妊娠高血压综合征患者血浆止凝血分子标志物水平变化的意义

目的探讨妊娠高血压综合征(妊高征)患者血浆止凝血分子标志物水平变化的意义.方法对45例妊高征孕妇(妊高征组,其中轻度20例、中度15例、重度10例)及20例正常孕妇(正常妊娠组)分娩前后的血浆止凝血分子标志物进行检测.其中,采用酶联免疫吸附试验(ELISA)检测两组孕妇分娩前后的P-选择素、凝血酶原片段1+2(F1+2)、D-二聚体、纤溶酶抗纤溶酶复合物(PAP);采用发色底物法检测两组孕妇分娩前后的抗凝血酶活性.结果 (1)P-选择素妊高征组中、重度孕妇分娩前分别为(66±24)μg/L、(80±30)μg/L,正常妊娠组为(49±15)μg/L,两组比较,差异有显著性(P<0.05).分娩后妊高征组重度孕妇为(65±34)μg/L,正常妊娠组为(40±12)μg/L,两组比较,差异有显著性(P<0.05).(2)F1+2妊高征组轻、中、重度孕妇分娩前分别为(2.2±0.2)nmol/L、(2.3±0.4)nmol/L、(2.2±0.2)nmol/L,均明显高于正常妊娠组的(1.2±0.3)nmol/L,两组比较,差异有显著性(P<0.05).(3)D-二聚体妊高征组轻、中、重度孕妇分别为(0.7±0.1)mg/L、(0.7±0.3)mg/L、(0.8±0.2)mg/L,正常妊娠组为(0.4±0.1)mg/L,妊高征组显著高于正常妊娠组(P<0.05),且妊高征组重度孕妇D-二聚体水平高于中度及轻度孕妇.(4)PAP妊高征组轻、中、重度孕妇分娩前分别为(0.7±0.4)mg/L、(0.8±0.4)mg/L、(0.8±0.4)mg/L,均高于正常妊娠组的(0.7±0.3)mg/L(P<0.05),且妊高征组轻、中、重孕妇PAP的升高水平与疾病的严重程度呈正相关(P<0.05).两组孕妇分娩后PAP水平比较,差异无显著性(P>0.05).(5)抗凝血酶活性正常妊娠组为(108±17)%,而在妊高征组则显著降低,其中重度孕妇为(44±37)%、中度孕妇为(64±25)%、轻度孕妇为(83±39)%,两组比较,差异有极显著性(P<0.01).妊高征组中、重度孕妇又显著低于轻度孕妇(P<0.01).结论 P-选择素及 F1+2可用于高危妊娠的筛查,D-二聚体可作为妊高征孕妇早期DIC的监测,抗凝血酶活性是反映妊高征疾病严重程度的有效指标.以上这些止凝血分子标志物可作为妊高征患者血栓前状态的监测指标.     

三胎妊娠胎儿发育及适宜分娩孕周的研究

目的探讨三胎妊娠的胎儿发育规律及适宜分娩孕周。方法回顾性分析中国医科大学第二临床学院1998年11月至2007年3月收治的29例三胎妊娠的胎儿超声测量结果、妊娠期限等。结果三胎妊娠自28孕周以后发育平均双顶径值较单胎小2.42mm（t=6.43,P〈0.01）,平均股骨长较单胎小3.1mm（t=8.710,P〈0.01）,平均出生体重明显低于单胎同孕周平均值（t=7.25,P〈0.01）,平均分娩周数为（34.0±1.5）周。结论三胎妊娠与单胎妊娠的发育规律不同,其新生儿出生体重明显低于单胎,平均分娩孕周较单胎明显缩短。     

正常妊娠妇女与重度子痫前期患者止凝血功能的研究

目的:通过测定正常孕妇和重度子痫前期患者止凝血功能指标和分子标志物,从出凝血角度早期监测妊娠高血压疾病的发生。方法:2005年4月至2006年1月动态采集100例正常妊娠妇女孕10~14周、孕20~24周、孕30~34周和28例孕30~36周重度子痫前期患者外周血,检测止凝血功能指标:凝血酶时间(TT)、凝血酶原时间(PT)、纤维蛋白原(FIB)和止凝血分子标志物凝血酶原片断1+2(F1+2)、凝血酶调节蛋白(TM)、纤溶酶原激活物抑制剂(PAI-2)、血栓素B2(TXB2)等。结果:(1)正常妊娠妇女随孕周增加TT、PT缩短,PAI-2、TXB2增加,F1+2妊娠晚期与妊娠中期相比呈增加趋势(P<0.05),FIB和TM无统计学差异。(2)与正常妊娠晚期妇女相比,重度子痫前期患者TT延长,FIB减少;F1+2、PAI-2、TXB2呈增加趋势(P<0.01)。PT和TM无统计学差异。结论:止凝血功能指标可作为反映孕妇高凝状态的筛选指标,而止凝血分子标志物F1+2、PAI-2、TXB2可作为早期监测妊娠高血压疾病发生的敏感指标。     

妊娠肝内胆汁淤积症胎儿总胆汁酸浓度与肾上腺皮质功能变化的关系

目的　探讨妊娠肝内胆汁淤积症(ICP)胎儿总胆汁酸浓度与胎儿肾上腺皮质功能变化的关系。　方法　采用放射免疫法测定正常孕妇22例(对照组)及ICP孕妇20例(ICP组)胎儿脐血皮质醇及硫酸脱氢表雄酮(DHEA S)浓度;循环酶法测定两组母血及脐血总胆汁酸浓度。　结果　ICP组胎儿脐血总胆汁酸浓度(8.93±3.16) mmol/L高于对照组(4.33±1.51) mmol/L,两组比较有显著性差异(P<0. 05),且与母血胆汁酸浓度呈正相关。ICP 组脐血皮质醇浓度(99. 83±41. 34)ng/ml与对照组(74.93±29.58)ng/ml相比无明显差别(P>0.05)。ICP组脐血DHEA S浓度(24.62±8.89)μg/dl明显低于对照组(69.18±39.37)μg/dl,两组比较有显著性差异(P<0.05)。ICP组脐血DHEA S与皮质醇比值(0.29±0.09)亦明显低于对照组(0.87±0.31),两组比较有显著性差异(P<0.05)。ICP组脐血皮质醇、DHEA S浓度及DHEA S与皮质醇比值均与脐血胆汁酸浓度相关(相关系数分别为:r1= 0.87,r2=-0.88,r3=-0.84;P<0.05)。　结论　ICP孕妇的胎儿总胆汁酸浓度增高,与母血总胆汁酸浓度呈正相关;ICP孕妇的胎儿肾上腺皮质功能受损,其受损程度与脐血总胆汁酸浓度呈正相关。     

Maternal hemodynamics influence fetal hemodynamics in normal and hypertensive pregnancy

ObjectivesThis observational case-control study aims to test whether there is a relationship between maternal systemic hemodynamics, maternal renin-angiotensin system and fetal hemodynamics in normal and hypertensive pregnancy.Study designFour groups of non-pregnant women (n = 18), pregnant controls (n = 25), women with gestational hypertension (n = 21) and preeclampsia (n = 10) were included.Main outcome measuresMaternal echocardiography parameters, plasma renin and aldosterone were correlated with fetal Doppler parameters in third trimester pregnancy.ResultsHigher maternal mean arterial pressure and total peripheral vascular resistance were associated with lower fetal middle cerebral artery pulsatility index (PI) (r = ?.51, p < 0.01 and r = ?.49, p < 0.01, respectively); mean arterial pressure correlated negatively with ductus venosus PI (r = ?.35, p = 0.01); higher maternal plasma aldosterone levels were associated with lower maternal uterine artery resistance (r = ?0.33, p = 0.03).ConclusionsIt seems that maternal hemodynamics influence fetal hemodynamics with protective adaptation in fetal cerebral and ductus venosus blood flow observed as maternal blood pressure and vascular resistance increase.     

Changes in haemostasis during normal pregnancy

OBJECTIVES: (1) To study the changes in the haemostatic variables during normal pregnancy, and (2) to compare them with the corresponding variables in a control group of nonpregnant women. SETTING: University Hospital. SUBJECTS: The study involves two groups of women: pregnant women (in 35th-40th gestational weeks (GW)) (N = 35) and a control group of nonpregnant women (N = 35). METHODS: We examined the global tests, the variables relating to coagulation and fibrinolysis and the group of natural inhibitors of coagulation, and compared them between the two groups. RESULTS: The pregnant women had statistically significantly higher values for: prothrombin time (PT) (P < 0.0001), thrombin time (TT) (P < 0.0001), fibrinogen (P < 0.0001), activity of factor VII (P < 0.0001), factor X (P < 0.0001) and alpha2-antiplasmin (P < 0.002), plasma concentration of D-dimer (plsDD) (P < 0.0001) and activity of heparin cofactor II (HCII) (P < 0.002). They had statistically significantly lower activity of protein C (PrC) (P < 0.0001) and of total protein S (TPrS) (P < 0.0001). CONCLUSION: During normal pregnancy the activation of coagulation is counterbalanced by the activation of fibrinolysis, which maintains the haemostatic balance.     

Maternal and fetal nitric oxide production in normal and abnormal pregnancy

Objectives: To characterize maternal and fetal nitric oxide (NO) production in normal and abnormal pregnancy by measuring nitrate (NO₃^-) and nitrite (NO₂^-) metabolites in maternal venous blood, umbilical venous and arterial blood and amniotic fluid. Methods: This was a prospective cross-sectional study in 160 singleton pregnancies: 60 with one complication (infection, n = 37; gestational diabetes, n = 12; pre-eclampsia, n = 11) and 103 normal controls. Nitrate plus nitrite levels were assayed by reduction with Griess reagent. Comparisons were: maternal vs. fetal compartments; normal vs. abnormal pregnancy; and early vs. late pregnancy. Results: Amniotic nitrate and nitrite levels increased from early to late normal pregnancy (20.79 to 28.42 μmol/l, p < 0.02), decreasing slightly at term, and increased from early to late abnormal pregnancy (23.29 to 39.18 μmol/l, p < 0.0001). Late pregnancy levels were higher in abnormal vs. normal pregnancy in amniotic fluid (36.25 vs. 21.70 μmol/l, p = 0.003) and maternal blood (25.80 vs. 18.26 μmol/l, p = 0.002). Overall levels were higher in amniotic fluid than in maternal plasma, and in fetal compartments than in co-sampled maternal plasma (p < 0.005, vs. normal pregnancy). Conclusions: NO metabolite levels increased through normal and particularly abnormal pregnancy, predominantly in the fetal compartments, suggesting that NO production is an additional instrument in the fetal control of the intrauterine environment.     

Maternal and fetal outcome after breast cancer in pregnancy.

We compared 118 women with breast cancer (119 pregnancies) with 269 nonpregnant control subjects matched on important prognostic factors. The distribution of breast cancer stages among the 118 pregnant women was compared with that among 5115 cases of breast cancer in women of reproductive age. Fetal outcome was compared with that of a control group matched for maternal age. Women having breast cancer in pregnancy were 2.5 times more likely to have metastatic disease (95% confidence interval 1.1 to 5.3) and had a significantly lower chance of having stage I disease (p = 0.015). Survival of pregnant women did not differ from that of the controls. Birth weights of babies born to women with breast cancer were significantly lower than those of control babies after gestational age was adjusted for (3010 +/- 787 vs 3451 +/- 515 gm, p = 0.016). The two stillbirths in 85 pregnancies that continued to term (2.4%) was not statistically different from the 1.1% rate for Ontario. We analyzed all 223 births occurring in women who had any form of cancer in the same hospital during the same 30 years. There were 10 stillbirths among these 223 cases (4.4%), significantly more than expected in Ontario (p less than 0.0005; relative risk of 4.23 with 95% confidence interval 2.0 to 7.8). Our data suggest that pregnant women are at a higher risk of presenting with advanced disease because pregnancy impedes early cancer detection.     

Maternal hemodynamics after normal delivery and delivery complicated by postpartum hemorrhage

Serial hemodynamic investigations were performed in 40 women at 38 weeks' gestation and then 1, 2, 6, 10, and 14 days after normal delivery. Cardiac output was measured by Doppler and cross-sectional echocardiography at the aortic valve. In 30 controls who received an average of 280 mL intravenous fluid during labor, the mean cardiac output remained elevated (7.15 L/minute) for 24 hours after delivery and then fell to 5.39 L/minute at 10 days as a result of decreases in both heart rate and stroke volume. Blood pressure fell during the first 2 days after delivery and thereafter increased to values not significantly different from those recorded at the end of pregnancy. In ten women who experienced postpartum hemorrhage, stroke volume decreased and heart rate increased, relative to the control group, during the first 48 hours after delivery. Blood pressure and cardiac output, however, were not significantly different from values in the control group.     

Maternal haemodynamics in pre-eclampsia compared with normal pregnancy during caesarean delivery

Objective  To determine how pre-eclampsia modifies maternal haemodynamics during caesarean delivery.
Design  Prospective study.
Setting  Tampere University Hospital, Finland.
Population  Ten pre-eclamptic parturients and ten healthy parturients with uncomplicated pregnancies scheduled for elective caesarean section under spinal anaesthesia.
Methods  Haemodynamic parameters were assessed by whole-body impedance cardiography noninvasively.
Main outcome measures  Stroke index (SI), heart rate (HR), cardiac index (CI), systemic vascular resistance index (SVRI) and mean arterial pressure (MAP) were recorded before operation, continuously during caesarean section, during the period of dissipation of anaesthesia and on the second to fifth postpartum day.
Results  Baseline haemodynamics in women with pre-eclampsia differed significantly from healthy women in higher SVRI and MAP and lower SI and CI. In women with pre-eclampsia, preload infusion increased both SI and HR, causing a significant rise in CI, while in healthy parturients, only HR rose. In both the groups, spinal blockade reduced SVRI but CI remained stable. At the moment of delivery, CI increased in both groups. In uncomplicated pregnancies, both SI and HR increased, but in women with pre-eclampsia, SI was not altered and the rise in CI was due to an increase in HR only. After the reversal of anaesthesia, haemodynamics in the control group returned to baseline values, whereas in women with pre-eclampsia, SI and CI fell to levels that were significantly lower than the levels observed before surgery.
Conclusions  In women with pre-eclampsia, inability to increase SI at the moment of delivery may suggest dysfunction of the left ventricle to adapt to volume load caused by delivery and prompts concern for the increased risk of pulmonary oedema.     

Maternal serum folacin levels during and after normal pregnancy

Maternal serum folacin levels decrease during pregnancy. This decrease could not be explained by hemodilution. Postpartum levels did not increase significantly compared to values measured at partum. In a healthy Dutch pregnant population receiving no vitamin supplementation the folacin status is at risk and after pregnancy it takes considerable time to refill folacin stores.