[Effects of Low-dose Antibiotic Exposure on Fetal Growth and Development].

Objective To analyze maternal blood exposure to non-therapeutic antibiotics in late pregnancy and explore the effects of low-dose antibiotics on fetal growth and development.Methods A total of 104 pregnant women in late pregnancy (28-32 weeks) without serious pregnancy complications were enrolled,who had regular antenatal examination and delivery in Peking Union Medical College Hospital and did not use therapeutic antibiotics 2 months before pregnancy and in the whole pregnant process.The levels of antibiotics in the maternal blood were detected by liquid chromatography-tandem mass spectrometry,and the pregnant women were assigned into an antibiotic exposure group (antibiotic positive) and a non-exposure group (antibiotic negative).The length,weight,placental weight,and placental volume of the newborns in the two groups were measured,and the data were statistically analyzed by t test or χ2 test.Results The maternal blood antibiotic test showed 7 positive cases (6.73%,antibiotic exposure group) and 97 negative cases (93.27%,non-exposure group). The average length of newborns in the antibiotic exposure group and the non-exposure group was (49.57±1.40) cm and (48.85±1.77) cm,respectively,with no significant difference (t=1.060,P=0.363).The average weight of newborns in the antibiotic exposure group and the non-exposure group was (3558.57±382.95) g and (3275.36±356.41) g,respectively,with significant difference (t=2.021,P=0.046).The mean placental weight in the antibiotic exposure group and the non-exposure group was (676.43±124.59) g and (631.96±129.25) g,respectively,with no significant difference (t=0.881,P=0.380).The mean placental volume in the antibiotic exposure group and the non-exposure group was (724.67±174.91) cm3 and (676.82±220.86) cm3,respectively,with no significant difference (t=0.560,P=0.388).Compared with those in the non-exposure group,the neonatal length,neonatal weight,placental weight,and placental volume in the antibiotic exposure group increased by 1.47%,8.65%,7.04%,and 7.07%,respectively.Conclusion There are antibiotics in the environment,and maternal blood exposure to non-therapeutic antibiotics can promote the growth and development of the fetus and placenta,especially increasing the fetal weight.

Preterm Births in Peking Union Medical College Hospital in the Past 25 Years.

Objective To investigate the changes in preterm birth rate,its gestational age distribution,and possible contributors in Peking Union Medical College Hospital (PUMCH) over the last 25-year period. Methods The clinical data of premature deliveries,both singleton and twins,in PUMCH from January 1,1990 to December 31,2014 were retrospectively analyzed. We counted the number of premature fetuses and assessed the changes of preterm birth rate and its gestational age distribution (including extremely preterm birth,early preterm birth,and late preterm birth) over time. The etiologies (including spontaneous and iatrogenic) of preterm birth were also surveyed. Results The overall preterm birth rate was 7.8% in PUMCH,showing a slightly up-trend in both singletons and twins. Twin prematurity accounted for 23.8% of total preterm births,increased from 15.1% to 28.5%. Preterm births subgrouped by gestational age included 26 cases (0.7%) of extreme prematurity (<28 weeks),1199 cases (33.9%) of early preterm birth (28- 33+6 weeks),and 2310 cases (65.3%) of late preterm birth (34- 36+6 weeks). The gestational age distribution in singletons and twins showed no significant difference(z=0.844,P=0.398). Changes in the proportion of preterm birth before 28 weeks was little,gradually increased in the 28- 33+6 weeks group (from 23.8% to 36.1%) and gradually decreased in the 34- 36+6 weeks group (from 75.5% to 63.3%). Trends of gestational age distribution of singleton and twins were similar to that of the total. Spontaneous preterm labor,preterm premature rupture of membrane,and medically indicated (iatrogenic) preterm birth accounted for 20.2%,38.9%,and 40.9% respectively. There was no difference in singletons and twins(χ2=1.071,P=0.301).The proportion of iatrogenic preterm was increased. Common reasons for iatrogenic preterm birth included gestational hypertension,fetal indications (including fetal distress,fetal growth restriction),placenta previa,and pregnancy complicated by heart disease. Conclusions The overall preterm birth rate shows an upward trend in the general hospital as a result of more multifetal gestations and more medically indicated preterm births. Reducing multifetal gestations and effective control of pregnancy complications should be the priorieties in preterm birth intervention.

Removal of transition metal ions from aqueous solution using dialdehyde phenylhydrazine starch as adsorbent.

Dialdehyde phenylhydrazine starch (DASPH) was synthesized by reacting dialdehyde starch (DAS) with phenylhydrazine (PH) and it was characterized by Brunauer-Emmett-Teller (BET), scanning electron microscope, Fourier transform infrared spectroscopy (FT-IR) and X-ray diffraction (XRD) techniques. FT-IR of DASPH revealed the incorporation of the Schiff Base group (C = N) group and the disappearance of the C = O (carbonyl) group. The adsorption behaviors of transition metal ions (Cd(2+), Zn(2+), Pb(2+) and Cu(2+)) were investigated as a function of pH and adsorption time. The results indicated that pH 5.0 and 120 min were the optimal conditions. Experimental results revealed that the maximum adsorption capacity of DASPH for the four transition metal ions was as follows: Cd(2+) (4.9 mmol/g) > Zn(2+) (3.3 mmol/g) >Pb(2+) (1.7 mmol/g) >Cu(2+) (0.83 mmol/g). In addition, the regeneration method of DASPH was also studied.

Real-time monitoring of auxin vesicular exocytotic efflux from single plant protoplasts by amperometry at microelectrodes decorated with nanowires.

Recent biochemical results suggest that auxin (IAA) efflux is mediated by a vesicular cycling mechanism, but no direct detection of vesicular IAA release from single plant cells in real-time has been possible up to now. A TiC@C/Pt-QANFA micro-electrochemical sensor has been developed with high sensitivity in detection of IAA, and it allows real-time monitoring and quantification of the quantal release of auxin from single plant protoplast by exocytosis.

Preparation and adsorption properties of dialdehyde 8-aminoquinoline starch.

Dialdehyde 8-aminoquinoline starch (DASQA) was synthesized by the reaction of dialdehyde starch (DAS) and 8-aminoquinoline and was used to adsorb various ions from aqueous solution. DASQA was characterized by Fourier transform infrared (FT-IR) spectra, thermogravimetric analysis, X-ray diffraction analysis. The adsorption properties of the polymer for Pb(2+), Cu(2+), Cd(2+), Ni(2+), and Zn(2+) were investigated. The result of the experiment reveals that the adsorption for Cd(2+) and Zn(2+)were approximately 2.51 mmol/g, 2.17 mmol/g, followed by Pb(2+) 1.93 mmol/g, Ni(2+) 1.66 mmol/g, Cu(2+) 1.19 mmol/g. Furthermore, the kinetic experiments indicated that the adsorption of DASQA for the above metal ions achieved equilibrium within 2 h. Therefore, DASQA is an effective adsorbent for the removal of different heavy metal ions from industrial waste solutions.

Association between vitamin D insufficiency and the risk for gestational diabetes mellitus in pregnant Chinese women.

OBJECTIVE: To investigate the association between vitamin D deficiency and risk of gestational diabetes mellitus (GDM) in pregnant Chinese women. METHODS: A nested case-control study was conducted. Clinical and biochemical data were analyzed for 200 subjects with GDM and 200 subjects with normal glucose tolerance (NGT). RESULTS: The median (interquartile range) serum 25-hydroxyvitamin D (25OHD) levels were 22.39 (17.67, 29.38) and 25.86 (19.09, 34.88) nmol/L in the GDM and NGT groups, respectively. Rates of 25OHD deficiency or insufficiency were significantly higher in the GDM group than in the NGT group. Subjects with 25OHD levels <25 nmol/L had a 1.8-fold higher risk of GDM compared with subjects with higher vitamin D levels. In the GDM group, serum 25OHD was independently associated with HbA1c and insulin resistance after adjusting for confounding factors. In the NGT group, serum 25OHD was independently associated with fasting plasma glucose and systolic blood pressure after adjusting for maternal age and other confounding factors. CONCLUSION: 25OHD insufficiency is very common in Chinese women. Low 25OHD status may be associated with insulin resistance and act as a risk factor for GDM.

Management of pregnancy with ankylosing spondylitis.

OBJECTIVE: To discuss the interaction between pregnancy and ankylosing spondylitis, and the management of pregnancy with ankylosing spondylitis. METHODS: Twelve cases of pregnancy with ankylosing spondylitis in Peking Union Medical College Hospital from September 2004 to July 2011 were analyzed retrospectively, focusing on the arteritis condition, pregnancy complications, and outcomes. RESULTS: All the 12 patients had full-term pregnancy. Five cases gave birth naturally, and 7 cases received cesarean section for maternity factors. No adverse pregnancy outcomes were encountered. Waist pain appeared in 2 cases in the second trimester, for both of which medication failed. One of the 2 cases had natural childbirth, while the other maintained pregnancy smoothly to cesarean section. CONCLUSIONS: Pregnancy monitoring can help obtain favorable pregnancy outcomes. Attention should be paid to postpartum change of the illness.

Adsorption of Zn(II) on dialdehyde m-phenylenediamine starch.

A new chelating material dialdehyde m-phenylenediamine starch (DASMPA) was synthesized by reacting m-phenylenediamine with dialdehyde starch. The obtained material was characterized by element analysis and Fourier transform infrared (FT-IR) spectra. The FT-IR of DASMPA showed an absorption peak at 1605.95 cm(-1) indicating the formation of a Schiff base (C=N). Adsorption activity of DASMPA for Zn(2+) was also investigated in terms of contact time, pH, the initial Zn(II) concentration and temperature, the results revealed that pH = 5, t = 1 h were the optimal conditions. With the degree of substitution (DS) of the DASMPA increased, the adsorption capacity increased gradually. The adsorption equilibrium data correlated well with Freundlich isotherm. Moreover, lower temperature was preferable for the process as it was exothermic.

[Management of pregnancy with myasthenia gravis: 7 cases report].

OBJECTIVE: To discuss the interaction of pregnancy and myasthenia gravis (MG) and the management of pregnancy with MG. METHODS: Seven cases of pregnancy with MG in Peking Union Medical College Hospital were analyzed retrospectively, with respect to the therapy of MG, pregnancy complications and outcomes. RESULTS: Totally 38,683 pregnant women were admitted to Peking Union Medical College Hospital between Oct. 1983 and Oct. 2010. Among them there were 9 patients suffered from MG, with the incidence of 0.023%. Two pregnancies were terminated because of personal reasons, and seven continued. (1) Onset of MG: in the 7 cases, 6 were diagnosed before conception, with the mean course of 5.9 years. The other one occurred in the third trimester. (2) MANAGEMENT: all the cases were under close surveillance during pregnancy. Four women took thymectomy before conception, and one of them kept taking medication after surgery. In those who received thymectomy, 3 cases remained stable and 1 case worsened during pregnancy. The latter one took medication at 33 weeks, and continued to full term. MG exacerbated in the other three women who had not undergone thymectomy before conception. Among them, one woman complicated with systemic lupus erythematosus and lupus nephritis delivered the baby at 31 weeks. (3) Delivery and neonatal outcomes: cesarean deliveries were performed in 5 cases and the other two underwent vaginal deliveries. All the newborns were admitted to neonatal intensive care unit for surveillance. There were three smaller than gestational week (SGA) infants. No MG was observed in newborns. CONCLUSIONS: Patients with MG should have an overall evaluation before conception. The course of MG during pregnancy is unpredictable. They may get a promising outcome under the control of a multidisciplinary team including obstetricians and neurologists. Newborns should be carefully monitored for sings of transitory MG in the department of pediatrics.

[Pregnancy outcomes of eight pregnant women with congenital adrenal hyperplasia due to 21-hydroxylase deficiency].

OBJECTIVE: To investigate the clinical features and pregnant outcomes of the pregnant women with congenital adrenal hyperplasia (CAH) 21-hydroxylase deficiency (21-OHD). METHODS: The clinical features, therapies, pregnant outcomes of the pregnant women with 21-OHD were retrospectively reviewed in Peking Union Medical College Hospital, from January 2005 to April 2011. RESULTS: There were 8 pregnant women with 21-OHD including 5 simple virilizing patients and 3 nonclassical 21-OHD women. Eight patients were accepted progestational and prenatal continual lower glucocorticoid treatment. During the gestational period, the dosage of glucocorticoid was adjusted in one pregnancy. The serum level of 17-alpha hydroxyprogesterone (17-OHP) were elevated after pregnancy [(70 ± 38) versus (24 ± 23) nmol/L, P < 0.05]. The fertility and offspring rate of 8 patients was 8/12, the fertility and offspring rate of patients who started treatment at preadolescence was significantly increased (4/5 versus 4/7). Four patients were accepted genital reconstructive surgery (clitorectomy, clitoroplasty, vulvoplasty) before pregnancy. The incidence of GDM was 1/8. All patients selected caesarean at from 37(+6) gestation weeks to 39(+6) gestation weeks. The average newborn birth weight was (3210 ± 447) g, and height was (48 ± 2) cm of 8 neonates, none of them was CAH. CONCLUSIONS: Medical and surgical therapy provides satisfactory fertility and pregnancy outcomes for women with 21-OHD. It is safe to pregnant women with 21-OHD and their fetus in continual lower glucocorticoid treatment. The dosage of glucocorticoid should be carefully adjusted during the pregnancy individually according to serum level of 17-OHP.

[Clinical analysis of pregnancies after vaginal radical trachelectomy].

OBJECTIVE: To explore the pregnancy outcome and obstetric management of pregnancy and delivery after vaginal radical trachelectomy (VRT). METHODS: Forty-two cases of VRT from December 2003 to May 2012 in Peking Union Medical College Hospital were analyzed retrospectively. Among them ten cases got pregnant successfully. RESULTS: The average age of patient at VRT surgery was (30.6 ± 3.7) years old and average follow-up time was 29.5 months. There were 31 patients attempted conception. Ten of them got fourteen conceptions successfully. Overall conception rate was 45% (14/31). There were four cases of first trimester abortion. Among them, two were miscarriage, two were elective abortion. There was one case of ectopic pregnancy operation and non of second trimester loss. Nine cases reached the third trimester. The total preterm delivery rate was 4/9. There were two cases delivered before 32 gestational weeks (2/9). Cesarean section was performed through a transverse incision in all of nine cases. No uterine rupture and postpartum hemorrhage occurred. All newborns had good outcomes. The average follow-up time after postpartum was 22.9 months. All cases were disease-free. CONCLUSIONS: The conception rate of patients after VRT in our series is 45%. The preterm birth rate of pregnancy after VRT is higher. Routine cerclage of cervix during VRT procedure and pregnancy is not necessary. Cesarean section shortly after full term pregnancy through a transverse incision should be considered as a suitable and safe procedure.

[Management of invasive cervical cancer in pregnancy: clinical analysis of 13 cases].

OBJECTIVE: To analyze the clinical characteristics and assess the outcome of treatment for cervical cancer during pregnancy. METHODS: A cohort of 13 patients with cervical cancer diagnosed during pregnancy from January 2001 to September 2011 in Peking Union Medical College Hospital (PUMCH) was retrospectively studied. Clinical information, gestational age at diagnosis, treatment options and maternal and child outcomes were collected and analyzed. RESULTS: Thirteen patients out of 2030 cases of invasive cervical cancer were diagnosed during pregnancy with an incidence of 0.64% (13/2030). The Mean gestational age at diagnosis of 13 patients is 21(+6) weeks. Two cases were diagnosed during the first trimester, 8 cases at second trimester and 3 cases at third trimester respectively. Vaginal bleeding during the pregnancy was main clinical manifestation presented in 8 patients and all thirteen cases were diagnosed by biopsy with pathological types of squamous cell carcinoma in 10 cases. The International Federation of Gynecology and Obstetrics (FIGO) stage was I in eleven cases and stage II in two cases. Six patients of them received treatment promptly after diagnosis. The other 7 patients had delayed treatment with mean diagnosis-treatment interval time of 65 days due to fertility reasons, who ended pregnancy by cesarean section at mean gestational age of 34(+6) weeks, two of them received chemotherapy with cisplatin + fluorouracil (PF) or cisplatin respectively before the end of the pregnancy, while the one with PF chemotherapy experienced neonatal death. The rest 6 neonatal outcomes were good. As follow-up of 13 cases: 11 cases in stage I received surgical treatment, and two of which had recurrence respectively, 15 months and 7 months post surgery, and one case had died. One case of Stage II patients died and one had recurrence after 53 months after radiotherapy. The recurrence rate in 13 cases was 3/13 and the mortality rate was 2/13. CONCLUSIONS: Most cases of cervical cancer diagnosed during pregnancy were in early FIGO stage. For those patients diagnosed in late pregnancy with strong fertility demand, considering delayed treatment according to FIGO stage of the disease and fetus maturity is appropriate. Chemotherapy during pregnancy may cause neonatal complications.

Cytogenetic and clinical analysis of 340 Chinese patients with primary amenorrhea.

OBJECTIVE: To analyze the relationship between karyotypes and clinic features of patients with primary amenorrhea. METHODS: G banding was done for 340 patients with primary amenorrhea to facilitate individual chromosome identification, and if specific staining for certain portions of the chromosome was necessary, C banding was used. The clinical data were recorded by physical examination and ultrasound scanning. RESULTS: Karyotype analysis of the 340 patients revealed that 180 (52.94%) patients had normal female karyotypes and 160 (47.06%) patients had abnormal karyotypes. The abnormal karyotypes included abnormal X chromosome (150 patients), mosaic X-Y chromosome (4 patients), abnormal autosome (5 patients), and X-autosome translocation (1 patient). The main clinical manifestations in patients with primary amenorrhea were primordial or absent uterus (95.9%), invisible secondary sex features (68.8%), little or absent ovary (62.6%), and short stature (30.0%). The incidence of short stature in patients with X chromosome aberration (46%, 69/150) was significangly higher that in patients with 46, XX (9.44%, 17/180) as well as 46, XY (6.67%, 3/45; Chi square = 146.25, P=0.000). All primary amenorrhea patients with deletion or break-point at Xp1 1.1-11.4 were short statures. CONCLUSIONS: One of the main reasons of primary amenorrhea is choromosome abnormality, especially heterosome abnormality. It implies the need to routinely screen chromosomal anomalies for such patients. There might be relationship between Xp1 1.1-11.4 integrity and height improvement.

Association of gestational anemia with pregnancy conditions and outcomes: A nested case-control study.

BACKGROUND: Gestational anemia is a serious public health problem that affects pregnant women worldwide. Pregnancy conditions and outcomes might be associated with the presence of gestational anemia. This study investigated the association of pregnancy characteristics with anemia, exploring the potential etiology of the disease. AIM: To assess the association of pregnancy parameters with gestational anemia. METHODS: A nested case-control study was conducted based on the Chinese Pregnant Women Cohort Study-Peking Union Medical College Project (CPWCS-PUMC). A total of 3172 women were included. Patient characteristics and gestational anemia occurrence were extracted, and univariable and multivariable logistic regression models were used to analyze the association of pregnancy parameters with gestational anemia. RESULTS: Among the 3172 women, 14.0% were anemic, 46.4% were 25-30 years of age, 21.9% resided in eastern, 15.7% in middle, 12.4% in western 18.0% in southern and 32.0% in northern regions of China. Most women (65.0%) had a normal prepregnancy body mass index. Multivariable analysis found that the occurrence of gestational anemia was lower in the middle and western regions than that in the eastern region [odds ratio (OR) = 0.406, 95% confidence interval (CI): 0.309-0.533, P < 0.001)], higher in the northern than in the southern region (OR = 7.169, 95%CI: 5.139-10.003, P < 0.001), lower in full-term than in premature births (OR = 0.491, 95%CI: 0.316-0.763, P = 0.002), and higher in cases with premature membrane rupture (OR=1.404, 95%CI: 1.051-1.876, P = 0.02). CONCLUSION: Gestational anemia continues to be a health problem in China, and geographical factors may contribute to the situation. Premature birth and premature membrane rupture may be associated with gestational anemia. Therefore, we should vigorously promote local policy reformation to adapt to the demographic characteristics of at-risk pregnant women, which would potentially reduce the occurrence of gestational anemia.

[Establishment of multiple quantitative fluorescent polymerase chain reaction assay and its application in rapid prenatal diagnosis of common chromosome aneuploidies].

OBJECTIVE: To establish the multiple quantitative fluorescent polymerase chain reaction (QF-PCR) assay and evaluate its clinical application in prenatal diagnosis. METHODS: Totally 170 samples were collected between May 2008 and July 2009 in prenatal center of Peking Union Medical College Hospital; 123 of them were amniotic fluid, 9 were chorionic villous samples, 20 were fetal blood and 18 were villi from aborted fetuses. All samples were from women of Han nationality, with mean age of (34.1 ± 4.6) years old, and with mean gestational age of (19.6 ± 1.0) weeks. Cytogenetic cultures and karyotyping were made to every sample. Genomic DNA was extracted from the samples. The sequences of twenty short tandem repeat (STR) markers were designed according to the GenBank and references, including 6 STR markers in chromosome 21, 4 in chromosome 18, 4 in chromosome 13, 4 in chromosome X, 1 in chromosome Y and 1 universal marker in both X and Y chromosome. Each sample was amplified by two sets of multiple QF-PCR, which included 4 STR markers in each of 21, 18, 13 and sex chromosomes. If the result was uninformative, the third set of another 4 STR markers was added. RESULTS: (1) Karyotyping. Cytogenetic analysis were made for all the 170 samples, 151 (89%) of which were normal, and 19 (11%) were abnormal. (2) QF-PCR assay. 167 (98%) samples were detected by QF-PCR. The results were obtained within 2 - 3 days after sampling. 134 samples were proved normal by QF-PCR, which was consistent with karyotyping. Among the 19 abnormal karyotype samples, 18 were detected as abnormal(eight were 21-trisomy, three were 18-trisomy)by QF-PCR. Among the 167 samples, 150 (90%) were detected using the first and second set of STR mixtures, and 3 (2%) were detected when the third set of STR was added. The remain 14 (8%) were uninformative. (3) The diagnostic efficiency of QF-PCR. The sensitivity of QF-PCR in prenatal diagnosis of common aneuploidities was 95%, the specificity, the false positive rate, the false negative rate, the positive predictive value and negative predictive value were 100%, 0, 5%, 100% and 99%, respectively. (4) Autosome and sex chromosome detection by QF-PCR. Among all the STR markers, D21S1270 and D21S1411 had the highest heterozygosities in chromosome 21, and DXS8377 had the highest in sex chromosome. The amplifications were stable. CONCLUSION: Multiple QF-PCR assay is a valid alternative in rapid prenatal diagnosis of common chromosome aneuploidies. With high accuracy, it can be used for numerous sample test in large-scale laboratories.

Pregnancy outcomes of repeat cesarean section in Peking Union Medical College Hospital.

OBJECTIVE: To evaluate the effect of elective repeat cesarean section on the maternal and neonatal outcomes. METHODS: A retrospective clinic- and hospital-based survey was designed for comparing the maternal and neonatal outcomes of elective repeat cesarean section [RCS group (one previous cesarean section) and MRCS group (two or more previous cesarean sections)] and primary cesarean section (FCS group) at Peking Union Medical College Hospital from January 1998 to December 2007. RESULTS: The incidence of repeat cesarean section increased from 1.26% to 7.32%. The mean gestational age at delivery in RCS group (38.1+/-1.8 weeks) and MRCS group (37.3+/-2.5 weeks) were significantly shorter than that in FCS group (38.9+/-2.1 weeks, all P<0.01). The incidence of complication was 33.8% and 33.3% in RCS group and MRCS group respectively, and was significantly higher than that in FCS group (7.9%, P<0.05). Dense adhesion (13.5% vs. 0.4%, OR=7.156, 95% CI: 1.7-30.7, P<0.01) and uterine rupture (1.0% vs. 0, P<0.05) were commoner in RCS group compared with FCS group. Neonatal morbidity was similar among three groups (P>0.05). CONCLUSIONS: Repeat cesarean section is associated with more complicated surgery technique and increased frequency of maternal morbidity. However, the incidence of neonatal morbidity is similar to primary cesarean section.

Maternal Serum Angiogenic Factor sFlt-1 to PlGF Ratio in Preeclampsia: A Useful Marker for Differential Diagnosis and Prognosis Evaluation in Chinese Women.

The ratio of soluble fms-like tyrosine kinase-1 to placental growth factor (sFlt-1/PlGF) is elevated and proved to be useful in preeclampsia (PE) diagnosis. Its value in differential diagnosis with other pregnancy complications and prediction of pregnancy duration has yet to be clarified in Chinese population. We retrospectively analyzed 118 singleton pregnancies with suspected or diagnosed PE at the Peking Union Medical College Hospital (PUMCH) in China. Among these, 62 pregnancies were diagnosed as PE (48 early onsets and 14 late onsets, with 39 and 5 severe PE, respectively), 12 gestational hypertension (GH), 15 chronic hypertension (chrHTN), 16 autoimmune diseases, and 13 pregnancies with uncomplicated proteinuria. And 76 normal pregnancies were included as control. The results showed (1) the sFlt-1/PlGF ratio in early onset PE subgroup was significantly higher than that in GH, chrHTN, and control groups; the sFlt-1/PlGF ratio in late onset PE subgroup was significantly higher than that in chrHTN and control groups, but similar as GH group; the sFlt-1/PlGF ratio was similar among GH, chrHTN, and control groups. (2) The sFlt-1/PlGF ratio was significantly increased in the PE group compared with autoimmune disease and uncomplicated proteinuria pregnancies. (3) By ROC curve analysis, the cutoff value of the sFlt-1/PlGF ratio was less than 21.5 to rule out PE and higher than 97.2 to confirm the diagnosis of PE. (4) The sFlt-1/PlGF ratio was higher in PE pregnancies delivering within 7 days than those more than 7 days, either in early onset PE or severe PE. In conclusion, we show that maternal sFlt-1/PlGF ratio is an efficient biomarker in the diagnosis and differential diagnosis of PE. This ratio can be used to predict the timing of delivery for PE pregnancies.

[Predictors of maternal and fetal outcome in systemic lupus erythematosus: a retrospective study of 94 cases].

OBJECTIVE: To evaluate the predictors of maternal and fetal outcome of pregnancy for systemic lupus erythematosus (SLE) patients. METHODS: Ninety-four patients with 96 pregnancies which were evaluated retrospectively from Jan 1990 to Jan 2008 in Peking Union Medical College Hospital were divided into two groups: disease stable during pregnancy (group A) and lupus flares during pregnancy (group B). Statistical analysis was performed by chi(2) or Fisher exact test and Student's t-test. A binary logistic regression model was used to evaluate the predictors of maternal and fetal outcome. RESULTS: There were 36 pregnancies with stable lupus disease (group A) and 60 pregnancies with lupus flares (group B). Of the 96 pregnancies, 18 resulted in therapeutic abortion and 7 in fetal loss, 71 resulted in a live birth,3 in neonatal death. The rates of preterm delivery, small gestational age (SGA) and neonatal asphyxia in group B were higher than those in group A (P < 0.05). By binary logistic regression analysis, preeclampsia/eclampsia low serum platelet count and SLE flares were associated with poor fetal outcome (beta = 2.463, 2.228, 2.769 respectively, P < 0.05). There were 56 pregnancies with stable lupus disease at the conception with 22 (39.3%) occurred lupus flares during pregnancies. Twenty-four preeclampsia and 2 eclampsia were seen in all the pregnancies. Fifty-two pregnancies were complicated with lupus nephritis, and 25 pregnancies (48.1%, 25/52) of which were disease stable at the conception, and among 22 pregnancies with disease stable over one year, twelve of which occurred lupus nephritis flares. Three pregnancies which have disease activity within one year before pregnancy all occurred lupus nephritis flares. There were four maternal death which all occurred at the postpartum. By binary logistic regression analysis, lupus nephritis flares were associated with preeclampsia/eclampsia (beta = 2.658, P < 0.05), and proteinuria at the conception before delivery were significantly associated with SLE flares (beta = 3.263, P < 0.05). CONCLUSION: An increase of fetal loss, preterm delivery, SGA and neonatal asphyxia was seen in patients with lupus flares during pregnancy compared with those with stable disease. About 1/3 lupus activity may increase after pregnancy. Preeclampsia and eclampsia were increased when there were lupus nephritis flares.

[Effect of induction delivery on maternal-neonatal outcomes in 41 gestational weeks primiparae].

OBJECTIVE: To estimate the maternal-neonatal morbidity associated with induction deliveries compared with spontaneous deliveries in 41 gestational weeks uncomplicated primiparae. METHODS: Three hundred and seventy-four uncomplicated primiparous deliveries at 41 gestational weeks at Peking Union Medical College Hospital from Sept 2002 to Apr 2007 were reviewed, including 225 women undergoing induced labor and 149 women undergoing spontaneous labor. The induction methods included drug induction (173), rupture of membrane induction (5) and combined drug with rupture of membrane induction (47). The maternal morbidity, delivery method, maternal cost on hospital stay and neonatal asphyxia associated with induction deliveries or spontaneous deliveries were retrospectively analyzed. RESULTS: (1) There was no maternal death. The caesarean section rate in the induction group (44.0%, 99/225) was significantly higher than that of spontaneous group (18.1%, 27/149; P<0.05). (2) No statistically significant difference (P>0.05) was observed between induction group and spontaneous group in the following puerperal complications: postpartum hemorrhage (2.7%, 6/225 and 1.3%, 2/149 respectively), puerperal morbidity (0.9%, 2/225 and 0.7%, 1/149 respectively), severe amniotic fluid contamination (11.6%, 26/225 and 13.4%, 20/149 respectively), wound infection (0.9%, 2/225 and 0.7%, 1/149 respectively) ,urinary retention(4.4%, 10/225 and 3.4%, 5/149 respectively), traumata (0.4%, 1/225 and 0 respectively) and neonatal asphyxia (1.3%, 3/225 and 2.0%, 3/149 respectively). (3) The average duration of first stage of labor in the induction group (413 min) was not significantly different from that of spontaneous group (461 min; P>0.05). In the induction group, more women had precipitate labors (P<0.05) and the average duration of the second stage of labor was shorter than that of spontaneous group (40 min and 48 min, P<0.05). (4) Spontaneous group had shorter maternal hospital stay [(5.7 +/- 1.9) days vs (6.9 +/- 2.7) days, P<0.05] and caesarean section after induction had the highest hospital expense (P<0.05). CONCLUSIONS: Induction delivery at 41 weeks of gestation increases the rates of caesarean section, precipitate labor, clinical workload and hospital costs. Induction delivery as a prevention method of over due labor needs to be further discussed. Uncomplicated pregnancies of 41 weeks should be intentionally monitored if continued surveillance is possible. They should wait for spontanous delivery, and decision of induction should be made based on its benefit to the case.

[Clinical analysis of 47 cases of placenta accreta in the second and third trimesters].

OBJECTIVE: To explore the clinical characters, diagnosis and treatment methods of placenta accreta. METHODS: A retrospective analysis was made of 47 cases of placenta accreta admitted during May 1997 to May 2007 into Peking Union Medical College Hospital. They included 17 cases in the second trimester and 30 cases in the third. RESULTS: Among all the patients, the incidence of placenta accreta was 0.262% (47/17 918). Most of these cases (81%, 38/47) experienced a uterine procedure. 30% (14/47) of the cases were found with placenta previa and 11% (5/47) with myoma in the current pregnancy. 11% (5/47) of all the cases suffered postpartum hemorrhage. In the 17 cases in the second trimester, 12 were diagnosed by ultrasonography and 5 by clinical evidence. While in the 30 cases in the third trimester, 8 were diagnosed by biopsy, 2 by ultrasonography, and 20 by clinical evidence. 45 cases were cured by conservative treatment, which included dilatation and curettage, uterine artery embolization (UAE) with or without methotrexate (MTX), tamping B-lynch suture, singly with MTX, and mifepristone. Only 2 cases received cesarean hysterectomy. CONCLUSIONS: The incidence of placenta accreta seems on the rise. The incidence in the second trimester is higher than that in the third. In the second trimester, most cases can be diagnosed by ultrasonography after labor, and presently UAE is the best conservative management. While in the third trimester clinical evidence is the most frequent diagnostic approach. A majority of the cases could be cured by conservative therapies, which help them avoid a hysterectomy.