Thrombophilia and pregnancy complications

OBJECTIVE: This systematic review examines the strength of the association between thrombophilia and recurrent pregnancy loss and other serious obstetric complications.Study design Electronic databases and manual bibliography searches were used to identify studies evaluating the association between thrombophilia and pregnancy loss, preeclampsia, fetal growth retardation, and placental abruption. RESULTS: Thrombophilic disorders are associated with an increased risk of fetal loss in the majority of case control and cohort studies. The risk is increased throughout pregnancy, but may be higher in the second and third trimester. The common pathologic finding of placental infarction suggests unexplained fetal loss may result from uteroplacental insufficiency and thrombosis. Thrombophilic disorders are not consistently associated with preeclampsia, fetal growth retardation, or placental abruption. Preliminary data suggest prophylactic anticoagulation may improve outcome in thrombophilic women with unexplained recurrent fetal loss. CONCLUSION: Women with thrombophilia have an increased risk of pregnancy loss and possibly other serious obstetric complications, although definition of the magnitude of risk will require prospective longitudinal studies. Preliminary data suggesting prophylactic anticoagulation may improve gestational outcome provide a rationale for prospective randomized trials in thrombophilic women with unexplained recurrent fetal loss.     

Cord serum glycodelin concentrations in normal pregnancies and pregnancies complicated by diabetes

Objective Glycodelin is a glycoprotein released by secretory/decidualized endometrial glands. Its synthesis increases during pregnancy. Hormonal factors whose levels have been shown to change in diabetes (vascular endothelial growth factor, relaxin) may mediate the actions or regulate the synthesis of glycodelin. Cord serum glycodelin levels have not been studied in pregnancies complicated by diabetes.Methods Cord serum glycodelin concentrations were measured at birth by an immunofluorometric assay in 62 normal pregnancies, in 67 pregnancies complicated by type 1 diabetes, and in 28 pregnancies complicated by insulin-treated gestational diabetes.Results The mean glycodelin concentration in cord serum was 2.7 ng/ml (standard error of the mean 0.6) in normal pregnancies. The concentration was not altered in pregnancies complicated by diabetes. Cord serum glycodelin concentrations were also unaltered in diabetic pregnancies with hypertensive disorders (chronic hypertension, pregnancy-induced hypertension or pre-eclampsia) or fetal macrosomia. There was a negative borderline correlation between cord serum glycodelin concentrations and the birth weight in pregnancies complicated by diabetes (r=–0.21, p=0.049).Conclusions Decidual function, as assessed by cord serum glycodelin levels, is not markedly altered in diabetic pregnancies. The negative correlation between cord serum glycodelin and the birth weight of the newborns in diabetic pregnancies may be due to the decline in glycodelin levels with advancing pregnancy in the third trimester.     

探讨43例不典型胎盘早剥漏诊原因及母胎预后

目的分析不典型胎盘早剥产前易漏诊的原因，改善母胎预后。方法回顾性分析17年间胎盘早剥产前未确诊的43例（观察组）患者的资料，并与同期产前确诊为胎盘早剥的63例（对照组）比较。结果观察组临床表现主要为腰酸、腹胀或胎心监护异常，早剥面积及总出血量均明显低于对照组。而死胎、死产、新生儿死亡、新生儿窒息及早产儿出生率与对照组比较差异无统计学意义。产科DIC等并发症与对照组比较差异无统计学意义。结论胎盘早剥漏诊的主要原因为发病诱因和临床症状不典型，虽轻型早剥占较大比例，但对母胎仍具有较大危害。     

胎盘早剥89例临床分析和护理体会

目的分析和总结胎盘早剥的病因及护理方法。方法对89例胎盘早剥患者提供正确的临床基础护理和心理护理。结果妊娠期高血压病是胎盘早剥的主要诱因,胎盘早剥患者胎儿窘迫、低体重儿、新生儿窒息、围生儿死亡率均高于同期正常分娩者（P〈0.01）,但经对89例产妇和60例存活儿的正确护理,母婴康复较快出院。结论加强孕产期保健,积极防治胎盘早剥的诱发因素是关键,正确的基础护理和心理护理是达到理想治疗效果的保证。     

Pituitary and placental hormone levels in pseudocyesis

Twelve patients with clinical features of pseudocyesis were divided into two groups according to the presence or absence of galactorrhea. The mean serum prolactin level of patients with galactorrhea was significantly higher than the normal values of the patients without galactorrhea. The mean serum levels of luteinizing hormone and follicle-stimulating hormone were markedly elevated in patients without galactorrhea. This was especially true of luteinizing hormone. Serum levels of human chorionic gonadotropin were undetectable in all patients. The significance of these observations is discussed.     

Taurine Transport in Human Placental Microvillous Membrane Vesicles

Taurine, a β-amino acid, is actively transported across the in vitro perfused human placenta. To further characterize the transport mechanism microvillous membrane vesicles (MVV) were prepared from the apical brush border of human term placentae by Mg^{2 +}-aggregation and differential centrifuga-tion. Vesicular uptake of taurine was measured by rapid filtration technique at 25^oC using [U-¹⁴C] taurine. All data are expressed as mean ± SEM. The course of uptake over time in the presence of an inward Na⁺ gradient (n = 4) revealed an “overshoot” phenomena. When Na⁺ was replaced with K⁺ in the incubation medium (n = 4), the overshoot was abolished and the uptake rate was sharply reduced. Uptake velocities at taurine concentrations from 1 to 35 μM were studied (n = 6) showing that taurine uptake was saturable and the K_m was 12.1 μM and the V_max was 36.2 pmol/mg protein/min. Hypotaurine, β-alanine, and taurine all inhibited the uptake of taurine by MVV (n = 4). Taurine is actively transported into MVV from human term placentae by a Na⁺-dependent carrier that is inhibited by β-amino acids, and therefore conforms to the β-carrier described in other tissues.     

药物流产后胎盘残留问题的研究

为减少药物流产后出血,缩短出血时间,将200例孕10～16周药物流产者按不同给药剂量采用不同给药途径终止妊娠,探讨其流产效果及流产后影响胎盘绒毛残留的因素。200例对象中192例流产成功,成功率96％。米索前列醇阴道用药效果明显优于口服(P<0.01)。24小时后清宫者绒毛胎盘残留明显低于即刻清宫(P<0.01)。残留与以往电吸人流次数及米非司酮剂量有关。提示做过二次或二次以上电吸人流手术者,药物流产后宜即刻行清宫术。     

米非司酮对孕7～9周人胎盘绒毛滋养细胞VEGF的影响

目的通过对比观察米非司酮对孕7～9周人胎盘绒毛滋养细胞血管内皮生长因子(VEGF)表达的影响,探讨米非司酮应用于人孕7～9周药物流产时的终孕机理,为临床上合理扩大米非司酮药流应用范围提供理论基础和实验参考依据。方法采用免疫组化法检测VEGF在米非司酮药流组与人流对照组(孕7～9周各12例)胎盘绒毛中表达的差异,了解米非司酮对孕7～9周人胎盘绒毛VEGF表达的影响。结果 VEGF主要表达于绒毛的滋养细胞和血管内皮细胞胞浆中,米非司酮药流组阳性表达较人流对照组弱(P0.01)。结论米非司酮作为孕激素受体拮抗剂,应用于人孕7～9周药物流产时,可通过降低VEGF在人早孕期绒毛滋养细胞中的表达,抑制胎盘血管的发育,进而不利于妊娠的维持。     

Natural frequency of polymorphisms linked to the chondroitin 4-sulfotransferase genes and its association with placental malaria

Our understanding about the role of the maternal genetic factors on placental malaria is scarce. The general aim of this work was to examine whether common polymorphisms of genes involved in chondroitin sulphate A (CSA) synthesis influence susceptibility to and manifestation of malaria during pregnancy. To achieve this, 96 women with placental malaria and 180 healthy controls without malaria from the province of Luanda, Angola, were genotyped using six microsatellite loci. No associations were found between polymorphisms of genes involved in CSA synthesis and placental malaria. All these findings suggest that there is no genetic susceptibility or increased risk attributed to polymorphisms of the enzymes involved on the synthesis of CSA.