UNLABELLEDTo investigate the relationship between imbalance of cardiac autonomic nervous system and sudden death in fetuses of rats with intrahepatic cholestasis of pregnancy (ICP), the animal model of ICP was induced by hypodermic injection of 17-alpha-ethinylestradiol and progesterone. The electrocardiograms and frequency domain analysis of heart rate variability (HRV) including low frequency (LF), high frequency (HF) and the ratio between low and high frequencies (LF/HF) of fetal rats by the 21st day of gestation were evaluated with Chart 5 software of Powerlab biologic signal extracting and analyzing system.

RESULTS(1) The serum total bile acids (TBA) levels of pregnant rats were (78.5 +/- 4.5) micromol/L in Group ICP and (24.6 +/- 3.6) micromol/L in Group control; significant difference was noted between the two groups (P < 0.01). (2) In Group ICP, fetal rats arrhythmias appeared after (29.3 +/- 6.4) minutes' observation, and fetal rats died suddenly after (23.5 +/- 4.6) minutes' arrhythmias; However, the fetal rats in Group control all showed normal electrocardiograms over 90 minutes' continuous observation. (3) The values of LF and LF/HF of fetal rats in Group ICP within 20 minutes before fetal rats arrhythmias were significantly higher than those in Group control (LF 48.45 +/- 4.11 nu vs. 33.87 +/- 4.31 nu, and LF/HF 0.99 +/- 0.14 vs. 0.61 +/- 0.10, respectively, P < 0.01). (4) Dynamic power spectral analysis of HRV indicated that the values of LF and LF/HF of fetal rats in Group ICP increased progressively within 15 minutes before the sudden death of fetal rats. These demonstrated that autonomic imbalance in association with increased sympathetic activity has been strongly implicated in the pathophysiology of fetal arrhythmogenesis and sudden death in ICP. HRV analysis could be a useful tool for fetal surveillance, especially for ICP.

Animals ; Cholestasis, Intrahepatic ; physiopathology ; Death, Sudden ; etiology ; Electrocardiography ; Female ; Fetal Death ; etiology ; Heart Rate, Fetal ; Male ; Pregnancy ; Pregnancy Complications ; physiopathology ; Rats ; Rats, Sprague-Dawley

Objective: To summarize the clinicopathological factors related to perinatal fetal death and to evaluate importance of fetal autopsy and placental pathology. Methods: The clinicopathological data of 105 perinatal fetal deaths in Beijing Haidian Maternal and Child Health Hospital from November 2012 to December 2020 were retrospectively analyzed. Relevant literature was also reviewed. Results: The maternal age of the deceased fetuses ranged from 22 to 43 years with the average (31.35±4.04 years), and the gestational weeks were 28-40⁺⁶ weeks. Among them, 101 were singleton cases and 4 twin cases. 103 fetuses died in uterus and 2 died during delivery. Relevant factors analysis of the 105 perinatal fetal deaths showed that 86 cases (81.9%, 86/105) were related to umbilical cord/placental abnormality, 10 cases (9.5%, 10/105) uterine infection, 6 cases (5.7%, 6/105) fetal factors, 1 case was fetal maternal blood transfusion syndrome, 1 case twin blood transfusion syndrome, and 1 case died of complete uterine rupture. Among the 86 cases related to umbilical cord/placental abnormality, the diagnosis was most often based on the gross examination of placenta. The most common cause of death was umbilical cord torsion with thin root, followed by placental abruption, tight umbilical cord winding, vascular rupture and umbilical cord true knot. The morphology of placenta revealed mainly functional changes. Among the 10 cases related to intrauterine infections, the placenta generally showed lobular placental edema. The morphological characteristics of ascending infection were mainly acute chorioamnionitis, and the morphological characteristics of blood-borne infection were mainly acute or chronic villitis, as well as villous interstitial inflammation. Identification of viral inclusions suggested viral etiology, while the final diagnosis was relied on laboratory testing. Among the 6 cases related to fetal abnormality, the diagnostic value of placenta was limited and the diagnosis could be made with fetal autopsy. Conclusion: The causes of perinatal fetal death are complex, diverse, and often the synergistic result of multiple factors. Fetal autopsy and placental pathology are the key technical means to identify the cause of death and deserve more attention and utilization.
Adult ; Autopsy ; Child ; Female ; Fetal Death/etiology* ; Fetus/pathology* ; Gestational Age ; Humans ; Placenta/pathology* ; Pregnancy ; Retrospective Studies ; Young Adult

OBJECTIVETo investigate the effect of night work near the day of ovulation on outcome of pregnancy.

METHODSDaily early morning urine samples were collected from eligible shift women workers, and human chorionic gonadotropin(hCG), follicle-stimulating hormone(FSH), the urinary steroid metabolites of estrogen and progesterone(PDG, E1C) were measured to confirm the day of ovulation and early fetal loss(EFL). Questionnaires were used to know workshift, other occupation exposures, and related information.

RESULTS12 clinical spontaneous abortion(SAB), 18(EFL) and 44 clinical living birth were analyzed in relation to SAB, EFL and night shift near the day of ovulation by using single factor and multi-factor logistic regression. The result showed that night shift on the day of ovulation and the day before or after ovulation was related with SAB both in single- and muti-factorial analysis(single factor: OR = 2.48, 95% CI 1.10-5.60; multi-factor; OR = 3.90, 95% CI 1.28-11.90).

CONCLUSIONNight shift near the day of ovulation may be related to SAB.

Abortion, Spontaneous ; etiology ; Chorionic Gonadotropin ; blood ; Female ; Fetal Death ; etiology ; Follicle Stimulating Hormone ; blood ; Humans ; Logistic Models ; Ovulation ; Pregnancy ; Work Schedule Tolerance

OBJECTIVETo explore the factors associated with perinatal death of hepatic diseases in pregnancy (HDIP) and make feasible suggestions and measures for perinatal care of high risk patients.

METHODSThe 80 perinatal death cases of hepatic diseases in pregnancy (HDIP) during 1991-2000 in our hospital were analyzed retrospectively.

RESULTSThe perinatal mortality of HDIP in our hospital during the last 10 years was 17.99 approximately 65% was in utero death. Perinatal mortality was different between male (21.64%) and female (10.11%) (P<0.01). Compared first 5 years with last 5 years author found that the perinatal mortality of HDIP had no significant decrease (P>0.05). The perinatal mortality in city and suburbs had decreased, while in the floating population from other provinces the perinatal mortality had increased. The perinatal death was mainly caused by pregnancy induced hypertension (PIH) and asphyxia. But for the HBV carrier mothers the causes of death included umbilical cord problems, premature rupture of membrane and asphyxia.

CONCLUSIONSThe perinatal death mortality was increased by HDIP, deaths were essentially associated with pregnancy induced hypertension and asphyxia and the floating population and male gender were high risks. To enhance the management of HDIP or immigration, take effective therapies of hepatitis and improvement of resuscitation of newborns are critically important.

Adolescent ; Adult ; Cause of Death ; Female ; Fetal Death ; epidemiology ; Fetal Distress ; etiology ; mortality ; Humans ; Infant Mortality ; Infant, Newborn ; Liver Diseases ; complications ; mortality ; Male ; Pre-Eclampsia ; complications ; mortality ; Pregnancy ; Pregnancy Complications ; mortality ; Retrospective Studies ; Sex Factors

Here we describe a Syrian couple having recurrent pregnancy loss in the first trimester, fetal malformations, and/or neonatal death. The father had a balanced chromosomal translocation t(5;15), an sY125 microdeletion of locus b in the azoospermia factor (AZF) gene, and an MTHFR C677T homozygous polymorphism with normal phenotype. Interestingly, his healthy wife had another MTHFR A1298C homozygous polymorphism. The couple experienced two pregnancy losses and had two stillborn children with severe malformations due to partial trisomy of the short arm of chromosome 5. The couple does not have any living offspring after 10 years of marriage.
Abortion, Habitual ; genetics ; Azoospermia ; genetics ; Chromosome Aberrations ; Chromosomes, Human, Pair 5 ; Female ; Fetal Death ; etiology ; Homozygote ; Humans ; Male ; Methylenetetrahydrofolate Reductase (NADPH2) ; genetics ; Polymorphism, Genetic ; Pregnancy ; Translocation, Genetic ; Trisomy

BACKGROUNDEarly onset severe preeclampsia is a specific type of severe preeclampsia, which causes high morbidity and mortality of both mothers and fetus. This study aimed to investigate the clinical definition, features, treatment, outcome and risk factors of early onset severe preeclampsia in Chinese women.

METHODSFour hundred and thirteen women with severe preeclampsia from June 2006 to June 2009 were divided into three groups according to the gestational age at the onset of preeclampsia as follows: group A (less than 32 weeks, 73 cases), group B (between 32 and 34 weeks, 71 cases), and group C (greater than 34 weeks, 269 cases). The demographic characteristics of the subjects, complications, delivery modes and outcome of pregnancy were analyzed retrospectively.

RESULTSThe systolic blood pressure at admission and the incidence of severe complications were significantly lower in group C than those in groups A and B, prolonged gestational weeks and days of hospitalization were significantly shorter in group C than those in groups A and B. Liver and kidney dysfunction, pleural and peritoneal effusion, placental abruption and postpartum hemorrhage were more likely to occur in group A compared with the other two groups. Twenty-four-hour urine protein levels at admission, intrauterine fetal death and days of hospitalization were risk factors that affected complications of severe preeclampsia. Gestational week at admission and delivery week were also risk factors that affected perinatal outcome.

CONCLUSIONSEarly onset severe preeclampsia should be defined as occurring before 34 weeks, and it is featured by more maternal complications and a worse perinatal prognosis compared with that defined as occurring after 34 weeks. Independent risk factors should be used to tailor the optimized individual treatment plan, to balance both maternal and neonatal safety.

Adult ; Cardiovascular Diseases ; epidemiology ; etiology ; Female ; Fetal Death ; Gestational Age ; Humans ; Pre-Eclampsia ; epidemiology ; mortality ; Pregnancy ; Pregnancy Complications ; epidemiology ; mortality ; Risk Factors

This study examined the effect of cholic acid (CA) on cultured cardiac myocytes (CMs) from neonatal rats with an attempt to explore the possible mechanism of sudden fetal death in intrahepatic cholestasis of pregnancy (ICP). Inverted microscopy was performed to detect the impact of CA on the beating rates of rat CMs. MTT method was used to study the effect of CA on the viability of CMs. CMs cultured in vitro were incubated with 10 μmol/L Ca(2+)-sensitive fluorescence indicator fluo-3/AM. The fluorescence signals of free calcium induced by CA were measured under a laser scanning confocal microscope. The results showed that CA decreased the beating rates of the CMs in a dose-dependent manner. CA could suppress the activities of CMs in a time- and dose-dependent manner. CA increased the concentration of intracellular free calcium in a dose-dependent manner. Our study suggested that CA could inhibit the activity of CMs by causing calcium overload, thereby leading to the sudden fetal death in ICP.
Animals ; Animals, Newborn ; Calcium ; metabolism ; Cells, Cultured ; Cholestasis, Intrahepatic ; complications ; metabolism ; physiopathology ; Cholic Acid ; metabolism ; pharmacology ; Death, Sudden ; etiology ; Dose-Response Relationship, Drug ; Female ; Fetal Death ; etiology ; Humans ; Microscopy, Confocal ; Myocardial Contraction ; drug effects ; Myocytes, Cardiac ; drug effects ; metabolism ; physiology ; Pregnancy ; Pregnancy Complications ; metabolism ; physiopathology ; Rats, Sprague-Dawley ; Time Factors