[Risk factors of adverse pregnancy outcomes during expectant management of early onset severe pre-eclampsia].

OBJECTIVE: To identify the risk factors of adverse pregnancy outcomes in expectant management of pregnant women with early onset severe pre-eclampsia (EOSP). METHODS: Totally, 136 gravidas, who were diagnosed as ESOP and received expectant management from January 2007 to June 2008 in Beijing Obstetrics and Gynecology Hospital, were selected and divided into two groups: the favorable pregnancy outcome group (control, n = 101) and the adverse pregnancy outcome group (n = 35). The general clinical information, pregnancy outcomes, routine urine test, hemodynamic data, routine blood test, liver and renal function test on admission were collected and the risk factors for adverse outcomes were retrospectively analyzed. RESULTS: (1) General clinical information: more women complained of preeclamptic symptoms on admission in the adverse outcome group than in the control group (35.6% vs. 57.1%, P < 0.05). No significant differences was found between the two groups in the maternal age, times of previous pregnancies, prevalence of concurrent complications, pre-pregnant body mass index (BMI), proportion of women who had regular antenatal checks (P > 0.05). (2) Pregnant outcomes: the average duration of expectant management in the control group were similar to the adverse outcomes group [(6.5 +/- 8.2) days vs. (6.8 +/- 10.0) days, P > 0.05]. The main complications in the adverse outcome group included placental abruption (n = 13), heart failure and pulmonary edema (n = 10), hemolysis, elevated liver enzymes and low platelet syndrome (HELLP syndrome, n = 5), and no eclampsia was reported. However, none of these complications was reported from the control group. (3) Blood pressure and proteinuria: the gestation ages at the onset of EOSP and at delivery in the control group were earlier than those of the adverse outcome group [(31.3 +/- 3.4) weeks vs. (33.0 +/- 4.9) weeks, (32.1 +/- 3.0) weeks vs. (34.0 +/- 3.6) weeks, P < 0.05], the systolic blood pressure and urinary protein and the proportion of women with urinary protein of (+++) were also much higher in the adverse outcome group (all P < 0.05). (4) Hemodynamics and routine blood tests: the blood viscosity in the control group was obviously lower than that of the adverse outcome group (P < 0.05). But there was no significant difference in the cardiac output, cardiac index, peripheral resistance and vascular compliance between the two groups (P > 0.05). The adverse outcome group showed lower platelet (PLT) level and higher red blood cell (RBC) count and hematocrit compared with those of the control (all P < 0.01). (5) Liver and renal function: the alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), blood urea nitrogen (BUN) in the adverse outcome group were significantly higher than those of the control group (all P < 0.05), but the plasma level of total protein (TP), albumin (Alb), uric acid (UA) and creatinine (Cr) were similar between the two groups (P > 0.05). (6) Risk factor analysis: RBC count (OR = 3.68, 95%CI: 1.90-7.13), PLT count (OR = 0.99, 95%CI: 0.98-1.00) and the gestations at delivery (OR = 0.87, 95%CI: 0.80-0.94) were the risk factors of adverse pregnancy outcomes during the expectant management of EOSP. CONCLUSION: Elevated RBC count, reduced PLT count and earlier delivery weeks are the risk factors of adverse pregnancy outcomes during the expectant management of EOSP.

[Clinical study on prevention of postpartum hemorrhage of cesarean section using hemabat in high risk pregnant women].

OBJECTIVE: To observe the effect and safety of hemabat (H) on prevention of postpartum hemorrhage in cesarean section and after cesarean section in high risk pregnant women. METHODS: Four hundred and sixty-nine pregnant women with high hemorrhagic risk factors including twin pregnancy, polyhydramnios, fetal macrosomia, placenta previa were planned cesarean section. A total of 457 pregnant women were divided into 3 groups by operation indications. There were 239 cases of fetal macrosomia, 145 cases of twin pregnancy and polyhydramnios, and 73 cases of placenta previa. Three kinds of hysterotonics were used randomly in each group. Group oxytocin (O): 20 U oxytocin injected into the uterine plus 20 U oxytocin intravascularly, 152 women; Group oxytocin + hemabate (O + H): 20 U oxytocin and 250 microg hemabat injected into the uterine, 192 women; group H: 250 microg hemabat, injected into the uterine, 125 women. The amount of bleeding during the operation and within 2-hour after delivery were measured. The side effect of each group was observed. RESULTS: The amount of bleeding during cesarean section in group O was (445 +/- 262) ml, in group O + H (332 +/- 218) ml, and in group H (375 +/- 265) ml. There was an extremely significant difference between group O and group O + H (P < 0.01). The amount of bleeding within 2 hours after delivery in group O was (176 +/- 193) ml, in group O + H was (110 +/- 114) ml, and in group H was (124 +/- 103) ml. There was a significant difference between groups O, O + H and H. Among the 469 women, 31 had total amount of bleeding more than 1000 ml during operation and within 2 hours after delivery. 48% (15 women) were in group O, 23% in group O + H and 29% in group H. The total amount of bleeding in group O was much more than group O + H and group H in the group of fetal macrosomia (P < 0.01, P < 0.01). Similar results were found in the group of twin pregnancy and polyhydramnios (P < 0.01, P < 0.01). The total amount bleeding in group O + H was much less than group O in the group of placenta previa (P < 0.05). There were 5% (12) pregnant women whose total amount of bleeding was >/= 1000 ml in the group of fetal macrosomia, 8% (11) in the group of twin pregnancy, 11% (8) in the group of placenta previa. No hysterectomy was done among the women. The incidence of side effects in the three groups was 2.6%, 11.5% and 7.0% respectively. Vomiting was frequently seen in the latter two groups, but recovered soon without treatment. CONCLUSION: Hemabat can significantly reduce the amount of bleeding during the cesarean section in pregnant women with high hemorrhagic risk factors and can be used with oxytocin as firstline medicine to prevent hemorrhage during and after delivery.

[Correlation between amniotic fluid glucose concentration and amniotic fluid volume and neonatal birth weight in pregnancy complicated by gestational diabetes mellitus].

OBJECTIVE: To investigate the relationship between amniotic fluid glucose concentration, amniotic fluid volume and neonatal birth weight in gestational diabetes mellitus (GDM). METHODS: Two hundred and fifty-five singleton, normal term pregnant women were divided into three groups: GDM, gestational impaired glucose tolerance (GIGT) and normal pregnancy according to the results of a 50 g, 1 hour glucose challenge test (GCT) or of a 75 g oral glucose tolerance test (OGTT). There were 85 study subjects in each group. All women had GCT at 24 - 28 gestational weeks. When they had a positive GCT, in which glucose level was > or = 7.8 mmol/L, and < 10.6 mmol/L at 1 hour after oral 50 g glucose, they were required to have a 75 g OGTT. Amniotic fluid glucose concentration (AFG), amniotic fluid index (AFI), neonatal birth weight (NBW), maternal fasting glucose level (MFG) and umbilical venous glucose level (UvG) were compared in three groups. Statistical analysis of linear regression was done on these indices. RESULTS: (1) The mean AFG in group GDM was (1.30 +/- 0.71) mmol/L, which was significantly greater than that in group GIGT, (1.02 +/- 0.57) mmol/L and that in normal group, (0.90 +/- 0.58) mmol/L. There were significant differences among three groups (P < 0.01). (2) In group GDM, the mean AFI was (16.1 +/- 4.6) cm, which was slightly greater than that in group GIGT, (14.8 +/- 4.3) cm (P > 0.05), but was significantly higher than that in normal group, (12.7 +/- 3.2) cm (P < 0.01). (3) The NBW of group GDM was (3612 +/- 510) g, which was lower than that of group GIGT, (3694 +/- 490) g, and higher than that of normal group, (3487 +/- 458) g, but there were no significant differences among three groups (P > 0.05). (4) Among women with GDM, AFG was significantly correlated with AFI (r = 0.330, P = 0.002), NBW (r = 0.347, P = 0.001), MFG (r = 0.589, P < 0.01), and with UvG (r = 0.218, P = 0.045). But in group GIGT and normal group, AFG was only correlated with AFI. (5) In GDM group, the AFG, (1.02 +/- 0.50) mmol/L; AFI, (13.9 +/- 4.2) cm; and NBW, (3497 +/- 475) g in women who had ideal blood glucose level were significantly lower than that in women whose blood glucose levels were not well-controlled [AFG, (1.92 +/- 0.76) mmol/L, AFI, (16.4 +/- 4.4) cm, NBW, (3869 +/- 481) g (P < 0.01, P < 0.05, P < 0.01)], and the mean values of these three indices were close to those of the control group. CONCLUSION: In the cohort with GDM, there were correlations between AFG, AFI, and NBW. The results show that an active management could significantly improve the prognoses of the diabetes mothers and their fetuses.

[Study of the causes of fetal growth restriction with unclear etiologies].

OBJECTIVE: To investigate different factors related to fetal growth restriction (FGR) and to find out the possible causes of FGR with unclear etiologies. METHODS: Sixty-three women who were suspected of FGR during pregnancy between March 2002 and March 2003 were included in this study. Their age, body mass index (BMI) before pregnancy, and gestational weeks were recorded at the time when they were first diagnosed. Haemoglobin levels, haematocrit (HCT), TORCH, anticardiolipin antibody (ACA), 50 gram glucose challenge test (50g GCT), 75 gram oral glucose tolerance test (75g OGTT), leptin levels, systolic/diastolic (S/D) ratio by color doppler monitor and chlamydia trachomatis (CT) were detected and urine culture was done in these groups during the same period. The gestational week, birth weight, body length and the gender were recorded at the delivery period. The FGR group was then divided into two subgroups according to the birth weights: study A group whose birth weights were lower than 10th% of the birth weights at the given gestational weeks (29 cases) and study B group whose birth weights were beyond 10th% (34 cases). The chromosome, leptin, C-peptide, insulin and TORCH of umbilical blood were measured at delivery. The other 25 normal pregnant women were included as control and the same tests were performed accordingly. RESULTS: The fasting glucose and the third hour's glucose of 75 gram oral glucose tolerance test of study A were (3.8 +/- 0.6) mmol/L and (4.5 +/- 1.1) mmol/L. The fetal leptin, C-peptide, and insulin were (7.3 +/- 5.2) ng/ml, (0.5 +/- 0.3) nmol/L and (2.3 +/- 1.3) mU/L. The S/D ratio of umbilical artery, maternal and fetal infection rate of CMV, positive rate of ACA-IgM and the rate of asymptomatic bacteriuria were 3.06, 20.7%, 24.1%, 44.8% and 62.1% respectively. The fasting glucose and the third hour's glucose of 75 gram oral glucose tolerance test of study B were (4.4 +/- 0.7) mmol/L and (4.6 +/- 1.1) mmol/L. The fetal leptin, C-peptide, and insulin were (13.2 +/- 11.3) ng/ml, (0.7 +/- 0.4) nmol/L and (4.3 +/- 3.3) mU/L. The S/D ratio of umbilical artery, maternal and fetal infection rate of CMV, positive rate of ACA-IgM and the rate of asymptomatic bacteriuria were 2.63, 2.9%, 0%, 5.9% and 44.1% respectively. The fasting glucose and the third hour's glucose of 75 gram oral glucose tolerance test in control were (4.3 +/- 0.7) mmol/L and (5.3 +/- 1.2) mmol/L. The fetal leptin, C-peptide, and insulin were (20.5 +/- 12.0) ng/ml, (1.0 +/- 0.4) nmol/L and (6.3 +/- 4.0) mU/L. The S/D ratio of umbilical artery, maternal and fetal infection rate of CMV, positive rate of ACA-IgM and the rate of the asymptomatic bacteriuria were 2.80, 0, 0, 0 and 24.0% respectively. All these items were significantly higher in study A than those in the control (P < 0.05). There was no significant difference between the study B and the control in all the items. CONCLUSIONS: Many factors may play a role in the pathogenesis of FGR, including the maternal blood glucose level, the ability for fetus to use the glucose, the infection of some microorganisms, insufficiency of the blood supply and the autoimmunity of the mother. Finding out the possible causes of FGR and managing them accordingly may improve the outcomes of the fetus.

Clinical observation of blood loss reduced by tranexamic acid during and after caesarian section: a multi-center, randomized trial.

OBJECTIVES: To explore the efficacy and safety of tranexamic acid at caesarian section (CS). STUDY DESIGN: Prospective, randomized, case-controlled clinical trial. POPULATION: One hundred and eighty primiparas were randomized into two groups. The study group, 91 women, received tranexamic acid immediately before CS whereas the control group, 89 women did not. METHOD: Blood was collected during two periods. The first period was from placental delivery to the end of CS and the second was from the end of CS to 2 h postpartum. The quantity of blood was measured and compared between the two groups. Complete blood count, urinalysis, liver and renal function, prothrombin time and activity, were tested in the two groups. RESULTS: Tranexamic acid significantly reduced the quantity of blood from the end of CS to 2 h postpartum: 42.75 +/- 40.45 ml in the study group versus 73.98 +/- 77.09 ml in the control group (P=0.001). It also significantly reduced the quantity of total blood from placental delivery to 2 h postpartum: 351.57 +/- 148.20 ml in the study group, 439.36 +/- 191.48 ml in the control group (P=0.002). No complications or side effects were reported in either group. CONCLUSIONS: Tranexamic acid statistically reduces the extent of bleeding from placental delivery to 2 h postpartum and its use was not associated with any side effects or complications. Thus, tranexamic acid can be used safely and effectively to reduce bleeding resulting from CS.

[Clinical evaluation of propess for induction of term pregnancy].

OBJECTIVE: To explore the efficacy and safety of continuously released prostaglandin E(2) (PGE(2)) suppository-propess used for induction of term pregnancy. METHODS: A multicenter, prospective, case control clinical study was carried out, propess was used in 100 cases as study group, the suppository without PGE(2) was used in 49 cases as control group. The cervical maturity (by Bishop scoring), the time to labor starting, membrane rupture and delivery, the application of oxytocin, ceserean section rate, fetal and neonatal condition were compared between 2 groups after inserting of the suppository. At the same time, side effects caused by propess were investigated. RESULTS: Bishop score was increased >or= 2 points in 93% cases, >or= 3 points in 87% cases in study group, whereas only 4% cases whose Bishop score increased >or= 2 points in control group. The time to labor starting, membrane rupture, and delivery was shortened obviously in study group than that in control group after inserting suppository. The application of oxytocin was much less in study group, cesarean section rate was reduced in study group (32% vs 61%). There was no significant difference between 2 groups in fetal and neonatal conditions. The overstimulation of uterine contraction and mild gastrointestinal tract reaction occurred in 3 cases and 2 cases respectively in study groups. CONCLUSION: Propess can be used for induction of term pregnancy effectively and safely.

[Multicenter study on screen method for gestational diabetes].

OBJECTIVE: To investigate the feasibility of using random blood glucose to screen gestational diabetes mellitus (GDM). METHOD: The random blood glucose was determined in 1 038 pregnant women between 24 and 32 gestational weeks. Then 50 gram glucose challenge test (50 g GCT) was performed followed immediately. Finally, 75 gram oral glucose tolerance test (75 g OGTT) was done without dietary control for 3 days. If two values of four were abnormal, GDM was diagnosed. Impaired glucose tolerance (IGT) was diagnosed if only one value was abnormal or the 2nd hour value ranged from 120 to 164 mg/dl. RESULTS: (1) The determination of the three steps was completed in 948 cases. Among them, 42 cases (4.4%) were GDM, 372 cases (39.2%) were IGT and other 534 cases were normal. (2) In the normal group, the random blood glucose were different in fasting and postprandial times. No difference was found among blood glucose values determined of 50 g GCT at different times except that the value of 50 g GCT 1 hour postprandial was higher than the value at other times. There was no significant association between random blood glucose and 50 g GCT. (3) The sensitivity and specificity were 50.0% and 67.7%, when IGT was diagnosed using the cut point of 6.4 mmol/L (115 mg/dl) of random blood glucose, which was similar with 51.1% of sensitivity and 71.2% of specificity when using >or= 7.8 mmoL/L (140 mg/dl) as the cut point of 50 g GCT. If 6.4 mmol/L (115 mg/dl) was used as the cut point in GDM group the sensitivity would be 80.0%, which was much higher than that of IGT group and the specificity was 61.2%. In this study, if the value of >or= 8.3 mmoL/L (150 mg/dl) was used as the cut-point of 50 g GCT to screen the GDM, the sensitivity decreased only 2.0% while the specificity increased more than 10.0%. CONCLUSIONS: (1) The determination of random blood glucose to screen GDM couldn't replace the 50 g GCT, but it can be used as a complemental method and can be used repeatedly at any gestational age and convenience the pregnant women and the doctors. (2) The value of 8.3 mmol/L (150 mg/dl) was used as the cut-point of 50 g GCT, the specificity would be increased and the requirement for OGTT would be lowered markedly, which would reduce economic and psychological stress.

[Postpartum reclassification in women with gestational diabetes and analyzing the high risk factors associated with them].

OBJECTIVE: To follow up the 75 g oral glucose tolerance test (OGTT) in gestational diabetes mellitus (GDM) at 2 month after birth for reclassifying and analyzing the risk factors associated with the abnormal blood glucose level. METHODS: 294 cases of GDM underwent a 2 hours 75 g OGTT two months postpartum. According to the WHO diagnostic criteria, they were divided into three groups: (1) type 2 diabetic mellitus (DM), impaired glucose tolerance (IGT) and normal. The related factors during pregnancy were analysed. RESULTS: 160 cases (54.4%) were normal, 75 cases (25.5%) and 59 cases (20.1%) were IGT and DM respectively. (2) In the DM group, the gestational age at diagnosis was much earlier than those of the other two groups (P < 0.01), the glucose level of 50 gram glucose challenge test (GCT) and fasting blood glucose values in OGTT and the value of HbAlc at diagnosis were evidently higher than the other two groups (P < 0.01, P < 0.01, P < 0.01), the gestational age of use of insulin for treatment was earlier than normal group, the dosage used markedly greater than the other two groups, the fasting blood glucose and 2 hours postprandial glucose were significantly higher than other two groups (P < 0.01) within 7 days after birth. Maternal age, body weight and family history did not show difference in the three groups. CONCLUSION: Among the GDM, about 1/4 were IGT and 1/5 were type 2 DM. The DM group showed early diagnosis, high fasting blood glucose, high frequency to use insulin during pregnancy.