Retraction of: The Significance of Thromboelastogram in Predicting Postpartum Hemorrhage and Guiding Blood Transfusion.

This retracts the article DOI: 10.7754/Clin.Lab.2021.210317.

The Significance of Thromboelastogram in Predicting Postpartum Hemorrhage and Guiding Blood Transfusion.

BACKGROUND: The aim of this study was to probe into the significance of the thromboelastogram (TEG) in predicting postpartum hemorrhage and guiding blood transfusion. METHODS: In total, our work selected 200 cases of postpartum hemorrhage patients admitted to the hospital from April 2017 to November 2020 as the research objects, namely the postpartum hemorrhage group. Another 200 cases without postpartum hemorrhage during hospitalized delivery during the same period were chosen as the no postpartum hemorrhage group. The 200 patients complicated with postpartum hemorrhage were allocated into two groups in accordance with whether the blood transfusion was guided by TEG, 100 cases in each group. The changes of blood coagulation as well as TEG indexes in the two groups with/without postpartum hemorrhage were compared, and the diagnostic significance of TEG detection as well as blood coagulation examination for postpartum hemorrhage were analyzed. The TEG index changes before and after infusion of blood products under TEG guidance were counted. The bleeding time and bleeding volume and the blood products infusion with/without TEG guidance were compared. Based on the changes in the coagulation index (CI) of TEG indexes and in D-dimer, correlation analysis between bleeding time and bleeding volume was carried out, predicting the ROC curve and calculating the AUC area through drawing TEG indexes. RESULTS: In the comparison of coagulation indexes, the APTT, PT as well as TT of the postpartum hemorrhage group were longer than those of the no postpartum hemorrhage group (p < 0.05), and the FIB level was lower than that of the no postpartum hemorrhage group (p < 0.05). The TEG indexes of R, MA, and K in the observation group were greater than those in the control group (p < 0.05); Angle-α and CI were lower than those in the control group (p < 0.05). The sensitivity and specificity of patients receiving TEG detection were higher than those receiving coagulation examination. After injecting blood products, the R, MA, as well as K of TEG indexes were less than before (p < 0.05), and the Angle-α as well as CI were greater than before (p < 0.05). If the patients were guided by TEG, the bleeding time was shorter (p < 0.05) and the bleeding volume was less than those not (p < 0.05). The dosage of blood products, including erythrocytes, fresh frozen plasma, cold precipitation as well as platelets given to those received TEG guidance was less than those who did not (p < 0.05). CI was negatively correlated with the change of D-dimer (p < 0.05), CI was negatively correlated with the change of bleeding time (p < 0.05), and CI was negatively correlated with changes in bleeding volume (p < 0.05). Using R we predicted postpartum hemorrhage AUC area = 0.772. Using MA our team predicted postpartum hemorrhage AUC area = 0.458. Using K we predicted postpartum hemorrhage AUC area = 0.924. Using Angle-α our team predicted postpartum hemorrhage AUC area = 0.728. CONCLUSIONS: For patients with postpartum hemorrhage, applying TEG to guide blood transfusion is available to more promptly guide clinical blood transfusion, reduce the blood transfusion volume, and bleeding volume, thus more effectively promoting the return of blood coagulation to normal and improving the prognosis.

Doppler Ultrasound under Image Denoising Algorithm in the Diagnosis and Treatment of Fetal Growth Restriction Using Aspirin Combined with Low-Molecular-Weight Heparin.

OBJECTIVE: This study explored the clinical application value of image denoising algorithm combined with Doppler ultrasound imaging in evaluation of aspirin combined with low-molecular-weight heparin (LMWH) on fetal growth restriction (FGR). METHOD: A two-stage image denoising by principal component analysis (PCA) with local pixel grouping (LPG-PCA) denoising algorithm was constructed in this study. Eighty FGR pregnant women were included in the study, and they were rolled into an experimental group (aspirin enteric-coated tablets + LMWH calcium injection) and a control group (LMWH calcium injection) according to the different treatment plans, with 40 cases in each group. All patients were performed with Doppler ultrasound imaging. The blood flow parameters (BFPs) were recorded and compared before and after the treatment in two groups, including power index (PI), resistance index (RI), high systolic blood flow velocity (S), high diastolic blood flow velocity (D), S/D value, and peak systolic velocity (PSV). In addition, the middle cerebral artery (MCA) BFPs, cerebral placental rate (CPR), amniotic fluid index (AFI) and perinatal outcome (PO) of the two groups were compared. RESULTS: The total effective rate of treatment in group A (87.5%) was greatly higher than that in group B (62.5%), showing statistical difference (P < 0.05). The PI (0.72 ± 0.19), RI (0.57 ± 0.17), and S/D values (2.26 ± 0.43) in group A were dramatically lower than those in group B, which were 0.92 ± 0.21, 0.75 ± 0.14, and 2.64 ± 0.45, respectively (P < 0.05), and the AFI was higher (13.71 ± 2.2 cm vs 11.38 ± 2.16 cm) (P < 0.05). The Apgar score (9.17 ± 0.26), weight (3.57 ± 1.08), and gestational age (38.85 ± 2.50) of group A were all higher in contrast to those of group B, which were 7.33 ± 0.25, 2.61 ± 1.13, and 36.18 ± 2.25, respectively (P < 0.05). In addition, the fetal double parietal diameter (2.4 ± 0.9 mm), femur diameter (2.2 ± 0.6 mm), head circumference (1.2 ± 0.4 mm), abdominal circumference (1.3 ± 0.7 mm), and uterine height (0.8 ± 0.3 mm) in group A were obviously superior to those in group B, which were 1.8 ± 0.4 mm, 1.7 ± 0.5 mm, 0.8 ± 0.2 mm, 0.9 ± 0.4 mm, and 0.4 ± 0.6 mm, respectively, showing statistically observable differences (P < 0.05). CONCLUSION: Doppler ultrasound based on image denoising algorithm can accurately evaluate the effect of aspirin combined with LMWH on the improvement of FGR and showed good application value.

[Analysis of genetic variant in a fetus featuring pontocerebellar hypoplasia type 6].

OBJECTIVE: To explore the genetic basis for a fetus with cerebellar dysplasia and widened lateral ventricles. METHODS: The couple have elected induced abortion after careful counseling. Skin tissue sample from the abortus and peripheral venous blood samples from both parents were collected for the extraction of genomic DNA, which was then subjected to whole exome sequencing. Candidate variant was verified by Sanger sequencing. RESULTS: Prenatal ultrasonography showed increased nuchal translucency (0.4 cm) and widened lateral ventricles. Magnetic resonance imaging revealed infratentorial brain dysplasia. By DNA sequencing, the fetus was found to carry compound heterozygous variants c.1A>G and c.1564G>A of the RARS2 gene, which were inherited from its father and mother, respectively. Among these, c.1A>G was known to be pathogenic, but the pathogenicity of c.1564G>A was unreported previously. Based on the American College of Medical Genetics and Genomics guidelines, the c.1564G>A variant of RARS2 gene was predicted to be likely pathogenic(PM2+PM3+PP3+PP4). CONCLUSION: The compound heterozygous variants c.1A>G and c.1564G>A of RARS2 gene contributed to the fetus suffering from pontocerebellar hypoplasia type 6, which expanded variant spectrum of RARS2 gene.

[Serum vitamin A and E levels in pregnant women in Huai'an region from 2017 to 2018].

OBJECTIVE: To investigate serum levels of vitamin A and E in pregnant women in Huai'an and evaluate their nutritional status. METHODS: Totally 2824 cases of pregnant women were chosen from the Huai'an Maternal and Child Health-Care Center during January 2017 to May 2018. The serum level of vitamin A and vitamin E in the blood was detected by high performance liquid chromatography(HPLC). RESULTS: The serum level of vitamin A was(0. 39±0. 08) mg/L, the overall abnormal rate was 12. 3%. The serum level of vitamin E was(13. 28±4. 67) mg/L, the overall abnormal rate was 3. 7%. Vitamin A level were positively correlated with age and dysarteriotony. Vitamin E level were also positively correlated age, dysarteriotony and appetite. CONCLUSION: The abnormal of vitamin A is mainly lack, the abnormal of vitamin E is mainly excessive.

High risk pregnancy associated perinatal morbidity and mortality: a second birth population-based survey in Huai'an in 2015.

BACKGROUND: The objective of this survey was to explore the association between pregnancy complications and perinatal outcome from regionally total birth population. METHODS: In this prospectively collected data of complete birth registries from all level I-III hospitals in Huai'an in 2015, perinatal morbidity and mortality in relation to pregnancy complications and perinatal outcome were analyzed using international definitions. The results were compared with that of 2010 survey in the same region. RESULTS: Of 59,424 total births in the hospitals of level I (n = 85), II (16) and III (6), delivery rate was 30.4, 40.1 and 29.5%, and rates of pregnancy complications were 12.9, 9.8 and 21.1% (average 14.1%), with antenatal corticosteroids rate in < 37 gestational weeks being 17.3, 31.0 and 39.9% (mean 36.6%), respectively. The preterm birth rate was 0.6, 2.7 and 9.5% (mean 4.06%), and the composite rate of fetal death, stillbirth, and death immediately after delivery was 0.1, 0.4 and 0.6%, respectively. By multivariable logistic regression analysis, congenital anomalies, low Apgar scores, multi-pregnancy and amniotic fluid contamination were risk factors of adverse perinatal outcomes. Despite a higher rate of pregnancy complications than in 2010 survey, perinatal and neonatal mortality continued to fall, in particular in very preterm births. The high cesarean delivery rate in non-medically indicated cases remained a challenge. CONCLUSIONS: Our regional birth-population data in 2015 revealed a robust and persistent improvement in the perinatal care and management of high risk pregnancies and deliveries, which should enable more studies using similar concept and protocol for vital statistics to verify the reliability and feasibility.

Invasion of trophoblast cell lines is inhibited by miR-93 via MMP-2.

Preeclampsia (PE) is a serious pregnancy-related syndrome, which is characterized by gestational hypertension and proteinuria. The microRNA-93 (miR-93) is upregulated in the maternal plasma of patients with PE. However, the functional role of miR-93 in PE remains unknown. Here, we identified that miR-93 inhibits trophoblastic invasion, which is correlated with PE development. In immortalized trophoblast cell lines, transwell assay showed that miR-93 mimics significantly inhibited the migration and invasion of immortalized trophoblast cells, whereas miR-93 inhibitors significantly promoted cell migration and invasion. Moreover, luciferase assays confirmed that miR-93 directly bound to the 3'untranslated region of matrix metalloproteinase-2 (MMP-2), and western blotting showed that miR-93 suppressed the expression of MMP-2 at the protein levels. This study indicated that miR-93 inhibits MMP-2 and reduces migration and invasion of immortalized trophoblast cells. Thus, miR-93 may represent a potential therapeutic target for PE intervention.