Amino acid concentrations in maternal plasma and amniotic fluid in relation to fetal insulin secretion during the last trimester of pregnancy in gestational and type I diabetic women and women with small-for-gestational-age infants

Free amino acid concentrations were determined in maternal plasma and amniotic fluid (AF) under standardized and unstressed conditions in four groups of women comprising 6 gestational and 13 type I diabetics, 10 women with small-for-gestational-age (SGA) infants, and 18 healthy control women between 36 and 39 weeks of gestation. Plasma values for branched chain amino acids (the sum of leucine, isoleucine and valine) did not differ significantly between the four groups. The corresponding values in AF were significantly higher (P less than 0.05) in the type I diabetic group and significantly lower (P less than 0.05) in the gestational diabetic group as compared to the control group. The mean AF C-peptide concentration was elevated but not significantly so in gestational (0.69 nmol/l) or type I diabetic (0.54 nmol/l) pregnancies and significantly lower (P less than 0.05) in women with SGA infants (0.28 nmol/l) as compared to the control group (0.38 nmol/l). There was a significant correlation between C-peptide in AF and branched chain amino acids in maternal plasma (r = 0.63; P less than 0.05) as well as to maternal blood glucose (r = 0.79; P less than 0.01) in the type I diabetic group, which merely suggests a greater beta cell reactivity to insulin secretagogues in offspring of diabetic mothers. The correlation between AF C-peptide and branched chain amino acids in maternal plasma was significantly inverse in women with SGA infants (r = -0.75; P less than 0.05). Both individual, branched chain, or total amino acid concentration in AF were unrelated to AF C-peptide.     

高龄孕妇子痫前期并发胎盘早剥妊娠结局分析

目的 探讨高龄对子痫前期并发胎盘早剥母儿结局的影响.方法 回顾性分析2017年1月至2019年12月在广州医科大学附属第三医院住院分娩的子痫前期并发胎盘早剥、单胎妊娠患者40例,以年龄≥35岁者为高龄组(14例),年龄<35岁者为对照组(26例),比较两组患者的临床资料特点、生化指标及围产儿结局.结果(1)两组孕妇一般...     

Fetal lung maturity in pregnancies complicated by insulin-dependent and gestational diabetes: a matched cohort study.

OBJECTIVE: To study fetal lung maturity (FLM) as determined by amniotic fluid (AF) tests in diabetic pregnancies (DP) under euglycemic metabolic control, in comparison with matched controls (C). PATIENTS AND METHODS: From 514 consecutive pregnancies where amniocentesis was performed for FLM assessment, we selected 45 glycemic controlled DP. Nineteen DP were Type I (IDDM) and 26 pregnancies were diagnosed Type III (GDM). Cases were matched to C by therapy with corticosteroids, gestational age at amniocentesis, pregnancy complications other than diabetes and gender. FLM was determined by the shake test and lamellar bodies (LB) count, lecithin/sphingomyelin (L/S) ratio (planimetric and stechiometric) and phosphatidylglycerol presence (PG). DP were further sub-divided according to gestational age period at amniocentesis, type of diabetes, associated therapy and fetal malformations. RESULTS: RDS (n=2) and neonatal wet lung (n=5) were diagnosed in neonates from diabetic mothers. We found no statistical difference when comparing FLM indices between DP and C groups: shake test 3.1:1+/-1.2 vs. 2.7:1+/-1.2, P<0.40; planimetric L/S 3.4+/-1.4 vs. 3.1+/-2.0, P<0.27; stechiometric L/S 8.2+/-7.4 vs. 7.1+/-6.1, P<0.54; percentage of PG positivity 57% vs. 46%, P<0.13; lamellar bodies count (X10(3)/microl) 42.8+/-36.9 vs. 41.5+/-30.4, P<0.72. No differences were found between DP and controls for subgroups according to gestational age, type of Diabetes (IDDM or GDM), congenital lesions and associated therapy. CONCLUSIONS: In euglycemic, metabolically controlled diabetic patients FLM is not delayed, however an increased risk for neonatal wet lung should be considered.     

CA 125 Levels in Chromosomally Abnormal Pregnancies

CA 125 levels have been measured in the amniotic fluid of 86 gravidas between 14 and 20 weeks gestation as well as in 18 women at term, all carrying chromosomally normal fetuses; in 36 gestations, the samples were paired with maternal serum specimens. These controls were then compared with the amniotic fluid values in pregnancies of karyotype trisomy 21 (n = 24), trisomy 18 (n = 7), sex chromosome trisomy (n = 5), and sex chromosome monosomy (n = 2), and in the maternal serum of 4 trisomy 21 pregnancies, in an effort to determine if CA 125 could act as a marker for these chromosomal anomalies. Results indicated no significant difference in the amniotic fluid measurements at the time of genetic amniocentesis in normal gestations (5,064 U/ml) and trisomy 21 gestations (4,864 U/ml). The sex chromosome anomalies, too, were not different. Alternatively, the values in trisomy 18 pregnancies were significantly lower (3,154 U/ml; P < 0.05) than controls. There appeared to be no significant correlation between the concurrently measured maternal serum and amniotic fluid levels of CA 125 either at mid-trimester (5,056 U/ml vs. 9.8 U/ml; r = 0.04) or at term (920 U/ml vs. 14.9 U/ml; r = 0.03).     

The relationship between the levels of proinflammatory cytokines, and AFI value in pregnancies complicated by premature rupture of membranes

OBJECTIVE: The aim of the study was to test the relationship between maternal serum proinflammatory cytokines level and AFI (amniotic fluid index) in pregnancies complicated by premature rupture of membranes (PROM). MATERIALS AND METHODS: The maternal serum levels of IL-6, IL-1 beta and TNF-alfa were assessed in patients with PROM between 24-34 weeks of gestation (n = 45) by means of commercially available ELISA assays. The patients were divided in two groups according to AFI values: < 50 (n = 25) mm and < or = 50 mm (n = 20). Cytokine concentrations were compared between groups. RESULTS: The median concentrations of proinflammatory cytokines in maternal serum were: IL-6--5.74 pg/ml (range 3.24-3111 pg/ml), IL-1 beta--0.76 pg/ml (range 0.001-3.16 pg/ml), TNF-alfa--1332.46 pg/ml (range 2.13-1969.68 pg/ml). Compared to patients with AFI values > or = 50 mm, the group of patients with AFI < 50 mm had significantly higher concentration of IL-6 (6.61 pg/ml vs. 4.66 pg/ml; p = 0.002). No significant differences in IL-1 beta and TNF-alfa levels have been found between groups. The significant correlation have been observed between maternal serum level of IL-6 and AFI values (R = -0.47, p = 0.003), but not of IL-1 beta and TNF-alfa. CONCLUSION: The assessment of AFI values in pregnancies complicated by premature rupture of membranes seems to be the valuable method of early diagnosis in cases of intrauterine infection.     

Amniotic fluid osteocalcin concentrations in pregnancies uncomplicated by fetal bone disease

Osteocalcin is the major noncollagenous bone protein. Serum osteocalcin concentrations increase in conditions when bone turnover is increased, reflecting enhanced osteoblastic activity. The presence of osteocalcin in amniotic fluid (AF) has not been reported. We undertook this study to determine if osteocalcin is present in AF and to establish standards for AF osteocalcin concentrations, to be used in pregnancies at risk for diseases with increased fetal bone turnover. One hundred and thirty-one samples of AF from 15 to 43 weeks gestation were analyzed for osteocalcin by a radioimmunoassay detecting greater than or equal to 0.1 ng/ml, with a coefficient of variation of 6%. Osteocalcin measured in AF had the same gel-filtration characteristics as serum osteocalcin and the standard curves for serum and AF osteocalcin were parallel. Indications for amniocentesis were genetic study (n = 15) and fetal lung maturation (n = 116). None of the pregnancies studied produced an infant with bone mineral disorder. In 67% of the AF samples, osteocalcin was undetected; in 95% of the samples the concentration was less than 2.4 ng/ml. Concentrations of AF osteocalcin did not correlate with gestational age or birthweight, and were lower than the reported concentrations in cord serum or maternal serum. Thus normal amniotic fluid osteocalcin concentrations are less than 2.4 ng/ml; we speculate that its elevation in fetal bone disorders may provide a genetic counselling tool.     

高龄孕妇合并妊娠期高血压疾病妊娠结局的临床分析

目的分析高龄孕妇合并妊娠期高血压疾病的临床特征,为改善其妊娠结局提供临床依据。 方法采用回顾性研究方法,收集和分析2018年1月至2018年12月在中山大学孙逸仙纪念医院住院分娩妊娠期高血压疾病71例患者的临床资料,其中年龄≥35周岁24例(高龄组),年龄<35周岁47例(对照组),比较两组患者发病孕周、入院孕周、分娩孕周、妊娠合并症或并发症、分娩孕周、新生儿出生体重、新生儿窒息、新生儿呼吸窘迫综合征发生情况;正态分布资料使用t检验,非正态分布资料,使用Mann-Whitney U法进行统计分析,计数资料采用χ²检验。 结果高龄组与对照组相比较,尿素(5.49±2.44)mmol/L vs (4.40±1.46)mmol/L, t＝－2.342)、入院孕周(34.86周vs 37.14周,t＝－2.095)、分娩孕周(36.07周vs 37.43周,t＝－2.564)、剖宫产率(70.83% vs 42.55%, χ²＝5.092)、顺产率(8.33% vs 46.81%, χ²＝10.510)、引产率(16.67% vs 2.13%, χ²＝5.130),差异有统计学意义(P<0.05)。两组新生儿体重(2 680 g vs 2 960 g, Z＝－1.876)、新生儿窒息率(8.33% vs 8.51%, χ²＝0.001)、新生儿呼吸窘迫综合征率(4.17% vs 14.89%, χ²＝0.913),差异无统计学意义(P>0.05)。 结论高龄患者合并妊娠期高血压疾病,与35岁以下孕妇发生妊娠期高血压疾病相比,临床特征为发病更早、肾脏功能损害更严重,终止妊娠孕周较早,早产率、剖宫产率升高,顺产率降低。对于高龄孕妇,应在妊娠过程中给予比普通孕妇更严密的母胎监测。     

Predictive value of mid luteal progesterone concentration before luteal support in controlled ovarian hyperstimulation with intrauterine insemination

BACKGROUND: There is no published data assessing whether higher mid luteal serum progesterone (P4) levels are associated with a higher cycle pregnancy rate (CPR) in controlled ovarian hyperstimulation (COH) with intrauterine insemination (IUI). Aims: To assess whether the mid luteal serum P4 level is predictive of pregnancy in COH with IUI. METHODS: A retrospective cohort study of all women with unexplained, minimal endometriosis or mild male factor infertility who underwent COH with IUI between October 1999 and December 2000 at our department was analysed. The COH was achieved with follicle stimulating hormone injections. All cycles were triggered with human chorionic gonadotropin when at least one follicle > or =15 mm was visible on ultrasound and IUI performed the following day. A serum P4 and beta human chorionic gonadotropin level was measured at 7 and 14 days post-trigger, respectively. RESULTS: There were 33 pregnancies in the 188 cycles analysed, giving a CPR of 18%. The median (range) mid luteal P4 level for all cycles was 51 nmol/L (1.8-234). This did not differ between the pregnant (55 nmol/L) and non-pregnant (50 nmol/L) cycles (P=0.282, Mann-Whitney U-test). There was also no difference in CPR between cohorts below or above the cut-off levels of 33 nmol/L (25th percentile) (13.3 vs 18.9%; P=0.39), 51 nmol/L (50th percentile) (16.0 vs 19.1%; P=0.57), or 69 nmol/L (75th percentile) (16.3 vs 21.3%; P=0.44), respectively. CONCLUSIONS: Increased mid luteal serum P4 levels are not associated with a higher CPR in women undergoing COH with IUI. However, a low mid luteal P4 level < or =25 nmol/L may help predict treatment failure.     

Maternal methadone dose and neonatal withdrawal

OBJECTIVE: The purpose of this study was to determine whether maternal methadone dosage correlates with neonatal withdrawal in a large heroin-addicted pregnant population. STUDY DESIGN: A retrospective review of all maternal/neonatal records of pregnancies that were maintained on methadone therapy in our institution was conducted. After in-hospital stabilization, women were given daily methadone therapy under direct surveillance, with liberal dosage increases according to maternal withdrawal symptoms. Neonatal withdrawal was assessed objectively by the neonatal abstinence score. The average methadone dose in the last 12 weeks of pregnancy and the last methadone dose before delivery (cutoffs of 40, 60, or 80 mg) were correlated to various objective measures of neonatal withdrawal. RESULTS: One hundred mother/neonate pairs on methadone therapy were identified. Women who received an average methadone dose of <80 mg (n=50 women) had a trend toward a higher incidence of illicit drug abuse before delivery than women who received doses of >/=80 mg (n=50 women; 48% vs 32%; P=.1). Women who received an average methadone dose of <80 mg had similar highest neonatal abstinence score, need for neonatal treatment for withdrawal, and duration of withdrawal compared with women whose condition was maintained with dosages of >/=80 mg (score, 11.1 vs 11.5; 68% vs 66%; and 13.3 vs 13.6 days, respectively; all P>.5). For all cutoffs that were used for high versus low dose and for both the average and last methadone dosage analyses, neonatal withdrawal was similar. CONCLUSION: The maternal methadone dosage does not correlate with neonatal withdrawal; therefore, maternal benefits of effective methadone dosing are not offset by neonatal harm.     

羊水内皮素-1与围产儿缺氧的关系

目的　探讨羊水内皮素１（ＥＴ１） 与围产儿缺氧的关系。方法　采用放射免疫法对１６１例孕（ 产）妇进行羊水ＥＴ１ 水平检测。将其分为正常妊娠组１１０ 例,对其中足月妊娠３０ 例同时进行母血和脐血ＥＴ１ 水平检测;宫内缺氧组５１ 例。结果　（１） 羊水ＥＴ１ 水平在正常妊娠组孕１４ ～２７ 周时为（７．７４０±２ ．１３３）ｎｇ／Ｌ,至妊娠晚期时为（１８．６４０ ±１ ．９６８）ｎｇ／Ｌ,随孕周增加呈上升趋势（ Ｐ＜ ０．０１） 。（２） 脐血ＥＴ１ 水平明显高于母血ＥＴ１ 水平,但较羊水为低（Ｐ＜０．０１） 。羊水与脐血ＥＴ１ 水平存在正相关关系（ｒ＝０．９５２,Ｐ＜０．０１）,而母血与脐血无相关关系（ｒ＝ ０．３３８,Ｐ＞ ０ ．０５） 。（３） 宫内缺氧组中,出现胎儿窘迫者羊水ＥＴ１ 水平为（３０．６５４ ±５．８３２）ｎｇ／Ｌ,较正常妊娠组明显升高（ Ｐ＜０．０１） ;出现重度新生儿窒息死亡者羊水ＥＴ１ 水平为（９６０ ．６５０ ±２３６ ．６９８）ｎｇ／Ｌ,为正常晚期妊娠的６０ 倍左右（ Ｐ＜０ ．００１） 。结论　正常妊娠羊水中存在ＥＴ１ ,且随妊娠进展而增加。胎儿缺氧时羊水ＥＴ１ 水平升高,并随缺氧程度加重而显著上     

Fetal lung surfactant and development alterations in intrahepatic cholestasis of pregnancy

AIM: To investigate the association between total bile acid (TBA) level during intrahepatic cholestasis of pregnancy (ICP) and fetal lung surfactant alteration. METHODS: We recruited 42 ICP and 32 normal pregnancy women in this study. The maternal blood, fetal blood and amniotic fluid TBA level were detected using a circulating enzymatic method. Umbilical blood pulmonary surfactant protein A (SP-A) was evaluated with enzyme-linked immunosorbent assay. High performance liquid chromatography was used for the determination of phosphatidyl choline (PC), phosphatidyl inositol (PI), lysolecithin (LPC) and sphingomyelin (SM). Amniotic fluid lamellar body was counted with a fully automatic blood cell counter. Fetal lung area and fetal body weight were calculated from data obtained with an iu22 color supersonic diagnostic set. Clinical information of a nonstress test, amniotic fluid properties and neonatal Apgar score, and birth weight were recorded for review. RESULTS: The TBA level in maternal blood, fetal blood and amniotic fluid in the ICP group were significantly higher than that in the control group (maternal blood: 34.11 ± 6.75 mmol/L vs 4.55 ± 1.72 mmol/L, P < 0.05; fetal blood: 11.9 ± 2.23 mmol/L vs 3.52 ± 1.56 mmol/L, P < 0.05; amniotic fluid: 3.89 ± 1.99 mmol/L vs 1.43 ± 1.14 mmol/L, P < 0.05). Amniotic fluid PC and PI in the ICP group were significantly lower than that in the control group (PC: 65.71 ± 7.23 μg/mL vs 69.70 ± 6.68 μg/mL, P < 0.05; PI: 3.87 ± 0.65 μg/mL vs 4.28 ± 0.74 μg/mL, P < 0.05). PC/LPC ratio of the ICP group was lower than that of the control group (14.40 ± 3.14 vs 16.90 ± 2.52, P < 0.05). Amniotic LB in the ICP group was significantly lower than that of the control group ((74.13 ± 4.37) × 10⁹/L vs (103.0 ± 26.82) × 10⁹/L, P < 0.05). Fetal umbilical blood SP-A level in the ICP group was significantly higher than that of the control group (30.26 ± 7.01 ng/mL vs 22.63 ± 7.42 ng/mL, P < 0.05). Fetal lung area/body weight ratio of the ICP group was significantly lower than that of the control group (5.76 ± 0.63 cm²/kg vs 6.89 ± 0.48 cm²/kg, P < 0.05). In the ICP group, umbilical cord blood TBA concentration was positively correlated to the maternal blood TBA concentration (r = 0.746, P < 0.05) and umbilical blood SP-A (r = 0.422, P < 0.05), but it was negatively correlated to the amniotic fluid lamellar corpuscle (r = 0.810, P < 0.05) and fetal lung area/body weight ratio (r = 0.769, P < 0.05). Furthermore, umbilical blood TBA showed a negative correlation to PC, SM and PI (r_pc = 0.536, r_sm = 0.438, r_pi = 0.387 respectively, P < 0.05). The neonatal asphyxia, neonatal respiratory distress syndrome, fetal distress and perinatal death rates in the ICP group are higher than that of the control group. CONCLUSION: ICP has higher TBA in maternal and fetal blood and amniotic fluid. The high concentration of TBA may affect fetal pulmonary surfactant production and fetal lung maturation.     

早发型与晚发型子痫前期的临床特点及母儿结局分析

目的 分析早发型与晚发型子痫前期的临床特征及母儿结局.方法 收集2015年1月至2020年12月6年间在广州医科大学附属第三医院分娩的诊断为子痫前期的单胎孕产妇2693例的临床资料,采用回顾性研究方法分析早发型(873例)与晚发型子痫前期孕妇(1820例)的临床特征及母儿结局.结果 早发型和晚发型子痫前期患者孕次比较[...     

高龄妊娠对产后出血的影响

目的探讨孕妇高龄是否对产后出血产生影响。 方法采用回顾性研究方法对2009年1月1日至2014年12月31日在广州医科大学附属第三医院妇产科住院分娩的年龄≥18岁单胎产妇28 839例的临床资料进行分析,按照孕妇分娩年龄进行分组,≥35岁为高龄组(3 670例),18～34岁为适龄组(25 169例),比较两组产后出血发病率、首发病因和妊娠结局;采用独立样本t检验、秩和检验、χ²检验对数据进行统计学分析。 结果本研究总的产后出血发生率为3.75%(1 081/28 839);高龄组产后出血发病率4.66%(171/3670),比适龄组产后出血发病率3.62%(910/25 169)高(χ²＝9.673,P＝0.002)。高龄组产后出血首发病因分别为：子宫收缩乏力(55.55%)、胎盘因素(39.77%)、软产道裂伤(3.51%)、凝血功能障碍(1.17%)。高龄组平均住院天数、顺产产后出血量、子宫切除率、转重症监护病房比例、输红细胞比例均高于适龄组,分别为(9.36±0.59)d和(6.42±0.96)d,(799.09±30.55)ml和(742.44±11.34)ml,12.87%和4.51%,5.8%和2.75%,28.65%和17.25%,P均<0.05。 结论高龄妊娠的孕妇更容易发生产后出血,且结局较差,子宫收缩乏力及胎盘因素是主要原因。     

Expression of CEA, CA-125 and SCC antigen by biological fluids associated with pregnancy.

Carcinoembryonic antigen (CEA), cancer antigen 125 (CA-125) and squamous cell carcinoma (SCC) antigen were measured in 56 full-termed pregnancies by enzyme-immunoassays (EIA-MEIA). The measurements were done in maternal serum (MS), umbilical cord blood (UCB) and amniotic fluid (AF) samples, during delivery. Very high antigen levels were found in AF samples (median: CEA = 124 ng/ml; CA-125 = 710 U/ml; SCC = 710 ng/ml) compared to UCB and MS. CEA and SCC showed significantly lower values in MS (0.6 and 1.7 ng/ml, respectively) than in UCB (1.6 ng/ml, P = 7.7 x 10(-9); 3.55 ng/ml, P = 6.5 x 10(-6), respectively), while CA-125 had significantly higher values in MS (6 U/ml) than in UCB (0.0 U/ml, P = 17 x 10(-6); Wilcoxon paired test). All CEA values in MS were below cut-off (less than or equal to 5 ng/ml), while 10% of CA-125 and 30% of SCC values were above cut-off (less than or equal to 35 U/ml and less than or equal to 2.5 ng/ml, respectively). Amniotic fluid CEA with meconium had higher values (P = 0.0002), while the highest CA-125 values in AF samples were found in primiparae (P = 0.02). Moreover SCC in AF samples from vaginal delivered pregnancies showed significantly higher values, compared to those from cesarean section (P = 4.2 x 10(-7); Mann-Whitney U-test). Thus, our findings suggest that pregnancy has an influence on maternal serum SCC and CA-125 values, while CEA is independent of gestation and seems to conserve its diagnostic value during pregnancy as well.     

Maternal serum cytokine levels in pregnancies complicated by PROM

OBJECTIVE: The aim of the study was to evaluate the maternal serum cytokines levels in pregnancies complicated by premature rupture of membranes (PROM). MATERIALS AND METHODS: Maternal serum of IL-1 beta, IL-4, IL-6, IL-8 and TNF-alfa levels were assessed in patients with PROM between 24-34 weeks of pregnancy (n = 45). Control group consisted of healthy pregnant women (n = 41) at 24-34 weeks of gestation. Serum cytokines concentrations were measured by commercial available enzyme-linked immunosorbent assays. C-reactive protein level and WBC were estimated in both groups. RESULTS: Compared to healthy pregnant, the group of patients with PROM had significantly higher serum levels of IL-1 beta (0.76 pg/ml vs 0.41 pg/ml, p = 0.022), TNF-alfa (1332.46 pg/ml vs 58.01 pg/ml, p < 0.00001) and IL-8 (15.79 pg/ml vs 0 pg/ml, p < 0.00001). CRP concentration and WBC were also significantly higher in serum of pregnant women with PROM then in healthy ones (CRP: 10 mg/l vs 0 mg/l, p = 0.043; WBC: 13,188 +/- 3625/mm3 vs 9132 +/- 1913/mm3, p < 0.00001). No significant differences in IL-6 and IL-4 levels were found between groups. CONCLUSION: Differences in serum maternal levels of cytokines between patients with premature ruptures of membranes and healthy pregnant women suggest that reasons and/or consequences of PROM results in changes in immunological system.     

阴道助产对剖宫产术后阴道分娩母婴结局的影响

目的探讨阴道助产对于剖宫产术后再次妊娠阴道分娩母婴结局的影响。 方法回顾性分析2014年1月1日至2018年12月31日广东省妇幼保健院收治的剖宫产术后再次妊娠阴道分娩的567例产妇的临床资料,将成功阴道分娩者纳入顺产组475例,将阴道分娩过程中接受助产手术者纳入助产组92例(产钳助产59例、胎头吸引助产33例),比较两组母婴结局和并发症情况,以及不同助产方式母婴结局和并发症情况。 结果(1)助产组高龄产妇29例(31.52%),顺产组89例(18.74%),两组相比差异有统计学意义(χ²＝7.64,P<0.001);助产组住院时间(2.80±0.73)d,顺产组(2.04±0.24)d,差异有统计学意义(t＝-18.13,P<0.001)。(2)助产组产后出血量(316.16±483.67)ml,产后出血率5.43%,顺产组产后出血量(201.38±144.43)ml,产后出血率1.26%,差异有统计学意义(t＝-4.29,P<0.001; χ²＝7.05,P＝0.008);两组其他分娩并发症及新生儿并发症发生率均无统计学差异(P>0.05)。(3)两种助产方式之间相比,产钳组出胎时间(10.36±1.75)min,胎吸引产组出胎时间(12.12±2.36)min,差异有统计学意义(t＝-4.09,P<0.001)。产钳组住院时间为(2.95±0.71)d,胎吸引产组为(2.55±0.71)d,差异有统计学意义(t＝2.63,P＝0.010);两种助产方式分娩并发症及新生儿并发症发生率无统计学差异(P>0.05)。 结论阴道助产可能会增加剖宫产术后再次妊娠阴道试产产妇产后出血的风险,但未增加新生儿并发症的发生风险,产程中应根据母胎情况选择恰当的助产方式。     

Maternal and perinatal outcome of pregnancies after the age of 45

OBJECTIVE: To describe the maternal and perinatal outcome of pregnancies in women aged 45 years or more at the time of delivery and to compare them with pregnancies in women aged between 20 and 29 years. METHODS: A retrospective review of hospital deliveries after 28 weeks gestation was performed at the Princess Badeea Teaching Hospital in North Jordan for patients delivered between 1st April 1994 and 31st December 1997. We compared the maternal and perinatal outcome of pregnancies in women aged of 45 years or more (study group, n = 114) with women aged between 20-29 years (control group, n = 121) delivered at the same hospital during the same period. RESULTS: The incidence of pregnant women aged 45 years or more was 3.3 per 1,000 births. The median maternal age was 45 years. The majority of women (81.6%) were 45 to 46 years old. Gravidity and parity was significantly higher in the study group (p < 0.0001), also antenatal and medical complications as pre-eclampsia and diabetes mellitus were higher in the study group. Caesarean section rate, incidences of placental abruption and placenta previa were more common in older patients compared with young patients (32.4 vs 10.7%, 6.1 vs 0.8% and 4.4 vs 1.6%, respectively). There were no differences in the incidences of neonatal deaths, lethal malformations and fetal weight between the 2 groups. CONCLUSION: Women aged 45 years or more at delivery may expect a good pregnancy outcome but should expect a higher incidences of placental abruption, placenta previa, preeclampsia and caesarean delivery.     

Prophylactic cefazolin in amnioinfusions administered for meconium-stained amniotic fluid.

OBJECTIVE: To determine if amnioinfusion with an antibiotic solution decreased the rate of clinical chorioamnionitis and puerperal endometritis in patients with meconium-stained amniotic fluid. METHODS: Patients in labor at 36 weeks of gestation or greater with singleton pregnancies and meconium-stained amniotic fluid were randomized to receive either cefazolin, 1 g/1,000 mL, of normal saline (n = 90) or normal saline (n = 93) amnioinfusion. Rates of clinically diagnosed chorioamnionitis and endometritis and of suspected and culture-proven neonatal infection were determined. RESULTS: Between the study and control groups, the incidences of clinical chorioamnionitis (7.8% vs. 8.6%), endometritis (2.4% vs. 3.5%), aggregate intrauterine infection (10.0% vs. 11.8%), suspected neonatal infection (17.8% vs. 21.5%), and proven neonatal infection (0.0% vs. 2.2%) were not significantly different. CONCLUSIONS: Prophylactic use of cefazolin in amnioinfusions did not significantly reduce rates of maternal or neonatal infection in patients with meconium-stained amniotic fluid.     

Fetal beta cell function in diabetic pregnancy. Amniotic fluid concentrations of proinsulin, insulin, and C-peptide during the last trimester of pregnancy

Proinsulin, insulin C-peptide, insulin-binding antibody, and glucose concentrations were measured in amniotic fluid samples from 43 insulin-treated diabetic patients and 17 nondiabetic control patients between the thirty-six and thirty-ninth weeks of gestation. Insulin-binding antibodies in amniotic fluid were present in only three diabetic patients, although antibodies in maternal serum were found in 22 of the diabetic subjects. In the diabetic group, maternal serum insulin-binding antibodies were statistically unrelated to levels of C-peptide in amniotic fluid. The mean amniotic fluid concentrations of proinsulin (0.07 nmole/L), insulin (0.08 nmole/L), C-peptide (1.17 nmoles/L), and glucose (2.09 mmoles/L) were markedly elevated (p less than 0.001) in diabetic patients, as compared to nondiabetic control patients, thus suggesting exaggerated fetal beta cell function. C-peptide was correlated to both insulin (r = 0.69) and proinsulin (r = 0.35) in the diabetic group only. Infant birth weight and amniotic fluid C-peptide was significantly correlated in both the control group (r = 0.54) and the diabetic group (r = 0.38). Diabetic pregnancies associated with neonatal morbidity (n = 25) had significantly higher mean amniotic fluid concentrations of both insulin and C-peptide than did pregnancies without neonatal morbidity (n = 18). The amniotic fluid values of C-peptide and insulin in these latter two subgroups were overlapping and, therefore, could not serve to predict neonatal outcome in the individual case.     

Obstetric outcomes in nulliparous women aged 35 and over with singleton pregnancies conceived by in vitro fertilization

Objective To investigate obstetric outcomes in singleton pregnancies conceived by in vitro fertilization (IVF) to nulliparous women older than 35 compared to those of their younger counterparts. Methods Nulliparous women 35 years and older at delivery conceived by IVF (n = 89) were compared with nulliparous women 34 years and younger at delivery conceived by IVF (n = 48). Data included antenatal data, gestational age at delivery, maternal and neonatal complications and mode of delivery. Results The incidence of pregnancy-induced hypertension in the younger group was significantly higher than that in the elderly group (13 vs. 3.4%, P = 0.043). There were no measurable differences in other obstetric outcomes such as placental abnormality, premature delivery or neonatal asphyxia between the two groups. Conclusion The current results suggest that obstetric complications in pregnancies conceived IVF are attributed to mechanisms other than those depend on advanced maternal age.