胎膜早破并发胎盘早剥的临床分析

目的　探讨妊娠晚期胎膜早破并发胎盘早剥的发生率、早期诊断和处理要点。方法　回顾分析2 0 0 1年～2 0 0 4年郑州大学第三附属医院产科分娩的胎膜早破病例,其中并发胎盘早期剥离者8例,与非胎膜早破发生胎盘早剥者进行比较。分析早期诊断和母婴结局。结果　3年分娩总数为4 12 4例,胎膜早破并发胎盘早剥者占全部胎盘早剥的2 8 6 % ,胎膜早破是胎盘早剥的首位发病诱因。胎膜早破并发胎盘早剥的发生率为2 77% ,而非胎膜早破者为0 5 2 % ,两者相比差异有显著性(P <0 0 1)。间断腰痛、血性羊水、胎心异常为常见的临床表现。胎膜早破并发胎盘早剥时围产儿的死亡率为12 5‰,无孕产妇死亡。结论　胎膜早破是胎盘早剥的诱因之一,重视临床表现,并结合B超和胎心监护有助于早期诊断,以降低母儿并发症。     

Alteration of Human Placental Vascular Tone by Antiarrhythmic Medications In Vitro

Antiarrhythmic and Placental Vessels. Introduction : Antiarrhythmic medications are commonly used during pregnancy for treatment of maternal or fetal arrhythmias, but little is known about their effect on human placental vascular tone and, consequently, placental blood flow. The objective of this study was to evaluate the tone responses caused by antiarrhythmic medications in human placental vessels from normal term pregnancies in vitro.
Methods and Results : Isolated human placental arteries and veins from uncomplicated term pregnancies incubated in Krebs'-bicarbonate under 5% oxygen/5% carbon dioxide/balance nitrogen (PO₂ 35 to 38 torr) were exposed to cumulative doses of quinidine, procainamide, lidocaine, flecainide, propranolol, amiodarone, verapamil, digoxin, and adenosine after submaximal contraction with 5-hydroxytryptamine. The study was conducted both in the presence and absence of endothelium. The addition of the tested medications caused a significant, dose-dependent relaxation of human placental arteries and veins except for adenosine, which induced a sustained, dose-dependent contraction of human placental vessels regardless of the presence or absence of tone. Removal of the endothelium did not alter these responses.
Conclusions : Based on these results, the medications tested should have no decremental effect on placental blood flow, with the possible exception of adenosine, which causes significant. dosedependent contraction of human placental vessels in vitro. Should similar contraction be present in vivo, it may have an adverse effect on the fetus when administering adenosine to pregnant women at term or during labor.     

The effect of placental removal method on the incidence of postcesarean infections

OBJECTIVE: Our purpose was to determine whether the incidence of postoperative endometritis and wound infection is associated with the method of placental removal at the time of cesarean section.STUDY DESIGN: Parturients undergoing cesarean delivery were prospectively randomized to have the placenta removed manually or spontaneously. Patients were excluded from participation if they had received intrapartum prophylactic antibiotics or had been determined to have chorioamnionitis. After delivery of the infant women in the manual group had the placenta extracted by the primary surgeon, whereas women in the spontaneous group had the placenta delivered by gentle traction on the umbilical cord. All study subjects received perioperative prophylactic antibiotics. The primary outcome variable was a postcesarean infection, defined as postcesarean endometritis or wound cellulitis requiring drainage and antibiotic therapy.RESULTS: A total of 333 women were enrolled in the investigation, with 165 assigned to the manual removal group and 168 allocated to have spontaneous removal. There were no statistically significant differences in mean gestational age, frequency or duration of ruptured membranes, frequency or duration of labor, or mean number of vaginal examinations between the two study groups. Postoperative infections occurred in 25 of 168 (15%) women in the spontaneous delivery group compared with 44 of 165 (27%) women in which the placenta was manually extracted (relative risk 0.6, 95% confidence interval 0.4 to 0.9, p = 0.01). Subset analysis of patients delivered with ruptured membranes similarly demonstrated a statistically significant reduction in the incidence of postoperative infections with spontaneous placental removal compared with manual extraction (20% vs. 38%, relative risk 0.5, 95% confidence interval 0.3 to 0.9, p = 0.02). There was a similar trend toward a reduction in postdelivery infections associated with spontaneous placental removal in women with intact membranes; however, this difference did not attain statistical significance.CONCLUSIONS: Spontaneous delivery of the placenta after cesarean delivery is associated with a decrease in the incidence of postcesarean infections. (Am J Obstet Gynecol 1997;176:1250-4.)     

胎盘型谷胱甘肽S转移酶mRNA在大鼠肝癌癌前病变组织中的原位表达

应用原位杂交技术，观察了二乙基亚硝胺（ＤＥＮ）诱发大鼠肝癌前病变组织中胎盘型谷胱甘肽Ｓ转移酶（ＧＳＴ－Ｐ）ｍＲＮＡ的表达。结果显示，ＧＳＴ－ＰｍＲＮＡ主要在癌前病变肝组织中的变异灶及灶外卵圆形细胞内表达，且在变异灶间或和同一灶内阳性细胞间表达程度不尽一致，而正常肝、再生肝组织中未见其表达。提示在分子水平上变异灶细胞及卵圆型细胞可能成为实验性肝癌的癌前期细胞     

雌激素,胎盘生乳素,钙,磷与妊高征的关系

目的：探讨雌激素，胎盘生乳素，钙在妊高征发病中的作用及其相互关系，方法：采用放射免疫法及离心分析钙试剂，测定了４２例妊高征患者血清雌二醇，胎盘生乳素，钙，磷及尿钙，磷的含量，３４例同期门诊正常孕妇作为对照组，结果：轻度妊高征患者血清雌二醇明显增加（Ｐ〈０．０５）。重度妊高征患者血清胎盘生乳素显著减少（Ｐ〈０．０５），轻，中，重度妊高征患者血钙，尿钙含量显著降低（Ｐ〈０．０５，Ｐ〈０．０１，Ｐ〈０．     

Transplacental passage of mifepristone and its influence on maternal and fetal steroid concentrations in the second trimester of pregnancy

The maternal and fetal endocrine effects of the maternal administration of the anti-progestin mifepristone in mid-pregnancy have been investigated. Mifepristone and the metabolite RU 42,633 were detected in the fetal circulation and in the amniotic fluid 4, 24 and 48 h after oral ingestion. Maximum fetal plasma concentrations of mifepristone occurred 4 h after treatment indicating rapid placental transfer of the drug. No significant changes in progesterone, cortisol, oestradiol or aldosterone concentrations were detected in the maternal circulation after mifepristone treatment. No significant changes occurred in the fetal progesterone, oestradiol or cortisol concentrations, but a significant increase in fetal aldosterone occurred 4 and 24 h after treatment. The significance of these results is discussed in relation to the possible therapeutic uses of mifepristone for inducing labour.     

Transfer of clonidine and dexmedetomidine across the isolated perfused human placenta

Background: The placental transfer of the a₂ receptor agonist clonidine, earlier used as an adjuvant in obstetric epidural analgesia, was compared with the transfer of the newer and more %-selective agonist dexmedetomidine.
Methods: Term placentas were obtained immediately after delivery with maternal consent and a 2-hour recycling perfusion of a single placental cotyledon was performed. Disappearance from the maternal circulation, accumulation in placental tissue and appearance in the fetal circulation of clonidine or dexmedetomidine with the reference compound antipyrine were followed in 4 experiments for both drugs.
Results: At 2 hours the percent dexmedetomidine found in the fetal circulation was 12.5 (SD 5.1)%, while 48.1 (SD 20.3)% was found in the perfused placental cotyledon. A higher mean clonidine than dexmedetomidine concentration was achieved in the fetal circulation (1.90 vs. 0.56 nmol/l, P <0.05). At 2 hours the percent clonidine found in the fetal circulation was 22.1 (SD 2.4)% ( P <0.05), while 11.3 (SD 3.3)% ( P <0.05) was re tained in the perfused placental cotyledon. The transfer indexes, describing maternal-to-fetal transfer of dexmedetomidine and clonidine normalized with the transfer of antipyrine, were 0.88 (SD 0.07) and 1.04 (SD 0.08) respectively ( P <0.05).
Conclusions: Dexmedetomidine disappeared faster than clonidine from the maternal circulation, while even less dexmedetomidine was transported into the fetal circulation. This was due to its greater placental tissue retention, the basis for which probably is the higher lipophilicity of dexmedetomidine.     

The phagocytic activity of human first trimester extravillous trophoblast

It has been suggested previously that phagocytic activity inthe human placenta is confined to cells of the macrophage lineage.However, earlier studies were hampered by the paucity and poorviability of cells inherent in primary trophoblast cell cultures,contamination by other cell types which themselves have phagocyticactivity, lack of reliable markers of trophoblasts, and by limitationsof methods available to demonstrate unequivocally the internalizationof particulate material. We have overcome these limitationsby using: (i) DNA transfection to provide unlimited suppliesof pure trophoblast cell lines; (ii) human placental lactogenas a marker unique to trophoblast; and (iii) confocal microscopyof demonstrate unequivocally the intracellular locality of phagocytosedmaterial. We found that both untransfected primary culture extravilloustrophoblast cells, as well as the cell lines, had the capacityto phagocytose sheep red blood cells, Staphylococcus aureusand baker's yeast cells, and that this activity was inhibitedby cytochalasin B and by culture at 4°C. Phagocytic activityin trophoblast cells was less avid than that seen in a professionalphagocyte. In physiological and pathological situations wheretissue remodelling occurs, such as the rapid turnover in theperiodontal ligament or during inflammation, epithelial cellsand other cells that are not considered professional phagocytesactively phagocytose components of the extracellular matrix.We postulate that phagocytosis by human trophoblasts may playan important role in the extensive tissue remodelling that occursduring trophoblastic invasion of the decidua.     

Morphology and immunohistochemistry of carcinoma in situ adjacent to testicular germ cell tumours in adults and children: implications for histogenesis

Observations differ on the pre-invasive malignant lesions associated with the various categories of testicular germ cell tumours. Such lesions have been found to be similar in appearance and are assumed to be composed of multipotent cells, or conversely a distinctive pre-invasive stage has been reported in association with each form of germ cell neoplasm. This study was undertaken to see whether distinctive morphological and immunohistochemical features of carcinoma in situ adjacent to various categories of germ cell tumours could be established. Carcinoma in situ adjacent to seminomas, teratomas and mixed germ cell tumours in 18 adults was indistinguishable morphologically. Placental alkaline phosphatase was demonstrated immunohistochemically but vimentin and low molecular weight cytokeratins were uniformly absent in these abnormal germ cells from all three groups. These findings support the concept of a multipotent pre-invasive malignant cell for both seminoma and teratoma in the adult. Carcinoma in situ was not seen adjacent to 15 spermatocytic seminomas, nor was placental alkaline phosphatase demonstrated in tubules adjacent to these tumours. These negative findings are additional evidence that spermatocytic seminoma differs from classical seminoma in its histogenesis. Carcinoma in situ, as defined morphologically and immunohistochemically in adults, was not identified adjacent to yolk sac tumours and differentiated teratomas in 20 prepubertal testes. The possibility that pre-invasive malignancy in children may not resemble that in adults must be considered when assessing the malignant potential of cryptorchid testes on biopsies taken during orchidopexy.