To study the characteristics of heart rate rhythm in pregnant women at different trimester of pregnancy, and to explore the relationship between the basic rhythm of heart rate and pregnancy complications. Thirteen pregnant women who were diagnosed with normal early pregnancy in the Reproductive Center of the Second Affiliated Hospital of Soochow University from June 2018 to December 2019 were prospectively selected. Personal files were created and the heart rate data of pregnancy women was collected 24 hours a day by wearable devices until delivery. Prenatal examination and pregnancy outcomes were surveyed at follow-up. The cosine analysis method and the designed statistical module were used to analyze the long-term rhythm of pregnant women's heart rate. The heart rate of pregnant women showed a significant rhythm at different gestational weeks. Compared with the gestational week of 12, the midline-estimating statistic of rhythm(MESOR) increased significantly at the gestational week of 28 and 32 (t=-2.751,P=0.013;t=-2.314,P=0.032).The phase of rhythm shifted from 14∶00 pm in the first trimester of pregnancy (12 weeks) to 16∶00 pm in the second trimester (24 weeks) (t=2.613,P=0.018) and returned to 14∶00 pm at the third trimester (32 weeks) (t=-2.176,P=0.046). Season had no significant effect on the changes of MESOR, amplitude and phase of maternal heart rate in the first trimester (t=-0.356,P=0.729;t=-0.777,P=0.464;t=-0.434,P=0.673), while season had no significant effect on the changes of MESOR, amplitude and phase in the third trimester (t=-0.663,P=0.532;t=-0.209,P=0.841;t=0.625,P=0.592). The heart rate of one pregnant woman with natural delivery had rhythm disorder from the start of labor to delivery. The heart rate of one pregnant woman with premature rupture of membranes showed rhythm disorder before and after the rupture of membranes, and smaller amplitude. Rhythm disturbance may play a suggestive role in preterm delivery and labor initiation. In conclusion, pregnancy may cause changes in the internal heart rate rhythm. Maternal internal rhythm disturbance may occur when delivery or premature rupture of membranes occurs. The heart rate rhythm of pregnant women may be related to some common complications of pregnancy such as premature rupture of membranes.
Infant, Newborn ; Pregnancy ; Female ; Humans ; Fetal Membranes, Premature Rupture ; Pregnancy Outcome ; Pregnancy Complications ; Pregnancy Trimester, Third ; Premature Birth ; Periodicity

To study the characteristics of heart rate rhythm in pregnant women at different trimester of pregnancy, and to explore the relationship between the basic rhythm of heart rate and pregnancy complications. Thirteen pregnant women who were diagnosed with normal early pregnancy in the Reproductive Center of the Second Affiliated Hospital of Soochow University from June 2018 to December 2019 were prospectively selected. Personal files were created and the heart rate data of pregnancy women was collected 24 hours a day by wearable devices until delivery. Prenatal examination and pregnancy outcomes were surveyed at follow-up. The cosine analysis method and the designed statistical module were used to analyze the long-term rhythm of pregnant women's heart rate. The heart rate of pregnant women showed a significant rhythm at different gestational weeks. Compared with the gestational week of 12, the midline-estimating statistic of rhythm(MESOR) increased significantly at the gestational week of 28 and 32 (t=-2.751,P=0.013;t=-2.314,P=0.032).The phase of rhythm shifted from 14∶00 pm in the first trimester of pregnancy (12 weeks) to 16∶00 pm in the second trimester (24 weeks) (t=2.613,P=0.018) and returned to 14∶00 pm at the third trimester (32 weeks) (t=-2.176,P=0.046). Season had no significant effect on the changes of MESOR, amplitude and phase of maternal heart rate in the first trimester (t=-0.356,P=0.729;t=-0.777,P=0.464;t=-0.434,P=0.673), while season had no significant effect on the changes of MESOR, amplitude and phase in the third trimester (t=-0.663,P=0.532;t=-0.209,P=0.841;t=0.625,P=0.592). The heart rate of one pregnant woman with natural delivery had rhythm disorder from the start of labor to delivery. The heart rate of one pregnant woman with premature rupture of membranes showed rhythm disorder before and after the rupture of membranes, and smaller amplitude. Rhythm disturbance may play a suggestive role in preterm delivery and labor initiation. In conclusion, pregnancy may cause changes in the internal heart rate rhythm. Maternal internal rhythm disturbance may occur when delivery or premature rupture of membranes occurs. The heart rate rhythm of pregnant women may be related to some common complications of pregnancy such as premature rupture of membranes.
Infant, Newborn ; Pregnancy ; Female ; Humans ; Fetal Membranes, Premature Rupture ; Pregnancy Outcome ; Pregnancy Complications ; Pregnancy Trimester, Third ; Premature Birth ; Periodicity

OBJECTIVE: To investigate pregnancy complications and related determinants, and provide scientific evidence for maternal health care. METHODS: A total of 13669 pregnant women who planned to deliver in the hospital were randomly identified and surveyed by questionnaire. Chi-square test and logistic regression models were used to screen the influencing factors for pregnancy complications. RESULTS: The incidence of pregnancy complication was 13.94%. The following diseases had higher incidence than others: anemia (2.95%), premature rupture of membranes (2.51%), diabetes (1.92%), severe preeclampsia (1.43%), mild preeclampsia (1.27%), and hypertensive disorder complicating pregnancy (1.27%). Data from logistic regression models showed that pregnancy complications were related to maternal age, education level, number of caesarean sections, ways to terminate pregnancy, gestation weeks and number of fetuses. CONCLUSION The rate of pregnant complication is high, which should be treated in time to ensure the safety of pregnant women.
Anemia ; Cesarean Section ; Diabetes, Gestational ; Female ; Fetal Membranes, Premature Rupture ; Gestational Age ; Humans ; Pre-Eclampsia ; Pregnancy ; Pregnancy Complications ; epidemiology

OBJECTIVETo investigate the effect of premature rupture of membranes (PROM) on maternal infections and outcome of preterm infants.

METHODSA total of 441 preterm infants and 387 mothers were enrolled as subjects. According to the presence or absence of PROM, the mothers were divided into non-PROM group with 104 mothers, PROM duration <72 hours group with 90 mothers, and PROM duration ≥72 hours group with 193 mothers. The three groups were compared in terms of clinical features of mothers and infants and complications.

RESULTSCompared with the control group and the PROM duration <72 hours group, the PROM duration ≥72 hours group had significantly higher maternal age, incidence rate of umbilical vasculitis, and rate of antibiotic use; the PROM duration ≥72 hours group had a significantly higher incidence rate of moderate-to-severe chorioamnionitis than the control group (P<0.05), while there was no significant difference between the PROM duration ≥72 hours group and the PROM duration <72 hours group (P>0.05). Compared with the control group and the PROM duration <72 hours group, the PROM duration ≥72 hours group had significantly higher incidence rates of pneumonia and intracranial hemorrhage in preterm infants; the PROM duration ≥72 hours group had a significantly higher incidence rate of congenital infection and a significantly longer mean length of hospital stay compared with the control group (P<0.05), while there were no significant differences between the PROM duration ≥72 hours group and the PROM duration <72 hours group (P>0.05). The multivariate analysis showed that PROM duration ≥72 hours was an independent risk factors for pneumonia (OR=2.200, 95%CI: 1.386-3.492) and intracranial hemorrhage (OR=2.331, 95%CI: 1.420-3.827) in preterm infants.

CONCLUSIONSPROM duration ≥72 hours significantly increases the risk of placental infection in mothers and it is an independent risk factor for pneumonia and intracranial hemorrhage in preterm infants.

Adolescent ; Adult ; Chorioamnionitis ; etiology ; Female ; Fetal Membranes, Premature Rupture ; Humans ; Infant, Newborn ; Infant, Premature ; Intracranial Hemorrhages ; etiology ; Logistic Models ; Pregnancy ; Pregnancy Complications, Infectious ; etiology ; Time Factors ; Young Adult

A case is presented of an amnionic rupture sequence which led to massive fetal ventral herniation and lordoscoliosis. Characteristic ultrasonographic findings of an omphalocele, fetal attachment to the placenta, and the absence of free-floating umbilical cord were observed.
Abnormalities, Multiple/*etiology/ultrasonography ; Adult ; Amnion ; Female ; Fetal Membranes, Premature Rupture/*complications ; Gestational Age ; Hernia, Umbilical/etiology ; Humans ; Infant, Newborn ; Male ; Pregnancy ; Umbilical Cord/abnormalities

OBJECTIVE: To evaluate the importance of assessment of fetal cardiac output (CO) for the prediction of complications of pregnancy. METHODS: We evaluated 65 fetuses and all of them had a fetal cardiac scan at 20 to 24 weeks of pregnancy. To measure CO, diameters (d) of the left right ventricle outflow tract were measured just above the valves. Each left CO (LCO) and right CO (RCO) was derived using the following equation: CO = velocity time integral ×π× d²/4 × heart rate. Pregnancy complications included gestational hypertensive disorders, fetal growth restriction (FGR) and preterm birth (PTB) caused from preterm labor or preterm premature rupture of membrane (PPROM). RESULTS: There were 23 cases with one more pregnancy complication (FGR, 9; gestational hypertensive disorders, 8; PTB caused from PTB or PPROM, 12). The LCO was lower in complication group than in normal group (88±53 vs. 117±48 mL/min, P=0.028). The RCO to the LCO ratio (RCO/LCO) was higher in complication group (2.43±1.69 vs. 1.48±0.81, P=0.001). Regression analysis demonstrated that RCO/LCO was a significant predictor of pregnancy complication; Odds ratio was 7.76 (95% CI, 1.15 to 52.21; P=0.029). The area under the receiver-operating characteristic curve for prediction of pregnancy complications from LCO was 0.71. The diagnostic cut-off value of LCO was 80 mL/min. The area under the receiver-operating characteristic curve from RCO/LCO was 0.68 and cut-off value was 1.41. CONCLUSION: This study demonstrated that pregnancy complications can be suspected based on fetal CO assessments at a GA of 20 to 24 weeks.
Cardiac Output* ; Echocardiography ; Female ; Fetal Development ; Fetal Growth Retardation ; Fetus ; Heart Rate ; Heart Ventricles ; Membranes ; Obstetric Labor, Premature ; Odds Ratio ; Pre-Eclampsia ; Pregnancy Complications* ; Pregnancy* ; Premature Birth ; Rupture ; Ultrasonography*

Acute atherosis is unique vascular changes of the placenta associated with poor placentation. It is characterized by subendothelial lipid-filled foam cells, fibrinoid necrosis of the arterial wall, perivascular lymphocytic infiltration, and it is histologically similar to early-stage atherosclerosis. Acute atherosis is rare in normal pregnancies, but is frequently observed in non- transformed spiral arteries in abnormal pregnancies, such as preeclampsia, small for gestational age (SGA), fetal death, spontaneous preterm labor and preterm premature rupture of membranes. In preeclampsia, spiral arteries fail to develop physiologic transformation and retain thick walls and a narrow lumen. Failure of physiologic transformation of spiral arteries is believed to be the main cause of uteroplacental ischemia, which can lead to the production of anti-angiogenic factors and induce endothelial dysfunction and eventually predispose the pregnancy to preeclampsia. Acute atherosis is more frequently observed in the spiral arteries of the decidua of the placenta (parietalis or basalis) than in the decidual or myometrial segments of the placental bed. The presence and deeper location of acute atherosis is associated with poorer pregnancy outcomes, more severe disease, earlier onset of preeclampsia, and a greater frequency of SGA neonates in patients with preeclampsia. Moreover, the idea that the presence of acute atherosis in the placenta may increase the risk of future cardiovascular disease in women with a history of preeclampsia is of growing concern. Therefore, placental examination is crucial for retrospective investigation of pregnancy complications and outcomes, and accurate placental pathology based on universal diagnostic criteria in patients with abnormal pregnancies is essential for clinicopathologic correlation.
Arteries* ; Atherosclerosis ; Cardiovascular Diseases ; Cholesterol ; Decidua ; Female ; Fetal Death ; Foam Cells ; Gestational Age ; Humans ; Infant, Newborn ; Ischemia ; Membranes ; Necrosis ; Obstetric Labor, Premature ; Pathology ; Placenta ; Placentation ; Pre-Eclampsia ; Pregnancy ; Pregnancy Complications ; Pregnancy Outcome ; Retrospective Studies ; Rupture

OBJECTIVETo observe the effect of intra-amniotic administration of pulmonary surfactant (PS) on the lung ultrastructure and expression of surfactant protein A (SP-A) in fetal rabbit with intrauterine infection.

METHODSIntra-amniotic PS injection was administered in a rabbit model of premature rupture of membrane and intrauterine infection induced by intrauterine colibacillus injection on the gestational days 24 and 26 days. The lung ultrastructural changes in the fetal rabbits were observed using electron microscope, and the expression of SP-A was measured with immunohistochemical staining and Western blotting 19.5 h after the PS administration.

RESULTSalveolar type I cell (AT I), alveolar type II cell (AT II). In fetal rabbits with intrauterine colibacillus injection, inflammatory cell infiltration was observed in the pulmonary alveolus, bronchus lumens and intracytoplasm irrespective of PS administration. Compared with those in normal fetal rabbits, the number of alveolar type II cells (AT II) in the lung tissue decreased in fetal rabbits with intrauterine infection, and vacuolization of the lamellar bodies occurred with evidence of cell apoptosis; PS administration resulted in increased number of the AT II cells and lamellar bodies and reduced the cell apoptosis. The expression of SP-A was significantly lower in the infection group than in normal control group (P<0.05), but comparable between the PS group and the control group (P>0.05).

CONCLUSIONChanges in pulmonary alveolar ultrastructure and decreased expression of SP-A occur in fetal rabbits after intrauterine infection, and intra-amniotic administration of PS can alleviate these changes to promote lung maturation.

Amnion ; Animals ; Female ; Fetal Membranes, Premature Rupture ; drug therapy ; Injections ; Lung ; embryology ; metabolism ; ultrastructure ; Pregnancy ; Pregnancy Complications, Infectious ; metabolism ; Pulmonary Surfactant-Associated Protein A ; metabolism ; Pulmonary Surfactants ; administration & dosage ; Rabbits

OBJECTIVETo analyze the high-risk factors of premature rupture of membranes (PROM) with neonatal infection and explore their clinical significance.

METHODSForty-two cases of PROM with neonatal infections were retrospectively analyzed for the risk factors with another 42 PROM cases matched for gestational age without neonatal infections as the control group. The relations of gestational age, time from membrane rupture to delivery, mode of delivery, placental pathology, maternal serum C-reactive protein concentration, leukocyte and neutrophil values to neonatal infections were analyzed.

RESULTSThe time from membrane rupture to delivery was significantly longer and the incidence of chorioamnionitis significantly higher in the study group (P<0.05). Meningitis and neonatal sepsis occurred at a significantly higher incidence in preterm PROM group (P<0.05).

CONCLUSIONAn appropriate extension of the gestation weeks and timely termination of pregnancy after dynamic monitoring of the biochemical changes and identification of the signs of infection are important to reduce the incidence of neonatal infection.

Adult ; Case-Control Studies ; Female ; Fetal Membranes, Premature Rupture ; epidemiology ; microbiology ; Humans ; Infant, Newborn ; Infant, Newborn, Diseases ; epidemiology ; microbiology ; Infection ; complications ; epidemiology ; Pregnancy ; Retrospective Studies ; Risk Factors ; Young Adult

The aims of this study were to determine whether sonographically measured cervical length is of value in the identification of microbial invasion of the amniotic cavity in women with preterm premature rupture of membranes (PPROM) and to compare its performance with maternal blood C-reactive protein (CRP), white blood cell count (WBC), and amniotic fluid (AF) WBC. This prospective observational study enrolled 50 singleton pregnancies with PPROM. Transvaginal ultrasound for measurement of cervical length was performed and maternal blood was collected for the determination of CRP and WBC at the time of amniocentesis. AF obtained by amniocentesis was cultured and WBC determined. The prevalence of a positive amniotic fluid culture was 26% (13/50). Patients with positive amniotic fluid cultures had a significantly shorter median cervical length and higher median CRP, WBC, and AF WBC than did those with negative cultures. Multiple logistic regression indicated that only cervical length had a significant relationship with the log odds of a positive AF culture. Transvaginal sonographic measurement of cervical length is valuable in the identification of microbial invasion of amniotic cavity in women with PPROM. Cervical length performs better than AF WBC, maternal blood CRP, and WBC in the identification of a positive amniotic fluid culture.
Adult ; Amniocentesis/methods ; Amniotic Fluid/*microbiology ; Bacterial Infections/*complications ; C-Reactive Protein/metabolism ; Cervix Uteri/*ultrasonography ; Female ; Fetal Membranes, Premature Rupture/etiology/*ultrasonography ; Gestational Age ; Humans ; Leukocyte Count ; Logistic Models ; Maternal Age ; Pregnancy ; Pregnancy Complications, Infectious/blood/etiology/ultrasonography ; Prospective Studies ; Risk Factors ; Ultrasonography/methods