Objective To investigate the process of Stark cesarean section (CS) and analyze its key procedures and patients outcomes in order to understand its advantages and promote its standardization. Methods Elective Stark CS cases were divided into two groups according to time sequence and procedure difference. Group A refered to cases underwent modified approaches before standardization (n=362), and group B refered to cases afterward (n= 302). Duration of operation, time interval from incision to delivery, intraoperative hemorrhage, postoperative flatus time, postoperative morbidity, duration of retained urinary catheter, urinary tract irritation, wound infection, and abdominopelvie adhesion in the second operation were compared between the two groups. Results The average duration of the operations and time interval from incision to delivery in group B, which were (27.7± 10. 8) min and (4.92±1.21) min, respectively, were significantly shorter than those in group A, which were (35.6±15.2) min and (7.81±2. 79) min, respectively (P<0. 05). No significant differences was found with regard to average intraoperative hemorrhage between group A and B [(214.34±62. 1) ml vs (201.54-53.1) ml, P>0.05]. Postoperative flatus time in group B was significantly shorter than that in group A [(16.85±11.8) h vs (25.9±12. 7) h, P<0. 05]. Postoperative morbidity in group B was significantly lower than that in group A [1.3%(4/302) vs 4.7%(17/362), P<0.05]. The average duration of retained urinary catheter in group B was significantly shorter than that in group A [(15.6±5.3)h vs (26. 2±6.1)h, P<0. 05], and the urinary tract irritation rate in group B was also lower than that in group A [2. 5%(9/362) vs 0(0/302), P < 0. 05)], No incisional infection or delayed healing was found in either group. Rectus muscles, fascia and peritoneum adhesions were found in three cases with second surgery in group A and none in group B. No omentum, peritoneum and visceral peritoneum adhesion was found in either group. Conclusions Compared to the modified Stark operation, standardized procedure decreases operation associated complications and improves maternal outcomes. Therefore, standardized Stark CS should be promoted for better operative outcomes.

Objective To investigate bone nutritional status of neonates and their mothers as well as the correlation between them by estimating the concentrations of 25-(OH)D3, calcium and phosphorus in maternal blood and cord blood at birth, and by measuring the bone speed of sound (SOS) of neonates and their mothers with quantitative ultrasound within 3 days after birth. Methods The concentrations of 25-(OH)D3, calcium and phosphorus in the serum were estimated both from 32 pregnant women who had a term delivery and from the umbilical cord at birth. Within 3 days after delivery, the bone SOS values of the mothers measured from their radius and neonates from their tibia were estimated and the correlation between the mothers and their neonates was analyzed. Thirty-nine non-pregnant healthy women who at the same age as the pregnant women were selected as control group and had their bone SOS measured. The difference of bone SOS between pregnant and healthy non-pregnant women was compared. Results There was positive correlation between cord blood and maternal blood 25-(OH)D3 concentration [(14. 7±7. 8) nmol/L and (30. 3±10. 2) nmol/L, r= 0 . 680, P=0. 000]. The calcium and phosphorus concentration in cord blood [2.36±0. 28)mmol/L and (1.57±0.76) mmol/L] were significant higher than that in maternal blood E(2.09± 0. 17) mmol/L and (1.04±0. 28) mmol/L], but no correlation was found (r=0. 146, P=0. 467; r=0. 148, P=0. 445). No significant correlation was shown in the bone SOS between the infants and their mothers[(3054±76)m/s and (4170+241)m/s, r=0. 223, P=0. 220]. The concentration of 25-(OH)D3 in cord blood was closely correlated with the bone SOS of infants(r=0. 412, P=0. 026). The SOS of healthy women was obviously higher than that of pregnant women [(4258±100)m/s vs (41704±241)m/s, P=0. 043]. Conclusions There are close correlations between fetus and their mothers in vitamin D status and also between vitamin D status and fetus bone development. Some pregnant women may be short of vitamin D in autumn and winter in Shanghai and we should monitor the bone nutritional states for pregnant women.

Objective To explore the effects of low serum-albumin on maternal and neonatal outcomes in severe pre-eclampsia. Methods Two hundred and thirty-three women with severe preeclampsia admitted to our hospital from Jan. 2000 to Mar. 2006 were retrospectively investigated and were divided into two groups according to the serum-albumin level: low serum-albumin group (Group A, n= 133) and normal serum-albumin group (Group B, n=90). Maternal and fetal outcomes were compared between the two groups. Results The proportion of women with abnormal retention of fluid (6.8%, vs 0), elevated liver enzymes (60.9% vs 38.9%) renal involvement (30.1% vs 11.1%) and complications (23.3% vs 11.1%) (placental abruption and postpartum hemorrhage) in group A were significantly higher than those in group B (all P<0. 05). Birth weight in group A was lower than that in group B[(2192. 78±795. 31) g vs (2454. 92±776. 24) g, P<0. 05] and neonatal mortality in group A was higher (26.0%vs 13. 6%, P<0. 05). Conclusions Severe pre-eclampsia with low serum-albumin is associated with severe maternal and neonatal outcomes. Appropriate termination of pregnancy should be considered following adequate and careful assessment of maternal and fetal well-being in order to improve perinatal outcomes.

Objective To investigate p16 promoter methylation in premature rats with chronic lung disease induced by hyperoxia. Methods Eighty premature Wistar rats were randomly divided into two groups: hyperoxia group (fraction of inspiratory oxygen) 0. 90 and control group (fraction of inspiratory oxygen 0. 21), 40 rats for each group. Semi-nested methylation specific polymerase chain reaction and methylation specific polymerase chain reaction were applied respectively to detect p16 promoter methylation in lung tissues. Additionally, p16 mRNA and protein expressions in lung tissue were detected by reverse transcription- polymerase chain reaction, Western blot and immunohistochemistry method. Results The methylation was not found in control group by seminested methylation specific polymerase chain reaction and methylation specific polymerase chain reaction, while was found in different aged rats of the hyperoxia group. The methylation detection rate was higher by using the semi-nested methylation-specific polymerase chain reaction (52.5%, 21/40) than that by methylation specific polymerase chain reaction (42.5%, 17/40) in the hyperoxia group,but there was no statistically significant difference between the two methods. The p16 mRNA in the hyperoxia group were significantly lower than in the control group at day 7, 14 and 21(1.73 ± 0.40 vs 2.11±0. 37,1.29±0. 19 vs 1.60±0. 27,0. 95±0.25 vs 1.72±0. 34, t=2.19, 2.95 and 10. 43,P＜0. 05). The p16 protein expressions by western blot in the hyperoxia group were significantly lower than in the control group at day 7, 14 and 21 also (88. 1±8. 7 vs 95.0±4.1,65.7±4.5 vs 83. 5±13.6 and 50.4±4.9 vs 86.7±11.9, t=2.27,3.95 and 13.40,P＜0.05). The expression of p16 mRNA (1.06±0.61) and protein (62.32±25.65) in lung tissues of rats with methylation was lower than that without methylation (1.63±0.62 and 94.93±22.21, respectively) (t=2.95, OR=0. 86;t=4.28, OR=0. 85,P＜0.01, respectively). Conclusions Exposure to hyperoxia might induce p16 promoter methylation in lung tissues in premature rats. Methylation risk increases as exposure time extends. p16 promoter methylation induced by hyperoxia might participate in the mechanism of lowering p16 mRNA and protein expression, but might not result in p16 gene silence.

Objective To investigate relations between villus Benzo (a)pyrene (BaP)-DNA adducts and blighted ovum in early pregnancy, and to explore possible environmental factors influencing embryo development. Methods One hundred and two pregnant women with blighted ovum were selected into this study as research group; and 102 normal pregnant women were taken as control group; the age, gravidity, parity and gestational weeks of the two groups were matched. After artificial abortion, villi of the patients were collected and washed by normal saline. Then, the tissue was homogenated and genome DNA was extracted to detect quantity of the tissue. BaP-DNA adducts levels were examined by high-performance liquid chromatography-fluorescence method (HPLC). The personal information of pregnant women was collected by questionnaire. Logistic regression model was used to investigate the association between BaP-DNA adducts and blighted ovum. Results BaP-DNA adducts level in villi of research group [(8. 9±8. 2) adducts/108 nucleotides] was significantly higher than that of control group [(2. 0±1. 4) adducts/108 nucleotides], P＜0.05. The higher the BaP-DNA adducts in villi, the higher risk the blighted ovum; when the BaP-DNA adducts level increased to 6.06 adducts/108 nucleotides, the risk of blighted ovum might increase 59.39 times (95% CI:15.50-227.55). Maternal education level was a protective factor (OR=-0.21, 95%CI:-0. 19--0.03) after controlling potential confounders. Conclusions High level of villi BaP-DNA adducts might increase the risk of blighted ovum in early pregnancy, and could have an adverse effect on embryo development.

Objective To investigate the effects of compound radix angelicae sinensis injection on oocyte and segmentation sphere injured by subacute exposure to diesel exhaust particles (DEP) in female mice. Methods Two hundred and ten 21-day-old ICR female mice were randomly divided into 5 groups: the control group (group A), DEP group (group B), DEP+low-dose group (group C),DEP±middle-dose group (group D) and DEP+high-dose group (group E). There were 42 mice in each group. The mice were inoculated with 30 μ1 DEP suspension at 12.0 μg/μl (group B-E) or the same volume of vehicle (PBS, group A) on pharynx posterior wall by sample pipettor beginning at day 21 and repeated every 3 days for 4 times. The mice were sacrificed three days after the last exposure.Compound radix angelicae sinensis injection containing 75 (group C), 150 (group D) and 300 (group E)grams of crude drug, respectively, which was intraperitoneally administered for each mouse daily from the day of the first DEP inoculation till the day before sacrifice, consecutively for 12 days. The general conditions were observed, and the body weight and ovary/body weight ratio were tested. Superoxide dismutase (SOD) activity, malondialdehyde (MDA) and reduced glutathione (GSH) contents in ovarian tissues were assayed. Rates of survival, germinal vesicle breakdown, extrusion of the first polar body and in-vitro fertilization, and quantity of mitochondrial DNA for oocytes were investigated.Ultrastructural changes of oocytes were observed. Results ( 1 ) No significant difference of the body weight was found among all the groups (P＞0. 05). The ovary weight, ovary/body weight ratio, ovary SOD and GSH content were significantly decreased in groups B [( 1.5 ± 0. 6) mg, ( 7.2 ± 2. 5) × 10-5 ,(192. 10±23.67) nU/mg prot and (262.40 ± 31.60) nmol/mg prot], and C [( 1.7 ± 0. 2) mg,(8.9±0.6)× 10-5, (198.92±24.27) nU/mg prot and (271.66±14.58) nmol/mg prot] and D [(2. 1±0. 2) mg, (9. 8±1. 1)×10-5, (214. 37±27. 19) nU/mg prot and (285. 93±9. 55) nmol/mg prot] as comparing to groupA [(3. 3±1. 5) mg, (15.4±7.3)×10-5, (292. 30 ± 40. 03) nU/mg prot and (367.98±24.59) nmol/mg prot (P＜ 0. 05 or P＜0.01); and significantly increased in group E [(3. 7±1.1) mg, (18. 7±5. 4)× 10-5, (279. 10±12. 63) nU/mg prot ]and (353. 59±10. 61) nmol/mg prot]comparing to group B (P＜0. 01). MDA content was signi-ficantly increased for groups B, C and D [(3. 88±0.35) nmol/mg prot, (3. 62 ± 0. 19) nmol/mg prot and (2. 63 ± 0. 34) nmol/mg prot] comparing to group A [(2. 18±0. 44) nmol/mg prot](P＜0. 05 or ＜0. 01, respectively); and significantly decreased for group D and E (2. 35±0. 37 nmol/mg prot) comparing to group B (P＜0. 01). (2) In all observed time points, oocyte survival rate in group B and C, extrusion rate of the first polar body and in-vitro fertilization rate in group B, C and D were significantly lower than in group A (P ＜ 0. 05 or ＜0. 01), and all those in group E were significantly higher than in group B (P＜0. 05). Rates of germinal vesicle breakdown were 100% in all five groups. (3) Logarithmic values of mitochondrial DNA copy numbers in group C, D and E were significantly lower than in group A; whereas significantly higher in group C and D than in group B (P＜0.01). (4) Normal appearance for oocytes in group A was seen. In groups B and C, a number of cytoplasmic organelles were dramatically degenerated in part of the oocytes and some necrotic oocytes were seen. Large body of mitochondria in the oocytes swelled and vacuolized in group D, while such changes dincished to a lesser extent and scope in group E. Conclusions Compound radix angelicae sinensis injection exerts a favorable curative and protective effect on oocyte and segmentation sphere injured by subacute DEP exposure in female mice.

Objective To evaluate the predictive accuracy of several risk-assessment strategies to predict the risk of significant neonatal hyperbilirubinemia, and to establish the best prediction model.Methods The transcutancous bilirubin (TcB) levels of 4907 term and near-team infants were measured.Trace blood bilirubin levels of the infants whose TcB levels ≥250 μmol/L were detected. Clinical data of newborns and their mothers were collected and were analyzed with Logistic regression model to investigate its correlation with signifrcant hyperbilirubinemia. Clinical high risk factors of significant neonatal hyperbilirubinemia were determined. Accuracy of three prediction methods for significant hyperbilirubinemia was compared by receiver operating characteristic (ROC) curve. The three methods included: whether predischarge bilirubin level (within 72 hours after birth) expressed in risk zone on an hour-specific bilirubin nomogram; clinical risk factors other than predischarge bilirubin level; and combination of the predischarge bilirubin risk zone and other clinical risk factors. Results Two hundred and eighty-six newborns (5.8%) were found with significant hyperbilirubinemia. The risk factors of significant neonatal hyperbilirubinemia were divided into three groups according to OR: (1) Major risk factors:predischarge (within 72 hours after birth) bilirubin level in the high risk-zone (OR=96. 39, 95% CI:53.32-174.27, P = 0. 000), large cephalohematoma (OR = 36.45, 95% CI: 10. 02-132.56,P=0. 0076), gestational age 35-36+6 weeks (OR= 30. 72, 95% CI 14.47-65.23, P=0. 0001) and exclusive breast feeding and weight loss was ＞9% of birth-weight (OR=22.44, 95% CI: 4.42-114. 03, P=0. 0016). (2) Minor risk factors: gestational age 37-37+6 weeks (OR=3.26, 95% CI:1.92-5. 55, P=0. 0232), predischarge bilirubin level in P76-P95(OR=13. 64, 95% CI: 8. 10-22.97,P=0. 0001) and bruising (OR = 2.32, 95% CI: 1.14-4.71, P = 0. 0497). (3)Protective factors (those factors associated with decreased risk of hyperbilirubinemia): predischarge bilirubin level in low-risk zone (≤P40) (OR=0. 00), gestational age ≥40 weeks (OR=0.21, 95% CI: 0.09-0.44,P=0. 0402) and mixed breeding (OR=0. 75, 95% CI: 0. 58-0.95, P=0.0059). The area under the ROC curve of predischarge bilirubin level was 0. 8687 and 0. 7375 for clinical risk factors other than predischarge bilirubin level. The area under the ROC curve of a combination of the predischarge bilirubin risk zone and additional clinical risk factors was 0. 9367. Conclusions The risk of significant neonatal hyperbilirubinemia could be simply and accurately predicted by infant's predischarge bilirubin level and the combination of predischarge bilirubin level, and clinical risk factors might improve the accuracy of prediction significantly.

Objective To investigate the prenatal diagnosis, perinatal management and standardized treatment protocol for neonates with duodenal obstruction. Methods A network in prenatal diagnosis, perinatal management and monitoring of congenital malformation was founded between Beijing Obstetrics and Gynecology Hospital and the Capital Institute of Pediatrics. Forty-four fetuses were prenatally diagnosed as duodenal obstructions by this network from July,2001 to September, 2010. The data of prenatal diagnosis, treatment after birth and prognosis were analyzed. Results Among 44 patients diagnosed as fetal duodenal obstruction by prenatal ultrasonography, three cases underwent induced abortion, three were in pregnancy, 14 were lost during follow-up and 24 were confirmed by surgical treatments after birth. Within 24 neonates underwent surgery, 21 showed double-bubble sign and 20 combined with polyhydroamnios in prenatal ultrasonography. Twenty-four neonates underwent upright abdominal plain film examination,22 showed double-bubble sign, 1 showed single-bubble sign and 1 showed triple-bubble sign,respectively. Nineteen neonates underwent upper gastroenterography which showed distention of stomach and duodenum, increased stomach peristalsis and an obstacle of duodenum emptying. Within 23 neonates underwent ultrasonographic studies, 10 showed distention and increased peristalsis of duodenum. Following surgical procedures were performed: diamond shape anastomosis was completed in 19 cases with annular pancreas; duodenal vertical resection, across suture and excision of the membrane was done in four cases with duodenum membranate stenosis; end-to-back anastomosis was taken in one case with duodenal separate atresia; Ladd's procedure was applied in 11 cases associated with malrotation. All patients were cured. Conclusions Standardized perinatal management and earlier intervention should be offered to newborns with duodenal obstruction to achieve better effects.

Objective To investigate the possibility of reserving uterus during severe postpartum hemorrhage. MethodsA retrospective analysis was conducted on the clinical data of 138 cases of severe postpartum hemorrhage (blood loss ≥2000 ml) from January 1, 2003 to December 31, 2009. Results Among 138 cases of severe postpartum hemorrhage, uterine atony (n= 60, 43. 38 ％ ) was the first cause and the second was placental factor (n= 55, 39.86 ％). The blood loss varied from 2000 ml to 10 000 ml and the mean level was about (3004± 1473) ml. The volume of blood transfusion for these patients varied from 800 ml to 7200 ml. Among these patients, the blood loss of 108 cases reserved uteri was from 2000 ml to 7500 ml, with the average of (2564±932) ml； while for 30 cases performed with hysterectomy, the blood loss was about 2500 to 10 000 ml averagly (4653± 1857) ml (t=8. 57, P=0.00). These patients were divided into two groups according to time series. Twelve cases of hysterectomy were performed during 2003to 2005, and the hysterectomy rate was 0. 47‰; 18 cases of hysterectomy were performed during 2006 to 2009, and the hysterectomy rate was 0. 36‰. The average blood loss of the above two groups was (3783±861) ml and (5233±2124) ml respectively (t=2. 234, P=0. 034). Among all the cases with blood loss ≥ 3000 ml, uteri were reserved in 24 cases with the average blood loss of (3818 ± 1284) ml； while hysterectomy were performed in 27 cases with average blood loss of (4900 ± 1789) rnl (t = 2. 453, P =0. 018). The time for blood loss to 3000 ml in the two groups was (160±129) min and (100±67) min,respectively, and the difference was significant (t=2. 113, P = 0.04).The uteri of six cases with postpartum hemorrhage over 4000 ml were successfully reserved, and average bleeding amount was 5570 ml.Two patients among the 138 women died of amniotic fluid embolism.The perinatal mortality rate was 3. 73％.ConclusionsThe postpartum hemorrhage volume and velocity is the key point to decide whether to reserve the uterus or not.For the population with high risk factors,prophylaxis treatment with prostaglandins should be initiated to reduce the bleeding volume.Uterine packing might be an effective treatment to stop postpartum hemorrhage, especially for those bleeding due to placenta previa.

Objective To investigate the vaginal flora characteristics,clinical symptoms and signs of lactating women 6-8 weeks after delivery and the influence factors.Methods Two hundred and twenty-three puerpera 6-8 weeks after delivery who went to outpatient department of Peking University First Hospital for postpartum review (study group) and 200 normal non-pregnant women (control group) from April to May,2010 were enrolled into this study.All in study group were evaluated by a questionnaire regarding their symptoms,sexual behavior,breast-feeding situation and delivery mode.Vaginal secretions from upper 1/3 of vagina were collected and evaluated by vaginal microbial evaluation system.Bacterial vaginosis (BV) was diagnosed if Nugent score ≥ 7.Enumeration data between groups was compared by t test,and quantitative data by Chi-square test.Results The density of vaginal flora in study group was different from that of control group (x2 =96.302,P＜0.001) ; so did the flora diversity of two groups (x2 =69.871,P＜0.001).There was no difference between mean age of study group [(30.5 ± 3.9) years] and control group [(30.9 ± 2.4)years],P＞0.05.The cesarean section rate was 52.7％ (89/169),13 women (7.7％) had began their sexual behavior before interview,116 women (70.3％) took breast-feeding.Dominant bacteria in the vagina of lactating women were Gram-positive cocci (69/175,39.4％) and Gram-positive bacillus (54/175, 30.9％), which was different from control group (Gram-positive bacillus,180/189,95.2％),P＜0.001.The vaginal pH of study group was 5.0±0.5,which was higher than that (＜4.5) of control group.In study group,incidence of lower hydrogen peroxide level of vagina was 84.3 ％ (177/210) ; positive rate of sialidase was 6.7 ％ (14/210) ; positive rate of leukocyte esterase was 91.0％ (191/210).A large number of postpartum women had an abnormal Nugent score,most of them showed a state of intermediate BV (132/195,67.7％) or BV (8/195,4.1％),while a few patients had symptoms of BV (23.5％,33/140).Sexual behavior had no significant effect on postpartum vaginal flora.The proportion of abnormal vaginal flora in breast feeding mothers (74.1 ％,86/116) was significantly higher than that (57.1％,28/49) in artificial feeding mothers,P=0.034.Delivery mode also affected postpartum vaginal flora.Women underwent cesarean section were more susceptible to abnormal vaginal flora (77.5％,69/89) than those underwent vaginal delivery (57.5％,46/80),x2 =7.726,P=0.005.Conclusions Vaginal flora of postpartum women 6-8 weeks after delivery had significant difference from that of nonpregnant women.The incidence of asymptomatic abnormal vaginal flora was high.Breastfeeding and delivery mode are influence factors of abnormal vaginal flora.