高压氧综合治疗对重度子(癎)前期合并胎儿生长受限患者的疗效分析

目的探讨在综合改善胎盘微循环的基础上，应用高压氧纠正重度子痫前期合并胎儿生长受限（FGR）的疗效，及患者对高压氧治疗的适应性。方法2004-03—2006-02河北沧州市人民医院将符合筛选指标的住院重度子痫前期合并FGR的孕妇60例按自愿原则分为高压氧治疗组32例（A组）及非高压氧治疗组28例（B组），另外选择同期孕检正常妇女30例作为正常妊娠对照组（C组），比较胎儿生长指标、脐动脉血流，血流变及新生儿结局等指标，监测高压氧仓内各时段孕妇血压变化。结果高压氧综合治疗能显著降低胎儿脐动脉阻力指数（RI值）、脐动脉血流速率在收缩期末和舒张期末的比值（S／D值）及全血黏度低切值（LBV）（P〈0．01）；A组与B组相比能明显促进胎儿生长，延长孕周，增加新生儿体重，改善母婴预后，提高重度子痫前期合并FGR患者治疗的有效率（P〈0.01）。结论高压氧结合常规治疗重度子痫前期合并FGR患者，可获得较好临床效果；重度子痫前期合并FGR的患者对高压氧治疗有较好适应性，母婴预后良好，值得临床推广。     

子痫前期胎盘因素在胎儿生长受限中的作用

胎儿生长受限(FGR)为子痫前期最常见的并发症,子痫前期和胎儿生长受限的发病基础有共同之处,与胎盘浅着床代偿性分泌一系列异常活性因子有关,并引发胎盘功能不良、胎儿生长受限等妊娠不良结局。近年许多实验着力于进一步研究子痫前期血管生长因子、胎盘内分泌激素及细胞因子的表达差异与FGR发生的相关性,为子痫前期的病情发展及预测妊娠结局和治疗提供新的依据。     

子痫前期并发胎儿生长受限的临床特征及妊娠结局分析

目的 探讨子痫前期并发胎儿生长受限(fetal growth restriction,FGR)的临床特征及母儿结局.方法 回顾性分析2009年1月1日至2019年12月31日在广州医科大学附属第三医院产科就诊并分娩的单胎子痫前期患者的病例资料,根据是否合并FGR,分为FGR组和对照组,分析两组的临床特征及母儿结局.结果...     

子痫前期合并胎儿生长受限的母儿妊娠结局分析

目的:探讨子痫前期(PE)合并胎儿宫内生长受限(FGR)的母儿结局。方法:选取591例PE孕妇,按新生儿出生体重分为小于胎龄儿组(SGA组,95例)和适于胎龄儿组(AGA组,496)。随访母体妊娠结局和新生儿结局。结果:与AGA组孕妇相比,SGA组孕妇的胎盘早剥发生率增加,因胎儿窘迫行剖宫产的比率增加(P0.05),新生儿病房收治率增加,住院时间延长,差异均有统计学意义(P0.05);其他孕妇严重并发症包括重度高血压、肺水肿、肾功能异常和HELLP综合征发生率,以及孕期和产后降压药和硫酸镁使用比率均无显著变化,差异无统计学意义。结论:PE合并FGR未导致除胎盘早剥之外母体严重不良妊娠结局的增加,但新生儿不良预后增加。     

游离胎儿DNA及抗DNA抗体与子(癎)前期的关系

目的 研究孕妇外周血游离胎儿DNA(fDNA)是否与子癎前期及其严重程度相关,检测子癎前期孕妇体内抗单链DNA抗体(抗ssDNA抗体)及抗双链DNA抗体(抗dsDNA抗体)是否存在异常变化.方法 选择2005年5月至2006年11月在浙江省人民医院妇产科住院的20例轻度子癎前期孕妇(轻度子癎前期组),14例重度子癎前期孕妇(重度子癎前期组),42例无妊娠合并症及并发症的孕妇(对照组),所有孕妇均妊娠男性胎儿.抽取孕妇外周血后采用实时荧光定量PCR技术(FQ-PCR)对fDNA进行定量,同时采用ELISA技术对抗ssDNA抗体和抗dsDNA抗体定量.结果 时照组、轻度子癎前期组和重度子癎前期组的fDNA均值分别为(67.83±43.70)拷贝/mL、(172.31±127.89)拷贝/mL、(321.37±47.07)拷贝/mL,差异有统计学意义(X2=21.8514,P＜0.01);三组的抗ssDNA抗体光密度均值(OD)分别为(0.067±0.074)、(0.075±0.039)、(0.160±0.214),差异有统计学意义(X2=6.3741,P＜0.05);而不同组间抗dsDNA抗体OD均值为(0.0230±0.0102)、(0.0257±0.0099)、(0.0281±0.0119),差异无统计学意义(X2=2.6340,P＞0.05);抗ssDNA抗体与抗dsDNA抗体之间存在显著的相关性(r=0.5985,P＜0.05),抗ssDNA抗体、抗dsDNA抗体及新生儿体重与fDNA浓度均无显著的相关性(P＞0.05).结论 fDNA与子癎前期的严重程度密切相关,抗DNA抗体在子癎前期的发病过程中可能起着重要的作用.     

Idiopathic urinary findings and fetal growth restriction in low risk pregnancy

Objective

To determine whether maternal urinary findings in the first trimester of pregnancy are associated with fetal growth restriction.

Study design

The prevalence of urinary findings in singleton pregnancies complicated by fetal growth restriction were compared with a low-risk control group of pregnancies who gave birth to normal weight babies, in the same condition.

Results

There were significant statistical differences in the mean gestational age (p < 0.001), isolated asymptomatic bacteriuria (p < 0.001), hematuria (p = 0.002, OR = 6.6, CI = 1.8–24.2) and proteinuria (p = 0.016, OR = 4.1, CI = 1.2–13.3). There was no recognizable relation between ketonuria and fetal growth restriction.

Conclusion

Our data showed a relation between the increase of adverse pregnancy outcomes, including fetal growth restriction, and hematuria, proteinuria and asymptomatic bacteriuria. Appropriate monitoring of pregnant women using these findings may be helpful in the identification of more complications.     

Senescence of fetal endothelial progenitor cell in pregnancy with idiopathic fetal growth restriction

Objective: The aim of our study was to investigate the change of count and the status of cellular senescence in fetal endothelial progenitor cells (EPCs) obtained from the umbilical cord blood of women with fetal growth restriction (FGR). Methods: Fetal EPCs were obtained from thirty five normal and thirty pregnant women with FGR. Each EPC was characterized and counted. EPC differentiation time and outgrowth endothelial cell (OEC) colony formation assay, senescence-associated β-galactosidase (SA-β-gal) activity assay, and telomerase activity assay were performed. Results: Fetal EPC counts were significantly decreased in the FGR group compared with normal controls. In the FGR group, the EPC differentiation time was prolonged, OEC colonies were much less formed, the staining intensity of SA-β-gal was relatively increased and the telomerase activity of EPCs was significantly decreased, compared with normal pregnancy (p < 0.001 for all). Conclusions: The fetal EPCs in FGR pregnancies were decreased, functionally impaired and senescently altered.     

Expectant management of severe preeclampsia with severe fetal growth restriction in the second trimester

ObjectiveWe investigated whether women with severe fetal growth restriction (FGR <5th percentile) associated with severe preeclampsia (PE) occurring in the second trimester are candidates for expectant management.Study designThis is a retrospective study involving 33 women who developed severe PE or superimposed PE in the second trimester and were expectantly managed at a tertiary center. They were divided into groups with and without severe FGR on admission (severe FGR (+) group: 17 women; severe FGR (−) group: 16 women) for comparison of the duration of pregnancy prolongation, major maternal complications, and perinatal outcomes. The data are presented as medians (range) or frequencies (percentage).ResultsThe duration of pregnancy prolongation was 10 days in both groups. Major maternal complications occurred in 5 of 17 women (29.4%) in the severe FGR (+) and 5 of 16 (31.3%) in the severe FGR (−) group, showing very similar incidence rates in the 2 groups. The perinatal survival rates were favorable at 82.4% (14/17) in the severe FGR (+) and 100% (16/16) in the severe FGR (−) group.ConclusionRegarding expectant management of severe preeclampsia occurring in the second trimester, there was no difference in the duration of pregnancy prolongation between the groups with and without severe FGR on admission. Because favorable perinatal outcomes can be expected without compromising maternal safety by prolonging pregnancy as expectant management for severe FGR, it was suggested that women with severe FGR are suitable candidates for expectant management.     

First-trimester adiponectin and subsequent development of preeclampsia or fetal growth restriction

Background/Aims: The evidence regarding the utility of assessing first-trimester adiponectin (ApN) serum levels in early prediction of preeclampsia (PE) and fetal growth restriction (FGR) is contradictory. This study aims to determine the role of maternal serum ApN levels as an early predictor of PE and FGR. Methods: A prospective case-control study among a pregnant population who attended their 11- to 14-week ultrasound scan at the University of Chile's Clinical Hospital's Fetal Medicine Unit. We included patients who developed PE or FGR (10 cases per group) and 35 healthy controls. We determined ApN levels in blood samples from these 55 patients using a commercial ELISA kit and assessed the relationship of ApN levels with variables like development of PE, FGR, weight at birth and maternal BMI. Results: There were no significant differences among first-trimester ApN serum levels in the groups. Average concentrations were 8, 6.8 and 10.8 ng/ml for the control, PE and FGR groups, respectively. Conclusion: In our study, maternal serum ApN levels were not useful in predicting subsequent development of PE and FGR. However, maternal serum ApN concentration adjusted by BMI was significantly higher during the first trimester in women who later developed FGR.     

转甲状腺蛋白在重度子痫前期及胎儿生长受限孕妇血清中的表达及意义

目的:探讨转甲状腺蛋白(TTR)与s PE及FGR发病的关系及意义。方法:选取2012年9月1日至2015年2月1日在首都医科大学附属北京潞河医院产检并住院分娩的单胎孕妇120例,将患者分为4组:FGR组、s PE组、s PE+FGR组和对照组(各30例)。ELISA法检测TTR浓度。比较4组患者的年龄、孕次、产次、孕周、母血清TTR浓度等指标。结果:4组患者的年龄、孕次、产次、孕周等比较,差异无统计学意义(P0.05)。FGR组、s PE组及s PE+FGR组的母血TTR浓度较对照组明显降低,差异有统计学意义(P0.01)。s PE组血清中TTR含量低于FGR组,差异有统计学意义(P0.01)。结论:TTR在s PE、FGR和s PE+FGR孕妇血清中表达下调,有望成为s PE及FGR发生的生物标志物。s PE合并FGR可能由s PE本身的病理变化引起,s PE与FGR有着共同的病理基础。