2020年 · 第02卷第03期

Venous thromboembolism (VTE) is a leading cause of maternal morbidity and mortality though with low rates. Compared to non-pregnant women of comparable age, women during pregnancy have five- to ten-fold increased risk of VTE, additional risk factors for VTE during pregnancy include a personal history of thrombosis, the presence of a thrombophilia, cesarean delivery, obesity, hypertension, preeclampsia, autoimmune disease, heart disease, sickle cell disease and multiple gestation. Thus, early clinical evaluation, preferably in peri-conceptional period, is crucial for VTE risk detection and, thus, for prophylaxis decision making. VTE thromboprophylaxis brought significant advantages in pregnancy outcomes and maternal deaths. Common pharmacological and mechanical forms of thromboprophylaxis includes heparin compounds, anti-embolic stockings and intermittent pneumatic compression devices. Low-molecular-weight heparin as first line strategy. Current guidelines or expert opinions on VTE treatment or prophylaxis during pregnancy diverge significantly. High quality research in this area is still needed, and China needs to develop its own VTE guidelines. Importantly, absolute risks and potential benefits of VTE thromboprophylaxis should be evaluated to make the best decisions on VTE screening, prevention, and treatment.

Objective: To investigate whether peroxisome proliferator-activated receptor γ (PPARγ) agonists, rosiglitazone and GW1929, activate the phosphatidylinositol 3-kinase (PI3K)-AKT/protein kinase B pathway and the mitogen-activated protein kinase (MAPK) /extracellular signal-regulated kinase1/2 (ERK1/2) pathway by upgrading the expression of chemerin. Methods: The HTR-8/SVneo trophoblastic cells were cultured in vitro in high glucose concentration (25 mmol/L) to mimic gestational diabetic phenotypes. We transfected small interfering RNA into HTR-8/SVneo cells to silence two receptors of chemerin, that are chemokine-like receptor 1 (CMKLR1) and G protein-coupled receptor1 (GPR1). And recombinant human chemerin, PPARγ agonists (rosiglitazone, 10 μmol/L and GW1929, 10 μmol/L) and PPARγ inhibitor (GW9662, 5 μmol/L) were additionally added to the medium, respectively. The existence of chemerin was verified by immunocytochemistry, and the expressions of PPARγ, chemerin, and its receptors as well as insulin signaling-related factors PI3K, AKT2, and MAPK (ERK1/2) were detected by real time quantitative-polymerase chain reaction and western blot. Results: Chemerin existed in the HTR-8/SVneo cells. Effects of chemerin on PI3K-AKT pathway and MAPK (ERK1/2) pathway were dependent on the density of chemerin. When rosiglitazone and GW1929 were added to the medium, the mRNA levels of PI3K, AKT2, and MAPK1 were upregulated (P < 0.05). Conversely, GW9662 downregulated the mRNA levels of AKT2 and MAPK1 (P < 0.05). Rosiglitazone and GW1929 increased the protein levels of PPARγ, chemerin, CMKLR1 and GPR1 (P < 0.05). Rosiglitazone and GW1929 had no effect on the expression of PI3K p110β and phospho-AKT2 without CMKLR1 (P > 0.05). Meanwhile, the expression of phospho-ERK2 remained unaffected in the absence of GPR1 (P > 0.05). Conclusion: Both rosiglitazone and GW1929 have the effect of improving insulin signaling pathways via upgrading the level of chemerin in high glucose treated HTR-8/SVneo cells.

Objective: This article aimed to compare the peripheral blood flow intensity (BFI) in the maternal right and left kidney in uncomplicated third trimester pregnancies and to study possible associations between parenchymal BFI in the kidneys and maternal, labor and new-born characteristics. Methods: We conducted a prospective cohort study in third trimester pregnancies at Trondheim University Hospital, Norway, from January to April 2018. The BFI in the maternal kidneys was examined with color Doppler ultrasound and the peripheral BFI was calculated using the Pixel Flux-method which is a method based on pixel wise calculation of color in an image. Velocity was coded by the color bar in the ultrasound device. The peripheral BFI was calculated as the product of velocity and area encoded by all colored pixels divided by all pixels within the cortical layer by a software examining the color in each pixel of a standardized region of interest of the renal parenchyma in video-clips through a complete heart cycle. BFI (cm/s) was thus calculated as follows: The primary outcome measure was peripheral BFI in the renal cortex. We also examined associations between BFI in the entire cortex with maternal age, body mass index, blood pressure, pH in the umbilical artery, Apgar score after 5 minutes and birthweight. Results: In all, 51 pregnant women were included in the study, but 17 were excluded, mainly due to movement artifacts from the pulsating aorta, leaving 34 women in the final study population. We found significantly lower BFI in the cortex of the left kidney compared with the right kidney, 0.37 cm/s versus 0.69 cm/s, respectively (P = 0.04). Dividing into regions, the BFI was significantly lower in the proximal 25% of the left renal cortex compared to the corresponding right side (P= 0.01), and in the proximal 50% cortex (P= 0.02), but the differences were not significantly different in the distal 25% (P= 0.06) or in the distal 50% (P= 0.20) of the renal cortex. We observed a significant negative correlation between peripheral BFI in the left kidney and both systolic blood pressure (r = -0.38; P= 0.03) and diastolic blood pressure (r= -0.36; P= 0.04), and no significant correlations between BFI with maternal age, body mass index, blood pressure, pH in the umbilical artery, Apgar score after 5 minutes and birthweight in the left kidney (P > 0.05). We did not observe any significant correlations between BFI in the right kidney and maternal or new-born characteristics (P > 0.05). Conclusion: The BFI in the left renal cortex was lower compared with the right renal cortex, and BFI in the left renal cortex was negatively correlated with blood pressure, but not significantly correlated with maternal age, body mass index or newborn characteristics. We did not observe any significant correlations between BFI in the right kidney and maternal or new-born characteristics.

Objective: This study was aimed to determine the changes in CXCR2 expression in preeclampsia placenta and its correlation with clinical parameters. Methods: Sixty-four gravidas ranging in age from 25 to 42 years referred to the obstetrics unit of the West China Second University Hospital from April 2012 to October 2012 were recruited in this case-control study; women were diagnosed and divided into early-onset preeclampsia group (n= 22), late-onset preeclampsia group (n= 22), and healthy pregnancy group (n= 20). After immunolocalized in human placenta, the levels of CXCR2 protein and messenger ribonucleic acid (mRNA) were detected by enzyme-linked immunosorbent assay and real-time quantitative polymerase chain reaction. Correlations between placental CXCR2 protein expression with systolic blood pressure and lactate dehydrogenase (LDH) in early-onset preeclampsia were examined using Pearson or Spearman’s correlation coefficients. Results: Placental CXCR2 protein and mRNA expression in early-onset preeclampsia was significantly lower than it was in placentas from healthy pregnancy pregnancies and late-onset preeclampsia (P < 0.05). The placental CXCR2 protein expression correlated negatively with systolic blood pressure and LDH in early-onset preeclampsia (r= -0.51, P < 0.05; r=-0.43, P < 0.05). Conclusion: Significant abnormal placental CXCR2 expression in early-onset preeclampsia, and its correlations with some clinical parameters (systolic blood pressure and LDH) were discovered, suggesting that CXCR2 may play a role in the pathogenesis of early-onset preeclampsia.

Objective: To review the literature on long-term neurodevelopmental outcome after fetoscopic laser surgery for twin-twin transfusion syndrome (TTTS). Methods: A literature search in PubMed, Embase, Emcare, Web of Science, Cochrane library, and Academic Search Premier was performed. Inclusion criteria were studies between 2009 and 2019 in TTTS-survivors treated with fetoscopic laser surgery and followed-up after the neonatal period with cognitive developmental tests and neurologic exams. Exclusion criteria were non-English articles and reviews, case reports, letters, and guidelines. Results: Nineteen articles were included. Long-term severe neurodevelopmental impairment (NDI) was reported by seven and ranged from 4.0% to 18.0% with a mean of 9.7% (95% confidence interval (CI): 7.8-11.5). The prevalence of cerebral palsy ranged from 1.6% to 18.2%, with a mean of 5.1% (95% CI: 4.1-6.2). The mean prevalence of minor impairment was 13.7% (95% CI: 11.4-16.0). However, only 78.9% (15/19) studies used a validated neurodevelopmental test. As studies lack uniform definitions of primary outcome, timing of follow-up, inclusion criteria, and methods, adequate comparison is hampered. Conclusion: The prevalence of severe NDI and cerebral palsy after fetoscopic laser surgery for TTTS in the last decade remains stable around 9.7% and 5.1%, respectively. International agreements on primary outcomes, methods, and follow-up are necessary to improve the knowledge of NDI in TTTS-survivors.

The time of birth is a critical determinant of perinatal and long-term outcomes, and even trans-generational effects. Preterm birth is still the leading cause of infant mortality and morbidity. Unfortunately, rates of preterm birth remain high worldwide. Preterm parturition is a complex syndrome, which can be induced by several factors such as infection, cervical pathology, uterine overdistension, progesterone deficiency, vascular alterations (utero-placental ischemia, decidual hemorrhage), maternal and fetal stress, allograft reaction, allergic phenomena, and probably other several unknown factors. The mechanisms responsible for early labor activation have been partially identified and involve receptors, chemokines, and inflammatory cytokines. It is very useful to understand the cellular and biochemical pathways responsible for preterm labor activation to identify, treat, and prevent negative outcome in a timely manner. Researchers and clinicians play a key role in improving biochemical knowledge on preterm delivery, identifying risk factors, and applying multilevel preventive strategies.

Monochorionic dizygotic twin gestation is clinically very uncommon but poses significant antenatal and postnatal complications. Here we review the diagnosis, mechanism, perinatal management, and pregnant outcomes of monochroic dizygotic twin gestation.

During the past decades, early fetal ultrasound and diagnosis have increasingly gained attention in pregnancy care with the development of high-frequency transducers, which make it possible to obtain detailed images of the early fetus and its organs, and thus move part of the anatomy and anomaly scan from the second to the first-trimester. By transabdominal sonography or transvaginal sonography, or a combination of both approaches, it is now able to diagnose a wide variety of fetal abnormalities at 11-13+6 weeks.