Objective To evaluate factors associated with labor pain and delivery outcomes.Methods From Jul.to Dec.2009,111 normal singleton cephalic presentation pregnancies (including 5 elderly parturient) who delivered at the Department of Obstetrics and Gynecology,Second Affiliated Hospital,Zhejiang Chinese Medical University were enrolled in this study to evaluate the relationship between factors of labor pain and delivery outcomes.The labor pain of latent phase and active phase were scored by the visual analogue scale (VAS).Factors associated with pain included the age of parturient,the number of gravidity and parity,occupation,education profile,dwell location,etc.The questionnaire was designed by ourselves.Childbirth awareness,psychological preparation of delivery,emotional controllability,couple relationship,the relationship of parturient and mother-in-law,the relationship of parturient and parents,family economic status,use of sedative during the labor process and delivery outcomes were collected and analyzed.Results (1)Factors associated with pain:in the latent phase,the rate of moderate labour pain of 1/5 in women with more than 35 years old was statistically lower than 76.4％ ( 81/106 ) in suitable age group (P＜0.05 ).The women with a good understanding about delivery had a statistically lower rate of moderate pain of 64.7％( 44/68 ) than 88.4％ ( 38/43 ) of those having a poor understanding( P＜0.05 ).The women who had a better couple relationship had a significandy higher rate of moderate pain of 77.2％ (78/101) than 4/10 of those who had a general couple relationship ( P＜0.05 ).There was significant difference in rate of moderate pain between pluripara group ( 50.0％,11/22) and primipara group(79.8％,71/89;P＜0.01 ).In the active phase,women with tense,scared or a poor emotion control expressed significantly severe labour pain(59.0％,36/61 ) than 35.6％ ( 16/45 ) in well-prepared group.The rate of severe labour pain in good control of emotion group of 44.8％ (43/96) was a statistically lower than 9/10 in poor control group.There was a statistically lower severe labour pain in women given by sedatives ( 29.2％,7/24 ) than 54.9％ (45/82) in women without sedatives treatment (P ＜ 0.05).(2) Delivery outcomes:in latent phase,the rates of fetal distress and cesarean section were 36.6％ (30/82) and 39.0％ (32/82) in moderate pain group,which were significantly higher than 13.8％ (4/29) and 17.2％ (5/29) in mild pain group.In active phase,the rate of fetal distress,cesarean section and postpartum hemorrhage were 36.5％ ( 19/52),40.4％ (21/52) and 13.5％ (7/52) in severe pain group,which were significantly higher than [18.5％ (10/54) ;20.4％ (11/54) ;0] in moderate pain group (P＜0.05).Conclusions Women with poor understanding of delivery,tense,scared,poor emotion control,young age and uniparous have severe labour pain.Sedative use could alleviate pain in active phase.Women with mild labour pain have good delivery outcomes.

Objective To analyze the cause and clinical characteristics of maternal cardiac arrest.Methods The data of all cases of maternal cardiac arrest from January 2005 to December 2009 in Third Affiliated Hospital of Guangzhou Medical College was retrospectively studied.Results ( 1 ) A total of 41 maternal cardiac arrests (6 in prenatal period,2 in the first stage of labor,7 in the third stage of labor,26 in postpartum period ) were included.All patients regained spontaneous circulation after basic life support.Twelve (29％) mothers survived.Twelve cardiac arrests occurred in the hospital,and the totaldelivery number from January 2005 to December 2009 was 17101,with occurrence rate of 1:1425.(2) Thecauses of arrest were hemorrhagic shock (12,29％),amniotic fluid embolism (7,17％),severepreeclampsia/eclampsia (7,17％),septic shock (6,15％),cardiac disease (2,5％),unidentified cause (2,5％ ) and other occasional causes.(3) Thirty-seven (90％) in-hospital maternal cardiac arrest occurred in operation room (16,39％ ),ICU (7,17％ ),maternity wards (6,15％ ),delivery room (5,12％ ) and the emergency room (3,7％ ).Three (7％) arrest occurred out of hospital and one in the ambulance.Matemal survival rate was 2/3 in the emergency room,8/16 in the operation room,1/5 in the maternity wards,and 1/6 in the delivery room.No mother survived in ICU,ambulance or out of hospital.(4) Five of the 12 survived women showed ischemic encephalopathy after cardiac arrest and one of them developed cerebral infarction in the right corona radiate.(5) In 4 of the 8 cases of cardiac arrest in pregnancy,perimortem caesarean section (PMCS) was performed.In the four PMCS,2 mothers and 2 children survived.In the 4 cases that PMCS was not carried out,no infant survived.Conclusions Hemorrhagic shock,severe preeclampsia and eclampsia,amniotic fluid embolism are the major obstetric causes of maternal cardiac arrest.Septic shock and cardiac diseases are the major non-obstetric causes.Cardiac arrests occurred in emergency room and operation room has a higher maternal survival rate than those occurred in the delivery room and maternity wards.Timely PMCS may ensure the optimal outcome for mothers and fetuses.

Objective To establish the methods of isolating and culturing human ovarian endometriosis-derived microvascular endothelial cells (OEMEC).Methods The tissues of human endometriotic cyst of ovary were finely minced with scissors,then digested by collagenase Ⅰ,Ⅱ and trypsinethylene diamine tetraacetic acid (EDTA).The cells were purified by using centrifugation of 2000 r/min speed.OEMEC were identified by light microscope and transmission electron microscope observing CD34,FⅧ-Rag and Weibel-Palade in microvascular endothelial cells.Results The OEMEC grew as confluent monolayer like cobblestones under light microscope.CD34 and FⅧ-Rag were expressed strongly,and the percentages of CD34 and FⅧ-Rag positive cells were 91.4％ and 92.5％.Weibel-Palade bodies could be observed under transmission electron microscope.The time of cell doubling proliferation was 4.5 days.Conclusion The established system of isolating OEMEC would provide lab base for studying the mechanisms of angiogenesis in endometriosis lesions.

Objective To investigate the role of the Wnt/LRPS/3-catenin signaling pathway in the pathogenesis of postmenopausal osteoporosis.Methods Fifty female Wistar rats aged 6-month-old,were randomly divided into control group ( NS,n =24 ) and ovariectomized group ( NOVX,n =26),NOVX underwent bilateral ovariectomy.At 0,4 and 8 weeks,all of rats were measured blood estrogen ( E2 ) and bone mineral density (BMD),4 and 8 weeks,low density lipoprotein receptor-related protein 5 (LRP5),3-catenin and Runx2 mRNA in bone were measured respectively by reverse transcription (RT)-PCR.Results In 4 and 8 weeks,compared with NS which had (117±29) and (114+15) pmol/L in E2 level,(0.098 ± 0.016 ) and (0.095 ± 0.028 ) g/cm2 in BMD,NOVX had significantly decreased to ( 92±15 ) and(95±22) pmol/L in E2 level ( P＜0.05 ),( 0.076 ± 0.016) and ( 0.052 ± 0.013 ) g/cm2 in BMD values ( P ＜ 0.01 ).And bone tissue LRP5,β-catenin and Runx2 mRNA expression was 1.02 ± 0.06,1.04 ±0.05,1.07 ±0.21 in NS,NOVX was significantly reduced to 0.97 ± 0.04,0.58 ± 0.05,0.86 ±0.03 (P＜0.05).Conclusion Wnt/LRP5/β-catenin signaling pathway may be important in the pathogenesis of postmenopausal osteoporosis.

Objective To investigate the association between the functional polymorphisms of Foxp3 gene and unexplained recurrent spontaneous abortion (URSA).Methods PCR-restriction fragment length polymorphism (rs3761548,rs2294021 ) and PCR with sequence-specific primers (rs2232365,rs5902434) were used to detect four polymorphisms of Foxp3 in 146 URSA cases and 112 normal controls.Results ( 1 ) The frequencies of rs3761548A/C were 10.3％,22.3％ in genotype C/C,38.4％,40.2％ in genotype A/C and 51.4％,37.5％ in genotype A/A between URSA patients and normal controls; the frequencies of rs2232365A/G were 5.5％,15.2％ in genotype A/A,47.9％,50.0％ in genotype A/G,46.6％,34.8％ in genotype G/G between URSA patients and normal controls; they all reached statistical difference ( P＜0.05 ).The carriers of rs3761548A allele and rs2232365G allele increased the risk of URSA (OR=1.73,1.61 ; all P ＜ 0.05 ).(2) There was no difference in the genotypic distribution of rs5902434del/ArTTpolymorphism between cases and controls ( P =0.10),but the frequency of del allele in URSA was statistically increased than that of controls (71.2％,62.5％ ; OR =1.49,P =0.04 ).(3) There was no different distribution in 3 genotypes (C/C,T/C,T/T) and 2 alleles (T and C) of rs2294021T/C between URSA patients and normal controls (P =0.18 and 0.08 ).(4) Estimated haplotype frequency distribution of rs5902434del/ATT,rs3761548A/C and rs22323565A/G showed haplotype del-A-G conferring the susceptibility to URSA ( OR =2.51,P ＜ 0.01 ) but haplotype del-C-G and ATT-A-A could provide protection on URSA ( OR =0.18,0.22 ; all P ＜ 0.01 ).Conclusion Functional polymorphisms of Foxp3 gene could probably confer the susceptibility to URSA,by altering Foxp3 function and (or) its expression.

Objectives To detect the expression of human leukocyte antigen-G (HLA-G) in tissues from pregnant women with preeclampsia and discuss the relationship between HLA-G and preeclampsia.Methods Pregnant women with preeclampsia in Maternal and Child Health Hospital of Shaanxi Province from March 2009 to December 2009 were included.Eight were included into mild preeclampsia groups and 22 were included into severe preeclampsia group.And 30 age-matched normal pregnancies were referred as the control group.All women in the three groups received cesarean section.The soluble HLA-G (sHLA-G)levels in peripheral blood,umbilical blood and amniotic fluid were examined by ELISA ; the expressions of HLA-G protein in placenta,fetal membrane and umbilical cord were examined by western blot.Results ( 1 ) The sHLA-G levels in peripheral blood,umbilical blood and amniotic fluid in each group.The sHLA-G levels in peripheral blood in mild and severe preeclampsia group were (50 + 14) and (30+6) μg/L respectively,and the sHLA-G levels in umbilical blood were (34 ± 10) and (26 ±8)μg/L respectively.All were significantly lower than those in the control group ( P ＜ 0.01 ),which were (100 ± 16) and (70±9) μg/L respectively.There was also statistical difference between mild and severe preeclampsia group (P ＜0.01 ).Although the sHLA-G level in umbilical blood of severe preeclampsia group was lower than that in mild preeclampsia group,there was no statistical difference ( P＞0.05 ).The sHLA-G levels in amniotic fluid in mild and severe preeclampsia groups were (26±7 ) and (25 ± 5 ) μg/L respectively,which were lower than that in the control group (27±6) μg/L,but the differences were not significant ( P＞0.05 ).There was no statistical difference between mild and severe preeclampsia groups ( P＞0.05 ).(2) The expression levels of HLA-G protein in placenta,fetal membrane and umbilical cord in each group.The expression levels of HLA-G in placenta and fetal membrane in the control group were 1.59 ± 0.36 and 0.42 ± 0.09 respectively.The expression of HLA-G in placenta was significantly higher than that in fetal membrane ( P＜0.05 ).The expression level of HLA-G in umbilical cord in the control group was 0.24±0.17,statistically different from those in placenta and fetal membrane,respectively (P＜0.01 ).The expression levels of HLA-G in placenta in mild and severe preeclampsia groups were 0.78 + 0.21 and 0.29 ± 0.17 respectively,significantly different from the control group ( P ＜ 0.01 ).There was no expression of HLA-G in fetal membrane and umbilical cord in mild and severe preeclampsia groups.Conclusions The expressions of HLA-G in the peripheral blood,umbilical blood and placenta in women with preeclampsia are significantly lower than those in normal pregnant women.The abnormal expression of HLA-G might be associated with the pathogenesis of preeclampsia.

Objective To study the value of cervical length(CL) by transvaginal sonography in the mid-trimester and late-trimester for the prediction of preterm delivery.Methods The CL was measured by transvaginal sonography for 5277 pregnant women between 22-24 weeks and 28-32 weeks gestation,who were prenatal cared and delivered at the First Hospital of Peking University from June 2008 to November 2009.The pregnancy outcomes were followed,and the relationship between CL and preterm delivery and preterm premature rupture of membrane was studied.Results ( 1 ) The incidence of preterm delivery was 5.4％ (289/5370) total,among of them the incidence of therapeutic preterm delivery was 1.7％ (93/5370),spontaneously preterm delivery was 1.2％ (62/5370),and preterm premature rupture of membrane was 2.5 ％ (134/5370).There are 4 cases (4/5370) who occured late abortion.(2) Excluding the 93 women who had therapeutic preterm delivery,the mean CL of 22-24 weeks was ( 38.8±4.0) mm.The relative risk for preterm delivery when the CL＜30 mm was 5.2,when CL＜25 mm,the relative risk was 11.1,and when CL ＜15 mm the relative risk for preterm delivery was 13.8.The average CL during 28-32 weeks of gestation was ( 34.6±4.8) mm,was significantly shorter than that of 22-24 weeks ( P＜0.05 ).During this period the relative risk for preterm delivery when the CL＜30 mm was 6.9,when CL＜25 mm,the relative risk was 11.1,and when CL＜15 mm the relative risk for preterm delivery was 20.0.(3) A CL＜30 mm as the cutoff value for predicting preterm delivery during 22-24 weeks of gestation has only a 3％ sensitivity and 19％ positive predictive value,but had a 99％ specificity and 96％ negative predictive value.The sensitivity,positive predictive value,specificity and negative predictive value for a CL ＜ 30 mm as the cut-off value for predicting preterm delivery during 28-32 weeks of gestation was 33％,21％,95 ％ and 97 ％ respectively.(4) The total number of preterm premature rupture of membrane pregnant women was 134 (2.5％ ),who had a mean CL of (38.4 ±4.7) mm during 22-24 weeks of gestation,was similar with the women without preterm premature rupture of membrane ( PPROM),but during 28-32 weeks of gestation the women who occured PPROM had a mean cervical length of ( 30.6 ± 8.1 ) mm,and was significantly shorter than that of women without PPROM ( 34.7 + 4.6 ) mm.Conclusions ( 1 ) CL in 28-32 weeks of gestation issignificantly shorter than that of in the mid-gestation,but more than 90％ of women has a CL≥30 mm.(2)The shorter the CL is,the greater the relative risk of preterm delivery.According to different CL for clinical consulting objective relative risk could be provide.(3) The CL during 28-32 weeks of gestation can also predict preterm delivery,the sensitivity is obviously better than that of 22-24 weeks of gestation.(4) The CL during 28-32 weeks of gestation is valuable for predicting of PPROM.

Objective To explore the relationship between tubal intraepithelial carcinoma (TIC) of the fimbria and pelvic high-grade serous carcinoma.Methods All 34 cases of pelvic high-grade serous carcinoma with clear fimbria were evaluated from January 2009 to June 2010,including ovarian carcinoma (n=26),tubal carcinoma (n=7) and peritoneal carcinoma (n=1).Among of these ovarian carcinomas,12 cases were surface deposits and the other 14 cases within ovarian parenchyma.All 42 cases of non highgrade serous carcinoma in this period including 13 endometrioid ovary carcinomas,11 clear cell ovary carcinomas,11 mucinous ovary carcinomas,6 low-grade serous ovary carcinomas,1 low-grade serous tubal carcinoma,were also collected as a reference.The presence of tubal intraepithelial carcinomas was assessed.Based on the presence of TIC,high-grade serous ovary carcinomas were divided into TIC positive (+) and TIC negative (-) groups,and the clinical and pathological features of them were also evaluated.Results Fifteen cases (44％) were identified TIC in 34 high-grade pelvic serous carcinomas,and all of them were in the fimbria only,while none of TIC was found in control cases.There were significant difference between the two groups (x2=23.086,P=0.000).Eleven cases(42％) were identified TIC in all 26 high-grade ovarian serous carcinomas,in which 8 cases with unilateral ovary carcinomas were associated with ipsilateral TIC,2 cases with bilateral ovary carcinomas associated with unilateral TIC and one case with bilateral ovary carcinoma was associated with bilateral TIC.Four TIC (4/7) were identified in 7 cases with high-grade tubal serous carcinomas,and there was no presence of TIC in the 1 high-grade serous peritoneal carcinoma.Of all 26 high-grade ovarian serous carcinomas,6/11 cases were surface deposits,and 5/11 were parenchyma tumors in TIC (+) group while 6/15 cases were surface deposits and 9/15 were parenchyma tumors in TIC (-) group,in which there were correlated in distribution of TIC between the two groups( P＞0.05 ).The average diameter of ovarian cancer were 6.9 and 6.5 cm between the two groups with no significant differences ( t=0.409,P=0.690).Conclusion TIC is specific to high-grade serous carcinomas and maybe have something to do with the pathogenesis of pelvic serous carcinomas.

Objective To investigate clinicopathological characteristics of recurrent endometriosis and outcomes of secondary surgery.Methods From Jan.2003 to Dec.2008,69 cases with recurrent endometriosis operated by the same senior gynecologist in Peking Union Medical College Hospital were studied retrospectively in order to summarize clinicopathological characteristics and clinical outcomes.In prior surgery,both ovaries were involved in 29 cases (42％,29/69),and unilateral ovarian endometriomas were found in 40 cases ( 58％,40/69),including 19 cases (48％,19/40) with left lesions and 21 cases (52％,21/40) with right lesions.After first surgery,57 cases presented recurrent pelvic cystic masses and 12 cases presented moderate to severe pain without pelvic mass.Results The median recurrence interval was 38 ( 1 - 144) months.Among 57 cases with recurrent pelvic masses,bilateral ovarian endometiomas recurred in 24 cases at median recurrence interval of 31 months.Unilateral ovarian endometrioma recurred in 33 cases at recurrence interval of 39 months.There was no significant different recurrence period between blilateral and unilateral recurrent ovarian mass ( P =0.452).The recurrent rate of left and right side ovarian lesion was 77％ (37/48) and 68％ (34/50 cases),respectively,which did not reach statistical difference (P=0.396).Among 12 recurrent cases with pure pelvic pain,10 cases were founded combined with adenomyosis ( AM),of which 4 cases had deep infiltrated endometriosis (DIE).Compared with the 40 cases of simple ovarian endometriomas,29 cases complicated by DIE and (or) AM had longer operation time (75.1 min vs.49.9 min,P=0.017) and more blood loss (114.9 ml vs.38.4 ml,P＜0.05).In those 69 recurrent endometriosis patients,the median period of following-up was 32 months (3 months to 8 years).Six cases showed recurrent disease again at median recurrence interval of 3 years ( 6 months 6 years).Thirty-eight cases had expecting childbearing,however,only 4 women underwent childbirth.Conclusions The rate of clinical diagnosis of recurrent endometriosis is quite high.Pain is mostly associated with AM.The major difficulty and challenge of secondary surgery was ovarian endometrioma combined with DIE or AM.Prognosis of recurrent endometriosis is not optimistic after secondary surgery.

ObjectiveTo investigate the expression of G protein-coupled ER (GPER) and ER in the activation of phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt) induced by 17β-estradiol (17β-E2 )in endometrial carcinoma cells,Ishikawa and HEC-1A.Methods Expressions of GPER,Erα and Erβ protein in Ishikawa and HEC-1A cells were detected by immunohistochemical SP method.Levels of GPER,Erα and Erβ were examined by western blot in Ishikawa and HEC-1A cells after treated with 1 ×10-6 mol/L 17β-E2 at different time (0,15,30,60,120 minutes).ResultsGPER was positive expressed in Ishikawa and HEC-1A cells.Erα and Erβ were both positive expressed in Ishikawa cells.While,Erα was weakly expressed and Erβ was almost negatively expressed in HEC-1A cells.Western blot analysis showed that 1× 10-6 mol/L 17β-E2 treatment,the Ishikawa and HEC-1A cells GPER protein level for 15 minutes markedly increased (P ＜ 0.05 ),which Ishikawa 30 minutes,when cells reached the highest level (0.192 ± 0.004),HEC-1A cells for 15 minutes and reached the highest level (0.184 ±0.006) ; Ishikawa and HEC-1A cells,Akt,activation of 15 minutes from the treatment start was significantly increased (P ＜ 0.05 ),which Ishikawa cells for 30 minutes and reached the highest level (0.666 ± 0.021 ),HEC-1A cells for 15 minutes and reached maximum (0.788 ± 0.035); Ishikawa and HEC-1 A cells,Erα and Erβ protein expression did not change significantly ( P ＞ 0.05 ).Conclusion GPER likely involved in non-nuclear activation of PI3K/Akt signaling pathways in endometrial carcinoma cells,Ishikawa and HEC-1A.