Hypertensive disorder of pregnancy (HDP) is a type of disease unique to women during pregnancy. The most common clinical types are gestational hypertension and preeclampsia, which seriously threaten the health of pregnant women and fetuses. At present, there are no established criteria for the prediction and prevention of HDP. In recent years, a large number of studies have been carried out on HDP around the world, and many studies have shown a close correlation between serum uric acid and HDP. This article reviews the results of existing literature, elucidates the relationship between serum uric acid and the pathogenesis of HDP, prediction of HDP occurrence and development, and adverse pregnancy outcomes.
Objective To assess the efficacy and safety of S-adenosyl-l-methionine (SAMe) for outcome improvement of intrahepatic cholestasis of pregnancy. Methods Randomized controlled trials (RCT) and quasi-randomized controlled trials were identified from MEDLINE (1983 to 2003), The Cochrane Library (Issue 4,2003), EMBASE (1980 to 2003), China Hospital Digital Library (CHDL) and Wanfang data (1994 to 2003). We also handsearched the relative references. Two researchers evaluated the quality of the trials and extracted the data independently. RevMan software 4.2 was used for meta-analysis. Results Eight studies involving 424 pregnant women were included. The following data were the results of meta-analysis of SAMe for improvements: ① Reducing cesarean-section ratio: no significant difference was seen between SAMe and placebo groups with OR 1.00, 95%CI 0.23 to 4.33 and P= 1.00; significant differences were seen SAMe versus dexamethasone and SAMe versus Dianglining with OR 0.44, 95%CI 0.23 to 0.85 and P=0.01; OR 0.28 95%CI 0.10 to 0.75 and P=0.01 respectively。② Prolonging the period of pregnancy: SAMe had no significant difference compared with placebo groups with WMD=0.70, 95%CI －0.69 to 2.10, P=0.32. SAMe was more effective than dexamethasone, Ganyinling and Qianglining on prolonging the period of pregnancy with WMD=1.10，95%CI 0.46 to 1.74, P=0.000 07; WMD=2.50，95%CI 1.86 to 3.14, P≤0.000 01; WMD=2.20，95%CI 1.61 to 2.79, P≤0.000 01 respectively；③ Increasing the weight of the newborn: meta-analysis showed that SAMe group had not significant difference compared with placebo group on increasing the weight of the newborn with WMD=-26.27，95%CI -338.35 to 285.82, P=0.87. Significant differences were seen between SAMe and dexamethasone, SAMe and Ganyiling, SAMe and Qiangling with WMD=386.86，95%CI 134.41 to 603.31, P=0.002; WMD=410.00,95%CI 321.10 to 498.90, P≤0.000 01 respectively. ④ Fetal distress: There was no significant difference compared with dexamethasone and Kuhuang groups on decreasing the fetal distress with OR=0.47, 95%CI 0.14 to 1.16, P=0.23; OR=0.44, 95%CI 0.10 to 1.97, P=0.29 respectively; ⑤ Decreasing pollution of amniotic fluid: no significant differences were seen in SAMe versus dexamethasone, SAMe versus ursoddeoxycholic and SAMe versus Kuhuang with OR=0.46, 95%CI 0.21 to 1.02, P=0.06; OR=0.68, 95%CI 0.20 to 2.31, P=0.53; OR=0.82 95%CI 0.24 to 2.81,P=0.75 recpectively. ⑥ Newborn stifile: SAMe group had no significant difference compared with dexamethasone and Kuhuang groups on decreasing the Newborn stifile with OR=0.19, 95%CI 0.01 to 4.06, P=0.29; OR=0.31, 95%CI 0.08 to 1.13, P=0.08 respectively. Compared with Qianglining group, SAMe group had better effect on reducing ratio of newborn stifile with OR=0.09, 95%CI 0.02 to 0.42, P=0.002. ⑦ Improving Apgar scores: no significant differences were seen between SAMe and placebo, dexamethasone and ursoddeoxycholic with OR=0.25, 95%CI 0.02 to 3.04, P=0.28; OR=2.09, 95%CI 0.70 to 6.27, P=0.19; OR=1.22, 95%CI 0.35 to 4.19, P=0.75 respectively. Six RCTs mentioned the side effects of S-adenosy-l-methionine, only one RCT reported mild gastrointestinal irritation. Conclusions SAMe is partly effective on improving the pregnancy outcomes of intrahepatic choletasis of pregnancy, such as reducting cesarean-section ratio, prolonging the period of pregnancy and increasing the weight of the newborn. The specified efficacy and safety of SAMe require rigorously designed, randomized, double-blind and placebo-controlled trials to offer evidence.
ObjectiveTo observe and analyze the risk factors of retinopathy in patients with hypertension in pregnancy.MethodsA retrospective clinical study. From January 2018 to December 2019, 260 patients with hypertension during pregnancy who were hospitalized in the Obstetrics Department of the Third Affiliated Hospital of Guangzhou Medical University were included in the study. All patients underwent fundus color photography examination. Their age, gestational age, course of hypertension, past history, number of pregnancy and childbirth, pre-pregnancy body mass index (BMI) and laboratory blood routine, alanine aminotransferase, aspartate aminotransferase, and urea Nitrogen, creatinine, uric acid, serum albumin concentration, and 24-hour urine protein concentration and urine protein content examination results were collected. Among the 260 patients, there were 60 and 200 patients with or without retinopathy in the fundus, respectively. Patients were divided into retinopathy group and no retinopathy group. The comparison of quantitative data between groups was performed by independent sample t test; the comparison of grade data was performed by Mann-Whitney U nonparametric test. The variable with statistical difference between the two groups was the independent variable, and the two-class logistic regression analysis was performed.ResultsGestational week (t=4.875), pre-pregnancy BMI (t=2.779), highest systolic blood pressure (t=－4.799), lowest systolic blood pressure (t=－4.797), highest diastolic blood pressure (t=－4.226), minimum diastolic blood pressure (t=－4.226), low and high platelet values and their fluctuations (t=7.701, 2.504, －6.083), serum albumin concentration (t=13.255), aspartic acid transaminase (t=－2.272), urea nitrogen (t=－5.117), creatinine (t=－2.735), uric acid (t=－2.130), 24-hour urine protein concentration (t=－7.801) and 24-hour urine protein (t=－7.567) were compared. The difference was statistically significant (P＜0.05). Logoistic regression analysis showed that pre-pregnancy BMI, maximum systolic blood pressure, low platelet value, and serum albumin were related to the occurrence of retinopathy of hypertension in pregnancy (P＜0.05).ConclusionHigh systolic blood pressure, low platelets, and low serum albumin are the risk factors for the occurrence of retinopathy of hypertension in pregnancy.
ObjectivesTo systematically review the efficacy and safety of local endometrial mechanical stimulation in patients with recurrent embryo implantation failure in vitro fertilization.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases were electronically searched to collect clinical controlled studies on the efficacy and safety of local endometrial mechanical stimulation in patients with recurrent embryo implantation failure from inception to March 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 10 studies, including 8 randomized controlled trials and 2 case-control studies, and involving 1 274 patients were included. The results of meta-analysis showed that: the clinical pregnancy rate of endometrial mechanical stimulation group was higher than that of control group (RR=1.40, 95%CI 1.04 to 1.89, P=0.03). However, no significant differences were found in implantation rate (RR=0.75, 95%CI 0.50 to 1.13, P=0.17), live births rate (RR=1.38, 95%CI 0.99 to 1.93, P=0.06), miscarriage rate (RR=0.83, 95%CI 0.55 to 1.24, P=0.36) and rate of multiple pregnancy (RR=0.90, 95%CI 0.61 to 1.35, P=0.63).ConclusionCurrent evidence shows that, for patients with repeated implantation failure, mechanical endometrial stimulation before re-transplantation may help to improve the clinical pregnancy rate of test-tube infants, however, it has no significant effects on implantation rate, live birth rate, abortion rate, multiple pregnancy rate and ectopic pregnancy rate. Due to limited quality and quantity of the included studies, more high quality studies are needed required to verify above conclusions.
ObjectiveTo explore the nursing method for patients with urerine incision pregnancy. MethodsBetween July 2012 and April 2013, 82 patients with uterine incision pregnancy were selected, including 6 with massive haemorrhage after dilatation and evacuation in other hospitals before received in our department. All of the patients underwent arterial chemotherapy infusion and embolization; dilatation and evacuation was performed under the monitoring of B-scan ultrasound; and the patients received intensive care. ResultsAll of the 82 patients with uterine incision pregnancy were cured via proper treatment and care. ConclusionUterine artery embolization is an effective treatment method for pregnancy incision, which has advantages like minimally invasion, quick effect, and uterus preservation. Strengthen psychological care and close observation of the disease, as well as health guidance are important for the success of incision pregnancy treatment.
ObjectiveTo compare the clinical efficacy of methotrexate perfusion combined with interventional treatment and the traditional treatment with methotrexate and mifepristone for cesarean scar pregnancy. MethodA total of 589 patients diagnosed with cesarean scar pregnancy after surgery between January 2012 and March 2015 in our hospital were selected to be our study subjects. The patients were informed of the two kinds of treatment, and based on their own will, they were arranged into corresponding groups. Group A had 234 patients who were willing to undergo the conventional therapy:intramuscular injection of methotrexate (20 mg, once per day for 5 days); oral mifepristone (50 mg once per day for 3 to 5 days); and the continuation of drugs was determined by local pregnancy tissue blood flow on B ultrasound and liver function of the patients. Group B had 255 patients who selected uterine artery perfusion and arterial embolism. There was no significant difference in terms of age, serum human chorionic gonadotrophin (HCG) and uterine incision gestation sac size between the two groups of patients (P>0.05). Then we compared the treatment effect between the two groups. ResultsThe differences in the amount of bleeding, the time of blood HCG dropped to normal, and hospitalization duration between the two groups were significant (P<0.05), while in the rate of hysterectomy, drug-induced liver injury were not (P<0.05). ConclusionsMethotrexate perfusion combined with interventional treatment is better than the traditional treatment with methotrexate and mifepristone for cesarean scar pregnancy in terms of clinical efficacy and safety.
Objective To investigate the adverse pregnant outcomes of hospitalized pregnant women in Lanzhou city, and analyze the corresponding risk factors and provide basis for the further research on better child-bearing and child-rearing. Methods In two provincial-level hospitals and one provincial-level specialized hospital, the method of cluster random sampling was applied to extract 6 825 medical records from January 2004 to December 2005. The relevant information was abstracted and correlative analyses were undertaken. Results The incidence of adverse pregnancy outcomes for the hospitalized pregnant women in Lanzhou city was 14.65%. Single-factor unconditional logistic regression analyses displayed that the variables with statistical significance were the number of previous pregnancies, the number of previous child delivery, abortion history, abnormal gestation history, and past medical history, whereas multi-factor unconditional logistic regression analyses revealed that the adverse pregnancy outcomes were positively correlated with abnormal gestation history and the number of previous pregnancies with statistical significance. Conclusion The incidence of adverse pregnancy outcomes for the hospitalized pregnant women in Lanzhou city is quite high. Abnormal gestation history and the number of previous pregnancies are the main risk factors for the adverse pregnancy outcomes.
Objective To summarize the characteristics and management of pregnancy complicated with aortic dissection, and to explore the reasonable diagnosis and treatment plan. Methods The clinical data of 10 patients of pregnancy complicated with aortic dissection in Wuhan Tongji Hospital from January 2011 to June 2017 were collected. Their age was 25.2 (21-29) years. Results In the 10 patients, the majority (8 patients) were primipara, and most of them were in the late stages of pregnancy (5 patients) and puerperal (4 patients). Among them, 1 patient had gestational hypertension, and the blood pressure of the left and right upper extremities was significantly abnormal (initial blood pressure: left upper limb blood pressure: 90/60 mm Hg, right upper limb blood pressure: 150/90 mm Hg). The major clinical manifestations were severe chest and back pain which happened suddenly, with D-dimmer and C-creative protein increased which may be associated with inflammatory reaction. All patients were diagnosed by thoracoabdominal aortic CTA, including 5 patients of Stanford type A dissection and 5 patients of Stanford type B dissection. In the 10 patients, 1 patient refused surgery and eventually died of aortic rupture with the death of fetus before birth. And the remaining 9 patients underwent surgical treatment, 3 patients of endovascular graft exclusion for thoracic aortic stent graft, 2 patients underwent Bentall operation, 1 patient with Bentall + total aortic arch replacement + vascular thoracic aortic stent graft, 1 patient with Bentall operation combined with endovascular graft exclusion for thoracic aortic stent graft, 1 patient with Bentall + coronary artery bypass grafting, 1 patient of thoracoabdominal aortic vascular replacement. Among them, 1 patient underwent endovascular graft exclusion for thoracic aortic stent graft died of severe postoperative infection, and the remaining 8 patients were discharged from hospital. Nine patients were single birth, among them 5 newborn patients had severe asphyxia, 4 patients had mild asphyxia. Finally, 3 neonates died of severe complications, and the remaining 6 survived. Conclusion The ratio of pregnancy with Stanford type A aortic dissection is far higher than in the general population, the possibility of fetal intrauterine asphyxia is larger, but through active and effective surgical and perioperative treatment, we can effectively save the life of mother and fetus.
ObjectiveTo investigate the effectiveness of the tubal reconstruction after laparoscopic tubal pregnancy operation by comparing with simple laparoscopic tubal pregnancy operation. MethodsBetween May 2007 and May 2010, 63 patients with tubal pregnancy underwent laparoscopic tubal pregnancy operation and tubal reconstruction in 30 cases (trial group) or simple laparoscopic tubal pregnancy operation in 33 cases (control group). There was no significant difference in age, pregnancy time, and position between 2 groups (P gt; 0.05). The tube patency test and hysterosalpingography (HSG) were carried out to evaluate the efficacy. ResultsThe operation was successfully completed in 29 cases of trial group; 1 case had too severe adhesion to receive re-anastomosis and was excluded. The tube patency test showed that the tube was patency in 26 cases of trial group and in 2 cases of control group during operation, showing significant difference (Z=5.86, P=0.00); it was patency in 25 cases of trial group and in 26 cases of control group at 1 month after operation, showing no significant difference (Z=0.48, P=0.63). HSG examination showed tube was patency in 25 cases of trial group and in 2 cases of control group at 2 months after operation, showing significant difference (Z=5.35, P=0.00). After 24 months, intrauterine pregnancy of trial group (n=25, 86.20%) was significantly higher than that of control group (n=19, 57.58%) (χ2=7.72, P=0.01). ConclusionThe reconstruction after laparoscopic tubal pregnancy operation can significantly increase the intrauterine pregnancy rate, and it is better than simple laparoscopic tubal pregnancy operation.
Objective To explore effects of macrophage migration inhibitory factor (MIF) inhibitor ISO-1 on intestinal injury in acute necrotic pancreatitis in pregnancy (ANPIP) rat. Methods Twenty-four pregnant SD rats were randomly averagely divided into three groups: a sham operation (SO) group, an ANP group, and an ANP model plus ISO-1 treatment group (ISO-1 group). A rat model of ANP was induced by the retrograde injection of 5% sodium taurocholate into the biliopancreatic duct. The rats were killed and the inferior vena cava blood and the tissues of pancreas and jejunum were harvested at 12 h after the operation. The serum amylase (AMY), lipase (LIP), diamine oxidase (DAO), interleukin (IL)-1β, and IL-6 levels were measured. The pancreatic and jejunal tissues were taken for the pathological examination scoring. The immunohistochemical method was used to detect the expression of the MIF, nuclear factor (NK)-κB, or tumor necrosis factor (TNF)-α protein. Results ① Compared with the SO group, the serum AMY, LIP, DAO, IL-1β, and IL-6 levels were increased in the ANP group (P<0.050), which in the ISO-1 group were decreased as compared with the ANP group, the DAO, IL-1β, and IL-6 levels had significant differences (P<0.050), but the AMY and LIP levels had no significant differences (P>0.050). ② The pathological points of the pancreas and jejunum tissues were increased in the ANP group as compared with the SO group, which were significantly decreased in the ISO-1 group as compared with the ANP group (P<0.050). ③ The average integrated optical density divide by area of the NF-κB,TNF-α, and MIF were significantly increased in the ANP group as compared with the SO group, which were significantly decreased in the ISO-1 group as compared with the ANPgroup (P<0.050). Conclusions MIF inhibitor ISO-1 could protect intestinal injury in ANPIP rat. It is suggested that MIF is one of mechanisms in ANPIP with intestinal injury and might be correlated with activities of TNF-α and NF-κB.