评价胎盘植入的超声诊断标准

目的探讨各种超声诊断指标在胎盘植入中的诊断价值。方法对73例胎盘声像图异常的孕妇进行随访,比较超声检查与妊娠结果。结果通过比较各项超声诊断指标的敏感度、特异度、阳性预测值、阴性预测值,胎盘后间隙消失,子宫肌壁厚度〈1mm,胎盘与子宫肌层间交界的低回声带中断,血管连接于胎盘和子宫浆膜层之间,以及胎盘种植处有血管穿过,这五项超声学指标用于胎盘植入的诊断,有统计学意义。结论上述五项超声指标对胎盘植入有良好的诊断价值,联合应用各指标可得到更高的敏感性、特异性、阳性预测值及阴性预测值。     

超声评分法预测凶险性前置胎盘合并胎盘植入及不良妊娠结局

目的:分析超声评分法在凶险性前置胎盘合并胎盘植入及不良妊娠结局中的预测方法及价值。方法:将100例凶 险性前置胎盘疑似胎盘植入患者纳入本研究,利用超声评分法对患者的胎盘植入程度进行评估,将评估结果与术后病理 结果进行对比分析。结果:超声评分法在粘连型、植入型和穿透型患者中的检出率分别为100.00%、100.00%和86.36%, 在凶险性前置胎盘合并胎盘植入的总检出率为95.59%,与病理诊断相比并无显著差异（P>0.05）;超声评分法在植入型中 的灵敏度和特异度分别为100.00%和72.22%,在穿透型中的灵敏度和特异度分别为86.36%和100.00%;植入型和穿 透型患者的不良妊娠结局发生率分别为76.09%和100.00%,均显著高于粘连型（P<0.05）,且穿透型明显高于植入型 （P<0.05）。结论:超声评分法可以有效实现对凶险性前置胎盘合并胎盘植入患者的预测,通过对患者病理类型分类,发现 穿透型患者的不良妊娠结局发生率最高,应当在临床中采取预防性干预措施。     

Conservative and timely treatment in retained products of conception: a case report of placenta accreta ritention

The term retained products of conception (RPOC) refers to intrauterine tissue that develops after conception and persists after medical and surgical pregnancy termination, miscarriage, and vaginal or cesarean delivery. One of the most important factor risk for RPOC is placenta accreta, defined as “the abnormal adherence, either in whole or in part, of the afterbirth to the underlying uterine wall”. We report a case of a 37 years old woman referred to our gynecologic department with irregular vaginal bleeding. On her medical history, she had a cesarean occurred 3 months before. Ultrasonography revealed in the uterine cavity hyperechoic mass, treated with curettage. Two weeks later the curettage, patient complained still vaginal bleeding. On the transvaginal ultrasound, the uterine cavity was occupied again by a hyperechoic mass. She underwent to hysteroscopic resection and histological diagnosis was compatible with placenta accreta residual. In the follow up she had not complications. Early diagnosis, prompt evaluation of bleeding is important for timely treatment and for preventing immediate complications and demolitive approach. A careful follow up is necessary to prevent late consequences. The purpose of this study is to report our experience in timely diagnosis and conservative management.     

Highly expressed FYN promotes the progression of placenta accreta by activating STAT3, p38, and JNK signaling pathways

Placenta accreta is an abnormality of the placenta caused by the chorionic villi invading the muscular layer, which can cause serious bleeding, infection, shock, bladder invasion, uterine perforation, and even death. However, the etiology of placental accreta is not entirely clear. In the present study, high-throughput sequencing results showed that FYN is highly expressed in the placental accreta position in the placenta accreta group and is a key regulator of cell invasion and migration. Therefore, we aimed to evaluate the role and potential molecular mechanism of FYN in placenta accreta. The results showed that FYN was highly expressed in the placenta tissues of the placenta accreta group. Furthermore, the levels of phosphorylated STAT3, p38, and JNK in the placenta accreta group were remarkably increased compared with those in the control group. In addition, FYN knockdown considerably decreased the migration and invasion rates of trophoblast cells (HTR8/SVneo) and inhibited the levels of phosphorylated STAT3, p38, and JNK. After subsequently blocking these signaling pathways, the invasion and migration abilities of HTR8/SVneo cells were substantially decreased. In conclusion, FYN may promote excessive trophocyte cell invasion by activating STAT3, p38, and JNK pathways and can be a new target for placenta accreta prevention and treatment.     

Supporting the hypothesis of pregnancy as a tumor: survivin is upregulated in normal pregnant mice and participates in human trophoblast proliferation

PROBLEM: Survivin, a tumor-promoting antiapoptotic molecule, is expressed in the human placenta. Here, we analyzed its expression during normal and pathological murine pregnancy and investigated its participation in human first trimester trophoblast cell survival and proliferation. METHOD OF STUDY: We first analyzed the expression of survivin on the mRNA and protein level at the fetal-maternal interface of normal pregnant (CBA/J x BALB/c) and abortion-prone (CBA/J x DBA/2J) mice at different pregnancy stages by RT-PCR and immunohistochemistry. We also evaluated apoptosis in murine trophoblasts in both mating combinations by TUNEL technique. Functional studies were carried out by knockdown survivin by means of siRNA methodology in two human first trimester trophoblast cell lines [Swan.71 (Sw.71) and HTR8 (H8)]. RESULTS: We observed a peak in mRNA levels on day 5 and a peak of protein levels on day 8 of pregnancy in both combinations. The level of survivin in animals from the abortion-prone group was decreased compared with normal pregnant mice on day 8, which was accompanied by elevated apoptosis rates. In later pregnancy stages (days 10 and 14), survivin levels decreased to levels comparable to those observed right after fecundation in both groups. Transfection of human first trimester cell lines (H8 and Sw.71) with siRNA targeting the survivin gene led to a 76-82% reduction of its expression leading to reduced trophoblast cell viability and proliferation. CONCLUSION: Our findings suggest an important role of survivin to promote trophoblast cell survival and proliferation during placentation, thus maintaining pregnancy. The pregnancy-associated expression of a cancer molecule such as survivin supports the 'pseudo-malignancy' hypothesis of pregnancy. Our data may contribute to the better understanding of trophoblast cell development during implantation and placentation.     

植入性胎盘的产前诊断与预后的关系

目的探讨55例植入性胎盘患者的产前诊断及与其预后的关系。方法选择2005年1月～2010年1月在山东省聊城市第二人民医院分娩,经过术后病理证实的植入性胎盘患者55例,采用回顾性病例统计分析方法进行研究。结果患者的产后出血量,是否行围产期全宫切除术以及是否合并不同类型的前置胎盘均与患者既往流产次数无关（P〉0.05）。产前超声明确诊断的植入性胎盘患者为14.55%,产前超声能否明确植入性胎盘的诊断与患者是否合并前置胎盘、植入性胎盘为前壁附着有关（P〈0.05）,相关分析表明产前超声诊断与产后出血量及胎盘植入面积明显相关（P=0.000）。患者是否行围产期全宫切除术与患者的产前出血量明显相关（P=0.000）,与是否合并中央性前置胎盘有关（P〈0.01）。结论植入性胎盘仅55.38%能够通过超声获得明确的产前诊断,但当植入性胎盘合并产前出血的前置胎盘时超声诊断则相对容易,而且这部分患者尤其是合并产前出血的中央性前置胎盘患者的预后较差,应做围产期全子宫切除术的准备。如产前应用核磁共振检测胎盘植入面积大小对产后出血的预测有重要的指导意义。     

妊娠期高血压疾病患者胎盘组织中抵抗素的表达

目的检测抵抗素（Resistin）在妊娠期高血压疾病患者胎盘组织中的表达,探讨抵抗素在妊娠期高血压疾病发病机制中的作用。方法选取妊娠期高血压疾病患者40例,包括妊娠期高血压患者20例,子痫前期患者20例,选取无高血压、糖尿病等并发症的孕妇20例作为对照组。并记录每个患者新生儿出生体重。应用免疫组化SP两步法检测抵抗素在其胎盘组织中的表达情况,对免疫组化切片采用Tanaka等级评分法进行评分。应用studengt t检验,分别对子痫前期组与对照组,妊娠期高血压组与对照组免疫组化评分结果进行比较;并采用双变量相关法,估计胎盘抵抗素的表达与新生儿出生体重的相关性,以P〈0.05为差异有显著性。结果本研究发现抵抗素表达于胎盘绒毛滋养细胞的细胞浆中;对免疫组化切片应用Tanaka等级评分法进行评分,经studengt t检验发现子痫前期组抵抗素在胎盘组织中的表达低于对照组,P〈0.05,差异有显著性;妊娠期高血压组与对照组差异无显著性,P〉0.05。抵抗素在胎盘组织中的表达与新生儿出生体重正相关（r=0.883,P〈0.05）。结论抵抗素可能参与了子痫前期的发病机制,推测其表达下降是由胎盘功能减退引起的,这可能是疾病发展过程中的一个结果而不是原因;抵抗素可能参与了子痫前期胎儿生长受限的发生,其具体机制将有待于进一步研究。     

不同类型胎盘植入对剖宫产患者麻醉方式选择的影响

目的探讨不同类型胎盘植入对剖宫产患者麻醉方式选择及手术效果的影响。方法回顾性分析于我院行剖宫产手术的胎盘植入产妇300例,根据胎盘植入严重程度将其分为粘连组(181例)、植入组(73例)及穿透组(46例),分析3组的麻醉方式实施率、术中及术后凝血功能指标、并发症情况。结果粘连组椎管内麻醉实施率明显高于植入组和穿透组,全身麻醉和复合麻醉实施率明显低于植入组和穿透组,差异均有统计学意义(P<0.05);植入组和穿透组全身麻醉实施率比较,差异无统计学意义(P>0.05),植入组椎管内麻醉实施率高于穿透组,复合麻醉实施率低于穿透组,差异均具有统计学意义(P<0.05)。3组产妇术中PLT、APTT、Fib及术后APTT、Fib、PT比较,差异无统计学意义(P>0.05);植入组和穿透组术中PT比较,差异无统计学意义(P>0.05),但均低于粘连组,差异有统计学意义(P<0.05);粘连组术后PLT明显低于植入组和穿透组,且植入组术后PLT明显低于穿透组,差异均有统计学意义(P<0.05)。粘连组胎儿窘迫、新生儿窒息发生率低于植入组和穿透组,植入组上述并发症发生率均低于穿透组,差异均具有统计学意义(P<0.05);粘连组产妇弥散性血管内凝血、产后出血、产褥感染发生率低于植入组和穿透组,植入组上述并发症发生率均低于穿透组,差异均具有统计学意义(P<0.05)。粘连组新生儿NICU入住率、围生期死亡率均低于植入组及穿透组,植入组以上指标均低于穿透组,差异具有统计学意义(P<0.05);粘连组新生儿Apgar评分高于植入组及穿透组,植入组新生儿Apgar评分高于穿透组,差异具有统计学意义(P<0.05)。粘连组产妇出血量低于植入组和穿透组,植入组产妇出血量低于穿透组,差异均有统计学意义(P<0.05)。结论对于胎盘植入的产妇应预先了解其严重程度,从而选择适宜的麻醉方式,在无禁忌证的前提下,应以椎管内麻醉为主,并在围生期给与相应的处理措施。     

The immunology of successful pregnancy

Immune responses play an important role in various reproductive processes, including ovulation, menstruation and parturition. Clearly, during pregnancy, when the mother must accept a semi-allogeneic fetus, immune responses also play a very important role. This was first recognized by Medawar in 1953, when the concept of the fetal allograft was presented in order to explain the immunological relationship between mother and fetus. Since then, the immunology of pregnancy has been the leading subject within reproductive immunology research. Yet, the question of why the semi-allogeneic fetus is not rejected by the mother remains unresolved. The present review provides an update of current knowledge on the subject of the so-called 'immunological paradox of pregnancy'.     

Progesterone receptor immunoreactivity at the maternofetal interface of first trimester pregnancy: a study of the trophoblast population

The aim of oar study was to localize oestrogen receptor (ER)and progesterone receptor (PR) in the trophoblast populationat the maternofetal interface in early pregnancy. Rat monoclonalantibodies to human ER and PR were used to study 44 cases ofchorionic villi and 82 cases of decidua using an immunocytochemicalmethod. The PR-immunoreactive products were localized in thenuclei of syncytiotrophoblast and cytotrophoblast cells of thevilli. Specific staining was also present in the cytoplasm.Villous stroma and vessels were stained occasionally. Usingcytokeratin staining in an adjacent section or double stainingwith PR and cytokeratin, the distribution of invading trophoblastcells and their PR expression were examined. In decidual stroma,a type of interstitial cell was identified which simultaneouslyexpressed cytokeratin and PR in the cytoplasm, indicating thatthe invading trophoblast cells may express PR. All extravillouspopulations at the interface were positive for PR, includingthe syncytial lining of the decidual surface, the cytotrophoblastcolumn, the cytotrophoblast shell and the interstitial trophoblast.The immunoreactivity of PR was also localized in the nucleiof vascular endothelial cells, whereas Factor VIII was localizedin the cytoplasm of the same cells, thus confirming their endothelialnature. In contrast to PR, little ER could be detected in thetrophoblast cell population using anti-ER antibody D75 in ourstudy.     

Endoglin基因在妊娠期高血压疾病胎盘中的表达及意义

目的探讨妊娠期高血压疾病患者胎盘组织中Endoglin基因水平的变化及临床意义。方法选择2010年8月至2011年4月在北京军区总医院住院分娩的妊娠期高血压疾病患者共44例（妊娠期高血压疾病组）,其中妊娠期高血压孕妇15例（妊娠期高血压组）,轻度子痫前期孕妇14例（轻度子痫前期组）,重度子痫前期孕妇15例（重度子痫前期组）;以同期正常晚期妊娠孕妇16例为对照组。采用实时定量RT-PCR检测各组孕妇胎盘组织中Endoglin mRNA表达水平。结果妊娠高血压疾病组患者胎盘组织中Endoglin mRNA相对表达量明显高于对照组,差异有统计学意义（P〈0.05）;轻度子痫前期组、重度子痫前期组患者胎盘组织中Endoglin mRNA相对表达量均明显高于对照组,差异有统计学意义（P均〈0.05）。结论 Endoglin在妊娠期高血压疾病患者尤其是轻度子痫前期及重度子痫前期患者胎盘中高度表达,其表达水平可能与病情的发生发展密切相关。     

胎盘生长因子及受体在妊娠肝内胆汁淤积症患者胎盘中的表达及其意义

目的探讨胎盘生长因子(PLGF)及受体(F lt-1)在妊娠肝内胆汁淤积症患者胎盘中的表达及其意义。方法采用免疫组织化学方法测定30例妊娠肝内胆汁淤积症患者(ICP组)和30例正常晚期妊娠妇女(对照组)的胎盘组织及8例早孕绒毛组织中PLGF及F lt-1的表达。同时还用抗FⅧRA抗体标记ICP组和对照组孕妇胎盘中的血管密度。结果PLGF及F lt-1在早孕绒毛中主要分布于滋养叶细胞,在ICP患者和对照组胎盘中分布基本一致,主要分布于合体滋养细胞、细胞滋养细胞、血管内皮细胞和绒毛间质细胞。在ICP胎盘中PLGF、F lt-1表达强度及胎盘血管密度均明显低于对照组(P<0.01)。相关分析显示,胎盘组织中PLGF表达强度与胎盘血管密度呈正相关。结论妊娠肝内胆汁淤积症患者胎盘PLGF及F lt-1表达下降与胎盘滋养叶细胞侵入异常、胎盘血管形成异常、胎盘血管密度降低有关,可能是ICP胎儿妊娠结局不良的原因。     

The integrative roles of chemokines at the maternal-feta interface in early pregnancy

Embryos express paternal antigens that are foreign to the mother, but the mother provides a special immune milieu at the fetal-maternal interface to permit rather than reject the embryo growth in the uterus until parturition by establishing precise crosstalk between the mother and the fetus. There are unanswered questions in the maintenance of pregnancy, including the poorly understood phenomenon of maternal tolerance to the allogeneic conceptus, and the remarkable biological roles of placental trophoblasts that invade the uterine wall. Chemokines are multifunctional molecules initially described as having a role in leukocyte trafficking and later found to participate in developmental processes such as differentiation and directed migration. It is increasingly evident that the gestational uterine microenvironment is characterized, at least in part, by the differential expression and secretion of chemokines that induce selective trafficking of leukocyte subsets to the maternal-fetal interface and regulate multiple events that are closely associated with normal pregnancy. Here, we review the expression and function of chemokines and their receptors at the maternal-fetal interface, with a special focus on chemokine as a key component in trophoblast invasiveness and placental angiogenesis, recruitment and instruction of immune cells so as to form a fetus-supporting milieu during pregnancy. The chemokine network is also involved in pregnancy complications.     

妊娠肝内胆汁淤积症胎盘因素与胎儿不良结局的关系

妊娠期肝内胆汁淤积症（ICP）是发生于妊娠中晚期的妊娠特有并发症,此病可以造成胎儿及新生儿的不良妊娠结局如死胎、死产、早产新生儿窒息死亡等,而这些结果的产生都与胎盘的病理改变有关。本综述就妊娠期肝内胆汁淤积症胎盘因素与胎儿不良妊娠结局的关系进行综述,以便更好的预防不良妊娠结局的发生。     

重度子痫前期孕妇血清和胎盘组织中脂质代谢的研究

目的探讨脂质代谢在子痫前期发病中的作用。方法回顾性分析310例重度子痫前期孕妇（子痫前期组）和300例健康晚孕妇女（正常妊娠组）的血脂水平;酶法检测26例子痫前期组和30例正常妊娠组血脂浓度;油红染色法检测12例子痫前期组和12例正常妊娠组胎盘组织中脂质水平。结果子痫前期组血脂水平明显高于正常妊娠组;子痫前期组胎盘组织较正常妊娠组有明显脂质沉积。结论子痫前期存在显著的高血脂异常代谢。脂质代谢可能在子痫前期发病中起着一定的作用。     

妊娠肝内胆汁淤积症患者胎盘瘦素的表达及意义

目的探讨妊娠肝内胆汁淤积症(ICP)患者胎盘瘦素表达的变化.方法采用S-P免疫组化方法.结果 (1)光镜下发现ICP患者胎盘绒毛水肿、绒毛间隙狭窄、绒毛血管合体膜增厚.(2)两组孕妇胎盘绒毛滋养层细胞胞浆内均有瘦素的表达,但研究组胎盘瘦素的水平高于对照组(P<0.05),并且随着ICP组分度的加重,表达增强.结论 ICP患者胎盘瘦素的高表达可能导致ICP的发生.     

妊娠早期绒毛及中晚期胎盘中Ghrelin的表达研究

目的探讨明确ghrelin是否参与了妊娠胎盘形成发育及胚胎早期发育进程。方法本研究利用免疫组化和实时定量RT—PCR技术检测了人妊娠早期绒毛及中晚期胎盘ghrelin蛋白的表达定位和ghrelin mRNA水平相对表达变化规律。结果免疫组化结果表明，ghrelin蛋白主要分布于滋养层细胞和血管内皮细胞；实时定量RT—PCR结果揭示人妊娠早期绒毛及中晚期胎盘ghrelin mRNA的相对表达量依据发育阶段的不同而呈现一定变化规律，即在妊娠早期6、7、8周显著高于12—15周胎盘（P〈0．05），16周表达量又出现上升趋势。在晚期胚胎中ghrelin表达明显下降。结论妊娠早期绒毛和中晚期胎盘中ghrelin蛋白的表达及ghrelin mRNA特定的表达模式，揭示这一新型分子在人妊娠早期绒毛形成及中晚期胎盘发育过程中具有潜在的调控作用。     

Stellate transformation of invasive trophoblast: a distinct phenotype of trophoblast that is involved in decidual vascular remodelling and controlled invasion during pregnancy

BACKGROUND: Successful implantation relies on the tightly regulated invasion of extravillous trophoblasts (EVTs). However, little is known about their phenotypic differentiation and relevant motile behaviour. Furthermore, the cell-cell interactions between EVTs and decidual arterioles during physiological transformation are also poorly understood. METHODS: A total of 128 decidual specimens from early and late gestations containing components of EVTs and spiral arterioles were investigated using immunohistochemistry and periodic acid-Schiff reaction. RESULTS: Unipolar, tadpole-like EVTs are observed throughout the interstitial area, with a tendency to decrease along the invasive pathway. The stellate differentiation of the EVTs is identified around and inside decidual arterioles or in the third-trimester myometrium. Furthermore, stellate transformation of EVTs precedes its interactions with the decidual arteriole. These specialized stellate trophoblasts invade and infiltrate the tunica media, accompanying lacuna formation inside the vessel wall and perturbation of actin fibre alignment of the tunica media. CONCLUSION: Stellate transformation of trophoblasts may explain controlled invasion of EVTs and probably plays a key role in initiating cell-cell interaction in decidual vascular remodelling.