Influence of pregnancy on ceftriaxone, cefazolin and gentamicin pharmacokinetics in caesarean vs. non-pregnant sectioned women

OBJECTIVE: To study the effect of pregnancy on postoperative ceftriaxone, cefazolin and gentamicin elimination rate constant, half-life, volume of distribution and systemic clearance. METHODS: Fifty-four patients undergoing caesarean section and 12 undergoing gynaecological surgery were given intravenous dose of ceftriaxone, cefazolin or gentamicin immediately before the operation, for chemoprophylaxis. The levels of antibiotics were measured in blood plasma, amniotic fluid and umbilical cord blood plasma by HPLC for the cephalosporins and by fluorescence polarization immunoassay for gentamicin. Pharmacokinetic parameters were estimated using a one-compartment model. RESULTS: Pregnancy significantly influenced the pharmacokinetics of ceftriaxone and gentamicin, but not that of cefazolin. Ceftriaxone constant of elimination decreased statistically significantly in caesarean-sectioned women relative to the non-pregnant subjects. Gentamicin constant of elimination increased significantly in caesarean-sectioned women relative to the controls. The concentrations of antibiotics in umbilical cord blood were higher, whereas they were substantially lower in amniotic fluid than in maternal plasma. Six hours after antibiotic administration, only the cefazolin concentrations exceeded the MIC for sensitive bacteria both in pregnant and in non-pregnant patients. CONCLUSION: Analysis of the pharmacokinetic data suggests that a single-dose of cefazolin may well be the optimal preoperative prophylactic treatment for obstetrical and gynaecological surgical procedures.     

孕妇静脉血与新生儿脐血的成分差异及关联性研究

目的探讨孕妇静脉血与新生儿脐血的成分差异及关联性。方法选取319例孕妇及其新生儿作为研究对象,所有孕妇均在分娩当天空腹抽取静脉血送检,而新生儿则在分娩结束时取近脐端脐血送检。对孕妇静脉血和新生儿脐血标本进行碱性磷酸酶(ALP)、拟胆碱酯酶(PCHE)、前清蛋白(PA)、视黄醇结合蛋白(RBP)、尿素氮(BUN)、肌酐(CR)、尿酸(UA)、总胆固醇(TC)、三酰甘油(TG)等指标检测。结果孕妇静脉血血清ALP、PCHE、PA、RBP、TC、TG显著高于新生儿脐血,差异有统计学意义(P0.05),孕妇静脉血与新生儿脐血之间血清BUN、CR、UA水平差异无统计学意义(P0.05)。孕妇静脉血与新生儿脐血之间血清PCHE、PA、RBP、BUN、CR、UA呈正相关(P0.05),而ALP、TC、TG无相关性(P0.05)。结论孕妇静脉血与新生儿脐血之间某些物质的浓度存在差异,新生儿脐血中PCHE等指标的浓度受母体影响。     

Levels of free and conjugated catecholamines in amniotic fluid and in umbilical and maternal blood in patients undergoing cesarean section

A new radioenzymatic assay was used to evaluate free and conjugate catecholamines in six pregnant women who underwent cesarean section at term, in their newborns and in the amniotic fluid. Free adrenaline in maternal plasma was higher while noradrenaline and dopamine were lower at the moment of surgery than 24 hours before the operation. In umbilical plasma adrenaline and noradrenaline are higher than in maternal plasma while only traces of free dopamine and salsolinol are present. In the amniotic fluid high levels of free and conjugated salsolinol are found. The high level of free and conjugated catecholamines found in the umbilical plasma demonstrates that fetal sympathetic nervous system is strongly activated at delivery. Furthermore the presence of sulfoconjugating activity similar to that of the adult is confirmed.     

Differences in the carbohydrate moieties of plasma and amniotic fluid fibronectins as revealed by crossed immunoaffinity electrophoresis with concanavalin A

Human fibronectins isolated from pooled human plasma and amniotic fluid were studied as to differences in their carbohydrate moieties. The chemical analyses showed that amniotic fluid fibronectin is different from adult plasma fibronectin in carbohydrate content and composition while there seems to be no significant differences in amino acid composition. Crossed immunoaffinity electrophoresis with free concanavalin A, as well as rocket immunoelectrophoresis with immobilized concanavalin A intermediate gel, indicated that amniotic fluid fibronectin has little or no reactivity with this lectin while adult plasma fibronectin is strongly reactive. Fetal cord plasma fibronectin apparently interacted with concanavalin A, but its reactivity was weaker than that of adult plasma fibronectin. Fibronectin isolated from ascitic fluid of an ovarian cancer patient which was examined in additional experiments showed much weaker Con A-reactivity than fetal cord plasma fibronectin. These results suggest that fibronectins from various body fluids differ in their carbohydrate structures.     

食欲素A水平与妊娠期糖尿病糖脂代谢指标及新生儿体重的相关性研究

目的 探讨妊娠期糖尿病(GDM)患者血清、脐血食欲素A(orexin-A,OXA)水平与糖脂代谢指标及新生儿体重的相关性.方法 收集90例GDM孕妇(GDM组)和50例正常孕妇(对照组),检测并比较两组孕妇分娩前总胆固醇(TC)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、三酰甘油(TG)、空腹血糖(FPG)、糖化...     

Placental transfer of cefmenoxime in late pregnancy

The broad spectrum of activity and the beta-lactamase stability of cefmenoxime provide this new cephalosporin a possible efficacy in the treatment of obstetrical infections. This study was designed to evaluate the placental transfer of cefmenoxime. The study group consisted of 21 pregnant women undergoing a cesarian section. After a single intramuscular injection of 1 g of cefmenoxime, samples of maternal blood and amniotic fluid were taken 30 min before and at delivery; the same samples as well as umbilical cord blood samples were also taken 1, 2, 3 or 4 h after the injection, in order to evaluate the kinetics of the drug. The antibiotic assay was carried out by microbiological procedure. The results of the study showed (1) a peak level of 16 micrograms/ml in maternal serum, with a slow decrease and a residual value of 3 micrograms/ml at 4 h; (2) increasing levels of the drug in cord blood, with a peak value of 4.8 micrograms/ml; (3) a progressive diffusion of cefmenoxime in amniotic fluid, reaching the highest value of 4.7 micrograms/ml at 3 h, and (4) parallel kinetics of the drug in amniotic fluid and in cord blood. On the whole, this study showed a significant placental transfer of cefmenoxime, achieving therapeutic concentrations required against microorganisms responsible for obstetrical infections.     

父亲血清HBV-DNA载量和孕母HBsAb对HBV父婴垂直传播的影响

目的探讨父亲血清HBV-DNA载量和孕母HBsAb对乙肝病毒(HBV)父婴垂直传播发生的影响,以期寻找阻断HBV父婴垂直传播的有效方法。方法在患者知情同意的前提下,以HBsAg及HBV-DNA为指标筛检父亲HBsAg阳性、孕母HBVM全阴或者仅HBsAb阳性及HBV-DNA均为阴性的121个家庭作为研究对象,依据其新生儿脐带血HBV-DNA检测结果作为分组标准,将HBV-DNA检测阳性23例作为病例组,阴性98例作为对照组,进行病例对照研究。结果 1新生儿脐带血HBV-DNA阳性率为19.0%(23/121);2父亲血清HBVDNA载量与新生儿脐带血HBV-DNA阳性率存在剂量反应关系(趋势χ2=60.108,P=0.000),受试者工作特征曲线(ROC曲线)分析表明:父亲血清HBV-DNA载量106拷贝/mL是预测HBV垂直传播发生较好的分界点;3孕母HBsAb阳性组与HBsAb阴性组其新生儿脐带血HBV-DNA阳性率差异有统计学意义(χ2=12.399,P=0.000),当父亲血清HBV-DNA载量≥?107拷贝/mL时,两组新生儿脐带血HBV-DNA阳性率差异无统计学意义(P>0.05)。结论父亲血清HBV-DNA阳性和孕母HBsAb阴性是HBV父婴垂直传播的危险因素,父亲血清HBV-DNA载量106拷贝/mL是较好的垂直传播发生的预测指标。     

巢式PCR法检测健康人群人类细小病毒B19感染的研究

目的：探讨肇庆地区健康人群人类细小病毒Ｂ１９感染状况，方法：采用巢式聚合物酶链反应（Ｎｅｓｔｅｄ－ＰＣＲ）技术包括对４１１名新生儿，１８６名婴幼儿童，３７４名成人，６８９名孕妇的健康人１６６２名的脐血或指端，静脉血检测Ｂ１９ＤＮＡ。结果：１６６２名Ｂ１９阳性检出率为８．７２％，无性别差异，其中正常新生的Ｂ１９阳性检出率１０．７１％接近孕妇１０．２７％，均高于正常成人的５．０８％，（Ｐ〈０．０１），     

脂质过氧化物对妊娠肝内胆汁瘀积症围产儿预后的影响

目的 :探讨脂质过氧化作用于ICP围产儿预后的关系。方法 :分别用硫代巴比妥酸荧光测定法和邻苯三酚自氧法测定同期正常晚期妊娠妇女 10 2例 (对照组 )及妊娠期肝内胆汁瘀积症 (ICP)患者 12 6例 (观察组 )的血浆和脐静脉血脂质过氧化物 (LPO)和红细胞超氧化物歧化酶 (RBC -SOD)活性 ;比较新生儿出生体重、Apgar评分和羊水状况。结果 :①ICP组宫内发育迟缓 (IUGR)、羊水异常和新生儿窒息率均明显高于对照组 (P均 <0 0 1)。②ICP组母儿血LPO浓度均明显高于对照组 (P 均 <0 0 1) ;母血RBC -SOD活性明显高于对照组 ( P<0 0 1) ,脐血RBC -SOD活性与对照组无显著性差异 ( P >0 0 5)。③在ICP组 ,IUGR、新生儿窒息和羊水异常时 ,脐血LPO浓度均明显增高 ,而脐血RBC～SOD活性均明显下降。④ICP组脐血LPO与新生儿出生体重和Apagr评分呈明显负相关 (γ =-0 584 ,P <0 0 1;γ =-0 4 75,P <0 0 5)。结论 :脂质过氧化物对ICP的IUGR、新生儿窒息和胎儿宫内窘迫等围产儿不良结局相关     

Plasma fibronectin level in newborn infants with suppurative inflammatory diseases

The level of plasma fibronectin was determined in healthy newborns (45 plasma samples were examined in the control group) and in newborns with pyo-septic diseases (67 plasma samples were examined) by the immunoenzyme method (on the basis of the "sandwich" modification of the immunoenzyme analysis). Noticeable hypofibrinectinemia was observed in the infants with pyo-inflammatory diseases, particularly in cases of generalized forms. Combined modality etiopathogenetic therapy including i.v. plasma transfusion, did not exceed fibronectin deficiency in clinical convalescence of infants. Fibronectin deficiency is regarded as a risk factor of the development and generalization of pyo-inflammatory diseases.     

Placental transfer of cefotiam dihydrochloride.

The concentrations of cefotiam dihydrochloride (CTM) in maternal and fetal blood and in amniotic fluid were determined by bioassay in 38 women at parturition. With an intravenous infusion of 1 g of CTM, the decline in concentration of CTM in maternal blood was biphasic; CTM was not detectable at 6 h after administration. Peak levels of CTM in umbilical cord blood (13.0 to 23.9 micrograms/ml) were attained between 15 and 28 min after intravenous infusion; those in amniotic fluid (19.6 to 23.5 micrograms/ml) were attained at ca. 2.5 h.     

妊娠期妇女感染HPV对产妇和胎儿的影响

目的分析妊娠期妇女感染人乳头瘤病毒(HPV)对产妇和胎儿的影响。方法选取116例感染人乳头瘤病毒的产妇作为实验组,另选取健康孕妇116例为对照组,分别对产妇分娩时羊水、胎盘组织及胎儿脐静脉血、口咽部分泌物与外阴分泌物中的HPV进行检测,分析产妇HPV的感染分型。随访1年,观察HPV感染对产妇和胎儿的影响。结果实验组中单型HPV感染及高危型HPV感染的患者所占比例较大,分别为66.38%和76.72%;患者宫颈肉眼形态异常炎症、细胞学检验呈鳞状上皮病变是感染HPV的危险因素;2组患者在分娩方式、产后出血及胎儿生长受限等方面比较,差异无统计学意义(P0.05);正常阴道分娩与剖宫产分娩的胎儿在羊水、胎盘组织及脐静脉血、口咽部分泌物、外阴分泌物或包皮分泌物中的HPV阳性检出率比较无显著差异(P0.05);胎儿HPV感染率为24.14%。结论单型HPV感染及高危型HPV感染是妊娠期妇女HPV感染的主要分型。     

Ionic calcium levels during pregnancy, at delivery and in the first hours of life

Free calcium ion concentration (mmol/l) and pH were determined in whole blood using a semiautomatic electrode system (ICA-1 Radiometer, Copenhagen, Denmark) in 37 normal women, 90 pregnant women (30 from each trimester of gestation), 28 mothers at delivery and their respective newborns. The blood samples from normal controls, pregnant women, umbilical cord and 40-50-hour-old infants were collected anaerobically in vacuum tubes. Duplicate samples drawn from newborns shortly after birth by heel puncture were collected in special heparinized capillary tubes. We observed that Ca2+ concentrations in the second (1.20 +/- 0.04) and third (1.20 +/- 0.05) trimesters of pregnancy, and at delivery (1.18 +/- 0.05), were lower than in the control group (1.23 +/- 0.04). The [Ca2+] in samples from the umbilical vein (1.44 +/- 0.11) and artery (1.45 +/- 0.08) and from newborns 2-5 min after birth (1.34 +/- 0.12) was greater than in control samples. The [Ca2+] in newborns 40-50 hours after birth was lower (1.16 +/- 0.14) than in the control group.     

足月新生儿脐血脂联素水平测定及临床意义

目的探讨足月新生儿脐血脂联素(APN)水平变化及其对新生儿发展趋势的影响。方法研究对象为大于胎龄儿(LGA)、适于胎龄儿(AGA)、小于胎龄儿(SGA)各30例。采用放射免疫分析方法测定脐血和母血脂联素水平。采用免疫比浊法测定三酰甘油(TG)、总胆固醇(TCH)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)水平。并分析脐血脂联素水平与母血脂联素、体质指数(BMI)、胎盘重量和血脂水平的相关性。结果 LGA脐血脂联素水平明显低于AGA,差异有显著性(P=0.002);SGA脐血脂联素水平稍低于AGA,但差异无统计学意义(P=1.000);LGA及AGA血TG、TCH、LDL-c、HDL-c水平与AGA比较:除LGA血TCH明显低于AGA差异显著(P=0.000)之外,其余两两比较差异无统计学意义(P>0.05)。LGA脐血脂联素水平与新生儿BMI、胎盘重量、脐血TG呈显著负相关(r=-0.848、-0.780、-0.783,P<0.01);SGA脐血脂联素水平与新生儿身长、新生儿BMI、胎盘重量呈正相关,但与脐血TG呈负相关(r=-0.231,P=0.026)(r=0.386、0.431、0.365,P>0.05)。脐血脂联素水平与母血脂联素,孕前及分娩时产妇BMI无相关性(P>0.05)。结论脐血脂联素水平变化与LGA约发生有关,测定脐血脂联素水平有助于判断LGA约发展趋势。     

Neuroapoptosis in newborns with respiratory acidosis at birth

BackgroundS100B protein is one of the most accurate biomarkers for diagnosis of neuroapoptosis and brain damage. The aim was to evaluate the lactate concentration and acid-base balance (pH, pCO₂, pO₂, HCO₃c and BEb) in umbilical cord blood to predict high risk of neuroapoptosis and analyze the relationship between the levels of these biomarkers and umbilical cord blood S100B protein concentration at birth.MethodsApparently healthy newborns were included. S100B protein and blood gas test (lactate and acid-base balance) were determined in umbilical cord blood at birth. Newborns were classified into two groups: with and without high risk of neuroapoptosis. Newborns with high umbilical cord blood S100B protein concentration were considered newborns at high risk of neuroapoptosis.ResultsSixty-one newborns were included, 12 had high risk of neuroapoptosis and 49 did not. S100B protein concentration correlate directly with pCO₂ levels (Rho: 0.286, p = .0321) and lactate concentration (Rho: 0.278, p = .0315); and indirectly with pH (Rho: −0.332, p = .01). The analysis of the ROC curves yielded significant curves for pH and pCO₂ to predict high risk of neuroapoptosis, pH optimal cutoff value was 7.19 (sensitivity: 50%, specificity: 83.7%, AUC: 0.708); and pCO₂ optimal cutoff value was 60 mmHg (sensitivity: 30%, specificity: 85.4%, AUC: 0.705).ConclusionsRespiratory acidosis is associated to high concentrations of S100B protein in umbilical cord blood at birth. Umbilical cord blood pH and pCO₂ may be useful in differentiating newborns at high risk of neuroapoptosis. Umbilical cord blood gas test may be valuable as risk indicator for neuroapoptosis at birth.     

母源性抗-HBs对婴儿乙型肝炎疫苗接种效果的影响

目的 了解母源性抗-HBs对婴儿乙型肝炎疫苗接种后抗体应答的影响.方法 定量检测43例抗-HBs阳性和29例抗-HBs阴性孕妇分娩前及其足月新生儿脐动脉血、第2针乙型肝炎疫苗接种前和接种后2.5个月的抗-HBs水平.结果 43例抗-HBs阳性母亲所生新生儿脐血抗-HBs均阳性,其抗体水平与母体高度正相关(r＝0.98,P＜0.01),1月龄时仍有42例股静脉血抗体阳性;29例抗-HBs阴性母亲的新生儿脐血和1月龄时抗-HBs均阴性.第2针乙型肝炎疫苗接种后2.5个月,两组儿童抗-HBs阳性率均为100%,但母源性抗体阴性组平均抗-HBs活性浓度为163 mIU/ml,明显高于母源性抗体阳性组的94 mIU/ml(P＜0.01);母源性抗-HBs大于1 000 mIU/ml的5名婴儿中,3名在接种第2针疫苗后没有产生主动抗体应答.结论 母源性抗-HBs可抑制乙型肝炎疫苗前两针接种后的抗体应答.     

No intrauterine vertical transmission in pregnancy with COVID-19: A case report

The coronavirus disease 2019 (COVID-19) has been a worldwide pandemic diseases, nearly 400,000 people died at now. The data of status of pregnant women and neonates after infection of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) is limited. We report a case of pregnant woman in her third trimester with critical COVID-19, and amniotic fluid, umbilical cord blood, placenta, and neonatal gastric fluid were retained during cesarean section. The SARS-COV-2 nucleic acid test results of these specimens were negative. There is no evidence of intrauterine vertical transmission during delivery in the third trimester, but the data are limited and need to be further explored.     

Ultrasound estimation of amniotic fluid volume using the largest vertical pocket containing umbilical cord: measure to or through the cord?

OBJECTIVES: The purpose of this investigation was to determine the preferable method, either measuring to the umbilical cord or through the umbilical cord to the base of the pocket, of ultrasonically estimating amniotic fluid volume. SUBJECT AND METHODS: This was a prospective study carried out in singleton pregnancies undergoing a third-trimester amniocentesis. The amniotic fluid index (AFI) and single deepest pocket (SDP) were measured prior to amniocentesis. If measured spaces contained umbilical cord, measurements were made to and through the cord. Actual amniotic fluid volume was determined by the dye-dilution technique. RESULTS: One-hundred pregnancies were evaluated. Low dye-determined volume was identified in a significantly greater number of pregnancies using the AFI to the cord (7/28, 25%) compared to through the cord (2/28, 7%) (P = 0.025). The SDP technique to the cord was superior in low volumes (2/28, 7%) vs. (0/28, 0%) through the cord (although statistical significance could not be determined because there were no low through-the-cord measurements). CONCLUSIONS: For the detection of low amniotic fluid volumes, the AFI to the cord is better than through the cord. Measurement to the cord and through the cord had similar accuracy for both the AFI and SDP techniques in normal and high dye-determined amniotic fluid volumes.     

胰岛素样生长因子-Ⅰ、Ⅱ水平与子癎前期相关性研究

目的：探讨胰岛素样生长因子Ⅰ、Ⅱ水平在子癎前期发病机制及诊断中的作用。方法：选择38例子癎前期孕妇为子癎前期组（其中轻度18例,重度20例）,30例正常妊娠晚期孕妇为对照组,应用ELISA检测对照组和轻、重度子癎前期组孕妇静脉血、新生儿脐血及羊水中胰岛素样生长因子-Ⅰ、Ⅱ的含量,分析与子癎前期发病相关性。结果：（1）孕妇血、新生儿脐血及羊水中胰岛素样生长因子 含量在重度子癎前期组明显低于轻度子癎前期组（P〈0．01）,轻度子癎前期组明显低于对照组（P〈0．01）。（2）孕妇血及羊水中胰岛素样生长因子Ⅱ含量在重度子癎前期组明显低于轻度子癎前期组（P〈0．01）,轻度子癎前期组明显低于对照组（P〈0．01）;新生儿脐血中胰岛素样生长因子-Ⅱ含量在重度子痢前期组明显高于轻度子癎前期组（P〈0．01）,轻度子癎前期组明显高于对照组（P〈0．01）。（3）子痢前期孕妇血及羊水中胰岛素样生长因子-Ⅰ、Ⅱ的水平与病情轻重呈正相关,新生儿脐血,胰岛素样生长因子-Ⅰ水平与病情轻重呈正相关,胰岛素样生长因子-Ⅱ水平与病情轻重呈负相关。结论：孕妇血、新生儿脐血及羊水中胰岛素样生长因子-Ⅰ、Ⅱ水平变化可作为预测和诊断子癎前期发病和疾病程度的一个指标。