Objective:To analyze and compare the adverse outcomes of women and infants with Preeclampsia (PE) combined with fetal growth restriction (FGR) and the pathological changes of maternal placenta, and explore whether the adverse outcomes of women and infants with PE combined with FGR are worse. In the case of PE pregnant women with FGR, whether the maternal placenta has more serious lesions, and explore the correlation between the severity of maternal placenta lesions and adverse maternal and infant outcomes.Methods:The pregnancy outcomes and maternal placenta pathology data of 148 women with PE who were hospitalized and gave birth in the Obstetrics Department of The Third Affiliated Hospital of Guangzhou Medical University from January 2019 to June 2022 were retrospectively analyzed, and 148 women were divided into two groups according to whether the pregnant women were combined with FGR: The FGR group (44 cases, 29.7%) was the observation group, and the non-FGR group (104 cases, 70.3%) was the control group.Results:(1) There was no significant difference in age and basic body mass index between the two groups. However, the proportion of first-time mothers and previous history of hypertension or FGR in the FGR group were higher than those in the non-FGR group [61.36% (27/44) vs 37.50% (39/104), 11.36% (5/44) vs 2.88% (3/104), 4.55% (2/44) vs 0% (0/104)], (all P<0.05), the difference was statistically significant. (2) The birth weight of newborns in the FGR group was lower than that in the non-FGR group [(1434.6±536.4) g vs (2288.7±976.7) g, t= 5.456, P<0.001], and the difference was statistically significant. The incidence of preterm birth and admission to neonatal department after birth in the FGR group was higher than that in the non-FGR group [79.5% (35/44) vs 50.0% (52/104) and 86.4% (38/44) vs 46.2% (48/104), P<0.001], the difference was statistically significant. (3) The incidence of related maternal complications in the FGR group was higher than that in the non-FGR group, especially the incidence of hypoproteinemia, which was significantly higher in the FGR group than in the non-FGR group [29.6% (13/44) vs10.6% (11/104)] (χ2=8.188, P=0.004). The difference was statistically significant. The incidence of liver and kidney dysfunction and thoracoabdominal effusion in patients with FGR was higher than that in patients without FGR [11.4% (5/44) vs. 3.9% (4/104), 13.6% (6/44) vs. 6.7% (7/104) and 9.1% (4/44) vs. 5.8% (6/104)]. There was no significant difference (P>0.05). (4) The placental weight in the FGR group was significantly lower than that in the non-FGR group [(345.93±101.06) g vs (436.78±125.70) g, t=4.246, P<0.001], and the placental coefficient was higher than that in the non-FGR group. [(0.26±0.09) vs (0.21±0.08), t=3.181, P=0.002], the differences were statistically significant, indicating that the placental hypoplasia of pregnant women with FGR was more significant. (5) The incidence of various placental lesions in the FGR group was higher than that in the non-FGR group, especially the incidence of decidua vascular disease and villus hypoplasia was about 2 times higher than that in the non-FGR group, and the placental lesions in the FGR group were mostly severe or diffuse.Conclusions:The overall incidence of maternal complications in the FGR group was higher than that in the non-FGR group, and the perinatal preterm birth and low birth weight were more serious. The placental lesions in the FGR group were more serious, that is, the incidence of related placental lesions was higher, and the lesions were mainly diffuse or severe. Severe placental pathology is likely to be associated with worse perinatal adverse outcomes.

Objective:To explore the risk and management approach of re-pregnancy and delivery after partial hysterectomy.Methods:Retrospective analysis was made on the patients who underwent partial hysterectomy to retain the uterus for PAS in the Third Affiliated Hospital of Guangzhou Medical University from January 1, 2015 to December 31, 2018.Following up the pregnancy process and outcomes of 12 re-pregnancy cases after the operation, the recurrence of placenta previa and/or PAS, intraoperative blood loss, uterine condition, delivery gestational weeks, complications, delivery mode, neonatal condition and puerperal recovery of these cases were analyzed.Results:1.Among the 12 cases, there are 1 scar pregnancy and 11 intrauterine pregnancies.Most of them had a good early embryo development(including 1 scar pregnancy) except for 1 embryo damage, and there was no embryonic dysplasia.2.Four women chose induced abortion at the first trimester(terminated at 6-8 gestational weeks, including 1 case of scar pregnancy). One woman chose induced labor in the second trimester (terminated at 13+ weeks).3.There were 7 live births (delivered at 36-38 gestational weeks, the mode of delivery was cesarean section, among which 1 case of central placenta previa combined with placenta increta underwent total hysterectomy). All the above operations were successful, the hemodynamics were stable, and no one was transferred to the ICU afterward. There was no obvious abnormality in their newborns, and the postoperative recovery was good.Conclusions:1.Women with PAS who underwent partial hysterectomy to preserve their reproductive function can have a chance of normal pregnancy afterward. 2.There are risks of scar pregnancy, placental abnormities and uterine rupture in the pregnancies after partial hysterectomy. If these pregnancies were to continue, they should undergo close observation by doctors during the entire gestation and delivery.

目的 探讨胎盘绒毛组织中肥胖相关蛋白(fat mass and obesity associated protein,FTO)mRNA和AlkB同源蛋白 5(Alk B homologous 5,ALKBH5)mRNA水平与复发性流产的相关性.方法 选取 2019年12月～2021年1月深圳市中西医结合医院产科接收的98例复发性流产患者为复发性流产组,同期选取正常早孕人工流产者96例作为对照组.比较两组一般资料;采用实时荧光定量PCR(qRT-PCR)法检测两组受试者胎盘绒毛组织FTO mRNA和ALKBH5 mRNA水平;采用Pearson法分析复发性流产患者胎盘绒毛组织FTO mRNA与ALKBH5 mRNA水平相关性;采用单因素及多因素Logistic回归分析影响复发性流产的因素.结果 复发性流产组胎盘绒毛组织FTO mRNA(0.72±0.16),ALKBH5 mRNA(0.64±0.18)水平低于对照组(1.02±0.24,1.01±0.21),差异均有统计学意义(t=10.263,13.185,均P＜0.05).复发性流产患者胎盘绒毛组织FTO mRNA与ALKBH5 mRNA水平呈正相关(r=0.537,P＜0.05).流产次数＞3 次的复发性流产患者胎盘绒毛组织FTO mRNA(0.40±0.12),ALKBH5 mRNA(0.47±0.11)水平低于流产次数 3 次患者(0.86±0.18,0.72±0.14),差异具有统计学意义(t=12.615,8.561,均P＜0.05).单因素Logistic回归分析结果显示,孕囊大小为复发性流产发生的危险因素[OR(95%CI):2.025(1.468～2.794),P＜0.05],FTO mRNA,ALKBH5 mRNA为复发性流产发生的保护因素[OR(95%CI):0.730(0.548～0.972);0.655(0.492～0.873),均P＜0.05].多因素Logistic回归分析结果显示,FTO mRNA和ALKBH5 mRNA为复发性流产发生的独立保护因素[OR(95%CI):0.674(0.519～0.874),0.541(0.392～0.747),均P＜0.05].结论 复发性流产患者胎盘绒毛组织FTO mRNA和ALKBH5 mRNA低表达,二者为复发性流产发生的独立保护因素.

目的 探究脑源性神经营养因子(BDNF)在妊娠糖尿病(GDM)小鼠胎盘中的表达及对小鼠子代宫内生长发育情况的影响.方法 30只雌性小鼠随机分为妊娠对照组(Control组)、GDM组、干预组(BDNF组).采用腹腔注射链脲佐菌素(STZ)法建立GDM小鼠模型.BDNF组每天尾静脉注射BDNF;Control组、GDM组尾静脉注射等量生理盐水,直至孕18d(E18).给药结束后,测定小鼠体质量、空腹血糖(FPG),观察胎盘、胎鼠大体形态;H-E染色观察小鼠胎盘组织病理学改变;检测小鼠胎盘组织氧化应激指标超氧化物歧化酶(SOD)、丙二醛(MDA)含量;qRT-PCR检测胎盘组织表皮生长因子受体(EGFR)、缺氧诱导因子-1α(HIF-1α)mRNA表达;免疫组化染色观察小鼠胎盘组织CD34的表达;Western blot检测胎盘组织BDNF、过氧化物酶体增殖物激活受体(PPARγ)、血管内皮生长因子(VEGF)蛋白表达.结果 与Control组相比,GDM组小鼠体质量、血糖,胎鼠、胎盘质量显著增加,胎盘血管分布紊乱,血管壁变薄,血细胞减少,胎盘迷路层血窦面积显著减少,SOD含量及CD34、BDNF、PPARγ、VEGF显著减少,MDA含量及EGFR、HIF-1α mRNA表达显著增加(P＜0.05);与GDM组相比,BDNF组小鼠体质量、血糖,胎鼠、胎盘质量显著减少,血管分布较整齐,血细胞有所增加,血窦面积明显增加,SOD含量及CD34、BDNF、PPARγ、VEGF显著增加,MDA含量及EGFR、HIF-1α mRNA表达显著减少(P＜0.05).结论 BDNF在GDM小鼠胎盘中表达下调,提高BDNF能够促进胎盘血管生成,改善因高血糖引起的胎盘缺血缺氧,抑制小鼠子代体型过大,降低GDM患者不良妊娠结局.

目的 对胎盘早剥产后大出血采用麦角新碱联合卡前列素氨丁三醇、缩宫素治疗的效果及对血红蛋白水平的影响进行研究.方法 本研究选择了2017年8月至2020年8月之间于深圳市中西医结合医院实施了治疗的84例胎盘早剥产后大出血产妇资料进行分析,将产妇随机分成了对照组(n=42)和观察组(n=42),对照组使用卡前列素氨丁三醇以及缩宫素治疗,观察组在对照组基础上再使用麦角新碱实施治疗,对比两组产妇的第三产程时间、出血时间、各时间段出血量、不良事件出现率以及治疗前后血红蛋白水平.结果 对照组第三产程时间和出血时间均高于观察组,组别数据对比有统计学意义(P<0.05).对照组产后15min、30min、60min以及120min出血量显著高于观察组,组别数据对比有统计学意义(P<0.05).对照组不良事件出现率显著高于观察组,组别数据对比有统计学意义(P<0.05).治疗之前,两组间产妇血红蛋白水平对比无统计学意义(P>0.5);治疗之后,对照组血红蛋白水平低于观察组,组别数据对比有统计学意义(P<0.05).结论 在对胎盘早剥产后大出血产妇实施治疗期间,对其使用麦角新碱联合卡前列素氨丁三醇、缩宫素的治疗方式效果佳,值得推广.