Angiotensin receptor subtypes in the uterine artery during ovine pregnancy

This study was undertaken to determine if changes in receptor density or affinity could account for the reduced vascular sensitivity to angiotensin II seen during pregnancy. Angiotensin receptor subtypes in the uterine arteries of non-pregnant, pregnant and postpartum ewes were investigated using saturation and competition receptor binding techniques with the specific receptor antagonists, losartan (DuP-753) and PD-123319 (S)1-[[4-(dimethylamino)-3-methylphenyl]-methyl]-5-(diphenylacetyl)-4,5,6,7-tetrahydro-1H-imidazo(4,5-c)pyridine-6-carboxylic acid, ditrifluoroacetate, monohydrate). Receptor density and affinity of total angiotensin receptors, as well as the angiotensin AT₁ and AT₂ receptor subtypes in uterine arteries were compared with those in the mesenteric artery and aorta. The uterine artery contains both AT₁ and AT₂ receptor subtypes, whereas the mesenteric artery and aorta contain primarily the AT₁ receptor subtype. In uterine arteries from pregnant sheep, angiotensin receptor density was increased because AT₂ receptors were increased. AT₁ receptor density was not altered. This change was not seen in the aorta. In the uterine artery, receptor affinity for [Sar¹,Ile⁸]angiotensin II decreased in mid-gestation (IC₅₀ 7.7±1.2×10⁻⁹ M) compared with non-pregnant ewes (IC₅₀ 3.0±0.6×10⁻⁹ M, P=0.006), and there was decreased affinity of angiotensin AT₁ receptors for losartan during pregnancy (IC₅₀ 2.8±1.0×10⁻⁴ M) compared with non-pregnant ewes (IC₅₀ 2.2±1.3×10⁻⁶ M, P=0.025). Our results show changes in the density and affinity of the angiotensin receptor subtypes in the uterine artery which could explain its reduced responsiveness to circulating angiotensin II during pregnancy.     

Genetic factors in puerperal affective psychoses

The hypothesis that puerperal affective psychosis (PAP) is genetically related to maniodepressive disorder was tested by comparing the morbidity risks for puerperal and non-puerperal affective disorders in the relatives of 17 PAP subjects and 20 parous manic-depressives (PMD) with no history of puerperal illness. The risk for affective disorder (mania, depression or suicide) and puerperal affective disorder was the same in the two groups of relatives and the test hypothesis was accepted, although the sample size was small. The fre-quencies of HLA-A, B and C locus antigens, nine blood group antigens and 10 red blood cell isoenzymes were not significantly different in the PAP and PMD subjects, showing that in this series genetic markers do not distinguish puerperal from non-puerperal affective psychoses.     

产后抑郁及其相关心理社会因素调查

目的探讨产后抑郁的发生率及其相关的心理社会因素,为早期心理卫生干预提供依据。方法采用爱丁堡抑郁量表及自拟的心理社会因素调查表对350例初产妇产后6w的抑郁状况进行测评分析。结果产后抑郁的发生率为22%,其中轻度占90.6%,中度占9.4%。产妇的年龄、学历、婴儿性别、分娩过程、婆媳关系不同,对产后抑郁的影响有显著性差异（P〈0.05）;夫妻关系、产后护理、居住条件、产后睡眠状况不同,对产后抑郁影响有极显著性差异（P〈0.01）;而产妇的职业、家庭收入、喂养方式不同,对产后抑郁影响无显著性差异（P〉0.05）。结论初产妇产后抑郁发生率较高,心理社会因素对产后抑郁的影响不容忽视。我们应做好孕产妇在围产期中的心理卫生保健工作,使产妇愉快地度过情感危险期,从而降低产褥期抑郁的发生。     

The risk of first venous thromboembolism during pregnancy and puerperium in double heterozygotes for factor V Leiden and prothrombin G20210A

Background : The risk of venous thromboembolism (VTE) during pregnancy in double heterozygous carriers of factor (F) V Leiden and prothrombin G20210A is not established. Hence, whether or not these women deserve antithrombotic prophylaxis when pregnant is unknown. Patients and methods : In the frame of a multicenter family study, 52 double heterozygous carriers of FV Leiden and prothrombin G20210A who had remained pregnant at least once before knowledge of thrombophilia, were retrospectively investigated with respect to the occurrence of first VTE during pregnancy and puerperium. They were compared with 104 heterozygous carriers of FV Leiden, 104 of prothrombin G20210A and 104 women without thrombophilia. Results : Double heterozygotes were similar to single heterozygous carriers and non-carriers for the age at first pregnancy, age at testing and rate of full-term pregnancies. No VTE during pregnancy was observed in the four groups of women, whereas in the puerperium it occurred in two double carriers (1.8% of pregnancies, 95% CI: 0.5–6.3), three single FV Leiden carriers (1.5%, 0.5–4.3), two single prothrombin G20210A carriers (1%, 0.2–3.6) and one non-carrier (0.4%, 0–2.5). Conclusions : The risk of first VTE during pregnancy and puerperium in double heterozygous carriers of FV Leiden and prothrombin G20210A is low and similar to that of single carriers. As for single heterozygotes, antithrombotic prophylaxis in asymptomatic double heterozygous carriers appears to be justified only in puerperium.     

肺栓塞产妇临床高危因素及生物指标分析

目的 探讨产妇肺栓塞(pulmonary embolism, PE)的临床特征、生物特点及危险因素.方法 收集2019年1月—2021年1月在同济大学附属第一妇婴保健院分娩的疑似诊断肺栓塞并行CT肺动脉血管造影( computer tomography pulmonary angiography, CTPA)的582例...     

Complications during pregnancy,peri- and postnatal period in a sample of women with a history of child abuse

Background. As a proposed risk factor for infant and child development, maternal history of abuse has been a frequent target of investigation. However, there have been no controlled studies about the impact of maternal history of abuse on the medical course of pregnancy, the peri- and postnatal period.

Method. All women with a newborn child were contacted by mail and presented with the Childhood Trauma Questionnaire (CTQ). The index group (n = 58) was formed by women who scored above the cutoff for moderate or severe abuse and compared to a control group (n = 60) with regard to pre,- peri-, and postnatal complications as documented in the patient charts.

Results. The results show that women with a history of abuse have significantly more prenatal medical complications and infant medical complications in the post- but not perinatal period.

Conclusions. Maternal history of abuse significantly impacts the medical course of delivery and the puerperium. Given the prevalence of abusive experiences, this finding is highly relevant from a preventive point of view.     

Cerebrovascular Complications in Pregnancy and Puerperium

Objectives

The aim of this study was to analyze the incidence, possible etiological factors, pathology, clinical manifestations, brain CT scan features, treatment, and prognosis of cerebrovascular complications occurring in pregnancy and puerperium.

Methodology

This is a prospective analytical study conducted at the Govt. Hospital for women and children, Chennai, from January 2006 to February 2008. During the above period, 26 women were diagnosed with various cerebrovascular complications. In these patients, the clinical data, risk factors, neurological features, investigations, results, and neuroimaging reports were analyzed.

Results

The incidence of cerebrovascular complications in this study was 66 per 100,000 deliveries. None had prior history of diabetes, hypertension, renal disease, or seizure disorder. Two women were suffering from cardiac disease. PET and eclampsia were seen in 19/26 (73 %) cases. Seven women were suffering from anemia and one with severe sepsis. The neurological complications manifested predominantly in the postpartum period. Cases presented with hemiplegia/facial palsy and aphasia. CT scan imaging showed intracerebral hemorrhage in four cases, cerebral infarcts in five cases, and cortical vein thrombosis in 16 cases. There were five maternal deaths in this study.

Conclusion

Stroke occurring in pregnancy, though rare, is a serious complication which can lead to maternal death. In this study, hypertension has emerged as an important risk factor; therefore, attention should be focussed on maintaining normotension in the peripartum period.     

孕产期心理相关危险因素筛查表的研制思路及过程

目的:研制孕产期心理相关危险因素筛查表。方法:采用文献分析、现场论证、专家论证以及小样本预试完成条目池的确定,通过对5家妇幼保健机构630名孕妇和540名产妇的现场调查最终完成筛查表的效能考评。结果:从文献分析收集到的64条孕产期相关危险因素经过遴选确定出孕期43条、产后44条的条目池,经条目优化后得到孕期35、产后35条条目,并确定了两级和四级综合评分法;效能考评结果显示筛查表有较好的信度和效度,确定的分界值保证了较高的灵敏度和特异度。结论:筛查表的研制对预防产后抑郁有较强的实际意义,效能考评结果较为满意。     

产褥期乳腺炎的危险因素分析

目的调查产褥期乳腺炎的危险因素。方法对该院846名产妇进行调查,收集产妇的基本资料和产褥期乳腺炎的发病情况,分析产褥期乳腺炎的危险因素。结果产褥期乳腺炎的发生率为4.3%,其中,文化程度高和低产妇发生率依次为3.2%和6.8%(P=0.017),经产妇和初产妇的发生率依次为1.6%和5.0%(P=0.036),母乳喂养和人工喂养为主的产妇发生率依次为3.1%和6.2%(P=0.029)。Logistic逐步回归分析结果显示,文化程度低(OR=2.201;95%CI:1.113～4.352)、初产妇(OR=3.460;95%CI:1.044～11.467)和人工喂养(OR=0.476;95%CI:0.241～0.941)是产褥期发生乳腺炎的独立危险因素。结论文化程度低、初产妇和人工喂养与产褥期乳腺炎明显相关,是产褥期乳腺炎的危险因素。     

家庭探访对初产妇产褥期生活质量的影响

目的探讨家庭探访对初产妇产褥期生活质量的影响。方法将110例单胎出院进行家庭探访的初产妇设为家访组,将过去未做家庭探访,只做电话随访的110例单胎初产妇设为对照组。比较两组产后4周时生理问题和生活质量。结果产后4周家访组发生产褥期常见生理问题的例数较对照组明显减少（P〈0.05）。家访组生活质量明显优于对照组,差异有统计学意义（P〈0.01或P〈0.05）。结论家庭探访对促进初产妇产褥期生理机能恢复和维护心理健康具有明显作用,可有效提高初产妇的生活质量。