Obstetric and neonatal outcomes of delayed interval delivery in cerclage: A retrospective study.

OBJECTIVE: Delayed delivery is sometimes selectively performed in twin pregnancy when the first birth occurs inevitably in order to improve the prognosis and decrease the morbidity and mortality of the second twin. The aim of this study is to explore the maternal and fetal outcomes of pregnancies in which cerclage is carried out following the loss of first fetus in twin gestation for delayed interval delivery. METHODS: Three cases of delayed-interval delivery of dichorionic-diamniotic twin pregnancies were reported in our center between 2017 and 2018 and were retrospectively analyzed. Once the first twin was delivered, the second twin was left in utero and the patient underwent in utero percutaneous umbilical cord ligation, antibiotics, tocolytic therapy and cervical cerclage. RESULTS: Mean gestational age at delivery of the first fetuses was 21.6 ±â€¯2.9 weeks and 24.8 ±â€¯4.0 weeks for the remaining fetuses, respectively. The mean interval of the delay was 22 days (4-50 days). Mortality of the first fetus was 66.7%, and the retained one was 33.3%. In general, maternal outcome was good, one patient experienced postpartum hemorrhage and placenta accreta. However neonatal aftermath was generally not favorable, probably due to extreme prematurity. CONCLUSIONS: Cervical cerclage after the first delivery could prolong the pregnancy until an adequate gestational age at which an enhanced prognosis and better perinatal outcome for the second twin can be achieved.

Roles of vascular endothelial growth factor and dexamethasone in expressions of surfactant protein B and transforming growth factor-β1 in type Ⅱ alveolar epithelial cells / 中华围产医学杂志

ObjectiveTo investigate the effects of vascular endothelial growth factor (VEGF) and dexamethasone on mRNA expressions of surfactant protein B (SP-B) and transforming growth factor-β1 (TGF-β1) of type Ⅱ alveolar epithelial cell (AECⅡ). MethodsAECⅡ were isolated and purified from fetal rat lung tissues,then cultured with different dose of VEGF (25,50 and 100 ng/ml) and dexamethasone (25,50,100 and 200 nmol/ml).The mRNA levels of SP-B and TGF-β1 were detected by real-time quantitative polymerase chain reaction (RT-PCR) and expression of TGF-β1 protein was detected by immunocytochemistry.ANOVAor q-test wasappliedtocompare the difference among groups.ResultsCompared with control group,SP-B mRNA levels in 25 ng/ml VEGF group and 25,50,100 and 200 nmol/ml dexamethasone groups were higher (13.500±3.172,3.547±0.690,5.219±0.782,3.493±0.335,and 3.981 ± 1.133 vs 1.001 ± 0.059,q=-5.286,-4.943,- 7.228,- 9.906 and - 3.525 respectively,P＜0.05) ; TGF-β1 mRNA expression of 25 ng/ml VEGF group,50,100 and 200 nmol/ml dexamethasone group was lower (0.451 ± 0.078,0.579±0.019,0.422 ± 0.020 and 0.769 ± 0.025 vs 1.019±0.226,q=4.110,3.356,4.551 and 1.901 respectively,P＜0.05) ; other groups had no significant differences compared with control group (P＞0.05).Immunocytochemistry showed that the positive rate of TGF-β1 expression in 25 ng/ml VEGF,50,100 and 200 nmol/ml dexamethasone group was 23％,26％,22％ and 29％,respectively,while in the control group,the expression of TGF-β1 was positive in most of the AECⅡ (80％).ConclusionsBoth VEGF and dexamethasone could increase the expression of SP-B at mRNA level at appropriate concentrations.At the same time,the expression of TGF-β1 is inhibited.It is suggested that both VEGF and dexamethasone might increase the mRNA expression of SP-B by inhibiting the expression of TGF-β1.

Evaluation on clinical application of three testing methods for human cytomegalovirus infection in pregnancy / 华中科技大学学报（医学）（英德文版）

The value of ELISA, N-PCR and RT-PCR in clinical practice for pregnant women with HCMV infection was investigated. 5581 pregnant women were screened by ELISA. Among them, 100 cases were positive for IgM (group 1), 69 for both IgM and serous DNA (group 2) and 69 for both IgM and mRNA (group 3). The infectious status, maternal-fetal transmission and pregnancy outcome were monitored. It was demonstrated that the accordance rate of group 3 and group 2 with group 1 was 56.25% and 43.75%, respectively. The maternal-fetal transmission rate in the group 1, 2 and 3 was 19.00%, 40.58% and 46.15%, respectively, with a significant difference found between group 2, 3 and group 1 (P < 0.01). Incidence of spontaneous abortion, fetal death, fetal abnormality and neonatal death in group 1, 2 and 3 was 10.00%, 15.94% and 30.77%, respectively, and that of group 3, 2 was 4 and 2 times as much as that of group 1, respectively (OR = 4.00, P < 0.001; OR = 2.343, P < 005, respectively). It was concluded that HCMV-IgM(+) can only be considered as an screening indicator for pregnant women with HCMV infection, while IgM(+) combined with serous DNA(+) or mRNA(+) indicates active infection and has a high incidence of maternal-fetal transmission and abnormal pregnancy outcome.

Evaluation on Clinical Application of Three Testing Methods for Human Cytomegalovirus Infection in Pregnancy / 中华围产医学杂志

Objective To evaluate the testing value of ELISA, N-PCR and RT-PCR in clinical practice for pregnant women with HCMV infection. Methods 5581 pregnant women were screened by ELISA. 100 cases with positive IgM (group 1), 69 positive IgM combined with positive serous DNA (group 2) and 69 with positive mRNA (group 3) were studied on maternal-fetal transmission and pregnancy outcome. Results The accordance rate of group 3 and group 2 with group 1 are 56.25% and 43.75%, respectively. The maternal-fetal transmission rate in three groups is 19.00%,40.58% and 46.15%, respectively. A significant difference existed between group 2, 3 and group 1(P0.05). The total rate of spontaneous abortion, fetal death, fetal abnormality and neonatal death are 10.00%,15.94% and 30.77% in different groups, respectively and that of group 3, 2 are 4 and 2 times as much as that of group 1, respectively (OR=4.00, P