觀察受體鼠妊娠和胚胎著床情況,并檢測胚胎移植時小鼠子宮內膜中白血病抑制因子(Lif)表達水平,探討超排卵對小鼠胚胎著床潛能的影響。方法:建立超排周期胚胎和自然周期胚胎移植小鼠模型,比較妊娠率、胚胎著床率的差異及其與Lif蛋白的表達水平之間的關系。結果:超排卵周期受體組的妊娠率(20.00%)和胚胎著床率(8.33%)顯著低于自然周期組的妊娠率(55.00%)和胚胎著床率(35.00%)(P＜0.05)。自然周期胚胎和超排周期胚胎受體組內膜中Lif蛋白的表達水平相似(P＞0.05),妊娠受體組Lif蛋白的表達水平顯著高于未孕受體組(P＜0.05),但單胎妊娠和多胎妊娠受體組內膜中Lif蛋白的表達水平相似(P＞0.05)。結論:超排卵可能降低胚胎的著床潛能,Lif蛋白的表達水平與胚胎著床有關,但與著床胚胎的數目無比例關系。
Objective To investigate the clinical characteristics and treatment of severe H1N1 influenza during pregnancy and postpartum.Methods Clinical data of 7 pregnant women and 2 postpartum women with severe H1N1 influenza admitted from October to December 2009 were reviewed. Results Three pregnant women underwent caesarean section during hospitalization. The main symptoms included fever ( in9 cases, and fever lasted more than 3 days in 7 cases) , cough and sputum ( in 9 cases) , and dyspnea ( in 7 cases) . Asthenia and muscular soreness were not serious, and there were no accompanying symptoms of digestive tract. Moist rales were heard in 5 cases. White blood cell count decreased in 3 cases, neutrophils increased in 6 cases, and lymphocytes reduced in 7 cases. Hepatic enzymes were abnormal in 4 cases, and myocardial enzymes were abnormal in5 cases. 8 patients had hypoxemia, with PaO2 less than 40 mmHg in5 cases. Chest X-ray films and CT showed double pneumonia in 9 patients. 9 patients were given oseltamivir antiviral treatment. 8 cases were given antibiotic therapy. 5 patients with bilateral severe pneumonia and respiratory failure were given corticosteriod therapy. 5 severe patients were treated with non-invasive ventilation. One case switched to invasive ventilation and eventually died. Conclusions Pregnant and postpartum women with influenzaH1N1 are likely to develop into severe condition which is commonly rapidlyprogressive and even life-threatening. The main causes of death are pneumonia and acute respiratory distress syndrome.
ObjectiveTo explore the therapeutic effects of different surgical strategies on women with mechanical valve dysfunction during pregnancy.MethodsA total of 11 patients with mechanical valve dysfunction during pregnancy who underwent surgeries in our hospital from 2007 to 2017 were retrospectively included. The average age was 27.5±3.7 years. The prognosis of patients was analyzed according to the gestational weeks, cardiac function and the severity of mechanical valve dysfunction.ResultsNo death occurred. Three of them suffered subtotal hysterectomy during the surgery because of uncontrolled bleeding, and the others recovered without complications. Among the 5 patients with pregnancies <28 weeks, 1 patient was found intrauterine death before hospital admission, 2 suffered fetal loss 5 days after the cardiac surgery, and the other 2 patients continued their gestations until deliveries. Among the other 6 patients with pregnancies >28 weeks, 1 fetus died because of intracranial hemorrhage, and the other 5 survived without embryopathy or foetopathy.ConclusionGestation week, cardiac function and severity of mechanical valve dysfunction may be taken into account when making a treatment regimen for women with dysfunctional valve prostheses during pregnancy.
Objective To explore the levels and the clinical significance of serum soluble Endoglin (sEng) and soluble Fms-like tyrosine kinase (sFlt-1) in patients with preeclampsia (PE). Methods Ninety-six patients with PE were included from June 2009 to June 2014. The patients were divided into mild PE group (n=54) and severe PE group (n=42), while 40 healthy pregnant women were in the control group. The general situation and laboratory testing were recorded and the serum levels of sEng and sFlt-1 were detected. All patients were routinely followed up with the recording of delivery and neonatal situation. Results The sEng and sFlt-1 levels were highest in the severe PE group [(7345.02±772.73) and (866.08±203.24) ng/L], which was followed by mild PE [(5 547.08±564.06) and (603.99±138.37) ng/L] and control group [(1 840.93±300.71) and (252.68±83.03) ng/L] (P<0.01). Levels of sEng were significantly correlated with sFlt-1 in both mild and severe PE groups. There were significantly correlations between sEng and sFlt-1 in mild or severe PE group respectively. The level of sEng and sFlt-1 was considerably positively correlated with mean arterial pressure, 24-hour urinary protein, serum creatinine, fibrinogen, umbilical artery shrink/diastole and resistance index value, but negatively correlated with prothrombin time, birth weight and the placenta weight (P<0.05). PE patients with sEng of <5 000 ng/L and sFlt-1 levels of <700 ng/L had the risk of severe complications of 6.8% and 14.0%; while patients with sEng of ≥5 000 ng/L and sFlt-1 of ≥700 ng/L had the ratio fo 40.4% and 37.0% respectively (P<0.01). Conclusion Serum levels of sEng and sFlt-1 in PE patients indicate that the severity of disease and outcomes of pregnancy.
Objective More and more women without child and female adolescents are undergoing medical abortion (MA), MA effect on subsequent pregnancy has been brought into focus. This research will evaluate the effect of MA on subsequent pregnancy. Methods To searched Medline, Embase, Cochrane Library, Chinese Biomed-database, correlative websites and nine Chinese medical journals. The studies that were included in the reference list were additionally searched. Only RCTs (randomized control trials), CCTs (clinical control trials) and prospective cohort studies were included. Two researchers evaluated the quality of the literature and combined the evidence independently. Revman 4.1 was used for meta-analysis. Results Eight prospective cohort studies with 2 934 cases were included. The incidences of miscarriage, postpartum hemorrhage and placental abnormality occurred in MA group were significantly lower than those occurred in SA group, and their OR (with 95%CI) were 0.42 (0.22 to 0.83), 0.58 (0.39 to 0.85) and 0.68 (0.54 to 0.87), respectively. No other significant differences were observed between the two artificial abortions groups. Though the tendency indicates that medical abortion has a probable influence on subsequent pregnancy, there was no significant difference about subsequent pregnancy between MA and first pregnancy. Conclusion Unnecessary abortion should be avoided. MA is safer than SA on subsequent pregnancy, so MA is the preferred option for women without child and female adolescent to terminate their unwilling pregnancy. However, as all the studies included were prospective cohort studies, further high-quality RCTs should be conducted.
ObjectivesTo systematically review the perinatal outcomes after laparoscopic myomectomy versus transabdominal myomectomy.MethodsPubMed, Web of Science, Elsevier, The Cochrane Library, CNKI, VIP and WanFang Data databases were searched from inception to July 2017, to collect randomized controlled trials or cohort studies comparing the perinatal outcomes after laparoscopic myomectomy and transabdominal myomectomy. Two reviewers independently screened literature, extracted data and assessed the risk of bias of include studies. Meta-analysis was then performed by RevMan 5.3 software.ResultsEight randomized controlled trials, twenty-one cohort studies involving 4357 patients were included. The results of meta-analysis showed that: the premature birth rate (OR=0.60, 95%CI 0.38 to 0.95, P=0.03) in the laparoscopic myomectomy was lower than that in the laparotomy group. However, the rate of uterine rupture during pregnancy (OR=3.19, 95%CI 1.29 to 7.89, P=0.01) in the laparoscopic myomectomy was higher than that in the laparotomy group. There were no significant differences between two groups in the myoma residual (OR=1.00, 95%CI 0.37 to 2.65, P=0.99), recurrence (OR=0.92, 95%CI 0.68 to 1.25, P=0.60), abortion (OR=0.90, 95%CI 0.63 to 1.28, P=0.56), ectopic pregnancy (OR=1.11, 95%CI 0.54 to 2.26, P=0.78), pregnancy rate (OR=1.06, 95%CI 0.89 to 1.27, P=0.52), cesarean (OR=0.82, 95%CI 0.57 to 1.19, P=0.31), and pregnancy complications (OR=0.84, 95%CI 0.45 to 1.59, P=0.60).ConclusionsCurrent evidence shows that there are no significant differences between two groups in the myoma residual, myoma recurrence, abortion, ectopic pregnancy, pregnancy rate, cesarean and pregnancy complications. While the rate of uterine rupture during pregnancy in the laparoscopic myomectomy is higher than that in the laparotomy group, the premature birth rate after operation in the laparoscopic myomectomy is lower and shorter than that in the laparotomy group. Due to the limited quantity and quality of the included studies, more high quality studies are required to verify the above conclusion.
Objectives To investigate calcium supplement in pregnancy for prevention of preeclampsia and relevant outcomes. Methods The Cochrane Library, PubMed, EMbase, CBM, WanFang Data, VIP and CNKI databases were searched online to collect randomized controlled trials (RCTs) of calcium supplement in pregnancy for prevention of preeclampsia and relevant outcomes from inception to July 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed by RevMan 5.3 software. Results A total of 33 RCTs involving 29 234 subjects were included. The results of meta-analysis showed that: compared with control group, the calcium supplement group was associated with lower preeclampsia (RR=0.48, 95%CI 0.38 to 0.62, P<0.000 01) and gestational hypertension (RR=0.65, 95%CI 0.55 to 0.77,P<0.000 01) incidence. The incidence of premature delivery, intrauterine growth retardation and severe preeclampsia in calcium supplement group was lower than that in placebo group, and the neonatal weight in calcium was higher than that in placebo group. However, there was no significant difference in the pregnancy cycle between the two groups. Conclusions Current evidence shows that calcium supplement is associated with lower risk of preeclampsia and gestational hypertension. Due to limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusion.