Treating oligohydramnios with extract of Salvia miltiorrhiza: A randomized control trial.

OBJECTIVE: To determine whether purified herbal extract of Salvia miltiorrhiza can improve the amniotic fluid volume in pre-term oligohydramnios by improving uteroplacental circulation. METHODS: Forty-three pregnant women with oligohydramnios received a daily intravenous dose of 30 mL of salvia extract mixed with 5% glucose 500 mL. A control group of 41 women received daily 5% glucose 500 mL only. The amniotic fluid index (AFI) was assessed at least twice a week by ultrasonographists who were blinded to the treatment. Both women and fetuses were monitored closely. The change in AFIwas calculated and compared by paired t test within and between groups. The revised recommendations for improving the quality of reports of parallel group randomized trials were used. RESULTS: After a mean of 7.2 +/- 2.7 days' therapy, ranging from 3 to 18 days, the AFIincreased significantly from a mean of 4.9 +/- 2.3 cm to a mean of 7.12 +/- 2.36 cm, by a mean of AFI0.18 +/- 0.06 cm/day (paired t = 3.62, p < 0.005). In the control group, the AFIincreased from a mean of 5.1 +/- 2.4 cm to a mean of 5.5 +/- 3.1 cm after a mean of 6.1 +/- 3.3 days' treatment, ranging from 4 to 15 days. The effect of salvia treatment on AFIin the salvia group was significantly greater than in the control group (p < 0.001). No side effects were observed in treated patients. CONCLUSION: Salvia miltiorrhiza is an effective Chinese medicine for the treatment of oligohydramnios.

Heparin successfully improved an early onset intrauterine growth restriction accompanied by severe oligohydramnios.

Oligohydramnios is an ominous pregnant complication with high perinatal morbidity and mortality of 80%-90%, if it was observed in second trimester. However, there is no promising modality to cure it at that period. In this case, heparin therapy was successful in an early onset extreme oligohydramnios.

[Effect of heparin on the ratio of peak systolic to least diastolic flow velocity of umbilical artery at second-trimester pregnancies].

OBJECTIVE: To evaluate the efficiency of heparin on the ratio of peak systolic to least diastolic flow velocity (S/D) of umbilical artery flow velocity waveforms at second-trimester pregnancies. METHODS: Sixty-seven pregnant women carrying 72 fetuses (5 twins) whose fetal umbilical artery flow S/D ratios were more than the 95(th) percentage were divided into study and control groups. In study group, 35 women carrying 38 fetuses were treated with heparin at a dose of 6250 U or 12,500 U + 5% glucose 500 ml intravenously per day for a mean of (3.7 +/- 2.1) days, ranging from 1 to 10 days. In control group, another 32 women with 34 fetuses were treated regularly with dextran-40,500 ml and 10% glucose 500 ml + rooted salvia 30 ml; and 10% glucose 500 ml + 654-II 20 mg for a mean of (6.8 +/- 2.8) days, ranging from 3 to 14 days. After treatment the S/D ratios were re-examined, and compared between two groups. RESULTS: The mean of decreased S/D ratios per day in heparin group and control group was 0.37 (t = 3.620, P < 0.01) and 0.135 (t = 3.061, P < 0.01), respectively. There was significant deference between two groups (t = 1.998, P < 0.05). The treatment time was significantly shorter in heparin group than in the control (t = 3.435, P < 0.01). The effective rate was significantly higher in heparin group than in the control (chi(2) = 10.636, P < 0.01). In the control group, there were 10 cases with S/D ratio increasing continuously. Two of them died of S/D ratio infinity. None of the study group died. CONCLUSIONS: Heparin can significantly decrease the high S/D ratios of umbilical artery flow velocity waveforms at second trimester of pregnancy. It is effective for improving fetal outcomes.

[Relationship between imbalanced synthesis of human chorionic gonadotropin alpha and beta subunits and pregnancy-induced hypertension].

OBJECTIVE: To study the relationship between imbalanced synthesis of human chorionic gonadotropin (hCG) alpha and beta subunits and the pathology of pregnancy-induced hypertension (PIH). METHODS: Total hCG, free alphahCG and betahCG were measured in serum samples collected from 60 cases of PIH and 30 normal gravid women by radioimmunoassay. The ratio of total hCG/betahCG, betahCG/FalphahCG, (FalphahCG+betahCG)/betahCG were calculated. Immunohistochemical staining was performed in 13 placenta from each group. RESULTS: In PIH group the levels of FalphahCG, total hCG and betahCG were significantly higher than those of normal group (FalphahCG: 528 +/-421 IU/L compared with 222 +/-129 IU/L; betahCG: 39396 +/-6412 IU/L compared with 24265 +/-5575 IU/L; total hCG: 66597 +/-9294 IU/L compared with 36078 +/-4767 IU/L, all P<0.001). The betahCG/FalphahCG ratio in PIH was lower than that of normal group (91.23 +/-53.38 Compared with 119.4 +/-80.1, P<0.05); (FalphahCG+betahCG)/betahCG ratio and total hCG/betahCG ratio in two groups were (1.022 +/-0.026 compared with 1.015 +/-0.011; 1.802 +/-0.339 compared with 1.807 +/-0.258, respectively P>0.05). The immunohistochemical intensity of betahCG and FalphahCG in syncytiotrophoblast was significantly increased in 13 PIH compared with the control. CONCLUSION: These data suggested that the imbalanced synthesis of hCG alpha and beta subunits may cause hypertension.

[Free alpha hCG--a serum marker for pregnancy-induced hypertension]

OBJECTIVE: To evaluate the free alpha subunit of human chorionic gonadotropin (FalphahCG) as a marker for pregnancy-induced hypertension (PIH). METHODS: The study group consisted of 74 pregnant women with hypertension. PIH admitted at 21-43 weeks of gestation. The control group was 37 non-PIH women. Serum FalphahCG was measured by radioimmunoassay with monoclonal technology. Using Youden's index of the receiver operator characteristic curve(ROC), a threshold value was determined. RESULTS: FalphahCG levels in PIH women were significantly higher than in the control group women [(556+/-428)IU/L compared with (232+/-131)IU/L,P<0.001].Using 260 IU/L of FalphahCG as the threshold value yields a sensitivity of 81.1% and specificity of 75.7% with a Youden's index of 0.57 for predicting PIH. CONCLUSION: Serum FalphahCG may serve as a useful marker to predict PIH.