Urinary kallikrein quantity and activity of normal pregnant women and toxemia patients in third trimester

In this study, urinary kallikrein quantity and activity were measured by the kallikrein direct RIA and kininogenase activity with human low molecular weight kininogen in 32 non pregnant healthy women, 20 normal 3rd trimester pregnant women and 18 3rd trimester hypertension type toxemia patients. There was no significant difference in urinary kallikrein quantity between non pregnant women (n = 32, 64.0 +/- 6.3 micrograms/day, mean +/- SE) and normal pregnant women (n = 20, 68.1 +/- 10.1 micrograms/day). There was a significant difference (p less than 0.001) between non pregnant women and toxemia patients (n = 18, 22.5 +/- 3.3 micrograms/day). There was a significant difference (p less than 0.001) between toxemia patients and normal pregnant women. There was a significant difference (p less than 0.05) in urinary kallikrein activity between non pregnant women (n = 32, 496.2 +/- 57.2 micrograms kinin/day) and normal pregnant women (n = 20, 319.5 +/- 48.1 micrograms kinin/day). There was a significant difference (p less than 0.0001) between non pregnant women and toxemia patients (n = 18, 82.6 +/- 13.6 micrograms kinin/day). There was a significant difference (p less than 0.01) between normal pregnant women and toxemia patients. There were no correlation in both urinary kallikrein quantity and activity between severe type toxemia patients (systolic blood pressure greater than or equal to 160mmHg or diastolic blood pressure greater than or equal to 110mmHg) and mild type toxemia patients (160mmHg greater than systolic blood pressure greater than or equal to 140mmHg and 110mmHg greater than diastolic blood pressure greater than or equal to 90mmHg).(ABSTRACT TRUNCATED AT 250 WORDS)     

妊娠晚期妇女性现状研究

目的　了解妊娠晚期妇女性行为现状并分析其影响因素。　方法　2003 年 6 月至 8月期间对在北京大学第一医院产科分娩的338例产妇,运用自行设计的《妊娠期妇女性现状调查表》,于产后2~4 d在专人指导下进行回顾性调查。　结果　28.4%的产妇在晚孕期有性行为,性行为次数的增加与缺乏妊娠期性知识(Waldχ2 = 12 10, P< 0. 01)、配偶文化程度(Waldχ2 = 9 68,P<0.01)呈正相关,与产妇本人文化程度(Waldχ2 =11 77,P<0.01)、既往妊娠次数(Waldχ2 =6 05,P<0.05)、主观认为妊娠期不可以性交(Waldχ2 =9 59,P<0.05)及性欲下降(Waldχ2 =5 50,P<0.05)呈负相关。分娩孕周与晚孕期性行为呈正相关(P<0.05)。　结论　妊娠晚期妇女仍有性要求,性行为不增加早产的发生。     

Increased lipolysis in non-obese pregnant women studied in the third trimester

BACKGROUND: During pregnancy, metabolic adaptation takes place in the mother to provide for the supply of substrates to the growing fetus. OBJECTIVE: To determine rates and endocrine regulation of lipolysis and glucose production (GPR) in late pregnancy. DESIGN: Energy substrate production was measured in healthy pregnant women by use of stable isotope-labelled compounds. SETTING: University Hospital, Uppsala, Sweden. SAMPLE: Eight healthy non-obese, non-smoking women with normal pregnancies were studied at 33-36 weeks of gestation after an overnight (12-14 hours) fast. METHODS: Rates of glycerol and glucose production were analysed by gas chromatography/mass spectrometry following constant rate infusion of [1,1,2,3,3-(2)H(5)]-glycerol and [6,6-(2)H(2)]-glucose. MAIN OUTCOME MEASURE: Glycerol and glucose production in the third trimester. RESULTS: The mean rate of glycerol production, reflecting lipolysis, was 3.06 (0.66) and the mean GPR was 13.2 (1.5) micromol kg(-1) minute(-1) [2.38 (0.27) mg kg(-1) minute(-1)]. There was a correlation between rate of glycerol production and GPR (r = 0.75, P = 0.033). Fasting insulin levels correlated inversely with both the rate of glycerol production (r = -0.85, P = 0.008) and GPR (r = -0.78, P= 0.021). CONCLUSIONS: Our results show that lipolysis is markedly increased during late pregnancy compared with reported data for non-pregnant women. The data also confirm the occurrence of an increased GPR in pregnant women. The finding of a correlation between rate of glycerol production and GPR corroborates the view that lipolysis promotes gluconeogenesis. Although late gestation is associated with insulin resistance, the results show that insulin plays a regulatory role both in lipolysis and glucose production.     

First trimester serum inhibin A in normal pregnant women

Objectives To establish reference ranges for maternal serum inhibin A in normal first trimester pregnant women. Materials and methods This was a cross-sectional study. We measured maternal serum inhibin A in normal pregnant women gestation age between 6⁺⁰ and 14⁺⁶ weeks using the enzyme-linked immunosorbent assay (ELISA) method. Maternal serum inhibin A was analyzed according to gestational ages (GA). Results Serum of 300 pregnancies was analyzed and the outcome demonstrated the median of maternal serum inhibin A according to gestational age. The levels of maternal serum inhibin A during the 6⁰–6⁺⁶ week of gestations are lowest when compared with other gestational age. The levels of maternal serum inhibin A during 9⁰–9⁺⁶ week of gestations are maximal. Maternal serum inhibin A then declined until 14 weeks of gestation. Conclusion Serum inhibin A can be measured during the first trimester of pregnancy by using the recent ELISA technique. Our reference ranges might be useful for further studies, such as prediction of adverse pregnancy outcome in threatened abortion.     

The relationship between neck circumference and pregnancy-induced hypertension in the third trimester pregnant women

Objective: The purpose of this study was to evaluate the relationship between neck circumference (NC) and pregnancy-induced hypertension (PIH) in the third trimester pregnant women. Methods: The study included 126 women who were in the third trimester pregnancy. All subjects completed a standard sleep questionnaire, anthropometric measurements and ultrasonic testing. Results: Pregnant women with NC ≥34.7?cm had significantly higher frequency of PIH than pregnant women with NC <34.7?cm (35.6% versus 2.5%, χ^2?=?25.863, p?=?0.000). Conclusions: The increase of NC was independent risk factor for PIH in the third trimester pregnant women.     

妊娠期糖尿病患者与正常孕妇妊娠中晚期胰岛素抵抗及胰岛B细胞功能观察

目的前瞻性纵向观察中期妊娠诊断为妊娠期糖尿病(GDM)患者及血糖正常孕妇在妊娠中晚期胰岛素抵抗及胰岛B细胞功能变化,并比较两者之间的差别。方法 2009年2月至2010年3月在中山大学孙逸仙纪念医院产前检查的82例孕妇于妊娠20～24周行葡萄糖耐量试验(OGTT)及胰岛素释放试验,诊断为GDM43例为GDM组,血糖正常的39例为对照组。于32～36周复查OGTT及胰岛素释放试验,纵向观察两组孕妇胰岛素抵抗及胰岛B细胞功能的变化。结果两组的胰岛B细胞分泌指数(HOMA-β)晚期妊娠均高于中期妊娠,时间主效应有统计学意义(F=7.863,P=0.007);GDM组的早期胰岛素分泌指数(△I30/△G30)中期妊娠及晚期妊娠均低于对照组,组间主效应差异有统计学意义(F=6.052,P=0.018),但GDM组从中期妊娠到晚期妊娠有所升高,而对照组逐渐下降。GDM组的血糖曲线下面积(AUCG)在中期妊娠及晚期妊娠均大于对照组(分别为P<0.0001,P=0.001),同时对照组的AUCG晚期妊娠显著高于中期妊娠(P=0.001);稳态模式胰岛素抵抗指数(HOMA-IR)及混合胰岛素敏感度的时间及组间主效应差异均无统计学意义。结论中晚期妊娠正常孕妇及GDM患者胰岛素抵抗均增加,后者胰岛素抵抗程度高于前者,胰岛B细胞代偿功能两者均增强;GDM组的早期胰岛素分泌功能较正常妊娠组下降。胰岛素抵抗和胰岛素分泌代偿不足是GDM发生、发展的重要机制。     

First trimester embryonic/fetal heart rate in normal pregnant women

Objective: To establish reference ranges for first trimester embryonic/fetal heart rate in normal pregnant women. Materials and methods: This was a cross-sectional study. We performed ultrasonogram in 319 normal pregnant women, gestation age between 6⁺⁰ and 14⁺⁶ weeks and measured embryonic/fetal heart rates using M-mode. The embryonic/fetal heart rates were analyzed according to gestational ages (GA). Results: Data of 319 pregnancies were analyzed and the outcome revealed the mean of fetal heart rate according to gestational age. The mean embryonic heart rates during the 6th–7th week of gestation are lower when compared with the other gestational ages. At the 8th week of gestation, the embryonic heart rate is maximum. Then the embryonic/fetal heart rate gradually decreased to 161 beats/min at the 14th week of gestation. The regression equation for embryonic/fetal heart rate (beat/min) [y] according to GA (day) [x] was y = −53.124 + 6.1333x + (−0.0407)x ² (r ² = 0.525; P < 0.001). Conclusion: Embryonic/fetal heart rates during the 6⁺⁰ and 14⁺⁶ week of gestation are related to GA. Our reference ranges may be useful for further studies such as for prediction of adverse pregnancy outcome in threatened abortion.     

A comparison of serum androgens in pre-eclamptic and normotensive pregnant women during the third trimester of pregnancy

Objective: To compare the serum androgens level during the third trimester of pregnancy between normotensive and pre-eclamptic women. Method: A case–control study was performed on 64 pregnant women with the gestational age of 28–34 weeks. 32 women were pre-eclamptic (case group), and 32 women were normotensive till term gestation (control group). The serum level of androgens including sex hormone binding globulin (SHBG), total and free testosterone, androstenedione (ADD), and dehydroepiandrosterone sulfate (DHEA-S), were compared between the two groups. Results: The women of the two groups had no statistically significant difference according to age, gestational age, BMI (body mass index), parity and fetal sex. Serum level of SHBG (90.86 ± 9.30 vs. 55.86 ± 8.02 nmol/l, p = 0.02), total testosterone (3.70 ± 0.57 vs. 2.06 ± 0.24 ng/ml, p = 0.01), free testosterone (1.28 ± 0. 17 vs. 0. 74 ± 0.07 pg/ml, p = 0.01), and ADD (2.47 ± 0.10 vs. 2.17 ± 0.10 ng/ml, p = 0.04), was higher in the pre-eclamptic women. However, there was no difference between the two groups for DHEA-S (0.75 ± 0.18 vs. 0.51 ± 0.08 μg/ml, p = 0.19). Conclusion: Serum androgen levels during third trimester of pregnancy are higher in pre-eclamptic women and this may propose an effect of androgens in the pathogenesis of pre-eclampsia.     

Urinary trypsin inhibitor in pregnant women with normal and pathological course of pregnancy

Urinary trypin inhibitor concentration (UTI) was measured by Fritz and all method in the groups of women: non-pregnant (I), pregnant (II), in pregnancy complicated by EPH-gestosis (III) and in the prolongated pregnancy (IV). Furthermore, in the urine from the investigated group the index protein/creatinine was established. There was noticed the statistically significant increase in the UTI concentration in II, III, IV groups comparing to the non-pregnant group--I, and the increase in UTI in III and IV group in comparison to group II. The UTI measurement in the pregnant women connected with the index protein/creatinine could be significant for diagnosing of the pathology of pregnancy.     

Transperineal versus transvaginal ultrasonographic evaluation of the cervix at each trimester in normal pregnant women

AIMS: To compare transvaginal and transperineal ultrasonography in the assessment of cervical length and cervical changes in normal gravid patients at each trimester. METHODS: Transperineal and transvaginal ultrasonographic cervical length was measured on 104 asymptomatic pregnant women between 10 and 14, 20-24, and 30-34 weeks' gestation and the presence of a funnel was also noted. The study used the McNemar chi2 test to assess the difference between two methods in their ability to obtain a measurement, and the Pearson correlation coefficient to determine the relationship between the paired transperineal and transvaginal cervical lengths. RESULTS: Cervical length measurements were obtained by transvaginal ultrasonography in all 104 patients and by transperineal ultrasonography in 101 patients (97.1%) (P = 0.1). By gestational age, the greatest length discrepancy (2.8 mm) between the two ultrasonographic methods was found at 10-14 weeks (P < 0.001). At 20-24 and 30-34 weeks' gestation, the mean length differences were less than 1 mm (P < 0.01 and P = 0.337, respectively). Cervical funnelling was observed in 16 patients by both methods, whereas in two patients from the 20-24 week gestational age group, funelling was observed by transvaginal ultrasonography and not by transperineal ultrasonography. CONCLUSIONS: Cervical length measurements by transperineal ultrasonography show good correlation with transvaginal ultrasonographic measurements and it is a satisfactory alternative to a transvaginal evaluation of the cervix throughout pregnancy.     

Vasopressor activity in incubated plasma of normal and hypertensive pregnant women

The pressor activity generated in incubated plasma of nonpregnant, normal pregnant, and hypertensive pregnant women was measured by means of a sensitive bioassay technique. It was found that the plasma of normal pregnant women generated significantly higher amounts of active pressor principle than the plasma of nonpregnant women. The plasma of hypertensive pregnant women generated significantly lower amounts of active pressor principle than the plasma of normal pregnant women. Plasma obtained from the antecubital vein revealed no difference in pressor activity compared to plasma collected from the uterine vein at the time of cesarean section. These data suggest that active pressor principle is not involved in the pathogenesis of pregnancy-induced hypertension and that the pregnant uterus is not the source of active pressor principle.     

Changes in natural killer cell activity in normal pregnant and postpartum women: increases in the first trimester and postpartum period and decrease in late pregnancy

Changes in the activity and number of natural killer (NK) cells in peripheral blood in normal pregnant and postpartum women were examined. NK activity was measured in a 4-h 51Cr-release assay and evaluated by conventional relative lytic units and absolute lytic units which represent the total NK activity within a fixed volume of circulating blood. The number of NK cells was analyzed with FITC-conjugated monoclonal antibodies and by use of an automated flow cytometer. Unexpectedly, the relative NK activity increased in the first trimester and also for 1 month postpartum compared to the activity in normal non-pregnant controls. On the other hand, absolute NK activity decreased in the third trimester compared to the activity in normal non-pregnant controls. The percentage of CD57+ cells decreased in the second trimester, but the percentage of CD16+ cells did not change during pregnancy or the postpartum period. The absolute counts of CD57+ cells and CD16+ cells decreased in the second and third trimesters and increased transiently in the postpartum period. These findings indicate that the increased NK activity in the first trimester and at 1 month postpartum is induced by increased cytotoxic activity of individual NK cells, and that the decreased NK activity in late pregnancy is induced by a decrease in the numbers of NK cells. These physiological changes may play an important role in implantation in early pregnancy, protection of the fetal allograft in late pregnancy and in the natural defense against infection during the puerperal period.     

孕晚期合并无症状新型冠状病毒感染一例

本文为孕晚期无症状新型冠状病毒感染一例报告,母儿结局良好。患者孕38周因"新型冠状病毒核酸检测阳性1 d"于2020年2月11日入住合肥市第二人民医院。患者孕期定期产前检查且均未见异常。因其丈夫及姐姐分别于患者入院前14和7 d先后确诊为新型冠状病毒肺炎(COVID-19),患者入院前咽拭子新型冠状病毒核酸检测阳性。患者入院前无任何不适。入院第3天,胸部CT示两肺未见异常,仅两侧少量胸腔积液;患者出现不规律宫缩,急诊剖宫产娩出一活女婴。未行羊水、脐带血、胎盘等病原学检查。术后未行母乳喂养,患者与新生儿分室隔离,参与剖宫产手术相关医护人员术后均采取单间隔离。新生儿于出生当天、1日龄分别取外周血、鼻咽拭子,9日龄分别取鼻咽拭子、肛拭子进行新型冠状病毒核酸检测,结果均为阴性。患者术后恢复情况良好,生命体征平稳,术后8 d胸部CT提示两侧少量胸腔积液,术后11和12 d复测咽拭子新型冠状病毒核酸结果均为阴性。母女于术后14 d顺利出院。参与手术的相关医护人员术后14 d咽拭子新型冠状病毒核酸检测结果均阴性。     

Glucose kinetics in nondiabetic and diabetic women during the third trimester of pregnancy

Glucose kinetics were measured with 78% enriched D-[U-13C] glucose by the prime constant infusion technique during the third trimester of pregnancy in nine nondiabetic women, nine insulin-dependent diabetic women, six gestational diabetic women, and five control women (nonpregnant, nondiabetic) after an overnight fast. The patients not dependent on insulin were diagnosed as diabetic by oral glucose tolerance tests with the use of O'Sullivan and Mahan's criteria as modified by Carpenter and Coustan during the third trimester. The turnover studies were repeated post partum (6 weeks to 5 months after delivery) in 14 of the 24 pregnant subjects. All pregnant groups had a progressive fall in plasma glucose concentration during the study, but there was a steady state of plasma glucose concentration during the turnover period. In comparison to the control subjects, both the pregnant nondiabetic and pregnant insulin-dependent diabetic women had significantly higher plasma insulin concentrations throughout the study (p less than 0.05). There were no differences in the glucose turnover rate between any of the pregnant groups (1.7 +/- 0.2 mg . kg-1 min-1 in pregnant nondiabetic women; 1.5 +/- 0.2 mg . kg-1 min-1 in pregnant insulin-dependent diabetic women; and 2.1 +/- 0.4 mg . kg-1 min-1 in gestational diabetic women) and the control group of women (1.8 +/- 0.2 mg . kg-1 min-1) (mean +/- SEM). When the pregnant patients were studied post partum, the glucose turnover rate was similar when referenced to body weight; however, because of a 9.6% to 14.5% fall in weight post partum, the absolute values were higher in the pregnant women. We conclude that, in the basal state after an overnight fast, (1) both nondiabetic and diabetic patients accelerated their glucose turnover rate during pregnancy to provide for increased maternal and fetoplacental metabolic requirements, and (2) in the diabetic subjects the nearly normal plasma glucose and insulin concentrations and other metabolic parameters, as well as the glucose turnover rate, suggested good metabolic control during pregnancy in most of the insulin-dependent and in all of the gestational diabetic patients.