硝苯地平联合拉贝洛尔治疗对子痫前期患者脐动脉S/D值、胎儿血流动力学的影响CSCD

目的 分析硝苯地平联合拉贝洛尔治疗子痫前期(PE)的疗效。方法 选取安徽省马鞍山市妇幼保健院PE患者110例,随机分为对照组(54例,予以硫酸镁及硝苯地平)、观察组(56例,在对照组基础上予以拉贝洛尔),比较两组临床疗效、治疗前后胎儿血流动力学相关参数,记录母婴结局、不良反应。结果 观察组治疗总有效率高于对照组(P <0.05);治疗后观察组24 h平均收缩压、平均舒张压、平均动脉压及脐动脉S/D值、动脉搏动指数(PI)、动脉血流阻力指数(RI)均低于对照组(P <0.05);观察组妊娠结局、新生儿结局不良发生率低于对照组,而出生后5 min Apgar评分高于对照组(均P <0.05);两组不良反应发生率差异无统计学意义(P>0.05)。结论 硝苯地平联合拉贝洛尔治疗PE可明显改善脐动脉血流动力学指标,有利于确保获得良好母婴结局。     

拉贝洛尔联合硝苯地平在子痫前期治疗中的应用效果

目的 探讨拉贝洛尔联合硝苯地平在子痫前期治疗中的应用效果。方法 选取本院134例子痫前期患者为研究对象,随机分为两组,各67例。对照组采用拉贝洛尔+不规律硝苯地平治疗,探讨组采用拉贝洛尔+规律硝苯地平治疗,比较两组的治疗效果、血压水平、母婴并发症发生率及不良反应发生情况。结果 探讨组治疗总有效率为98.51%,高于对照组的85.07%(P<0.05);治疗后,探讨组平均舒张压、平均收缩压、24 h蛋白尿定量或随机尿蛋白水平低于对照组（P<0.05）;探讨组母婴并发症发生率为2.99%,低于对照组的16.42%(P<0.05);探讨组不良反应发生率为2.99%,低于对照组的14.93%(P<0.05)。结论 拉贝洛尔+规律硝苯地平治疗子痫前期,能够减少血压波动及脏器损伤,改善胎盘血流灌注,改善母婴不良分娩结局,降低不良反应发生率,从而提高预后效果及治疗效果,值得在临床治疗中推广和应用。     

静脉导管、脐静脉和脐动脉及大脑中动脉血流检测对子痫前期胎儿预后分析

目的:探讨子痫前期(PE)胎儿静脉导管(DV)、脐静脉(UV)和脐动脉(UA)及大脑中动脉(MCA)血流检测对围生儿预后分析。方法:应用彩色多普勒超声检测PE胎儿的DV、UV和UA及MCA血流参数,并与相应孕周正常妊娠胎儿的血流测值进行对照分析,研究分析其与胎儿不良结局的关系。结果:28~31+6周及36周~分娩前,重度PE胎儿的DV、UV血流测值较正常、轻度PE胎儿升高(P0.05),轻度PE与正常胎儿比较差异无统计学意义(P0.05)。32周~35+6周,PE胎儿的DV血流参数测值PLI、PVIV、PIV及Qdv/Quv随着PE严重程度呈上升趋势(P0.05)。28周~分娩前,重度PE胎儿UA血流测值较正常、轻度PE胎儿升高(P0.05),轻度PE胎儿UA血流测值RI、PI、S/D与正常胎儿比较差异无统计学意义(P0.05),28~36周PE胎儿的MCA血流测值RI、PI、S/D与正常胎儿比较差异有统计学意义(P0.05)。PE胎儿DV、UV、UA血流测值与新生儿的出生体重、Apgar评分、脐动脉血氧饱和度、脐静脉p H值呈负相关。PE胎儿DV的PVIV、PIV,UV的Qdv/Quv,UA的PI、S/D和MCA的RI值与新生儿出生结局相关(P0.05)。结论:DV、UV血流频谱变化可反映PE胎儿宫内状况及预测出生不良结局,若结合UA、MCA血流频谱进行联合分析,将能更准确地评估胎儿的宫内状况。     

胎儿畸形的脐动脉彩色多普勒血流频谱分析

目的探讨脐动脉彩色多普勒血流频谱分析在胎儿畸形中的临床意义.方法1997年10月至1999年11月于本院行彩色多普勒超声检查胎儿发育异常59例,全部病例在出生或引产后得到证实.同期收集正常孕妇154例作为对照组,研究其脐动脉血流收缩期峰速与舒张期末期最低速度之比值(S/D值).结果胎儿畸形组的S/D值明显高于正常组(P＜0.01);各类畸形中,多发畸形、消化系统畸形和中枢神经系统畸形组脐动脉血流S/D值异常者明显多于正常对照组(P＜0.005);而泌尿系统畸形和胸、腹水组与正常对照组比较,无显著差异(P＞0.01).结论胎儿畸形,尤其是多发畸影、消化系统畸形和中枢神经系统畸形可引起S/D值增高.     

用彩色超声仪与多功能多普勒仪监测胎儿脐血流S/D值的比较

胎儿脐动脉血流速度波形是反映胎儿－胎盘循环状态的指标之一,当胎儿脐动脉血流出现阻断或逆流的异常波形时,反映胎儿－胎盘循环血流量严重不足;血流阻力指标极度升高表明胎儿宫内缺血、缺氧严重,在胎儿脐动脉逆流波形出现时有４０％～５０％的围产儿死亡,及时终止妊...     

关于妊娠中晚期脐动脉血流速度S/D值分布曲线图的研究

目的　通过对非筛选人群的妊娠中晚期脐动脉血流速度 S/ D值的测定 ,描绘出各孕周S/ D值的各百分位曲线图。　方法　测定 1996年 1月～ 1998年 12月共 75 99人次的孕 2 4～ 44周脐动脉 S/ D值 ,统计出各孕周段的 P5 0 、P80 、P85 、P90 、P95 、P97.5 ,描绘出曲线图。　结果　随孕龄增加 ,各百分位值渐降低 ,孕 37周后的 S/ D值 ,P85 <2 .5 ,P97.5 <3.0。　结论　在非筛选人群中应根据实际临床意义 ,取某个百分位的值 ,作为该孕周的 S/ D异常值界限。     

维生素E对子痫前期-子痫患者脐血诱导脐动脉平滑肌细胞胶原表达及NF-kB活性的影响

目的:探讨子痫前期子痫患者脐血清诱导脐动脉平滑肌细胞(HUASMC)前胶原I、Ⅲ的表达、NF-κB活性及维生素E对其的影响。方法:采用组织块培养法培养正常妊娠HUASMC,传代后待细胞长满至70% ~80%后,加或不加维生素E作用30min后分别加入子痫前期子痫患者脐静脉血清,培养2h,Westernblotting测定细胞胞浆I -κB、胞核NF κB含量;培养48h,MTT法测定细胞增殖活力,流式细胞学测定细胞周期,RT -PCR测定平滑肌细胞前胶原I、Ⅲ的表达。结果:子痫前期子痫患者脐静脉血清培养的HUASMC胞浆I- κB含量明显低于对照组,胞核NF- κB含量、细胞增殖活力、前胶原ImR NA的表达、S及G2 /M期细胞百分比明显高于正常妊娠组(P<0 .01),G0 +G1 期细胞百分比明显低于妊娠组(P<0. 01)。维生素E处理可以抑制子痫前期子痫患者血清引起的NF -κB核转位、细胞增殖活力、前胶原I的表达(P<0 .01),G0 +G1 期细胞百分比明显增加(P<0 .01)。结论:子痫前期子痫患者脐静脉血清HUASMC增殖、NF- κB核转位及I型胶原表达,VitE可抑制子痫前期子痫患者脐静脉血清诱导的HUASMCNF -κB核转位、细胞增生及I型胶原表达。     

载脂蛋白B/A1比值对子痫前期患者妊娠结局的预测价值

目的:探讨载脂蛋白B/载脂蛋白A1(ApoB/A1)比值对子痫前期(PE)患者妊娠结局的预测价值。方法:选取2020年1月至2021年1月郑州大学第二附属医院妇产科收治的112例PE孕妇,根据病情分为轻度PE组(52例)和重度PE组(60例),另选取同期健康孕产妇56例为对照组。根据妊娠结局分为结局良好组(n=62)与结局不良组(n=50)。对比分析3组孕产妇的ApoB、ApoA1及ApoB/A1比值。ROC曲线评估ApoB/A1对PE的诊断价值,logistic回归及ROC曲线分析ApoB/A1对PE妊娠结局的预测价值。结果:与对照组比,轻度及重度PE组的ApoB、ApoB/A1均显著升高(P<0.05),重度PE组的ApoB、ApoB/A1高于轻度PE组(P<0.05),ApoA1水平低于轻度PE组(P<0.05)。ApoA1、ApoB、ApoB/A1诊断PE的曲线下面积(AUC)分别为0.710、0.860和0.882。与妊娠结局良好组相比,妊娠结局不良组的ApoB、ApoB/A1均显著升高,ApoA1降低(P<0.05)。ApoB、ApoB/A1是PE孕...     

核因子κB顺式诱骗寡脱氧核苷酸对子痫前期患者脐血清培养的脐动脉平滑肌细胞功能的影响

目的 探讨核因子κB顺式诱骗寡脱氧核苷酸(ODN)对子痫前期患者脐血清诱导人脐动脉平滑肌细胞(HUASMC)前胶原Ⅰ、Ⅲ及肿瘤坏死因子α(TNF-α)表达的影响.方法 将原代培养的HUASMC分4组:A组(加入正常新生儿脐血清培养)、B组(加入子痫前期患者的新生儿脐血清培养)、C组(加入子痫前期患者的新生儿脐血清及核因子κB顺式诱骗ODN培养)和D组(加入子痫前期患者的新生儿脐血清及无序ODN培养).通过四甲基偶氮唑蓝比色法及流式细胞仪检测各组HUASMC的增殖活力[以吸光度(A)表示]和凋亡率;应用RT-PCR检测各组HUASMC的前胶原Ⅰ、ⅢmRNA的表达,蛋白印迹法检测TNF-α蛋白的表达[均以A值表示].结果 (1)增殖活力:A组为0.11±0.02,B组为0.19±0.02,C组为0.14±0.02,D组为0.18±0.03;B、C、D组增殖活力显著高于A组(P＜0.05),B、D组显著高于C组(P＜0.05).(2)凋亡率:A组为(14.3±1.2)%,B组为(7.8±1.3)%,C组为(10.1±1.2)%,D组为(8.1±1.3)%;B、C、D组凋亡率显著低于A组(P＜0.05),B组与C组比较,差异也有统计学意义(P＜0.05).(3)前胶原Ⅰ mRNA:A组为0.16±0.02,B组为0.31±0.04,C组为0.23±0.04,D组为0.30±0.03,B、C、D组前胶原Ⅰ mRNA表达水平显著高于A组(P＜0.05),B组与C组比较,差异也有统计学意义(P＜0.05).(4)前胶原ⅢmRNA:4组前胶原ⅢmRNA表达水平相互比较,差异均无统计学意义(P＞0.05).(5)TNF-α蛋白:A组为0.15±0.03,B组为0.74±0.11,C组为0.36±0.09,D组为0.79±0.12,B、C、D组TNF-α蛋白表达显著高于A组(P＜0.05);B、D组又显著高于C组(P＜0.05),但B组与D组比较,差异无统计学意义(P＞0.05).结论 核因子κB顺式诱骗ODN能降调子痫前期患者脐血清促HUASMC增殖、胶原合成及炎性因子合成的作用.核因子κB在子痫前期患者胎盘血管病变过程中可能起重要作用.     

Prediction of perinatal outcome in preeclampsia using middle cerebral artery and umbilical artery pulsatility and resistance indices

Objective: In preeclampsia, changes in fetal hemodynamics can be detected 2–3 weeks earlier than any changes in cardiotocogram. Thus, these Doppler changes can be used to predict perinatal outcome. The present study is planned to assess the accuracy of the middle cerebral artery to umbilical artery (UA) pulsatility index (PI) and resistance index (RI) in predicting adverse perinatal outcome in pregnancies complicated by preeclampsia. Methods: Total of 115 and 108 pregnant women were included in preeclampsia and control group, respectively. Weekly Doppler study was done in both groups starting from 30 weeks till 36 weeks or delivery, whichever is later. Results: Mean gestational age at delivery was 250 ± 13 and 273 ± 8 days, respectively, in preeclampsia and control group (p < 0.01). Thirty-four babies in preeclampsia group had been admitted to nursery; out of which three died (p < 0.01). On receiver operating characteristic analysis, MCA /UmA PI ratio and MCA /UmA RI ratio had sensitivity of 9% and 9.7% and specificity of 98% and 96.6%, respectively, for predicting adverse perinatal outcome. Conclusion: Doppler indices of MCA and Um A are significantly abnormal in preeclampsia. But on diagnostic statistical analysis they have good specificity but low sensitivity for detecting adverse perinatal outcome.     

The effect of loading dose of magnesium sulfate on uterine,umbilical, and fetal middle cerebral arteries Doppler in women with severe preeclampsia: A case control study

IV MgSO₄ administration in women with severe preeclampsia resulted in a decrease in umbilical artery, uterine artery, and fetal middle cerebral artery Doppler indices.

Objective: To evaluate Doppler parameters of the umbilical artery (UmA), uterine artery (UA), and fetal middle cerebral artery (MCA) before and after MgSO₄ administration in women with severe preeclampsia. Methods: A case control study included 100 pregnant women with severe preeclampsia. Umbilical artery, uterine artery, and fetal middle cerebral artery Doppler were measured before and 20 minutes after intravenous administration of 6 g of magnesium sulfate. Results: There was a significant difference between maternal systolic blood pressure (173.20 ± 22.72 vs. 156.60 ± 19.18), diastolic blood pressure (109.60 ± 9.14 vs. 101.90 ± 10.05), and heart rate (80.52 ± 11.52 vs. 88.48 ± 12.08) before and after administration of MgSO₄ in the studied patients (p value < 0.001). There was a significant difference between umbilical artery, middle cerebral artery, and uterine artery Doppler parameters before and after administration of MgSO₄ in the studied patients (p value < 0.001). There was no significant difference between umbilical artery/middle cerebral artery with regard to RI and PI. However, there was significant difference with regard to the S/D ratio (p value < 0.001). The decrease in the values of Doppler parameters before and after administration of MgSO₄ was more in the middle cerebral artery than in the umbilical artery. Conclusion: Intravenous administration of magnesium sulfate in pregnant women with severe preeclampsia resulted in a decrease in umbilical artery, uterine artery, and fetal middle cerebral artery Doppler indices with reduced resistance to blood flow in these vessels.     

Effects of fetal breathing movements on umbilical venous blood flow in fetal lambs

The effects of fetal breathing movements on the blood flow pattern in the common umbilical vein were studied in six chronically instrumented fetal lambs between 106 and 143 days gestation. Umbilical venous blood flow was measured with an electromagnetic flow transducer around the intra-abdominal common umbilical vein. Fetal breathing movements were recorded by means of an intratracheal catheter. During rapid irregular breathing movements instantaneous umbilical venous blood flow showed undulations with the frequency of the breathing movements. An inspiratory movement, characterized by a fall in tracheal pressure (mean +/- S.D. = 5.3 +/- 1.7 mmHg) was accompanied by a decrease in instantaneous umbilical venous blood flow (mean +/- S.D. = 10.5 +/- 2.8%). This decrease in umbilical blood flow during inspiration was accompanied by an increase in intra-abdominal pressure. A much greater decrease (mean +/- S.D. = 40.6 +/- 18.4%) in instantaneous umbilical venous blood flow occurred during deep inspiratory efforts (mean pressure drop +/- S.D. = 15.5 +/- 4.3 mmHg), accompanied by marked increases in intra-abdominal pressure. Isolated expiratory efforts resulted in an increase in both tracheal (mean +/- S.D. = 6.3 +/- 2.6 mmHg) and intra-abdominal pressure, while umbilical venous blood flow decreased (mean +/- S.D. = 33.5 +/- 21.3%). These observations show the great influence of fetal respiratory movements on the blood flow pattern in the common umbilical vein. The changes in instantaneous umbilical venous blood flow are possibly brought about by changes in intra-abdominal pressure.     

Maternal,fetal and perinatal characteristics of preeclampsia cases with and without abnormalities in uterine artery Doppler indexes

Abstract

Objective: To compare the maternal and fetal characteristics and perinatal outcome in mild and severe preeclampsia cases with and without uterine artery Doppler abnormalities.

Methods: Two hundred and fifty-nine mild and severe preeclampsia cases were evaluated retrospectively. Doppler measurements were done in the section where uterine artery raised from the hypogastric artery. Pulsatility index above the 95th percentile of the corresponding gestational age was accepted as abnormal.

Results: In mild and severe preeclampsia cases with abnormal Doppler (AD), the rate of intrauterine growth restriction, preterm birth and low birth weight was higher than, but the neonatal intensive care unit stay was similar to the cases with normal Doppler. Base excess was higher in the AD group, in mild and severe preeclampsia. The rate of low Apgar score at 5?min and perinatal mortality was higher in the AD group, in the mild preeclampsia. The strongest independent predictor of the perinatal morbidity and mortality was the presence of prematurity and of the prematurity was the presence of abnormal uterine artery Doppler.

Conclusions: Maternal and perinatal morbidity and perinatal mortality increase in mild to severe preeclampsia cases with abnormal uterine artery Doppler. The abnormal uterine artery Doppler increases the morbidity and mortality by increasing the risk of prematurity.     

Placental growth hormone is increased in the maternal and fetal serum of patients with preeclampsia

Objectives. Placental growth hormone (PGH) is a pregnancy-specific protein produced by syncytiotrophoblast and extravillous cytotrophoblast. No other cells have been reported to synthesize PGH Maternal. PGH Serum concentration increases with advancing gestational age, while quickly decreasing after delivery of the placenta. The biological properties of PGH include somatogenic, lactogenic, and lipolytic functions. The purpose of this study was to determine whether the maternal serum concentrations of PGH change in women with preeclampsia (PE), women with PE who deliver a small for gestational age neonate (PE + SGA), and those with SGA alone.

Study design. This cross-sectional study included maternal serum from normal pregnant women (n = 61), patients with severe PE (n = 48), PE + SGA (n = 30), and SGA alone (n = 41). Fetal cord blood from uncomplicated pregnancies (n = 16) and PE (n = 16) was also analyzed. PGH concentrations were measured by ELISA. Non-parametric statistics were used for analysis.

Results. (1) Women with severe PE had a median serum concentration of PGH higher than normal pregnant women (PE: median 23,076 pg/mL (3473–94 256) vs. normal pregnancy: median 12 157 pg/mL (2617–34 016); p < 0.05), pregnant women who delivered an SGA neonate (SGA: median 10 206 pg/mL (1816–34 705); p < 0.05), as well as pregnant patients with PE and SGA (PE + SGA: median 11 027 pg/mL (1232–61 702); p < 0.05). (2) No significant differences were observed in the median maternal serum concentration of PGH among pregnant women with PE and SGA, SGA alone, and normal pregnancy (p > 0.05). (3) Compared to those of the control group, the median umbilical serum concentration of PGH was significantly higher in newborns of preeclamptic women (PE: median 356.1 pg/mL (72.6–20 946), normal pregnancy: median 128.5 pg/mL (21.6–255.9); p < 0.01). (4) PGH was detected in all samples of cord blood.

Conclusions. (1) PE is associated with higher median concentrations of PGH in both the maternal and fetal circulation compared to normal pregnancy. (2) Patients with PE + SGA had lower maternal serum concentrations of PGH than preeclamptic patients without SGA. (3) Contrary to previous findings, PGH was detectable in the fetal circulation. The observations reported herein are novel and suggest that PGH may play a role in the mechanisms of disease in preeclampsia and fetal growth restriction.     

脐带螺旋指数与脐动脉血流S/D比值及妊娠结局关系的研究

目的:探讨脐带螺旋指数(umbilical coiling index,UCI)与脐动脉血流收缩期最大血流速度(S)/舒张期末血流速度(D)比值(S/D比值)及妊娠结局之间的关系。方法:选择在我院住院分娩妊娠37~40周的孕产妇720例,计算UCI值,分析UCI与脐动脉血流S/D比值及胎儿窘迫、新生儿体重、新生儿窒息、围产儿死亡、羊水指数、产后出血及剖宫产率之间的关系。结果:UCI正常组与UCI不足组之间脐动脉血流S/D比值及羊水指数、产后出血、剖宫产率无显著差异,UCI不足组胎儿窘迫、新生儿窒息、围产儿死亡发生率显著高于UCI正常组。UCI过高组的脐动脉血流S/D比值、羊水过少发生率及剖宫产率明显高于UCI不足组,两组间胎儿窘迫、新生儿窒息、围产儿死亡发生率无显著差异。UCI过高组脐动脉血流S/D比值、胎儿窘迫、新生儿窒息、围产儿死亡、羊水过少发生率及剖宫产率明显高于UCI正常组,两组差异有统计学意义。结论:UCI异常可能与脐动脉血流S/D比值及妊娠结局相关。     

Cardiotocography alone versus cardiotocography plus Doppler evaluation of the fetal middle cerebral and umbilical artery for intrapartum fetal monitoring: a Greek prospective controlled trial

Objective: The present study was designed to assess the utility of Doppler velocimetry in the setting of non-reassuring cardiotocography tracings. Methods: Two hundred fifty six women with term singleton pregnancies were enrolled in a controlled trial. Patients received either routine cardiotocograpic (CTG) monitoring, or CTG with the addition of Doppler velocimetry in cases of non-reassuring CTG tracings. The results were analyzed according to protocol. Results: In the CTG+Doppler group, there was a trend toward lower risk of neonatal metabolic acidosis than in the CTG group, although the incidence was rare. The CTG+Doppler group had significantly lower rates of cesarean section for fetal distress, and improved neonatal outcomes. Conclusions: We conclude that intrapartum fetal Doppler velocimetry, when combined with CTG, increases the clinicians’ ability to accurately identify fetal hypoxia, and decreases the rate of Cesarean section.     

Identification of patients at risk for preeclampsia with the use of uterine artery Doppler velocimetry and copeptin

Purpose: To investigate the relationship between maternal copeptin levels and uterine artery Doppler examination and progress of preeclampsia.

Materials and methods: A cross-sectional study was designed with women those were screened at 20?+?0 – 24+ 6 weeks’ gestation between May 2014 and August 2014. The obstetric records of all normotensive women were examined. Uterine artery Doppler velocimetry results and serum copeptin levels were measured. The patients were divided into two groups according to normal (n?=?67) and abnormal uterine artery Doppler (n?=?21) findings.

Results: Maternal age was significantly lower in group 1 (n?=?21, 23.9%) than in group 2 (n=?67, 76.1%) (p?p?=?0.002).

Conclusions: Copeptin levels are significantly higher in patients who develop preeclampsia.