Placental transfer of lead,mercury and cadmium in women living in a rural area

Summary The influence of the lead content of drinking water on the transplacental transfer of lead was investigated in 70 pregnant women living in a rural area of Belgium. The mothers were divided into 2 groups: group A: morning water lead below 50 g/liter; group B: morning water lead above this value. In group A, the mean lead content of water was 11.8 g/liter and in group B it amounted to 247.4 g/liter.The difference in the mean lead concentration between the two groups were for maternal blood: 3.2 g/100 ml, for umbilical cord blood: 3.3 g/100 ml, and for placenta: 3.6 g/100 g. These differences are statistically significant.There were significant correlations between water lead and lead concentration in blood (mother, newborn) or placenta. An increment of water lead concentration from 50 to 500 g/liter increases blood lead concentration in mother and in newborn by about 3 g/100 ml and in placenta by about 2.5 g/100 g (wet weight).     

胎盘早剥32例临床分析

目的 通过对胎盘早剥的临床分析，探讨早期诊断及治疗方法，以降低孕产妇和围产儿死亡率。方法 对我院200l—2002年元月收治的qd胎盘早剥32例进行顾性分析。结果 围产儿死亡19例，死亡率59．3％，其中胎死宫内者17例，新生儿死亡2例。孕产妇32例中1例并发DIC及凝血功能障碍，经及时刨救治愈。无孕产妇死亡。结论 胎盘早剥的早期诊断更应注重病史及诱因，B超已成为胎盘早剥的重要辅助诊断方法。适时终止妊娠可减少母子严重的并发症。     

过期妊娠胎盘滋养细胞Bax、Bcl-2基因表达情况的研究

目的 :通过观察过期妊娠患者促凋亡基因Bax和抑凋亡基因Bcl 2在胎盘滋养细胞层的表达 ,探讨细胞凋亡与过期妊娠的关系。方法 :采用免疫组织化学方法对20例过期妊娠和20例正常足月妊娠产妇的胎盘滋养细胞层Bax和Bcl 2基因表达进行检测和对比研究。结果 :胎盘滋养细胞层Bax和Bcl-2基因表达过期妊娠组分别为 (44 87±3 16) %和 (20 03±3 82) % ,足月妊娠组分别为 (43 89±3 96) %和 (34 14±3 85) %。2组比较Bax表达差别无统计学意义 (P>0 05) ,而Bcl 2表达差别有统计学意义 (P<0 05)。结论 :(1)胎盘滋养细胞层抑凋亡基因Bcl 2表达减少 ,可能与过期妊娠有关。 (2)胎盘滋养细胞层促凋亡基因Bax表达与过期妊娠无明显关系     

产后出血的高危因素分析

目的　分析产后出血发生的相关危险因素 ,探讨预防和减少产后出血的措施。方法　对我院1 990年 1月～ 2 0 0 2年 1 2月间住院分娩的产妇出现产后出血的产妇 31 9例 ,对照 6 38例。通过多元Logistic回归分析评价各危险因素的相对危险性。结果　产后出血的发病率为 2 0 9%。相对独立的多个危险因素作用大小的顺位为 :胎盘粘连或植入、前置胎盘、多胎妊娠及胎儿体重≥ 4 0 0 0g、重度妊高征、流产次数≥ 2次、胎盘早剥 ;在阴道分娩的产妇中 ,作用相对独立的危险因素的顺位为胎盘粘连或植入、胎儿体重≥ 4 0 0 0g、妊高征、第三产程 >1 0min、流产次数≥ 2次。结论　避免产前非意愿妊娠以减少前置胎盘、胎盘粘连或植入 ;减少巨大儿、多胎的发生 ,有助于预防和减少产后出血     

DIAGNOSIS OF CONGENITAL CYTOMEGALOVIRUS INFECTION BY EXAMINATION OF PLACENTA: Application of Polymerase Chain Reaction and in Situ Hybridization

We examined the placentas of 12 patients in whom congenital cytomegalovirus CMV infection was suspected from serological and or pathological evaluation. Seven patients died including four intrauterine deaths and five survived. On histological examination, the characteristic inclusion bodies were detected in only three placentas, and villitis with plasma cell infiltration was seen in eight placentas. Immunohistochemistry using a specific antibody against CMV improved the sensitivity of CMV detection 10 cases were positive . With the polymerase chain reaction PCR following the extraction of DNA from formaldehyde-fixed placenta samples, CMV DNA was detected in seven cases. All 12 subjects were diagnosed with CMV infection by additional Southern blot analysis after the PCR. CMV DNA was also detected by an in situ hybridization method in all cases. With current molecular biological techniques the placenta can be reliably used for the diagnosis of congenital CMV infection.     

Increased placental apoptosis in intrauterine growth restriction

OBJECTIVES: Our purpose was to investigate a possible role for apoptosis in the pathophysiologic mechanisms of intrauterine growth restriction. STUDY DESIGN: Placental samples were obtained from 43 uncomplicated third-trimester pregnancies and from 26 pregnancies complicated by intrauterine growth restriction. The definition used to identify cases of intrauterine growth restriction depended on three criteria: clinical evidence of suboptimal growth, ultrasonographic evidence of deviation from an appropriate growth percentile, and individualized birth weight ratios <10th percentile. Light microscopy was used to quantify the incidence of apoptosis. Electron microscopy and TUNEL (terminal deoxynucleotidyl transferase–mediated deoxyuridine triphosphate nick end labeling) staining were used to confirm the occurrence of apoptosis. RESULTS: Quantification of apoptosis (medians and interquartile ranges) resulted in the following values: normal third trimester (n = 43) 0.14% of cells (0.08% to 0.20%) and intrauterine growth restriction third trimester (n  = 26) 0.24% of cells (0.16% to 0.29%). The incidence of apoptosis was significantly higher in placentas from pregnancies with intrauterine growth restriction compared with normal third-trimester placentas (p < 0.01, Mann Whitney U test). CONCLUSIONS: These results suggest that apoptosis may play a role in the pathophysiologic mechanisms of intrauterine growth restriction.(Am J Obstet Gynecol 1997;177:401)     

Intraplacental Choriocarcinoma Associated with Viable Pregnancy: Pathologic Features and Implications for the Mother and Infant

Choriocarcinoma arising in the placenta, or intraplacental choriocarcinoma, has seldom been reported, particularly in the absence of maternal metastases. Reluctance to diagnose choriocarcinoma in the presence of chorionic villi can delay diagnosis; however, timely diagnosis of choriocarcinoma is prognostically important, both for the mother and infant. We report the clinicopathologic findings in five mothers and infants in whom choriocarcinoma was identified in the placenta. None of the mothers had a history of gestational trophoblastic disease in previous pregnancies. Three placentas were similar with a single small lesion grossly suggesting a small infarct; microscopically these consisted of infarcted areas surrounded by choriocarcinoma. These three mothers were unusual in that none had metastatic choriocarcinoma; two were treated with chemotherapy and remained disease-free; the third was lost to follow-up shortly following delivery. The remaining two mothers had known pulmonary metastases at time of delivery. One of these latter two placentas contained a large marginal lesion microscopically identified as choriocarcinoma. The fifth placenta had rare microscopic foci of choriocarcinoma, and sheets of necrotic choriocarcinoma were identified in “blood clot” submitted with the placenta. In four of the five cases the choriocarcinoma appeared to be arising from otherwise normal chorionic villi, and in no case was there invasion of the villous stroma. All of the infants survived, and none had evidence of choriocarcinoma. These cases support the concept that choriocarcinoma associated with otherwise normal pregnancy arises in the placenta and may be more common than reported. Received August 11, 1997; accepted December 8, 1997.     

新生儿窒息513例临床分析

目的 探讨新生儿窒息的相关因素及预防措施。方法 对1995年1月～2004年12月哈尔滨二四二医院住院分娩发生的新生儿窒息513例临床资料进行分析。结果 新生儿窒息与胎儿窘迫高度相关。脐带因素、产程异常、胎盘功能不全是新生儿窒息的主要产科原因。结论 新生儿窒息是胎儿窘迫产程中缺氧在出生后的表现和继续。应以预防为主：要重视产前检查，对高危妊娠进行系统管理，指导胎动计数，加强产程监护，综合判断后选择最佳分娩方式。一旦发生，及时进行复苏术。     

Effects of di-(2-ethylhexyl)-phthalate (DEHP) and its metabolites on fatty acid homeostasis regulating proteins in rat placental HRP-1 trophoblast cells.

Di-(2-ethylhexyl)-phthalate (DEHP) is a widely used plasticizer and ubiquitous environmental contaminant. The potential health hazards, including teratogenicity, from exposure to DEHP may be related to the role of DEHP or its metabolites in the trans-activation of peroxisome proliferator-activated receptors (PPARs). Fetal essential fatty acid (EFA) homeostasis is controlled by directional transfer across the placenta through a highly regulated process, including PPAR activation. Using HRP-1 rat trophoblastic cells, the effects of DEHP and two of its metabolites, mono-(2-ethylhexyl)-phthalate (MEHP) and 2-ethylhexanoic acid (EHA), on the mRNA and protein expression of the three known PPAR isoforms (alpha, beta, and gamma), fatty acid transport protein 1 (FATP1), plasma membrane fatty acid binding protein (FABPpm), and the heart cytoplasmic fatty acid binding protein (HFABP) were investigated. This study also investigated the functional effects of exposure on the uptake and transport of six long chain fatty acids (LCFAs): arachidonic acid (AA), docosahexaenoic acid (DHA), linoleic acid (LA), alpha-linolenic acid (ALA), oleic acid (OA), and stearic acid (SA). In the presence of DEHP, MEHP, and EHA, the expression of PPARalpha, PPARgamma, FATP1, and HFABP were up-regulated in a dose- and time- dependent manner, while PPARbeta and FABPpm demonstrated variable expression. The uptake rates of EFAs (AA, DHA, LA, ALA) increased significantly upon exposure, and the transport of AA (omega-6) and DHA (omega-3) were directionally induced. These results suggest that DEHP, MEHP, and EHA can influence EFA transfer across HRP-1 cells, implying that these compounds may alter placental EFA homeostasis and potentially result in abnormal fetal development.     

Fetal circulation and placental blood flow in monochorionic twins

Objectives. Twin to twin transfusion syndrome (TTTS) is one of the most important problems for perinatal management of monochorionic twins. Since TTTS is deeply related to the prognoses of both fetuses, fetal circulation and placental blood flow of monochorionic twins were studied with the purpose of clarifying characteristic features.

Methods. The patterns and numbers of vascular anastomoses were checked on the placental surface, arterio-arterial (A-A) anastomosed vessels by ultrasound, and circulatory changes were studied with relation to uterine contraction.

Results. The high risk of monochorionic twin pregnancies was largely related to the patterns of vascular anatomy of the placenta and numbers of anastomosed vessels. The first placental vascular connection detected in vivo was the A-A anastomosis characterized by the bidirectional flow waveform in pulsed Doppler velocimetry.

Conclusion. TTTS is related to anastomosed vessels on the surface of placenta. To manage and prevent TTTS, fetal circulation and placental blood flow should be carefully observed.