妊娠期血脂改变与妊娠期糖尿病的关系

妊娠期随着雌孕激素的变化,内分泌代谢也会发生相应的生理性改变,但当改变超过生理性上限时会引发一系列妊娠期并发症,如妊娠期糖尿病（gestational diabetes mellitus,GDM）、妊娠期高血压疾病、胎膜早破、早产和巨大儿等。GDM是其中较为常见的并发症,作为一种内分泌疾病,GDM常伴有糖代谢和脂代谢异常。而血脂代谢的异常也会增加GDM的患病风险。在妊娠早期发现血脂异常并加以控制,对GDM的预防、确诊和治疗意义重大,因此对GDM脂代谢的研究是十分有意义的。究竟是血脂代谢的改变增加了GDM的患病风险,还是GDM的发病导致了血脂代谢的紊乱,并没有明确的研究成果。综述妊娠期正常血脂代谢及妊娠期血脂代谢与GDM关系的研究进展。     

Maternal Plasma P-selectin at 11 to 13 Weeks of Gestation in Hypertensive Disorders of Pregnancy

Objective. To determine if development of preeclampsia is preceded by altered maternal plasma P-selectin and if the levels are related with uterine artery pulsatility index. Methods. Plasma P-selectin and uterine artery pulsatility index were measured at 11–13 weeks in 121 cases that subsequently developed preeclampsia, 87 cases that developed gestational hypertension and 208 unaffected controls. Results. In the preeclampsia group the median multiple of the median in controls (MoM) P-selectin and uterine artery PI were significantly increased (1.2 MoM and 1.3 MoM). There was no significant association between P-selectin and uterine artery pulsatility index in either the preeclampsia or control group. Conclusion. In pregnancies that develop preeclampsia there is evidence of platelet activation from the first trimester. However, there is no direct link between the degree of impaired placentation and platelet activation.     

Plasma concentrations of 11-deoxycorticosterone in women during the menstrual cycle

As plasma 11-deoxycorticosterone (DOC) can arise from adrenal secretion and from 21-hydroxylation of plasma progesterone in extraadrenal tissues, alterations in plasma progesterone concentrations might alter significantly the plasma DOC levels in humans. Therefore, the authors measured DOC in plasma of 6 normal, ovulatory women daily throughout their menstrual cycles and in plasma of normal men. The plasma DOC concentrations in women during the follicular phase, when plasma progesterone levels are low, were also low (42 +/- 1.7 pg/ml, mean +/- SE). An increase in the plasma levels of DOC and progesterone occurred at midcycle. The plasma DOC levels remained elevated (P less than .001, as compared with levels during the follicular phase) throughout most of the luteal phase (119 +/- 7.9 pg/ml), declining prior to the onset of menses. However, the plasma levels of cortisol and dehydroepiandrosterone sulfate did not fluctuate during the cycle. The plasma DOC levels in men were 57 +/- 4.3 pg/ml (N = 10). The authors conclude that, during the ovarian cycle of women, significant changes in the plasma levels of DOC occur that are coupled to fluctuations in plasma progesterone concentrations.     

妊娠相关血浆蛋白-A与促卵泡激素在卵泡发育中的关系

目的:探讨妊娠相关血浆蛋白-A(PAPP-A)是否直接参与了卵泡发育中的FSH作用系统。方法:将来自体外受精-胚胎移植的卵巢黄素化颗粒细胞纯化后,在不同剂量FSH作用下进行体外培养。收集培养液,并采用时间荧光免疫分析法测定培养液中的PAPP-A量。结果:一定浓度范围(0.5-25IU/ml)的FSH能够刺激体外培养的黄素化颗粒细胞分泌PAPP-A(P<0.05),而高浓度(50IU/m)的FSH对颗粒细胞分泌PAPP-A无显著影响。结论:PAPP-A与一定浓度的FSH在卵泡内的作用机制相关,参与卵泡生长发育的调节。     

Maternal Plasma Plasminogen Activator Inhibitor-2 at 11 to 13 Weeks of Gestation in Hypertensive Disorders of Pregnancy

Objective. In patients with preeclampsia maternal plasma concentration of plasminogen activator inhibitor-2 (PAI-2) is reduced. The objective of the study was to determine if the altered levels of PAI-2 precede the onset of the disease. Methods. Plasma PAI-2 was measured at 11–13 weeks of gestation in 119 pregnancies that developed preeclampsia, 85 that developed gestational hypertension and 204 controls. Results. There were no significant differences in PAI-2 between the preeclampsia, gestational hypertension and controls (1.07 MoM, 1.08 MoM and 0.96 MoM). Conclusion. The decrease in plasma PAI-2 observed in preeclampsia does not precede the clinical onset of the disease.     

Pregnancy Induced Hypertension: Observations on Chemical-Physical Properties of Syncytiotrophoblast Plasma Membranes from Human Placenta

The Pregnancy Induced Hypertension (PIH) was associated to alterations of ion transport, which may be due to abnormalities of membrane composition and function.We studied the syncytiotrophoblast plasma membranes of PIH mothers compared with normal ones.We observed a decreased microviscosity and an alteration of cholesterol to phospholipid ratio, together with an increased percentage of unsaturated fatty acid respect to the controls.

We therefore hypothesized an involvment of the chemical-physical properties of the syncytiotrophoblast plasma membranes in the modified functional properties observed in the PIH.     

早孕期母体血清中PAPP-A水平与妊娠期糖尿病的相关性及预测价值研究

目的:分析早孕期母体外周血中妊娠相关血浆蛋白A(PAPP-A)水平与妊娠期糖尿病(GDM)的关系,探究PAPP-A对GDM的预测价值。方法:对完成产前检查并分娩的599例GDM孕妇(GDM组)和986例正常孕妇(对照组)的临床资料进行回顾性分析,比较两组孕妇早孕期血清中PAPP-A水平的差异,采用二分类Logistic回归分析GDM的相关影响因素,采用受试者工作特征(ROC)曲线分析PAPP-A对GDM的预测价值。结果:(1)GDM组年龄、孕前BMI、糖尿病家族史、经产妇、辅助生殖技术的比例、剖宫产的比例高于对照组,差异有统计学意义(P0.01);GDM组分娩孕周早于对照组,差异有统计学意义(P0.01)。(2)GDM组PAPP-A Mo M值为0.88(0.601.28),低于对照组的0.97(0.671.37),差异有统计学意义(P0.01)。(3)Logistic回归分析:PAPP-A与GDM的发生呈负相关,比值比(OR)值为0.794(95%CI 0.6410.983)。(4)临床资料预测GDM的ROC曲线下面积(ROC-AUC)为0.680(95%CI 0.6530.707),临床资料联合PAPP-A Mo M预测ROC-AUC为0.682(95%CI 0.6550.709),两者差异无统计学意义(P=0.429)。结论:尽管早孕期孕妇外周血中PAPP-A水平是GDM发生的独立影响因素,但其对GDM的预测价值有限。     

Spontaneous Rupture of the Liver during Pregnancy: A Case Report

Hepatic congestion resulting in hepatic rupture during pregnancy is a rare yet catastrophic event carrying a 60 to 70% maternal mortality rate. With preeclampsia and associated epigastric pain continuing to be a major problem confronting pregnant women, hepatic congestion may be more prevalent than believed. Current etiology, treatment, and characteristics of women who experience hepatic rupture are examined. A case report and nursing protocol are presented.     

Pregnancy during obstetrics and gynecology residency: effect on surgical experience

Objective

This study explored residents' views about pregnancy during residency and the effect leaves of absence had on the quantity of surgical procedures performed.

Study design

Physicians who graduated from an obstetrics and gynecology residency between 1994 and 2002 were contacted by mail. Respondents completed a questionnaire and consented to use of the program's surgical database to obtain information regarding surgical procedures performed during their training.

Results

Thirty-one of the 41 eligible resident physicians returned the questionnaire and consent form (response rate, 75.6%). Among the 14 responding men, 2 had taken a total of three nonvacation, noneducational leaves. Among the 17 women respondents, there were 16 leaves associated with deliveries, and the nonvacation, noneducational leave for women who were pregnant was statistically longer than for other residents (median of 6 weeks compared with 0 weeks, P<.001). Most pregnancies were planned (27/29, 93.1%) and were delivered in the third or fourth year of training (11/16, 68.8%). Former residents listed several ways that the program accommodated pregnancy and were satisfied with the program. The mean number of procedures for women with deliveries compared with other residents were as follows: cesarean section, 315 versus 281 cases (P = .20); abdominal hysterectomy, 116 versus 102 cases (P = .08); laparoscopy, 87 versus 92 cases (P = .72); vaginal hysterectomy, 51 versus. 45 cases (P = .11).

Conclusion

Pregnancy and delivery did not decrease surgical experience of four major procedures in this program, and pregnant physicians perceived appropriate support from their colleagues and the program administration.     

The Pregnancy Mobility Index: a mobility scale during and after pregnancy

BACKGROUND: During pregnancy, every second woman will experience some degree of back or pelvic pain. While several validated instruments to assess back pain exist for the general population, these are not suitable for application in a pregnant population and have not been validated for this purpose. A pregnant population not only differs from the general population regarding the type of back pain--frequently a pelvic girdle component is added--but pregnant women also have different mobility patterns and expectations. We therefore present in this study a self-report mobility scale specifically designed for a pregnant population: the Pregnancy Mobility Index. METHODS: Longitudinal cohort study including 672 nulliparous women with a singleton low-risk pregnancy. The Pregnancy Mobility Index consists of items concerning day-to-day activities selected through literature research and clinical experience. Participating women completed the questionnaire at 12 and 36 weeks' gestation and one year after delivery. Reliability, construct and criterion validity were tested. RESULTS: The internal consistency (Cronbach's alpha) was 0.8 or higher. The Pregnancy Mobility Index scales correlated best with the physical and pain scale of the RAND-36, indicating a good construct validity. The assumptions that the Pregnancy Mobility Index scores increase during pregnancy and decrease after delivery and that women with back or pelvic problems scored higher on the Pregnancy Mobility Index domains than women without back or pelvic pain were confirmed, indicating a good criterion validation. CONCLUSION: The Pregnancy Mobility Index has been shown to be a reliable and valid questionnaire well suited for use during and after pregnancy.