检测胎儿纤维连接蛋白浓度预测早产

目的通过检测妊娠满28—37周孕妇宫颈分泌物的胎儿纤连蛋白（fFN）,探讨其与早产的关系。方法检测50例妊娠满28—37周孕妇宫颈分泌物的fFN。结果fFN阳性16例,其中14例在2—7内分娩,阳性预示值87．5％（14／16）;阴性34例,有2例在1w内分娩,其他均经适当治疗后出院,阴性预示值94．1％（32／34）。结论fFN检测可用于预测早产的发生。     

胎儿纤维连接蛋白在早产预测诊断中的研究近况

早产是围产儿死亡和疾病的首要原因，75％以上围产儿死亡与早产有关。早产可能会导致新生儿听力丧失、智力发育迟缓、脑瘫等残疾以及其他一些健康问题，给家庭和社会带来沉重的经济和心理负担。如何预测和早期诊断早产，从而积极处理，减少早产及相应并发症的发生，是产前保健的重要任务之一。     

胎儿纤维结合素测定预测早产的进展

早产约占分娩总数的5%-15%,早产儿中约有15%于新生儿期死亡,有8%的早产儿虽能存活,但留有智力障碍或神经系统的后遗症.也有人认为75%以上的围产儿死亡与早产有关.     

胎儿纤维连接蛋白联合宫颈长度检测在早产预测中的价值探讨

目的探讨胎儿纤连蛋白(FFN)联合B超宫颈长度(CL)测量对先兆早产孕妇发生早产的预测是否比单独使用两者时更具有价值。方法 385例先兆早产孕妇行阴道后弯窿分泌物FFN的测定,同时对其中338例采用阴道B超测量CL,并追踪妊娠结局。结果 1.385例孕妇中,120例FFN阳性,其中33例早产,FFN阳性的孕妇在7d,14d和37周内分娩例数和发生率分别为15例(12.5%)、26例(21.7%)、33例(27.5%);超声测量CL 338例中,88例CL≤30mm,其中34例早产,CL≤30mm组在7d,14d,37周内分娩例数和发生率分别为15例(17%)、28例(31.8%)、34例(38.6%);FFN阳性并CL≤30mm的37例孕妇中22例早产,其在7d,14d,37周内分娩的例数及分娩率分别为12(32.4%),22(59.5%),22(59.5%)。2.FFN预测<37周早产的敏感性、特异性、PPV和NPV分别为62.3%,73.8%,27.5%,92.5%;而CL预测上述指标分别为73.9%,81.5%,38.6%,95.2%;二者联合预测上述指标为78.6%、92.2%、59.5%、96.7%,明显高于单独测定FFN或CL。采取多因素logistic回归分析:CL是预测<37周分娩的危险因素(P=0.000,OR=3.8)。结论 FFN阳性及CL≤30mm对预测早产均有一定价值,且有很好的一致性,NPV的预测价值更高,两者联合应用,可以明显提高先兆早产孕妇预测<37周早产的敏感性、特异性、PPV及NPV。     

宫颈分泌物胎儿纤维连接蛋白检测与宫颈长度在延期妊娠引产预测中的应用

目的探讨宫颈分泌物胎儿纤维连接蛋白（fetal fibronectin,fFN）检测与宫颈长度在延期妊娠引产预测中的应用价值。方法选择孕周41～41＋6周无明显剖宫产指征及妊娠并发症并自愿要求阴道试产的孕妇96例进行宫颈分泌物fFN检测及阴道超声测量宫颈长度,按催产素引产常规引产,并记录取样至分娩时间。结果宫颈分泌物fFN阳性组、宫颈长度小于3.0cm组3d内引产分娩率均明显高于宫颈分泌物fFN阴性组、宫颈长度大于3.0cm组（91.9%、81.3%VS27.3%、25.0%,P均〈0.01）。宫颈长度小于3.0cm的宫颈分泌物fFN阳性组〈24、〉72、24～72 h引产成功率均明显高于宫颈长度大于3.0cm的宫颈分泌物fFN阳性组（60.0%、6.7%、33.3%VS 0、42.9%、57.1%,P均〈0.01,P〈0.05）。结论宫颈分泌物fFN检测联合宫颈长度测定进行引产预测,可提高引产成功率。     

胎儿纤维连接蛋白检测的围产临床应用近况

胎儿纤维连接蛋白（fetal Fibronectin,fFN）是一种分子量约31000～33500的糖蛋白,主要由滋养层细胞分泌产生,分布在羊水、胎盘组织及绒毛蜕膜交界面,在胎盘绒毛膜和蜕膜的相互粘附和保护方面起着重要作用。20孕周前孕囊种植和附着于子宫内膜,但胎膜和蜕膜连接尚不紧密,宫颈分泌物中可检测到fFN,之后绒毛膜与蜕膜逐渐融合阻止了fFN的释放,所以正常妊娠情况下,在22—35孕周期间,     

孕妇外周血中游离胎儿DNA的检测在早产预测中的价值

目的探讨孕妇外周血中的游离胎儿DNA检测的可行性及其水平变化在早产预测中的价值。方法普通PCR检测17例先兆早产孕妇和20例正常孕妇血浆中Y染色体性别决定基因(SRY),继应用荧光定量PCR技术对有SRY基因表达者的胎儿DNA水平进行定量分析并进一步比较早产孕妇组和正常孕妇组间DNA水平的差异。结果17例先兆早产患者及20例对照组中各有9例、10例出现SRY阳性信号。先兆早产组的胎儿DNA水平明显高于正常对照组(P<0.01)。结论孕妇外周血中的游离胎儿DNA可望作为预测早产的指标之一。     

胎儿纤连蛋白预测早产及围产儿结局100例临床分析

目的探讨胎儿纤维连接蛋白（fFN）预测早产的价值及围产儿结局。方法利用美国ADEZA公司生产的fFN测定试剂盒,用酶联免疫吸附（ELISA）法对100例有先兆早产征、早产史及多胎妊娠的孕妇进行测定,并追踪病例结果进行分析。结果100例病例中,测试结果阳性36例,早产实际发生31例（86.1%）。测试结果阴性64例,早产实际发生7例（10.9%）。共出生新生儿112例（9例多胎妊娠）,≥34孕周85例早产儿全部存活,〈34孕周27例早产儿,死亡5例（18.51%）。结论fFN检测对有高危因素的孕妇可有效预测早产的发生。测试结果阳性时,应及时给予干预措施从而提高早产儿生存率,降低早产儿的病死率及并发症的发生率。测试结果阴性时,可以减少过度干预。     

胎儿纤维连接蛋白与支原体宫颈炎和羊水胎粪污染关系的研究

目的通过检测胎儿纤维连接蛋白（FFN）,研究支原体宫颈炎和羊水胎粪污染的关系,为预测胎儿窘迫提供新方法。方法采用酶联免疫吸附法（ELISA）对支原体宫颈炎患者120例（研究组）,健康孕妇81例（对照组）进行宫颈阴道分泌物FFN检测,以FFN≥50ng／mL为判断阳性标准。结果研究组FFN阳性患者75例,阳性率62．5％（75／120）,对照组FFN阳性患者31例,阳性率38．2％（31／81）;研究组羊水胎粪污染18例,阳性率24％（18／75）,对照组羊水胎粪污染2例,阳性率畅（2／50）。两组比较均有显著性差异（P〈0．05）。结论FFN与支原体宫颈炎有关系,对预测羊水胎粪污染及早期治疗胎儿窘迫有价值。     

先兆早产孕妇血清IL-6和宫颈分泌物fFN测定的临床分析

目的：探讨血清白细胞介素-6（IL-6）、宫颈分泌物胎儿纤维连接蛋白（fFN）检测对预测早产的临床价值。方法：随机选择先兆早产孕妇38例作为先兆早产组,予以保胎治疗,根据保胎成功与否,又分为保胎成功组（26例）与保胎未成功组（12例）。检测保胎成功组、保胎未成功组治疗前后血清IL-6、宫颈分泌物fFN含量情况,并与正常妊娠组（36例）比较。结果：治疗前,先兆早产组（保胎未成功组、保胎成功组）血清IL-6、宫颈分泌物fFN明显高于正常妊娠体检组（均P〈0.01）。治疗后,保胎成功组血清IL-6、宫颈分泌物fFN明显低于保胎未成功组（均P〈0.01）;保胎成功组血清IL-6、宫颈分泌物fFN,与治疗前比较有明显降低（均P〈0.01）。结论：临床可以通过检测孕妇血清IL-6、宫颈分泌物fFN的含量来预测早产;同时,可以将上述指标的好转作为临床保胎治疗有效的指标。     

Risks of preterm delivery and association with maternal age, birth order, and fetal gender.

The risk of preterm delivery in a recent sample (1990-1994) of Italian liveborns was examined, taking into account child birth order, and maternal age and education in addition to the fetal gender. Univariate analyses showed that a higher risk was associated with male than female babies, with first- than second-born children, with older mothers, and with less educated mothers. The relative weights of the factors examined were evaluated through logistic regression analyses and the highest and the lowest risks were found to be associated with advanced maternal age and male fetal gender respectively. Our findings therefore suggest that biological factors associated more with advanced maternal age than with the male gender of the fetus may influence premature onset of labour.     

Intercellular adhesion molecule-1 (ICAM-1) in cervicovaginal fluid of women presenting with preterm labor: predictive value for preterm delivery

PROBLEM: Clinically useful tests for the prediction and diagnosis of preterm labor and delivery remain to be established. We have hypothesized that soluble intercellular adhesion molecule-1 (sICAM-1) in the cervicovaginal fluid of women with preterm labor may be a useful diagnostic tool. METHOD OF STUDY: The cervicovaginal fluid of 103 women between 24(0) and 33(6) weeks gestation with preterm contractions and intact membranes was assayed for sICAM-1. RESULTS: Elevated sICAM-1 concentrations predicted short intervals to delivery (area under receiver operator characteristic (ROC) curves, 0.70-0.72 for delivery within 3, 7 and 10 days), with high specificity. Characteristics for delivery within 3 days at a 3 ng/mL threshold for a positive test were sensitivity 33.3%, specificity 98.9%, and positive and negative predictive values of 75.0% and 93.9%, respectively. Predictive ability was independent of and complementary to that of fetal fibronectin (fFN). CONCLUSIONS: Measurement of sICAM-1 in cervicovaginal fluid has potential as a predictor of preterm delivery in women with symptoms of preterm labor, particularly in conjunction with fFN testing.     

超声监测先兆早产患者宫颈的临床意义

目的 探讨B超监测先兆早产患者子宫颈,检测子宫颈机能不全的临床意义。方法 采用B型超声腹式法,测定35(观察组)和46例正常孕妇(对照组)的子宫颈宫颈内口、颈管长度、宫颈管筒状扩张及胚胎与宫颈的关系。结果 观察组官颈内口(1.66±0.32)cm,颈管长度(2.05±0.63)cm,宫颈管筒状扩张(1.76±2.1)cm,对照组为(1.34±0.14、2.95±0.77、1.26±1.8)cm,两组比较差异极显著(P<0.005)。其中有13例出现“漏斗形成”占37.14%,平均漏斗长度为(2.6cm),漏斗宽度为(1.6cm),早产分娩的10例,占76.9%。结论 超声监测妊娠期宫颈对诊断子宫颈机能不全有较好的预测作用。     

IVF-ET后妊娠早产的相关因素分析

目的探讨体外受精-胚胎移植（IVF-ET）助孕妊娠后发生早产的相关因素。方法回顾性分析2000年1月-2008年12月我院IVF-ET术后妊娠早产的患者233例及同期IVF-ET后足月分娩的183例妇女,分析与早产相关因素。结果ART后早产的相关因素有宫颈操作次数（OR=1.201）、胎膜早破（OR=9.232）以及双胎妊娠（OR=4.916）。结论在辅助生殖技术中要减少多胎妊娠的发生,有多次宫颈宫腔操作史者,妊娠后应严密B超监测宫颈长度,必要时考虑行宫颈环扎术。     

Clinical value of postnatal autopsy and genetics consultation in fetal death

The aim of the present study was to investigate the clinical use of postnatal autopsy and genetics consultation in cases of fetal death in a teaching hospital. A retrospective analysis of medical records including pathology and genetics reports was performed in all cases of fetal death in which a woman delivered at Ben Taub General Hospital, Houston, Texas over a 2‐year period. Cases were excluded when gestational age of the fetus was less than 20 weeks. Fetuses were only included when the 1‐ and 5‐min Apgar scores were 0 and 0, respectively. There were 139 fetal deaths and 12,209 live born infants during the study period (stillbirth rate 1.125%). Although pathology services were used in 96.2%, a genetics consultation was obtained in only 12% of cases. Fetal autopsy provided a certain cause of fetal death in 19.4%, a probable cause for death in 36.3%, and was inconclusive in 44.3%. Among the cases in which a genetics consultation was obtained, a certain and probable cause for fetal death was found in 20% and 20% of cases, respectively. The utilization of genetics consultation was found to be independent of multiple clinical variables examined including ultrasound data, identification of maceration, and training level of resident. Our data show a frequent use of pathologic examination in cases of fetal death and an infrequent use of genetics consultation services. The request for genetics consultation seemed to have been made at random. © 2001 Wiley‐Liss, Inc.     

75例胎膜早破患者阴道液FFN与绒毛膜羊膜炎的临床分析

目的通过检测胎膜早破患者中的胎儿纤连蛋白（FFN）,探讨其与绒毛膜羊膜炎的关系,为预测胎膜早破中绒毛膜羊膜炎的发生提供较灵敏的检测方法。方法采用固相免疫吸附法对胎膜早破患者75例,健康孕妇50例进行血清C-反应蛋白定量检测、阴道液FFN定性检测,分娩后胎盘胎膜行病理检查。结果研究组CRP阳性率为37.33%,对照组为2%;FFN阳性率为85.33%,对照组为4%,差异有显著性（P〈0.01）。研究组中FFN阳性者绒毛膜羊膜炎发生率明显高于阴性者,敏感性及特异性分别高达93.02%、75.00%,差异亦有显著性（P〈0.01）。结论FFN与绒毛膜羊膜炎关系密切,可用于胎膜早破中预测绒毛膜羊膜炎的发生。     

Neonatal outcome after preterm delivery in HELLP syndrome

The present study compares neonatal outcome after preterm delivery of infants in pregnancies complicated by the HELLP syndrome or severe preeclampsia (PS). The maternal and neonatal charts of 71 out of a total of 409 pregnancies that were complicated by hypertensive disorders at Severance hospital between January 1995 and December 2004 were reviewed. Twenty-one pregnancies were complicated by HELLP syndrome and 50 pregnancies were complicated by PS. Fifty normotensive (NT) patients who delivered because of preterm labor comprised the control group. Results were analyzed by the chi-square test and ANOVA. Gestational age and maternal age at delivery were matched among the three groups. The neonatal outcomes of the HELLP syndrome group were compared with the PS and NT groups. There were significant differences between the HELLP syndrome group and the PS group in the incidence of intraventricular hemorrhage (IVH) (61.9% vs. 26%, p=0.006), sepsis (85.7% vs. 44%, p =0.003) and mechanical ventilation (MV) rate (81% vs. 54%, p=0.039). There were significant differences between the HELLP syndrome group and the NT group in the incidence of neonatal death (ND) (19.5% vs. 2.0%, p=0.034), respiratory distress syndrome (RDS) (38.1% vs. 8%, p=0.0045), IVH (61.9% vs. 4%, p < 0.0001), sepsis (85.7% vs. 14%, p < 0.0001), intensive care (IC) (85.7% vs. 24%, p < 0.0001) and MV rate (80.1% vs. 14%, p < 0.0001). There were also significant differences between the PS and NT groups in the incidence of ND (20% vs. 2%, p=0.0192), RDS (30% vs. 8%, p=0.0085), IVH (26% vs. 4%, p=0.0070), sepsis (44% vs. 14%, p=0.0015), IC (78% vs. 24%, p < 0.0001), MV rate (54% vs. 14%, p < 0.0001) and low 5-min APGAR score (50% vs. 16%, p=0.0005). This study shows increased morbidity in newborns of mothers complicated with HELLP syndrome and indicates that early, regular and high quality management of these patients is essential to improve both maternal and neonatal outcome.     

Pro-inflammatory maternal cytokine profile in preterm delivery

PROBLEM: The objective of this study was to determine the levels of cytokines produced by maternal peripheral blood mononuclear cells (PBMC) upon stimulation with a mitogen, with autologous placental cells and with a trophoblast antigen extract. METHOD OF STUDY: Peripheral blood mononuclear cells from 54 women with a history of successful pregnancy and 30 women undergoing preterm delivery (PTD) were stimulated with the mitogen and antigens, and the cytokine levels in mitogen-stimulated culture supernatants assessed. RESULTS: Significantly higher levels of the type 1 cytokines, interferon (IFN)-gamma and interleukin (IL)-2, were produced by the PTD group than by the normal pregnancy group, which on the contrary showed significantly greater production of the type 2 cytokines, IL-4, IL-5 and IL-10. A comparison of the ratios of type 2 to type 1 cytokines is indicative of a type 1 cytokine bias in PTD. CONCLUSIONS: These data are suggestive of a maternal type 1 cytokine bias in PTD.