LncRNA-NEAT1 blocks the Wnt/ß-catenin signaling pathway by targeting miR-217 to inhibit trophoblast cell migration and invasion.

OBJECTIVE: This study aimed to study the correlation between preeclampsia (PE) and lncRNA nuclear paraspeckle assembly transcript 1 (NEAT1), and to examine the molecular mechanisms behind the development of PE. METHODS: 30 PE and 30 normal pregnant women placental samples were assessed the levels of NEAT1 and miR-217 by quantitative real-time PCR (qRT-PCR). The trophoblast cell line HTR8/SVneo was used for silencing NEAT1 or miR-217 inhibitor in the absence or presence of an inhibitor and H2O2. Cell counting Kit 8 (CCK-8), flow cytometry, and Transwell were used to detect cell proliferation, apoptosis, migration, and invasion. Luciferase reporter gene assay was utilized to verify the binding between miR-217 and Wnt family member 3 (Wnt3), and between the miR-217 and NEAT1. Proteins related to the Wnt/ß-catenin signaling pathway were detected using western blotting. RESULTS: The PE group exhibited a significantly downregulated expression of miR-217 and a significantly upregulated expression of NEAT1. NEAT1 targeted miR-217, and Wnt is a miR-217 target gene. siRNA-NEAT1 inhibited the apoptosis of trophoblast cells, but promoted their invasion, migration, and proliferation. MiR-217 inhibitor could partially reverse the effects of siRNA-NEAT1. The expression of the Wnt/ß-catenin signaling pathway-related proteins, WNT signaling pathway inhibitor 1 (DKK1), cyclin-D1 and ß-catenin, was significantly increased after siRNA-NEAT1. CONCLUSIONS: NEAT1 could reduce trophoblast cell invasion and migration by suppressing miR-217/Wnt signaling pathway, leading to PE.

Analysis of the clinical diagnosis and treatment of fetal meconium peritonitis.

BACKGROUND: The purpose of this study was to improve diagnostic and therapeutic standards by examining the clinical features, treatment, and prognosis of fetal meconium peritonitis (FMP), as well as the diagnostic efficacy of ultrasound for FMP. METHODS: The clinical data of 41 infants and pregnant women diagnosed with meconium peritonitis (MP) and treated at the Fujian Maternal and Child Health Hospital from January 2013 to January 2020 were analyzed retrospectively. Clinical data, imaging data, complications, treatment strategies, pregnancy outcomes, neonatal prognoses, and follow-up outcomes were all analyzed. RESULTS: The MP prenatal diagnosis rate was 56.1% (23/41), the neonatal surgery rate was 53.7% (22/41), and the survival rate was 85.4% (35/41). Intraperitoneal calcification (23 pregnant women, 56.1%), intestinal dilatation (13 pregnant women, 31.7%), peritoneal effusion (22 pregnant women, 53.7%), intraperitoneal pseudocyst (7 pregnant women, 17.1%), and polyhydramnios were diagnosed via prenatal ultrasound (18 pregnant women, 43.9%). Twenty-two pregnant women were assigned to the surgical treatment (operation) group, while 18 were assigned to the conservative treatment group. In the operation group, there were 9 cases of ileal atresia (40.9%), 7 cases of jejunal atresia (31.8%), 2 cases of atresia at the jejunum-ileum junction (9.1%), 2 cases of ileal perforation (9.1%), 1 case of ileal necrosis (4.5%), and 1 case of adhesive obstruction (4.5%). There was no statistically significant difference (p > .05) in the occurrence of various prenatal ultrasound findings by etiology. CONCLUSION: Multiple prenatal ultrasound markers have been identified for MP. To improve the efficacy of newborn treatment for FMP and reduce neonatal mortality, dynamic monitoring of ultrasound image alterations and strengthened integrated perinatal management are necessary.

Prediction of pre-eclampsia complicated by fetal growth restriction and its perinatal outcome based on an artificial neural network model.

Objective: Pre-eclampsia (PE) complicated by fetal growth restriction (FGR) increases both perinatal mortality and the incidence of preterm birth and neonatal asphyxia. Because ultrasound measurements are bone markers, soft tissues, such as fetal fat and muscle, are ignored, and the selection of section surface and the influence of fetal position can lead to estimation errors. The early detection of FGR is not easy, resulting in a relative delay in intervention. It is assumed that FGR complicated with PE can be predicted by laboratory and clinical indicators. The present study adopts an artificial neural network (ANN) to assess the effect and predictive value of changes in maternal peripheral blood parameters and clinical indicators on the perinatal outcomes in patients with PE complicated by FGR. Methods: This study used a retrospective case-control approach. The correlation between maternal peripheral blood parameters and perinatal outcomes in pregnant patients with PE complicated by FGR was retrospectively analyzed, and an ANN was constructed to assess the value of the changes in maternal blood parameters in predicting the occurrence of PE complicated by FGR and adverse perinatal outcomes. Results: A total of 15 factors-maternal age, pre-pregnancy body mass index, inflammatory markers (neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio), coagulation parameters (prothrombin time and thrombin time), lipid parameters (high-density lipoprotein, low-density lipoprotein, and triglyceride counts), platelet parameters (mean platelet volume and plateletcrit), uric acid, lactate dehydrogenase, and total bile acids-were correlated with PE complicated by FGR. A total of six ANNs were constructed with the adoption of these parameters. The accuracy, sensitivity, and specificity of predicting the occurrence of the following diseases and adverse outcomes were respectively as follows: 84.3%, 97.7%, and 78% for PE complicated by FGR; 76.3%, 97.3%, and 68% for provider-initiated preterm births,; 81.9%, 97.2%, and 51% for predicting the severity of FGR; 80.3%, 92.9%, and 79% for premature rupture of membranes; 80.1%, 92.3%, and 79% for postpartum hemorrhage; and 77.6%, 92.3%, and 76% for fetal distress. Conclusion: An ANN model based on maternal peripheral blood parameters has a good predictive value for the occurrence of PE complicated by FGR and its adverse perinatal outcomes, such as the severity of FGR and preterm births in these patients.

Interactive Affection of Pre-Pregnancy Overweight or Obesity, Excessive Gestational Weight Gain and Glucose Tolerance Test Characteristics on Adverse Pregnancy Outcomes Among Women With Gestational Diabetes Mellitus.

Purpose: To examine the combined effect of pre-pregnancy overweight or obesity, excessive gestational weight gain, and glucose tolerance status on the incidence of adverse pregnancy outcomes among women with gestational diabetes mellitus. Methods: A observational study including 5529 gestational diabetes mellitus patients was performed. Logistic regression were used to assess the independent and multiplicative interactions of overweight or obese, excessive gestational weight gain, abnormal items of oral glucose tolerance test and adverse pregnancy outcomes. Additive interactions were calculated using an Excel sheet developed by Anderson to calculate relative excess risk. Results: Overall 1076(19.46%) study subject were overweight or obese and 1858(33.60%) women gained weight above recommended. Based on IADPSG criteria, more than one-third women with two, or three abnormal glucose values. Preconception overweight or obesity, above recommended gestational weight gain, and two or more abnormal items of oral glucose tolerance test parameters significantly increased the risk of adverse pregnancy outcomes, separately. After accounting for confounders, each two of overweight or obesity, excessive gestational weight gain, two or more abnormal items of OGTT parameters, the pairwise interactions on adverse pregnancy outcomes appear to be multiplicative. Coexistence of preconception overweight or obesity, above recommended gestational weight gain and two or more abnormal items of oral glucose tolerance test parameters increased the highest risk for adverse pregnancy outcomes. No additive interaction was found. Conclusions: Pre-pregnancy overweight or obesity, excessive gestational weight gain, two or more abnormal items of OGTT parameters contribute to adverse pregnancy outcomes independently among women with gestational diabetes mellitus. Additionally, the combined effect between these three factors and adverse pregnancy outcomes appear to be multiplicative. Interventions focus on maternal overweight or obesity and gestational weight gain should be offered to improve pregnancy outcomes.

Examining the effects of second-and third-trimester gestational weight gain rates on the perinatal outcomes among Chinese twin pregnancies: a retrospective cohort study.

BACKGROUND: This paper investigated how second- and third-trimester gestational weight gain relates to perinatal outcomes among normal weight women with twin pregnancies in Fujian, China. METHODS: A retrospective study examining the medical records of 931 normal weight twin-pregnant women was conducted in Fujian Maternity and Child Health Hospital from 2014 to 2018.The 2nd and 3rdtrimester weekly weight gain rates were calculated, and women were categorized as gaining below, within, or above the 2009 Institute of Medicine (IOM) recommended rates. The association between the trimester-specific weight gain rate and perinatal outcome was determined by traditional regression analysis among groups. RESULTS: A total of 25.9%, 19.8% and 54.3% of women had rates of weight gain across the 2nd and 3rd trimesters less than, greater than or within the recommended rates respectively. Multivariate logistic regression analysis showed that weight gain greater than the recommended rate in the 2nd trimester was associated with a decreased risk of preeclampsia (aOR:0.489,95%CI:0.289 ~ 0.974). Weight gain less than the recommended rate of weight gain in the 3rd trimester was associated with increased risks of premature delivery(aOR:2.079, 95%CI:1.467 ~ 2.968), gestational diabetes mellitus (aOR: 2.048, 95%CI:1.411 ~ 2.971), intrahepatic cholestasis syndrome (aOR:3.015,95%CI: 1.058 ~ 8.587), pre-labour rupture of membrane (aOR: 1.708,95%CI: 1.169 ~ 2.493), average twin birth weight < 2500 g(aOR:1.532,95%CI: 1.125 ~ 2.084) and neonatal respiratory distress syndrome (aOR:4.934,95%CI:1.626 ~ 15.083) and was associated with decreased risks of caesarean section (aOR:0.589,95%CI:0.386 ~ 0.898) and preeclampsia (aOR:0.471, 95%CI:0.274 ~ 0.808). In addition, weight gain greater than the recommended rate of weight gain in the 3rd trimester was associated with increased risks of premature delivery (aOR:1.589,95%CI:1.428 ~ 2.951) and gestational hypertension (aOR:2.137,95% CI:1.034 ~ 4.415) as well as preeclampsia (aOR:2.246, 95%CI:1.462 ~ 3.452). The stratified analysis of weight gain in the 3rd trimester showed that there was no significant difference in the incidence of adverse pregnancy outcomes compared to the 2nd trimester weight gain groups. CONCLUSIONS: While this study showed that a gestational weight gain rate above or below the recommendation in the 3rd trimester was associated with some adverse maternal and neonatal outcomes, further prospective and multicentre studies are required to explore alternate ranges of gestational weight gain rates in twin pregnancies.

Serum procalcitonin to differentiate acute antepartum pyelonephritis from asymptomatic bacteriuria and acute cystitis during pregnancy: A multicenter prospective observational study.

OBJECTIVE: To examine whether serum procalcitonin (PCT) is useful for differentiating acute pyelonephritis (APN) from asymptomatic bacteriuria and acute cystitis during pregnancy. METHODS: A multicenter prospective observational study was conducted to compare serum white blood cell (WBC) counts, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, and PCT level among pregnant women with asymptomatic bacteriuria, acute cystitis, and APN and healthy pregnant women (controls). Utility of WBC count, ESR, CRP, and PCT biomarkers for the prediction of APN during pregnancy were measured. RESULTS: Area under the curve (AUC) values of PCT, CRP, ESR, and WBC count for predicting asymptomatic bacteriuria were 0.576, 0.628, 0.542, and 0.532, respectively; those for predicting acute cystitis were 0.766, 0.735, 0.681, and 0.597, respectively; and those for predicting acute pyelonephritis 0.859, 0.763, 0.711, and 0.732, respectively. Compared with the other inflammatory markers used to predict APN, PCT exhibited the highest AUC (0.859 [95% confidence interval (CI) 0.711-0.935]). A cutoff value of >0.25 ng/ml had a sensitivity of 87% and a specificity of 79%. CONCLUSION: Serum PCT can be a valuable addition to existing methods of differentiating asymptomatic bacteriuria, acute cystitis, and APN during pregnancy and can facilitate the early identification of APN during pregnancy.

Clinical analysis of eight cases of fetal intracranial hemorrhage in pregnancy.

OBJECTIVE: To explore the clinical characteristics, treatment and prognosis of fetal intracranial hemorrhage in pregnancy and to improve the level of diagnosis and treatment. METHODS: We retrospectively analyzed the clinical data of eight cases of fetal intracranial hemorrhage in our hospital from 2014 to 2017, including the clinical manifestations, etiology, imaging features, treatment and prognosis. RESULTS: All the cases were diagnosed by prenatal color ultrasound or magnetic resonance imaging (MRI); one of the cases had decreased fetal movements and abnormal fetal heart rate monitoring, and the remaining seven cases had no special clinical symptoms. No clear cause was found in all the cases. Two patients with grade I fetal intracranial hemorrhage and 1 patient with grade II had a cesarean delivery, and no neurological sequelae were found in these neonates after 6 months of follow-up. There was one patient with grade III and four patients with grade IV fetal intracranial hemorrhage; one of the patients with grade IV was stillborn at the time of the discovery, and cesarean section was selected due to scarring of the uterus; intra-amniotic injection of ethacridine lactate was selected to induce labor in three cases, and vaginal delivery was selected; one of the patients with grade IV chose vaginal delivery, and the neonatal cranial brain magnetic resonance imaging after delivery showed no increase in intracranial lesions but showed incomplete development of the remaining nervous system. CONCLUSION: Fetal intracranial hemorrhage can be diagnosed by prenatal color ultrasound and MRI, yet it is often impossible to determine the cause. The prognosis of fetal intracranial hemorrhage is related to grade, and the prognosis of cerebral hemorrhage in patients with grades III-IV is poor.

A Clinical Analysis of the Diagnosis and Treatment of Fetal Sacrococcygeal Teratomas.

OBJECTIVE: The present study aims to discuss the clinical features, treatment, and prognosis of fetal sacrococcygeal teratomas (SCTs) to improve the standard of diagnosis and treatment. METHODS: The clinical data of 15 pregnant females with fetal SCT, admitted to Fujian  Maternity and Child Health Hospital from January 2013 to January 2020, were retrospectively analyzed with respect to clinical characteristics, imaging features, complications, treatment options, and pregnancy outcomes. RESULTS: The 15 cases of fetal SCT were all detected by color ultrasonography. There were two cases of cystic tumors and 13 cases of solid cystic tumors. In terms of tumor blood supply, there was one case without blood flow signal, eight cases with little blood flow signal, and six cases with abundant blood flow. At the time of delivery, there were two cases with a tumor diameter less than 5 cm, five cases with a diameter of 5-10 cm, and eight cases with a diameter of more than 10 cm. In terms of tumor shape and location, there were two cases of type I, ten cases of type II, and three cases of type III. There were six cases with an increased fetal heart to chest ratio, four cases of fetal edema, three cases of placental edema, four cases of excessive amniotic fluid, one case of insufficient amniotic fluid, three cases of fetal distress, one case of stillbirth, two cases of gestational diabetes mellitus, two cases of mirror syndrome, and two cases of postpartum hemorrhage. According to the pathological diagnosis, there were seven cases of mature teratoma, seven cases of immature teratoma, and one case of mixed germ cell tumor. There were six cases of induced delivery, nine cases of cesarean section, one case of premature birth, and two cases of mild neonatal asphyxia. CONCLUSION: Fetal SCT was generally diagnosed by prenatal ultrasonography. The tumor blood supply, growth rate, size, nature of the tumor, clinical type, pathology, and maternal-fetal complications are all closely correlated with the prognosis. The timing and manner of the termination of pregnancy should be determined on the basis of the pregnant female, the fetus, and the tumor.

Prediction of vaginal birth after cesarean delivery in Southeast China: a retrospective cohort study.

BACKGROUND: We aimed to develop and validate a nomogram for effective prediction of vaginal birth after cesarean (VBAC) and guide future clinical application. METHODS: We retrospectively analyzed data from hospitalized pregnant women who underwent trial of labor after cesarean (TOLAC), at the Fujian Provincial Maternity and Children's Hospital, between October 2015 and October 2017. Briefly, we included singleton pregnant women, at a gestational age above 37 weeks who underwent a primary cesarean section, in the study. We then extracted their sociodemographic data and clinical characteristics, and randomly divided the samples into training and validation sets. We employed the least absolute shrinkage and selection operator (LASSO) regression to select variables and construct VBAC success rate in the training set. Thereafter, we validated the nomogram using the concordance index (C-index), decision curve analysis (DCA), and calibration curves. Finally, we adopted the Grobman's model to perform comparisons with published VBAC prediction models. RESULTS: Among the 708 pregnant women included according to inclusion criteria, 586 (82.77%) patients were successfully for VBAC. Multivariate logistic regression models revealed that maternal height (OR, 1.11; 95% CI, 1.04 to 1.19), maternal BMI at delivery (OR, 0.89; 95% CI, 0.79 to 1.00), fundal height (OR, 0.71; 95% CI, 0.58 to 0.88), cervix Bishop score (OR, 3.27; 95% CI, 2.49 to 4.45), maternal age at delivery (OR, 0.90; 95% CI, 0.82 to 0.98), gestational age (OR, 0.33; 95% CI, 0.17 to 0.62) and history of vaginal delivery (OR, 2.92; 95% CI, 1.42 to 6.48) were independently associated with successful VBAC. The constructed predictive model showed better discrimination than that from the Grobman's model in the validation series (c-index 0.906 VS 0.694, respectively). On the other hand, decision curve analysis revealed that the new model had better clinical net benefits than the Grobman's model. CONCLUSIONS: VBAC will aid in reducing the rate of cesarean sections in China. In clinical practice, the TOLAC prediction model will help improve VBAC's success rate, owing to its contribution to reducing secondary cesarean section.

An analysis of the maternal and infant outcomes in the delayed interval delivery of twins.

OBJECTIVE: To investigate the treatment methods used for the delayed interval delivery of twins and to evaluate the maternal and infant outcomes. MATERIALS AND METHODS: The clinical data of 5 patients that underwent delayed interval delivery of twins at Fujian Maternal and Child Health Hospital from 2014 to 2018 were analyzed. The gestational ages at delivery, obstetrical management, the interval between deliveries, and the maternal and child outcomes were analyzed. RESULTS: The average gestational age at delivery of the first child was 23+3 weeks (range: 20+1-30+2 weeks). All 5 mothers underwent high ligation of the umbilical cord and received prophylactic antibiotic treatment. Tocolytics were administered to 3 patients, 1 of which had previously undergone cervical cerclage placement. No tocolytics were administered to the remaining 2 patients. The average delayed delivery time was 15 days (range: 3-31 days). The second child was delivered at an average gestational age of 25+5 weeks (range: 20+4-31+3 weeks). The average birth weight of the second twin was 957 g (range: 360-1930 g). Three of the patients delivered vaginally, 1 delivered via a cesarean section, and 1 required a breech extraction. Of these deliveries, there were 3 neonatal survivals. Pathogens were detected in the cervical secretion cultures in all cases. Two patients had grade 2 placental abruption, 5 had an intrauterine infection, 1 developed sepsis, 1 developed postpartum hemorrhage, and 5 showed a placenta adherence. CONCLUSION: The delayed interval delivery of twins is a unique treatment for patients experiencing a twin pregnancy. Successful performance of this method can improve the survival rates for the second twin and improve prognosis. However, careful attention is required when performing this treatment to prevent and treat possible complications that may arise during the procedure.

Expression of advanced glycation end products in placenta and concentration in maternal and umbilical serum in pre-eclampsia.

AIM: To study the function of free fatty acid (FFA) in maternal serum and advanced glycation end products (AGE) in maternal serum, umbilical cord blood and in the placenta of women with pre-eclampsia. METHODS: Sixty women with pre-eclampsia and 60 normal pregnant women as controls participated in this study. Women with pre-eclampsia were divided into an early-onset group and late-onset group, with 30 normal pregnant women as the early control group and 30 as the late control group. Competitive enzyme-linked immunosorbent assay was used to measure AGE in maternal serum and umbilical cord blood. Western blotting was performed to analyze AGE in the placenta. Improved copper agent colorimetry was performed to measure FFA in maternal serum. RESULTS: Mean AGE in maternal serum in the early-onset and late-onset pre-eclampsia groups was significantly higher than in the control groups. Mean concentration of umbilical cord blood AGE was significantly higher in the early-onset and late-onset pre-eclampsia groups when compared with the control groups. On western blot the level of placental AGE in the early-onset and late-onset pre-eclampsia groups was significantly higher than in normal placenta. Serum FFA in the early-onset and late-onset pre-eclampsia groups was higher than in healthy pregnant women. Maternal serum FFA in the early-onset and late-onset pre-eclampsia groups correlated positively with maternal serum AGE (r = 0.764 and r = 0.774, P < 0.05). CONCLUSIONS: AGE and FFA, which are upregulated in pre-eclampsia, are likely to be involved in pre-eclampsia through some common mechanism.

[Relationships between concentrations of free fatty acid in serum and oxidative-damage levels in placental mitochondria and preeclampsia].

OBJECTIVE: To investigate the relationships between concentrations of free fatty acid (FFA) in maternal serum and oxidative damage levels in placental mitochondria and preeclampsia (PE). METHODS: A total of 60 women with PE and 60 normal pregnant women as control participated in this study. All were admitted to Fujian Maternity and Child Health Hospital for delivery from August 2010 to May 2011. Patients with PE were divided into early-onset group (n = 30, presented at < 34 weeks of gestation) and late-onset group (n = 30, presented at ≥ 34 weeks of gestation), with 30 normal pregnant women as early control group (< 34 weeks of gestation) and 30 as late control group (≥ 34 weeks of gestation). Improved copper agent colorimetry was used to detect FFA in maternal serum. Ultraviolet colorimetry was used to detect glutathione peroxidase (GPX) and catalase (CAT) activity in maternal placenta and malondialdehyde (MDA) and permeability transition (PT) pore in placental mitochondria. Total superoxide dismutase (SOD) assay kit-WST was used to detect SOD activity in placenta. Real-time fluorescent quantitative PCR was used to detect mitochondrial DNA (mtDNA) expression in placenta. RESULTS: (1) Maternal serum FFA was (1.6 ± 0.5) mmol/L in early-onset PE group and (1.5 ± 0.4) mmol/L in late-onset PE group, significantly elevated as compared to (1.0 ± 0.5) mmol/L in early control group and (0.9 ± 0.5) mmol/L in late control group (P < 0.05). However, no significant difference was found between early-onset and late-onset PE groups (P > 0.05). (2) The mean placental GPX, CAT and SOD activity were significantly decreased in the early-onset PE group [(47 ± 6), (19 ± 5), (62 ± 13) U/mg] and late-onset PE group [(67 ± 6), (20 ± 4), (96 ± 17) U/mg] as compared to late control group [(80 ± 3), (55 ± 3), (123 ± 19) U/mg], respectively (P < 0.05). (3) The mean placental mitochondria MDA was significantly elevated in the early-onset PE group [(115 ± 22) nmol/mg] and late-onset PE group [(90 ± 17) nmol/mg] as compared to late control group [(52 ± 11) nmol/mg, P < 0.05]. The mean absorption value that present the permeability of placental mitochondria PT pore was significantly elevated in the early-onset PE group (0.086 ± 0.013) and late-onset PE group (0.069 ± 0.014) as compared to late control group (0.052 ± 0.012, P < 0.05). The mean placental mtDNA expression was significantly elevated in the early-onset PE group (3.0 ± 0.7) and late-onset PE group (2.8 ± 0.7) as compared to late control group (2.6 ± 0.6, P < 0.05). (4) The mean placental mitochondria MDA concentration correlated positively with the concentrations of FFA in maternal serum in the early-onset PE group (r = 0.703, P < 0.05) and late-onset PE group (r = 0.457, P < 0.05), and negatively with placental antioxidant enzyme in the early-onset PE group (r = -0.652, -0.787, -0.952; P < 0.05) and late-onset PE group (r = -0.378, -0.689, -0.854; P < 0.05). CONCLUSIONS: Increased FFA in maternal serum and high levels of oxidative damage in placental mitochondria may be involved in the pathogenesis of preeclampsia. Increased FFA in serum and decreased activity of antioxidant enzyme in placenta may contribute to oxidative damage levels in placental mitochondria in women with PE.

[Expression and significance of adipocyte fatty acid-binding protein in placenta, serum and umbilical cord blood in preeclampsia].

OBJECTIVE: To investigate the change of adipocyte fatty acid-binding protein (FABP4) in maternal serum and umbilical cord blood and FABP4 mRNA placental expression in patients with preeclampsia (PE). METHODS: A total of 60 women with PE and 60 normal pregnant women as control participated in this study.All are admitted to Fujian Maternity and Children Health Hospital for delivery from December 2008 to October 2009. Patients with PE were divided into early-onset group (n = 30, presented at ≤ 34 weeks of gestation) and late-onset group (n = 30, presented at > 34 weeks of gestation), with 30 normal pregnant women as early control group (≤ 34 weeks of gestation) and 30 as late control group (> 34 weeks of gestation). Enzyme-linked immunosorbent assay (ELISA) was used to detect FABP4, fasting serum glucose, fasting insulin (FINS) in maternal serum and FABP4 in umbilical cord blood. Real-time fluorescent quantitative reverse transcription PCR was used to detect placental FABP4 mRNA expression. Furthermore, clinical and biochemical parameters were recorded, such as body mass index (BMI), systolic pressure (SP), diastolic pressure (DP), mean arterial pressure (MAP), total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL), high density lipoprotein (HDL), creatinine (Cr), uric acid (UA), glomerular filtration rate (GFR), 24 hours urine protein in pregnant women and neonatal weight. RESULTS: (1) Maternal serum FABP4 was (176 ± 9) ng/L in early-onset PE group and (170 ± 9) ng/L in late-onset PE group, significantly elevated as compared to (81 ± 13) ng/L in early control group and (94 ± 15) ng/L in late control group. (2) Mean maternal FINS, homeostasis model of assessment for insulin resistence index (HOMA-IR) were significantly elevated in the early-onset PE group and late-onset PE group as compared to control groups, respectively. (3) Mean placental FABP4 mRNA expression were significantly elevated in the early-onset PE group and late-onset PE group as compared to late control group. However, no significant difference was found in placental FABP4 mRNA expression between early-onset and late-onset PE groups. (4) Mean umbilical cord blood FABP4 concentrations were significantly decreased in the early-onset PE group and late-onset PE group as compared to late control group. Furthermore, umbilical cord blood FABP4 concentration correlated negatively with maternal serum FABP4 level and placental FABP4 mRNA expression, but positively with neonatal weight. (5) Mean maternal serum FABP4 concentrations correlated positively with placental FABP4 mRNA expression, TG, FINS, HOMA-IR, Cr, UA; and negatively with HDL, GFR. CONCLUSIONS: Increased FABP4 expression in maternal serum and placenta may be involved in the pathogenesis of preeclampsia. Increased FABP4 mRNA expression in placenta may contribute to high serum FABP4 level in women with PE.

[Maternal serum level of adiponectin and expression of adiponectin mRNA in subcutaneous and omental adipose tissues in women with preeclampsia].

OBJECTIVE: To determine the expression of adiponectin mRNA in omental and subcutaneous adipose tissues and serum levels of adiponectin in pregnant women complicated with pre-eclampsia (PE) in order to find out its association with the pathogenesis of PE. METHODS: The expression of adiponectin mRNA in omental and subcutaneous adipose tissue of 49 women with severe PE, which were divided into early-onset group (n = 24, presented at 34 weeks of gestation), and 30 healthy pregnant women (control), who presented to Fujian Maternity and Child Health Hospital for prenatal care from September 2007 to July 2008, were determined by real-time fluorescent quantitative reverse transcription PCR. The maternal serum level of adiponectin was detected by enzyme-linked immunosorbent assay for all subjects. RESULTS: (1) The levels of serum adiponectin in the early-onset and late-onset severe PE groups were (5.9 +/- 2.7) and (7.9 +/- 2.8) mg/L, which were significantly lower than that of the control (11.2 +/- 4.2) mg/L, respectively (P < 0.01), and the level in the early-onset group was lower than in the late-onset group (P < 0.05). (2) Among the early-onset, late-onset PE group and the controls, significant difference was found between any two groups of the three in the adiponectin mRNA expression in omental adipose tissue (0.56 +/- 0.17, 0.69 +/- 0.23 and 1.00 +/- 0.22, P < 0.01), but not in the subcutaneous adipose tissue (0.90 +/- 0.19, 0.93 +/- 0.23 and 1.00 +/- 0.16, P > 0.05). (3) The adiponectin mRNA expressions in the subcutaneous and omental adipose tissue were positively correlated with the maternal serum level of adiponectin in all groups (P < 0.05). (4) The omental adiponectin mRNA levels were negatively correlated with maternal serum triglyceride levels in all of the three groups (r = -0.610, -0.659, -0.446, respectively, and all P < 0.05). Negative correlation was also found between the omental adiponectin mRNA level and the prepregnant body mass index in the control group (r = -0.436, P < 0.05). CONCLUSION: Decreased maternal serum adiponectin level may be involved in the pathogenesis of pre-eclampsia and also may contribute to the reduced expression of adiponectin in the omental adipose tissue.

[Multi-center study of motherwort injection to prevent postpartum hemorrhage after caesarian section].

OBJECTIVE: To evaluate the efficacy and safety of motherwort (herba leonuri/leonurus heterophyllus sweet) injection for preventing postpartum hemorrhage after caesarian section. METHODS: The prospective study was designed as a randomized and single blind multi-center research matched with positive agent as controls from Apr 2007 to Aug 2007. 440 women underwent caesarian section (CS) indicated by obstetric factors were enrolled from 15 teaching hospitals in China and assigned into three groups: group of motherwort: 147 cases were administered by motherwort 40 mg uterine injection during CS and 20 mg intramuscular injection per 12 hours 3 times after CS; group of motherwort+oxytocin: 144 cases were administered by motherwort 40 mg and oxytocin 10 U uterine injection during CS and motherwort 20 mg intramuscular injection per 12 hours 3 times after CS and group of oxytocin: 149 cases were administered by oxytocin 10 U uterine injection and oxytocin 10 U+5% glucose 500 ml intravenously injection during operation and oxytocin 10 U intramuscular injection per 12 hours 3 times after CS. The following clinical parameter were collected and analyzed: (1) The amount of blood loss during operation, at 2, 6, 12, 24, 48 hours after operation. (2) The total amount of blood loss in 24 hours after CS and the incidence of postpartum hemorrhage. (3) The change of level of hemoglobin (Hb) and counting of red blood cell (RBC) from prepartum to postpartum. (4) Adverse reaction. RESULTS: (1) The mean amount of blood loss during operation were (368+/-258) ml in group of motherwort, (255+/-114) ml in group of motherwort+oxytocin and (269+/-141) ml in group of oxytocin, which exhibited significant difference among three groups (P<0.01). Meanwhile, no statistical different amount of blood loss among three groups were observed at 2, 6, 12, 24, 48 hours after CS. (2) The amount of blood loss of postpartum at 24 hours were (480+/-276) ml in group of motherwort, (361+/-179) ml in group of motherwort+oxytocin, (381+/-179) ml in group of oxytocin, which showed significant difference among 3 groups (P<0.01). (3) The incidence of postpartum hemorrhage were 32.0% (47/147) in group of motherwort, 11.1% (16/144) in group of motherwort+oxytocin, and 18.8% in (28/149) in group of oxytocin. When comparing the lowest rate of postpartum blood loss in group of motherwort+oxytocin and the highest rate in group of motherwort, it displayed statistical difference (P<0.01). (4) The decreased level of RBC and Hb were shown that RBC (0.3+/-0.5)x10(12)/L and Hb (9+/-13) g/L in group of motherwort, RBC (0.2+/-0.4)x10(12)/L and Hb (6+/-10) g/L in group of motherwort+oxytocin and RBC (0.2+/-0.4)x10(12)/L and Hb (7+/-30) g/L in group of oxytocin respectively. However, the comparison of different value of RBC and Hb in group of oxytocin and motherwort+oxytocin showed significant difference (P<0.05). (5) Two cases with allery reaction was observed. CONCLUSION: It is safe and efficacious that combined use of motherwort injection and oxytocin was to prevent postpartum hemorrhage during or after caesarian section.