2019年 · 第01卷第02期

Placenta accreta spectrum disorders resulting in a series of maternal morbidity and mortality has raised attention worldwide including China. There is an urgent need to confront with the dilemma of less evidenced-based recommendation on management, especially the key issues of controversial topics, including accurate prediction, conservative management with adjunct approaches. Chinese academic society along with international exports are on the way to pursue sensible solutions.

Objective: To describe the outcomes of Stage I twin-to-twin transfusion syndrome among patients treated with expectant management (EM), amnioreduction (AR), or fetoscopic laser occlusion of chorioangiopagous vessels (FLOC). Methods: A cohort of 89 cases was studied. Based on the initial management strategy, patients were classified into three groups: the EM, AR, and FLOC. We assessed perinatal survival to 28 days of age and categorized pregnancy outcomes as good (twin live birth at ≥30.0 weeks), mixed (single fetal demise or delivery between 26.0 and 29.9 weeks), or poor (double fetal demise or delivery at <26.0 weeks). Results: 26 (29.2%) patients underwent EM, 35 (39.3%) underwent AR, and 28 (31.5%) underwent FLOC therapy. Of those managed expectantly, 19.2% experienced spontaneous abortion, 50% progressed in stage, and 30.8% remained stable or regressed. After adjusting for potential confounders including maternal age, nulliparity, placenta location, and recipient maximum vertical pocket, and so on, FLOC therapy and AR were associated with significantly [odds ratio (OR) = 0.09] and borderline significantly (OR = 0.20) reduced risks of poor pregnancy outcomes and of no survivors to 28 days of age after birth (OR = 0.04 and OR = 0.20, respectively) compared with EM. Conclusion: About 70% of those treated with EM progressed in stage or experienced fetal loss. Compared to EM, intervention may decrease the risk of poor pregnancy outcomes and improve the perinatal survival rate.

Objective: To investigate thyroid-stimulating hormone (TSH) levels and thyroid peroxidase antibody (TPOAb) in early pregnancy and to estimate the risk of development of gestational diabetes mellitus (GDM). Methods: The levels of TSH, free thyroxine, free triiodothyronine, and TPOAb were retrospectively evaluated in 2333 pregnant women. All women recruited were divided into groups of TSH high (H), TSH low (L), TSH (H) TPOAb positive (+), TSH (H)TPOAb negative (－), TSH normal (N)TPOAb (+), TSH (L)TPOAb (+), TSH (L)TPOAb (－), and estimated the risk of GDM. Results: TSH level (X2=13.0024, P= 0.0015) and TSH combined TPOAb (X2=20.0038, P= 0.0012) were correlated to development of GDM. The level of TSH in 95 women was increased, and in 216 women were decreased. Of the 2333 pregnant women, 546 patients were diagnosed with GDM, with a prevalence of 23.40%. The prevalence of GDM was 35.78% and 28.70% for the TSH high (H) and TSH low (L) pregnant women, respectively. The increased TSH (P= 0.0013, odds ratio: 2.09, confidence interval:1.34-3.28) was correlated to increase GDM incidence. TSH (H) TPOAb (+) (n = 29), TSH (H) TPOAb (－) (n = 58), TSH normal(N) TPOAb (+) (n= 265), TSH (L) TPOAb (+) (n= 30), TSH (L) TPOAb (－) (n = 154) were in this study. The prevalence of GDM was 51.72%, 29.31%, 23.02%, 26.67%, and 29.87% for the TSH (H) TPOAb (+), TSH (H) TPOAb (－), TSH (N) TPOAb (+), TSH (L) TPOAb(+), and TSH (L) TPOAb (－) pregnant women, respectively. Only the TSH (H) TPOAb (+) pregnant women had a significant higher incidence of GDM (P= 0.0018, odds ratio: 3.63, confidence interval: 1.62-8.16). Trimester specific results showed that only second trimester had higher GDM risk either analyze TSH or the combination of TSH and TPOAb. Conclusion: Elevated TSH level and TPOAb positive in the second trimester of pregnancy were correlated to an increased risk of GDM.

Proper development of the human placenta is of vital importance for a successful pregnancy, and a series of pregnancy complications are considered originating from dysfunctional placentas. Like other organ system development, placentation requires large numbers of co-regulators, while the underlying molecular mechanisms orchestrating the placental formation and function are poorly understood. Although we have made many signs of progress in understanding the placental architectures and developments using mouse models, the species-specific differences impede our progress due to the lack of appropriate model systems. In the past few years, major progress has been made by the establishment of novel in-vitro self-renewing stem cell models, as well as identifying the full picture of the cellular organization of the maternal and fetal interface. Providing the tools for the investigation of placentation and reproductive-related regulation mechanism. In this review, we focus on the detailed progress of the human trophoblast stem cells culturing system, and the cellular and molecular terrain at the maternal-fetal interface, respectively, thus providing new insights into placental development.

The tissue stiffness is always an interesting issue to clinicians. Traditionally, it is assessed by the manual palpation, and this now can be measured by the ultrasound-based elastography. The basic physics is based on Young’s modulus through the Hooke’s law: E= S/e, where the Young’s modulus (E) equals to the stress applied to the object (S) divided by the generated strain (e). With the rapid advancement of technology, the elastography has evolved from quasi-static elastography (ie, strain elastography) to dynamic elastography (i,e, shear wave elastography). The key differentiation of these two categories roots in the stimuli applied, namely mechanical or acoustic radiation force, and the response of the soft tissue. The strain elastography requires the operator to compress and decompress the tissue manually and the motion of the tissue during the stimuli is tracked to calculate the strain to reflect the tissue stiffness. While strain elastography is operator-dependent, shear wave elastography is not. Using shear wave elastography, the tissue is stimulated by the acoustic radiation force which can generate shear wave traveling through the tissue transversely. The shear wave propagation speed (Vs) is related to the shear modulus (μ) of the medium: μ= ρVs2, where ρ is the density of the tissue and assumed to be a constant as 1000 kg/m3. In the incompressible biological tissue, the Young’s modulus is approximately three times the shear modulus (E≈3 μ). So the quantitative measurements of the tissue stiffness can be attained by shear wave elastography. The clinical application of elastography and its diagnostic capability has been extended. The knowledge of the basic physics of the various type of elastography facilitates the effective use of elastography. This review presented the clinical application and the risks of different types of elastography.

This review is to better clarify the role of ultrasonography during pregnancies complicated with gestational diabetes mellitus (GDM). It will focus on the effect of GDM on pregnancy, and the use of ultrasound modality to estimate fetal size and accordingly the mode of delivery. It will also shed light on how this technology can be used to improve our understanding of the pathophysiology of this diagnosis and hopefully improve the maternal-fetal outcome.

Gestational diabetes mellitus (GDM) is associated with long-term maternal and fetal adverse outcomes. Recent evidences suggest GDM increases long-term maternal cardiovascular disease, chronic kidney disease, and cancer risks. Maternal hyperglycemia is associated with offspring obesity, overweight, insulin resistance, and neurocognitive development. It remains unclear whether treating mild GDM would reduce long-term maternal and fetal adverse effects.

Congenital syphilis (CS) is a significant public health problem worldwide. The majority of cases of CS are caused by in utero transmission. The World Health Organization launched the global elimination of CS initiative with the goal of reducing mother-to-child transmission of syphilis. The risk for CS is mainly related to three factors: (1) high maternal prevalence, (2) low coverage of antenatal care services, and (3) treatment failure. The long-acting penicillin preparations such as benzathine penicillin G are the preferred therapies for maternal syphilis. There are several challenges in preventing CS from both pregnant women and their health care providers. These problems include that prenatal care lack or delay, syphilis management flaws from health care providers, lacks of basic information, and awareness about maternal syphilis and CS by public. Many efforts have been made to solve the problems. These include that dual elimination of mother-to-child transmission (EMTCT) of both human immunodeficiency virus (HIV) and syphilis or triple EMTCT of HIV, syphilis and hepatitis B, World Health Organization country validation of EMTCT of syphilis and HIV, set up a CS case review board and a National Day to combat syphilis and CS.

Where required, abstracts are limited to 500 words, which is excluded from the overall manuscript word count. The abstract is unstructured and should briefly describe: (1) the problem being addressed in the study, (2) how the study was performed, (3) the salient results, and (4) what the authors conclude from the results.