulted from multiple malformations (75.64%, 118/156), abdominal wall defects (62.22%, 28/45), diaphragmatic hernia (61.54%, 24/39), cleft lip and palate (55.32%, 26/47) and cardiovascular malformations (49.51%, 201/406). For nervous system (27.80%, 169/608), urinary tract (25.80%, 137/531) and digestive system malformations (26.94%, 66/245), induced labor rates were <30%. For abdominal lesions (14.04%, 25/178) and sacrococcygeal teratoma (13.64%, 3/22), induced labor rates were<15%. (5) Continuation of pregnancy in 1 687 cases:Cesarean section was conducted in 1 046(61.94%). Neonatal death occurred in 117(6.94%).(6) Perinatal treatment:Twenty-one cases were treated during pregnancy, including thirteen cases with fetal ascites and hydrothorax treated by drainage, five cases with fetal anemia treated by intrauterine transfusion and three cases with fetal tachycardia treated by digoxin. Ten cases were treated by ex-utero intrapartum treatment. After birth, 297 newborns immediately underwent neonatal surgery. Among these, 259 cases underwent radical surgery, eleven palliative surgery, and sixteen elective surgery after follow-up. Conclusions Prenatal multidisciplinary consultation can make comprehensive multidisciplinary assessment of fetal prognosis and improve the diagnosis and treatment of structural malformations.
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Objective To investigate the role of human leukocyte antigen-G ( HLA-G ) on the invasion and the molecular mechanism involved in this cellular progress in HTR-8/SVneo cell line. Methods There were three groups: groups of transfection, negative control and blank control, which corresponding to treatment by HLA-G specific siRNA, negative siRNA and only lipofectamine 2000 using lipofection technology in HTR-8/SVneo cell line. The efficiency of down-regulated of HLA-G was detected by reverse transcription-polymerase chain reaction and western blot analysis in mRNA and protein level,respectively. Changes of p38 mitogen-activated protein kinases (p-p38MAPK)/p38MAPK protein levels and the cell invasion were respectively detected by western blot analysis and transwell test. Results ( 1 ) The mRNA levels of HLA-G transfection group, negative control group and blank control group were 0. 26 ±0. 08, 0. 71 ±0. 11, 0. 79 ±0. 07, respectively. There was significant difference between transfection group and negative control group ( P ＜ 0. 01 ), while there was no significant difference between negative control group and blank control group ( P ＞ 0. 05 ). The efficiencies of down-regulated of HLA-G were ( 69. 8 ±6. 3)%, ( 14. 9 ± 2. 2 )%, 0 in transfection group, negative control group and blank control group respectively in mRNA level. (2)In protein levels, HLA-G were 0. 20 ±0. 15, 0. 75 ±0. 12, 0. 76 ±0. 21 in transfection group, negative control group and blank control group, respectively. There was significant difference between transfection group and negative control group ( P ＜ 0. 01 ), whereas there was no significant difference between negative control group and blank control group ( P ＞ 0. 05 ). The efficiencies of down-regulated of HLA-G were (81. 1 ± 14.4)%, ( 18.0 ± 7.7)%, 0 in transfection group, negative control group and blank control group respectively. ( 3 ) The invasive number of transfection group, negative control group and blank control group were 57 ± 38,364 ± 79 and 260 ± 84, respectively, with a significant difference between transfection group and negative control group (P ＜ 0. 01 ). There was no significant difference between negative control group and blank control group ( P ＞ 0. 05 ). ( 4 ) The p-p38MAPK/p38MAPK values of the HLA-G transfection group, negative control group and blank control group were 0. 74 ±0.04, 0. 47 ± 0. 09 and 0. 36 ± 0. 21, respectively. HLA-G transfection group was significantly different compared with the other two groups( P ＜0. 01 ). (5)Without or with SB203580, the p-p38MAPK/ p38MAPK values of the HLA-G transfection group were 0. 89 ± 0. 09 and 0. 16 ± 0. 04, the values of negative control group and blank control group were 0.76 ±0.08, 0. 14 ±0.03 and 0.51 ±0.05, 0.03 ±0.01, respectively. There was significant difference between without SB203580 and with SB203580 ( P ＜ 0. 01 ). (6)Without or with SB203580, the invasive number of transfection group were 51 ± 13 and 90 ± 21 ,respectively,which was significantly different ( P ＜ 0. 01 ). The invasive number of negative control group and blank control group were 290 ± 52, 298 ± 33 and 290 ± 73, 264 ± 64, respeczively, which was no significant difference between without SB203580 and with SB203580 (P ＞ 0. 05 ). Conclusions HLA-G gene may regulate invasion of trophoblast-derived cell line HTR-8/SVneo via p38MAPK signaling pathway. The lower expression of HLA-G in trophoblast cells may lead to the occurrence of pathologic pregnancy.
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Objective To review the clinical treatment and outcome of ultrasonographic soft markers in prenatal diagnostics. Methods This study recruited 268 pregnant women who underwent prenatal diagnostics in our hospital between Jun 2005 to Mar 2009. Fetuses were followed up postnatally. The outcome and chromosomal abnormalities of ultrasonographic soft markers were assessed. Results Of 268 cases consulted, 29 cases were missed (10.8%), 34 cases (12.7%) chose abortion, and 205 cases (76.5%) delivered. The top four most common delivered isolated markers were thickened nuchal fold, mild pyelectasis, echogenic bowel and rhizomelic limb shortening. Mild ventriculomegals had the highest aborted rate (17.2%). Six chromosomal structural abnormalities and one 21-trisome were detected in 59 fetuses who received chromosomal examination. Conclusions Ultrasonographic soft markers are risks to both fetal trisome and chromosomal structural abnormalities. Owing to extinction in most cases, consultant should be strengthed to avoid unnecessary invasive examination and abortion.
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Objective To investigate the effect of human leukocyte antigen-G(HLA-c)on the growth and invasion of JEG-3 cell line and the role of HLA-G in the onset and development of pre-eclampsia.Methods The experiment was composed of three groups:groups of transfection,negative control and blank control.which corresponded to groups of HLA.G siRNA transfection,negative siRNA transfection and no transfection HLA-G overexpressed choriocarcinoma cell line JEG-3 was used.The role of HLA-G in JEG-3cell monolayer was examined by RNA interference technology using HLA-G specific small interfering RNA (siRNA).Expression of HLA.G was detected by reverse transeriptase-polymerase chain reaction and western blot analysis.Changes of cell cycle,apoptosis,proliferation and invasion were respectively detected by methvl thiazolyl tetrazolium(Ma r).flow cytometry assay and transwell test.Results (1)The mRNA and protein levels of HLA.G control group and blank control group were 0.0013±0.0014.0.0163 ±0.0007 and 0.1923 ±0.0384.0.2184 ±0.0153,respectively,which were both significantly different(P<0.05);the number of negative transfcction group was 0.1606±0.0133 and 0.2020±0.0132.which had no significant difference compared with blank control group(P>0.05).(2)The integral absorbance(IA)valUCB of the HLA-G transfecfion group and blank control group were 0.44±0.04 and 0.75±0.13 respectively.which was significantly different(P<0.01);the/A value of negative control group was 0.69±0.10.which was not significantly different compared with blank group(P>0.05).(3)The ratios of G2/M and S phase cells in transfection group were(10.9±2.2)%and(58.6±0.8)%respectively,significantly different compared with the blank control group[(15.4±1.9)%and(52.9±2.3)%respectively;P<0.01].(4)The ratio of early apoptosis cells in transfection group[(14.5±2.7)%]Was significantly increased compared with neg~ive[(5.3 ±1.1)%]and blank control group[(4.7±0.6)%;P<0.01].(5)The invasion number of transfecfion group and blank control group were 121±12 and 452±17 respectively.with a significant eclampsia by regulating proliferation and invasion of trophoblast.
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Objective To assess the efficacy of ultrasound contrast agent Levovist in evaluating vascularization of ovarian tumors.Methods Nineteen ovarian lesions (seven benign ovarian tumors,twelve malignant ovarian tumors) were submitted to color Doppler flow imaging (CDFI) before and after i.v.Levovist for examining their vascularization,including the number of blood vessel,vessel torsion and Doppler signal enhancement. And then receiver operator characteristic(ROC) curves were established.Results Compared to benign tumors',after contrast color Doppler signals in malignant tumors enhanced obviously and character characteristic vessel morphologies were observed.Vessel numbers and tortuosity increased obviously.Doppler signal enhancement appeared earlier,arrival to peak enhancement was quicker,and duration longer.ROC showed time to commencement for the enhancement ≤50 s,time to peak ≤100 s and enhancement duration ≥400 s,at which the sensitivity and specificity were the highest.Conclusions Levovist,as a contrast agent, increases the intensity of color Doppler signals obviously,and allows a more complete display of the vascular patterns of ovarian tumor.It improves markedly the role of CDFI in the diagnosis and differentiation of ovarian tumors.
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Captopril (CPT, 40, 80mg/kg, ig) enhanced serum superoxide dismutaseactivity, and suppressed luminal-dependent chemiluminescence of peritoneal macrophagesin mice. CPT (160mg/kg, ig) had a suppressive action on lipid peroxidation of mice. Theseresults suggested that CPT had antioxygen free radical effect or anti-lipid peroxidationeffects. CPT at 25 ?g/ml concentration suppressed ConA-induced prolifeation of mousesplenic T lymphocytes in vitro, which suggested that CPT had a suppressive effct on Tlymphocyte function.