BACKGROUND:Electronic foetal monitoring (EFM), a method to monitor foetal intrauterine conditions and foetal reserve capacity, is the most extensively used intrauterine monitoring technology in obstetrics. OBJECTIVE:This study aims to compare the Thoth wearable foetal electrocardiogram (foetal ECG [FECG]) monitoring system with a traditional Doppler foetal heart monitoring system before labour to investigate their respective values in clinical application. METHODS:A total of 393 pregnant women admitted to our hospital between 2020 and 2022 participated in this study. They were recruited using the convenience sampling method. We employed a paired design to assess the confusion rate, trend overlap, and foetal heart rate/ECG monitoring consistency, whereas a completely randomised design was used to measure pregnancy outcome indicators. The participants were divided into two groups using a random number table: the Thoth group (n= 196) and the traditional Doppler group (n= 197). Each group was monitored using the corresponding system. RESULTS:The Thoth monitor demonstrated a lower confusion rate compared with the traditional Doppler monitor (0.25% vs 2.04%; χ2= 5.508, P= 0.019). The trend overlap in foetal heart rates was consistently 100%, with 91.2% of readings showing a consistency rate of ⩾ 95%. Additionally, the Thoth monitor recorded a higher cumulative interruption time in the foetal heart rate curve (12.13 ± 2.22 vs 21.02 ± 2.34; t= 18.471, P< 0.001) and more abnormal ECGs (21.21 ± 4.32 vs 18.21 ± 2.91; t= 7.582, P< 0.001) than the traditional Doppler system. CONCLUSION:The Thoth wearable FECG monitor offers several advantages over the traditional Doppler foetal heart monitoring system. These include a reduced confusion rate, more accurate data collection, a lower rate of clinical misjudgement, reduced workload for medical staff, and enhanced comfort during vaginal delivery. The rates of emergency caesarean sections and neonatal asphyxia in the Thoth group were marginally lower than those in the Doppler group, which may be attributed to issues such as ECG disconnection or interference from the maternal heart rate.

Abstract Objective To compare interpretation of prenatal non-stress (NST) pattern between obstetricians and artificial intelligence (AI), and to determine the degree of agreement of AI system. Methods One thousand records of prenatal NST pattern with 20 to 30 minutes were interpreted using AI system, as well as visual interpretation of five obstetricians, to explore the agreement and accuracy of AI system. Weighted kappa was used to assess reliability of AI for interpretation of prenatal NST pattern. Results A total of 967 cases enroll in this study. Moderate agreement (kappa, 0.48) was found among the five obstetricians for FHR pattern during antepartum period. The AI system recognized NST pattern like obstetricians, with a moderate kappa coefficient of agreement of 0.42. When AI was used to assess the strong consistent set of inter-obstetricians, the agreement was high (kappa, 0.75). AI could identify major non-reactive NST pattern, with high sensitivity of 91.67%. A concordant identification was observed 71.76% of preterm cases and 66.05% of term cases. Conclusion Based on the visual interpretation of obstetricians, AI was excellent for antepartum FHR monitoring interpretation, regardless gestational age. Further, AI showed a competitive ability to identify non-reactive NST pattern and the potential avoidance of unnecessary clinical intervention.

Background: This study aims to compare the fetal heart rate (FHR) baseline predicted by the cardiotocograph network (CTGNet) with that estimated by clinicians.Material and methods: A total of 1,267 FHR recordings acquired with different electrical fetal monitors (EFM) were collected from five datasets: 84 FHR recordings acquired with F15 EFM (Edan, Shenzhen, China) from the Guangzhou Women and Children's Medical Center, 331 FHR recordings acquired with SRF618B5 EFM (Sanrui, Guangzhou, China), 234 FHR recordings acquired with F3 EFM (Lian-Med, Guangzhou, China) from the NanFang Hospital of Southen Medical University, 552 cardiotocographys (CTG) recorded using STAN S21 and S31 (Neoventa Medical, Molndal, Sweden) and Avalon FM40 and FM50 (Philips Healthcare, Amsterdam, The Netherlands) from the University Hospital in Brno, Czech Republic, and 66 FHR recordings acquired using Avalon FM50 fetal monitor (Philips Healthcare, Amsterdam, The Netherlands) at St Vincent de Paul Hospital (Lille, France). Each FHR baseline was estimated by clinicians and CTGNet, respectively. And agreement between CTGNet and clinicians was evaluated using the kappa statistics, intra-class correlation coefficient, and the limits of agreement.Results: The number of differences <3 beats per minute (bpm), 3-5 bpm, 5-10 bpm and >= 10 bpm, is 64.88%, 15.94%, 14.44% and 4.74%, respectively. Kappa statistics and intra-class correlation coefficient are 0.873 and 0.969, respectively. Limits of agreement are -6.81 and 7.48 (mean difference: 0.36 and standard deviation: 3.64).Conclusion: An excellent agreement was found between CTGNet and clinicians in the baseline estimation from FHR recordings with different signal loss rates.

电子胎心监护(electronic fetal monitoring,EFM)这一名词是20世纪60年代用来描述监测胎儿心率和宫缩信号技术的自然名称,这一名称将这种技术与先前存在的机械方法区分开来,多用于英语国家;而心分娩力描迹法(car-diotocography,CTG)源于希腊语,多用于非英语国家,但在英国这两个名称可互换使用.

目的 探讨阴道分娩中第二产程时间长短对新生儿脐动脉血气分析情况及影响因素的分析.方法 选择2018年7月到11月江西省妇幼保健院阴道分娩的足月单活胎无妊娠合并症孕妇720例,对其进行回顾性病例对照研究,根据第二产程时间分三组,比较新生儿脐动脉血气结果及各项相关指标的影响.结果 第二产程时间t<1h;1h≤t<2h;t≥2h,比较此三组的新生儿脐动脉血PH值、Apgar评分、新生儿体重、产时出血量、会阴侧切数,前两组之间差异无统计学意义(P>0.05),与第三组比较,新生儿脐动脉血PH值及会阴侧切数差异有统计学意义(P<0.05).结论 第二产程时间过长,尤其是未行会阴侧切术胎头拨露时间长,可影响新生儿脐动脉血气结果,积极处理第二产程,更好的改善母儿结局.

目的 分析硅芯片纳米微流体技术在捕捉孕妇外周血中胎儿有核红细胞(fnRBC)和胎盘滋养层细胞(EVT)的应用效果.方法 选取2018年5月至2019年12月该院产科门诊进行产前筛查的孕妇,利用生物抗原抗体的生化特性辨认,再通过硅芯片纳米微流体技术捕捉最大量的fnRBC和EVT.结果 孕妇平均年龄(36.9±2.8)岁,平均孕周(20.2±2.3)周,在8 mL母体血中,第1次捕捉fnRBC平均个数为(20.6±6.1)个/mL,第2次为(20.4±5.8)个/mL,两次间差异无统计学意义(t=2.362,P>0.05);第1次捕捉EVT平均个数为(67.6±7.9)个/mL,第2次为(67.2±8.2)个/mL,两次比较差异无统计学意义(P>0.05).免疫荧光鉴定fnRBC纯度为(95±2)％,EVT纯度为(93±1)％.结论 通过硅芯片纳米微流体技术能较准确捕捉、分离和识别孕妇外周血液样本中的fnRBC和EVT.

Gestational diabetes mellitus increased the risk of maternal and fetal diseases, such as hypertensive disorder complicating pregnancy, polyhydramnios, macrosomia, shoulder dystocia, fetal malformation, fetal growth restriction, fetal distress, intrauterine fetal death, neonatal hypoglycemia, neonatal hyperbilirubinemia and long-term neonatal complications. The standardized, professional and multidisciplinary management of blood glucose in gestational diabetes mellitus is helpful to reduce the risk of maternal and infant complications. Reasonable intrauterine monitoring is helpful for early detection of fetal abnormalities and appropriate intervention measures.

Pre-eclampsia (PE) is a pregnancy disease that causes maternal death and threatens the health of newborns. Accumulating evidence has revealed the essential roles of long noncoding RNAs (lncRNAs) in the progression of PE. The present investigation determined lncRNA ZEB2 antisense RNA 1 (ZEB2-AS1) expression in PE and looked into the potential role of ZEB2-AS1 in modulating trophoblastic cell functions. Quantitative real-time polymerase chain reaction evaluated gene expression. Western blot analyzed the placental growth factor (PGF) protein level. Cell counting kit-8 and Transwell invasion assays assessed the proliferative and invasive abilities of placental trophoblast cells, respectively. Wound healing assay determined cell migratory potentials. Dual-luciferase reporter assay assessed the targeting relationship among ZEB2-AS1, miR-149, and PGF. Downregulation of lncRNA ZEB2-AS1 was detected in placentas from patients with PE when compared with those from normal pregnancies. Moreover, ZEB2-AS1 upregulation markedly promoted proliferative, migratory, and invasive potentials in HTR-8/SVneo cells, while knockdown of ZEB2-AS1 had the opposite effects. The effects on HTR-8/SVneo cells mediated by ZEB2-AS1 was correlated with the miR-149/PGF axis. These findings indicate that ZEB2-AS1 contributes to PE progression by affecting cell proliferative and invasive capacities via the miR-149/PGF axis in HTR-8/SVneo cells. In sum, we identified that ZEB2-AS1 was a novel aberrantly expressed lncRNA in the placentas of PE patients and lncRNA ZEB2-AS1 modulated trophoblastic cell line HTR-8/SVneo's proliferative and invasive potentials via targeting the miR-149/PGF axis.

1 病例报告 患者,29岁,因孕31+5周,头痛6小时,于2018年7月31日入深圳市人民医院产科.末次月经2017年12月20日,预产期2018年9月27日.停经30+天自测尿hCG(+),孕4+月自觉胎动.孕12+周于外院建立围产保健手册,并定期规律产前检查,建册时基础BP 110/70 mmHg,随机尿蛋白阴性,唐氏筛查低风险,地中海贫血筛查、孕中期彩超筛查及口服葡萄糖耐量试验(OGTT)结果均未提示异常.孕18+周产前检查时测尿常规提示随机尿蛋白可疑阳性,其后产前检查时多次复查尿常规均提示随机尿蛋白阴性.2018年5月左右患者无明显诱因出现双下肢水肿,无头痛、眼花、心慌、胸闷等不适;产前检查过程中监测血压未见异常,仅1次随机尿蛋白可疑阳性,未做特殊处理.2018年7月30日22时患者无明显诱因出现剧烈钝性头痛伴胸闷、乏力,无恶心、呕吐、视物模糊等不适,遂急诊呼120;120院前急救接诊时测血压214/106 mmHg,予硫酸镁解痉(5 ～6 g)、硝苯地平5 mg降压治疗后,患者头痛较前缓解,就近送入当地医院,急查血常规:血小板计数(PLT)3×109/L,尿常规:尿蛋白(+++),尿潜血(+++),留置尿管可见酱油色尿液,遂转送我院.

Objective To study the expression and clinical significance of myocardial troponin Ⅰ in cord blood and serum of asphyxia newborn umbilical cord.Methods 79 full-term asphyxia neonates,including 19 cases of suffocation merger myocardial injury and 60 cases of no merge myocardial injury,were selected.The expression of cTnI was detected both in umbilical cord blood and in serum during acute phase progress.100 full-term healthy newborns were selected as a control group at the same time;the cTnI umbilical cord blood was detected.The results of the two groups were compared.Results The cTnI levels in umbilical cord blood and acute phase progress of the no merge myocardial injury group were (0.20±0.12) ng/ml and (0.64±0.15) ng/ml,respectively,with a statistical difference (P ＜ 0.05).The cTnI levels in umbilical cord blood and acute phase progress of the suffocation merger myocardial injury group were (0.51±0.24) ng/ml and (1.18±0.36) ng/ml,respectively,with a statistical difference (P ＜ 0.05).The cTnI level expression in umbilical cord blood of the control group (0.09±0.08) ng/ml,and was significantly lower than those of the mild asphyxia group and severe asphyxia group,with statistical differences (P ＜ 0.05).39 cases had severe abnormal fetal monitor graphics in the asphyxia group,18 cases in the myocardial injury group,and 21 cases in the no merge myocardial injury group,with statistical differences (P ＜ 0.05).Conclusion Abnormal fetal monitor graphics combined with early detection of cTnI in umbilical cord blood is helpful for early detection of asphyxia newborns with myocardial injury,and is useful for early intervention and treatment,so it can reduce the poor prognosis in neonates.

Objective To evaluate the value of glycosylated CD59 in peripheral blood for the diagnosis and treatment of gestational diabetes mellitus (GDM). Methods A total of 300 patients who were examined and delivered in our hospital from January 2016 to October 2017 were randomly selected, including 80 GDM and 20 PGDM. The rest were included in the normal control group. Blood cells (erythrocytes, granulocytes, lymphocytes) were tested for percentage of expression of glycosylated CD59 by FC500 flow cytometry. Comparison between groups was performed using an independent sample t test.The ROC curve was used to assess the predictive value of glycosylated CD59 for the risk of maternal T2DM in GDM. The optimal intercept point was determined by the value corresponding to the maximum value of the Yoden index (sensitivity+specificity-1), and the specificity, sensitivity, positive predictive value, and negative predictive value were calculated.Results The glycosylated CD59 levels in the GDM group and the PGDM group were significantly higher than those in the control group (P＜0.05). The glycosylated CD59 level in the GDM group was lower than that in the PGDM group, and the difference was not statistically significant (P＞0.05). Glycosylated CD59 predicts the area under curve of ROC of GDM was 0.005～0.706. When the glycosylated CD59 value was 92.15％, the sensitivity was 89.20％, the specificity was 90.52％, the positive predictive value was 90.52％, and the negative predictive value was 59.24％. Conclusion By detecting the GCD59 level of peripheral blood cells, it had certain specificity in gestational diabetes prediction and disease monitoring, and it had clinical evaluation value.

Objective By comparing the related factors of placental abruption between Shenzhen and Hunan region,to find out the high risk factors of placental abruption in Shenzhen area,provide a basis for reducing the occurrence of placental abruption.Methods Department of Obstetrics,Shenzhen People's Hospital were selected as the research object in Shenzhen area (research group),Department of Obstetrics,Hunan Provincial Maternal and Child Health Care Hospital were selected as the research object in Hunan area (control group).The clinical data of placental abruption from June 2016 to May 2017 was retrospectively analyzed and summarized in the two hospitals,and the incidence of placental abruption,classification,clinical manifestations,laboratory examination,placental pathology,maternal and infant outcomes,and other related factors were analyzed.Results The incidence of placental abruption in the research group was significantly higher than that in the control group (0.56％ vs.0.19％) (P＜0.05);There were 16 patients (38.1％) with pregnancy complications in the research group,which were significantly more than those in the control group (4 cases,15.4％),with statistically significant difference (P＜0.05).There were 16 patients (38.1％) diagnosed as placental abruption before admission in the research group,26 cases (61.9％) were hospitalized or during childbirth;there were 25 patients (96.2％) diagnosed as placental abruption before admission in the control group,there was statistically significant difference between the two groups (P＜0.05).There were 24 patients with mild anaemia in the research group,which was significantly higher than that in the control group,with statistically significant difference (P＜0.05).The rate of cesarean delivery in the research group was significantly higher than that in the control group (57.1％ vs.30.8％),with statistically significant difference (P＜0.05).There were 12 cases of chorioamnionitis by postpartum placental pathologic examination in the research group,significantly more than that in the control group (1 case),with statistically significant difference (P＜0.05).Conclusion The incidence of placental abruption in Shenzhen area is associated with the high incidence of anemia and infection during pregnancy.We can reduce the incidence of placental abruption in Shenzhen area by correction of anemia in pregnancy,and identifying the possible infection factors in time.