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Clinical analysis of pregnancy complicated with cervical epithelial neoplasia-18 cases

Tao Lü ; Huanyu ZHENG ; Jian ZHAO ; Zhaohui LIU ; Qinping LIAO

Chinese Journal of Perinatal Medicine.2009;12(4):277-280. doi:10.3760/cma.j.issn.1007-9408.2009.04.012

Objective To discuss the diagnosis,treatment and following-up of cervical intraepithelial neoplasia (CIN) during pregnancy.Methods Eighteen pregnant women with CIN,presented to the hospital from Jan.2004 to May.2008,were retrospectively reviewed.Pap smear,HPV,copolscopy and cervical biopsy were performed for diagnosis and all were followed up by Pap smear and copolscopy during pregnancy every 12 weeks,while 15 were followed up until 6-8 weeks postpartum.Results The incidence of CIN during pregnancy was 0.16%.All of the 18 women had abnormal Pap smear,followed by colopscopy and biopsy.Conservative management during the pregnancies every 3 months showed no progress in CIN.Among the 18 cases,17 delivered at term and only 1 preterm (36+4 weeks).Two out of the 18 women had normal delivery (11.1%),2 by forceps(11.1 %) and 14 by cesarean sections (77.8%).No neonatal apnea or neonatal respiratory distress syndrome had been observed.Pathological diagnosis was confirmed in all cases prenatally,including 4 CIN1,4 CIN2 and 10 CIN3.Four out of the 10 CIN3 remained after delivery,while 1 changed to CIN2.These 5 cases underwent leep electrical excision procedure and Pap smear results turned to normal at 6 to 11 months after delivery.One HSIL case were lost.The rest 4 CIN3 and all of the 8 CIN1 and CIN2 cases turned to normal or lesser degree.Fourteen of the 18 women received HPV test during pregnancy,and 12 (85.7%) were positive,among which 7 women were followed up at postpartum and 6 of them were HPV positive.Conclusions The three steps method for diagnosis of CIN during pregnancy is safe and effective.Conservative management of CIN during pregnancy is recommended.

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Survey on prenatal intake of various nutrients and pregnancy outcomes

Hong WANG ; Liqian CAI ; Yanfeng FAN

Chinese Journal of Perinatal Medicine.2009;12(4):245-249. doi:10.3760/cma.j.issn.1007-9408.2009.04.002

Objective To investigate the maternal nutritional status and its influences on pregnancy outcomes in order to provide evidence for possible prenatal interventions.Methods A survey was conducted in 800 pregnant women,who presented at Xiamen Maternal and Child Healthcare Hospital between January 2006 to April 2008.The information of knowledge,attitude and behavior towards maternal nutrition were collected in 734 women and 571 women were followed up before 20 weeks of gestation,at 26-27 weeks,and 35-36 weeks to analyze the relationship between different nutrients and the pregnant outcomes.Results The questionnaire survey showed that women who had received higher education presented with better knowledge,attitude and behavior on maternal nutrition (P<0.05).Among the 734 women,39.2%(288) had poor knowledge,44.5%(326) were lack of knowledge,and 44.8%(358) with poor behavior.Prenatal diet analysis found that the percentage of these women with milk,fish and beans intake daily was 52.2%,34.3%,and 29.5%,respectively.Before 20 weeks of gestation,significant difference was identified only in the level of triglyceride among different BMI groups,and the higher the BMI,the higher the level of triglyeeride (P<0.01).With the progress of pregnancy,the level of serum ferritin and folic acid was decreasing (P<0.05),while the level of triglyceride and cholesterol was increasing (P<0.01).The newborn's birth weight was positively correlated to maternal BMI before 20 weeks (r=0.23,P<0.05),and higher BMI was a risk factor for abnormal birth weight (OR=4.051,95%CI:1.085～15.117,P<0.05) and also complicated with higher cesarean section rate than those women with lower or normal BMI (60.3%vs 29.4%and 34.7%,P<0.05).The rate of postpartum hemorrhage was increased with the reduced ferritin level (P<0.05).Conclusions The pregnancy outcomes can be improved through the following measures:appropriate control of the maternal weight before and during the pregnancy,increased intake of milk,fish,beans and so on,reduced intake of food containing abundant fat and sugar,more intake of red animal foodstuff,supplementation of folie acid,iron and calcium throughout the pregnancy,and prevention against high level of triglyceride and cholesterol.

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Longterm influence of hypoxic-ischemic brain damage in 3-day-old rats on their brain MR imaging and memory and learning ability

Jiangqin LIU ; Zhiheng HUANG ; Qingguo WANG ; Chao CHEN

Chinese Journal of Perinatal Medicine.2009;12(3):205-208. doi:10.3760/cma.j.issn.1007-9408.2009.03.013

Objective To investigate the activation of apoptotic genes of the brain with hypoxia- ischemia (HI) in newborn SD rats, and MRI changes and memory and learning ability in adulthood. Methods HI was induced by right carotid artery ligation followed by 2.5 h of hypoxia (6% O2) on 3-day-old SD rats (n=36). Control pups were sham-operated (n = 27). Right brain hemisphere was collected at 12 h and 7 d after HI and subjected to an apoptosis Oligo GEArrayR. MRI and Morris water maze test were performed on both groups at 42 and 44 days old, respectively. Results Comparing to 12 h after HI, up-regulated apoptotic genes included TNF, Caspase and pro-apoptotit genes of Bcl2 families, whereas the anti-apoptotic genes of Bcl2 family were down-regulated at 7 d after HI. The MRI assessment of the rats in HI group demonstrated that the area of the right cerebra l cortex was significantly smaller than the left side and control [periventricular layer: (23.5±3.6) mm2 vs (33.0±4.3) mm2, (34.5±3.9) mm2; hippocampus layer: (18.9±4.4) mm2 vs (29.1±5.0) mm2,(30.8±4.5) mm2, both P<0.01]. During the navigation trial, the HI rats demonstrated longer escape latency (4th day: (52.7±35.9) vs (17.8±8. 9) s, P<0.01). HI rats passed the platform less times than the control ones (T= 292.5, P<0.05) in space probe trial. Conclusions The activation of apoptotic genes induced by HI brain injury remains until 7 days later, involving intrinsic and extrinsic apoptotic pathway. The apoptosis of neural cells may lead to poor development of the cortex and impair the memory and learning ability in the adult rats after neonatal hypoxia- ischemia injury.

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Amnioreduction in management of twin-twin transfusion syndrome

Xin WANG ; Weiyuan ZHANG

Chinese Journal of Perinatal Medicine.2009;12(3):194-196. doi:10.3760/cma.j.issn.1007-9408.2009.03.010

Objective To find out the clinical outcomes of twin-twin transfusion syndrome (TTTS) after aminioreduction. Methods Twenty-nine pregnancies with TTTS delivered in Beijing Gynecological and Obstetric Hospital from Nov. 1, 2002 to Sept. 30, 2007 were recruited. The effect of gestational age at the onset, the degree of TTTS and amnioreduction therapy on the fetal outcomes were compared. Results All of the 8 cases with the onset of TTTS before 26 weeks without treat- ment were lost, but 4 out of the 6 with the onset after 26 weeks survived (P=0. 015). Among the 9 cases received amnioreduction, 4 out of the 5 with onset before 26 weeks survived, and significant difference was found compared to those untreated ones (P= 0. 007), but no difference was shown when compared with those developed after 26 weeks(4/4)(P= 1. 000). The average delivery weeks in the untreated ones was earlier than those received treatment E(28.7±4.7)weeks vs (33.2±4.9) weeks, P=0. 001]. Amnioreduction improved the umbilical cord blood flow. For severe TTTS(stage Ⅲ～Ⅳ) with the onset before 26 weeks, the survival rate after amnioreduction was significantly high- er than those untreated ones[4/5 vs 0/5, P=0. 048)]. Conclusions Aminioreduetion is effective in improving the cord blood flow, prolonging the pregnancies, and achieving a higher fetal survival rate.

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Appropriate weight gain during pregnancy in women complicated with gestational abnormal glucose metabolism

Guirong ZHAI ; Huixia YANG

Chinese Journal of Perinatal Medicine.2009;12(4):250-252. doi:10.3760/cma.j.issn.1007-9408.2009.04.003

Objective To investigate the appropriate range of gestational weight gain in pregnant women with abnormal glucose metabolism.Methods A retrospective study was conducted on 661 term singleton pregnant women with gestational abnormal glucose metabolism,who delivered in the Department of Obstetrics and Gynecology of Peking University First Hospital from Jan.2005 to Dec.2007,by reviewing the medical records.All sujects were divided into 4 groups according to their body mass index (BMI) before pregnancy:group Ⅰ (n=40):BMI<18.5;group Ⅱ (n=400):BMI18.5-23.9;group Ⅲ (n=162):BMI 24.0-27.9;group Ⅳ (n=59):BMI≥28.0.The weight gain among different groups and that between women who delivered normal birth weight infant and maerosomia were analyzed.The weight gain of pregnant women who delivered babies weighing 3000～3500 g in each group was determined as the appropriate weight gain for that group.Results The same results were achieved that the weight gain in pregnant women who delivered macrosomia was significantly higher than those who delivered normal birth weight newborns in each group,ie,the weight gains for women who had macrosomia and normal birth weight infants were (17.0±5.2) kg and (14.1±4.7) kg in group Ⅱ,(16.8±7.3) kg and (11.9±5.1) kg in group Ⅲ and (18.3±6.7) kg and (11.2±5.4) kg in group Ⅳ,respectively (P<0.05).The appropriate ranges of weight gain for each group were (15.6±3.3) kg,(14.0-18.0) kg for group Ⅰ,(13.9±4.6) kg,(11.0-16.5) kg for group ]],(11.5±5.2)kg,(9.0-15.0) kgforgroup Ⅲ,(10.1±2.9) kg,(7.0-12.7) kg forgroup Ⅳ.Conclusions Appropriate weight gain based on prepregnant BMI,together with glucose monitoring in women with gestational abnormal glucose metabolism,is helpful for fetal weight control.

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Effects of prolonged oxygen exposure at different concentrations on expressions of vascular endothelial growth factor and its receptors mRNA in pulmonary tissues of neonatal rat

Haiyan FENG ; Chao CHEN

Chinese Journal of Perinatal Medicine.2009;12(3):170-172. doi:10.3760/cma.j.issn.1007-9408.2009.03.004

Objective To study the effects of prolonged oxygen exposure at different concentrations on expressions of vascular endothelial growth factor (VEGF) and its receptors (VEGF receptor-1 ,VEGFR1 and VEGF receptor-2, VEGFR2)mRNA in lungs of neonatal rat. Methods Thirty-two SD rat pups were randomly divided into control and experimental group. Rats in the experimental group were further divided into three subgroups: 30% O2, 50% O2 and 75% O2 group. Each group had 8 rats. The rats were ,sacrificed at postnatal day 21 and their right lower lobes were collected. Expressions of VEGF, VEGFR1 and VEGFR2 mRNA were detected by RT-PCR. Results There was no effect on VEGF, VEGFR1 or VEGFR2 mRNA expression in 30% O2 group. The expressions of VEGF mRNA in the 75% O2 group was 0. 48 times of the control (P<0. 05). The expressions of VEGFR1 mRNA(P<0.01) and VEGFR2 mRNA (P<0.01) in 50% O2 and 75% O2 group were lower than those of control. Condusions Prolonged exposure to moderate or high oxygen concentration may reduce the expression of VEGF and its receptors' mRNA in the lung tissues of neonatal rats.

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Expression of aquaporin-1,3,8,9 mRNA in human amniotic membranes in polyhydranmios

Huishu LIU ; Rongzeng HAO ; Zhengfang XIONG

Chinese Journal of Perinatal Medicine.2009;12(3):197-200. doi:10.3760/cma.j.issn.1007-9408.2009.03.011

Objective To determine the expression of aquaporin-1,3,8,9 mRNA (AQP-1,3,8, 9) in amniotic membranes in pregnant women with polyhydramnios. Methods Amniotic membranes were collected from women who presented with either polyhydramnios (n= 5)or normal amniotic fluid volume (control, n= 5) underwent elective cesarean sections at term. The AQP-1,3,8,9 mRNA expression were detected by reverse transcriptase-polymerase chain reaction (RT-PCR). Results The expression of AQP-9 mRNA on fetal membranes were significantly higher in polyhydramnios groups (1. 1403±0. 0831) than that of control (0. 5903±0. 1909) (P = 0. 002), although the expression of AQP-1, 3 and 8 showed no significant difference between the two groups (P= 0. 972, 0. 242,0. 608, respectively). Conclusions AQP-9 may play an important role in maintaining the volume and the balance of different components of amniotic fluid in polyhydramnios cases.

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Pregnant outcomes and prognosis of women complicated with systemic lupus erythematosus

Yan ZHANG ; Huixia YANG ; Qinping LIAO

Chinese Journal of Perinatal Medicine.2009;12(2):117-120. doi:10.3760/cma.j.issn.1007-9408.2009.02.012

Objective To understand the clinical features, management, pregnant outcomes and prognosis of pregnant women complicated with systemic lupus erythematosus (SLE). Methods Retrospective analysis of 34 women (35 pregnancies) complicated with SLE were conducted and 26 of them were followed up for 0.5～15 years. Results (1) Out of the 35 pregnancies in these 34 women, 8 were in remission stage, 8 in the well-controlled period, 1 in active phase and 18 were primary onset (10 diagnosed during the pregnancy, and 8 after terminations) during the pregnancy. (2) Among those diagnosed during the pregnancy, 2 women in the remission group and 3 in the well-controlled group were in the active stage of SLE. The several most common clinical manifestations indicating SLE deterioration were proteinuria, fatigue, edema, hypertension, erythra and decreased serum C3. (3) In women with onset during the pregnancy, 7 (38.9%) presented with proteinuria, edema and hypertension which similar to symptoms of gestational hypertension. (4) The average maternal age of the remission group was much older than those women with onset during pregnancy [(32.4±5.5) years vs (26.6±3.9) years, P=0.034]. while the proportion of active lupus nephritis was lower than that of the later (1/4 vs 16/16, P=0.004) and the well-controlled group (1/4 vs 6/6,P=0.033) during post-partum follow-ups. Conclusions Pregnancy prompted lupus nephritis has nothing to do with maternal age, but the stage of SLE. Patients who conceived in the remission stage are the least likely to have nephritic damage. Although women with onset during the pregnancy is relatively young, they are expected to have more serious renal damage and poor prognosis.

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Detection rate of chromosomal abnormalities in women with different indications for invasive prenatal diagnosis and procedure-related complications

Jie LI ; Tong RU ; Haiyan ZHU ; Ruifang ZHU ; Ying ZHANG ; Yan GU ; Xing WU ; Ying YANG ; Honglei DUAN ; Chenyan DAI ; Yan YANG ; Yali HU

Chinese Journal of Perinatal Medicine.2009;12(2):88-92. doi:10.3760/cma.j.issn.1007-9408.2009.02.003

Objective To discuss the detection rate of chromosomal abnormalities in women with different indications for invasive prenatal diagnosis(amniocentesis and eordocentesis), and the procedure-related complications. Metheds A retrospective analysis was conducted on 1264 women, who underwent invasive prenatal diagnosis (1082 amniocentesis and 182 eordocentesis), and the procedure-related complications were reviewed. Results The indications for invasive prenatal diagnosis in these 1264 women were: increased risk at prenatal screening (651, 51.5%), advanced maternal age (≥35) (318, 25.2%), abnormal foundings through uhrasonograph (136, 10.8%),history of adverse pregnancy (88, 6.9%), one or two abnormal serologic markers (52,4.1%), and chromosomal balance translocation carrier in either one of the couple(19, 1.5%). Thirty-seven cases were found to be chromosomal abnormalities with clinic significance and the indications for them were: ultrasonic abnormality (20/136, 14.7%); increased risk at prenatal screening (12/651, 1.8%); one or two abnormal serologic markers (1/52, 1.9%); history of adverse-pregnant (1/88, 1.1%)chromosomal balance translocation carrier in either one of the couple (3/19, 15.8%); advanced maternal age (0/318). Among the 1264 cases, 5 experienced spontaneous abortion and the procedure-related fetal loss rates were 0.28% for amniocentesis (3/1082) and 1.09% for cordocentesis (2/182), P=0. 154. The rate of complications after cordocentesis was significantly higher than amniocentesis (9.89 % vs 0.18 %, P= 0.0001). Conclusions Routine fetal karyotyping should be prompted after prenatal ultrasonographic abnormalities. However, invasive prenatal diagnosis due to advanced maternal age alone is controversial. Amniocentesis is the fist choice for invasive prenatal diagnosis.

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Expression and significance of thioredoxin system in placenta of preeclampsia

Jifen HU ; Meixian ZHU ; Xiu ZHENG

Chinese Journal of Perinatal Medicine.2009;12(1):20-23. doi:10.3760/cma.j.issn.1007-9408.2009.01.006

Objective To assess the expression of thioredoxin reductase(TR)and thioredoxin (Trx)mRNA,TR activity in human placenta in women with preeclampsia,and to discuss the relationship between Trx system and the pathogenesis of preeclampsia.Methods Twenty-sixwomen with preeclampsia(10 mild and 16 severe)and 28 healthy gravidas (control) were included in this study.Semi-quantitative reverse transcription polymerase chain reaction(RT-PCR)were employed to demonstrate the expression of TR and Trx in placentas.TR activity was measured spectrophotometrically.Results The expression of TR mRNA(mild:0.865±0.018;severe:0.800±0.025,P＜0.05)and Trx mRNA(mild:0.873±0.008;severe:0.818±0.025,P＜0.05)were lower in placenta of preeclampsia than in the control group(TR mRNA:0.893±0.023;Trx mRNA:0.918±0.023.P＜0.05),and those levels in the severe preeclampsia group were lower than in the mild ones.Both the mild and severe preeclampsia groups showed lower TR activity than the control(mild:17.732±1.653;severe:15.626±1.543 vs 19.770±2.432,P＜0.05),and that of the severe preeclampsia group was lower than that of the mild ones.Positive correlation was found between the TR activity and TR mRNA expression in both groups(r=0.612,P＜0.001).Conclusions Abnormal decreased expression of TR mRNA and Trx mRNA and TR activity in human placenta of preeclampsia might participate and play an important role in the pathogenesis of preeclampsia.

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