目的 探索临床指标联合MRI征象评估胎盘植入谱系疾病(placenta accreta spectrum,PAS)高危患者术中子宫切除风险的价值.材料与方法 回顾性分析251例妊娠晚期(32周以上)PAS高危孕妇的MR图像及临床资料,包括64例子宫切除患者及187例子宫保留患者,对相关临床指标及MRI征象进行单因素及多因素分析,构建预测PAS高危患者子宫切除风险Logistic回归模型.结果 单因素分析显示,剖宫产次数、前置胎盘、T2WI胎盘内暗带、胎盘膨出、子宫肌层变薄或消失、膀胱壁T2WI低信号中断、局部外突性肿块和子宫浆膜面异常血管在两组之间差异具有统计学意义(P<0.01).Logistic回归分析显示,剖宫产次数(X1)、T2WI胎盘内暗带(X2)、胎盘膨出(X3)、子宫浆膜面异常血管(X4)是PAS高危患者子宫切除的独立危险因素,联合预测模型为Logistic(P)=-4.713+0.960X1+1.477X2+1.569X3+1.901X4,模型AUC值0.915(95％CI:0.873～0.946),敏感度、特异度分别为87.50％、81.82％.校准曲线显示模型校准能力好.结论 基于临床指标及MRI征象,有望产前为PAS高危患者子宫切除风险的评估提供依据,改善患者预后.

Objective:To investigate the clinical features, early diagnosis, and treatment of acute fatty liver of pregnancy (AFLP).Methods:The clinical data of 42 pregnant women with acute fatty liver treated at our hospital from January, 2015 to December, 2019 were collected and analyzed. According to their prothrombin activities (PTA), the patients were divided into a severe group ( n=19), whose PTA value was <40%, and a mild group ( n=23), whose PTA value was ≥40%. The clinical characteristics, laboratory tests, the outcomes of the maternal and fetus were compared between the two groups. Results:There were no statistical differences in the levels of AST, PT, UA, LDH, and NH3 between the two groups (all P>0.05). The levels of AT-Ⅲ, PLT, PTA, Fb, Glu, and ALT were lower and the levels of TBIL, DBIL, WBC, and Cr were higher in the severe group than in the mild group [(38.36±20.03)% vs. (59.16±23.32)%, (139.44±89.69)10 9/L vs. (183.46±79.14)10 9/L, (31.96±7.32)% vs. (93.40±28.96)%, (0.92±0.63) g/L vs. (1.93±1.06) g/L, (3.56±1.09) mmol/L vs. (5.53±1.22) mmol/L, (186.27±169.33) U/L vs. (297.46±168.69)U/L, (172.59±106.61) μmol/L vs. (54.46±46.86) μmol/L, (142.06±79.36) μmol/L vs. (46.39±40.89) μmol/L, (17.59±4.36)10 9/L vs. (11.36±7.69)10 9/L, and (151.49±49.66) μmol/L vs. (119.45±41.69) μmol/L; all P<0.05]. Of these 42 cases with AFLP, 41 cases occurred upper gastrointestinal symptoms. The complications, such as eclampsia, low protein, low glucose, failure of liver and kidney, DIC, and lung infection were more common in the severe group than in the mild group (all P<0.05). Conclusions:AFLP is a severe complication of pregnancy, which occurs in the third trimester of pregnancy and has a high risk for both mothers and fetus. During the clinical procedures, more attention should be paid to the patients in order to make early diagnosis and active treatment; timely termination and plasma exchange can improve the outcomes.

The current study investigated whether placentation and systemic inflammation are associated with pregnancy-induced hypertension (PIH) or pre-eclampsia (PE), and evaluated some measurable indexes for assessment of maternal factors contributing to high-risk pregnancy. Photoplethysmographic reflection index (PPG RI), uterine artery (UtA) pulsatile index (PI) and reflection index (RI), as well as maternal serum placental growth factor (PlGF) and soluble endoglin (sEng) were measured in pregnant women with singleton pregnancy at the gestational age of 22 to 23 weeks. Study subjects were women with normal pregnancy (NP, n=24), PIH (n=14) and PE (n=16). It was found that individuals in the PIH group exhibited higher UtA RI and UtA PI values, as well as PPG RI values compared with individuals in the NP group. Individuals in the PE group had the highest UtA RI, UtA PI and PPG RI values among these 3 groups. UtA and PPG results were significantly different in PIH and PE groups compared with the NP group. Significant differences were found in both PlGF and sEng levels between PIH and PE groups. A strong inverse across-subject correlation was found between PlGF and sEng levels. A weak inverse correlation was found between PlGF and UtA RI, and PlGF and UtA PI. A moderate inverse correlation was found between PlGF and PPG RI. A moderate positive correlation was found between either sEng and UtA RI or sEng and UtA PI. A very strong positive correlation was found between sEng and PPG RI. Taken together, the current results indicated that maternal effects related to cardiovascular adaptation to placentation and systemic inflammation exhibited significant differences between NP and PIH or PE groups. Therefore, assessment of UtA and PPG could be used for identifying high-risk pregnancy.

目的:探讨妊娠中期子宫动脉超声搏动指数(UtA PI)和阻力指数(UtA RI)联合血清胎盘生长因子(Placental growth factor,PlGF)和可溶性血管内皮因子(soluble endoglin,sEng)水平的变化与子痫前期(preeclampsia, PE)发病的相关性.方法:从深圳市人民医院产检建册的孕妇中遴选符合纳入标准的244例用作研究队列;收集妊娠中期(20~24周)的指端容积血流脉动波形描记信号反射指数(PPG RI)、UtA PI和UtA RI以及PlGF和sEng检测数据.根据妊娠结局分为正常对照组、轻度PE组和重度PE组,比较妊娠中期上列指标与PE发病的相关性.结果:244例队列中得到229例有效样本,轻度PE组(14例)和重度PE组(16例)的PPG RI值、UtA PI和UtA RI都大于对照组(199例),组间差异均有统计学意义.并且,重度PE组与轻度PE组比较,差异有统计学意义;同时,轻度PE组和重度PE组的血清PlGF水平显著低于正常对照组,且重度PE组低于轻度PE组;相反,轻度PE组和重度PE组的血清sEng水平显著高于正常对照组,且重度PE组高于轻度PE组.结论:PPG RI、UtA PI和UtA RI与血清PlGF及sEng水平动态变化趋势与后续子痫前期发病及其严重程度相关.

羊水栓塞是一种罕见而危重的产科并发症,严重威胁母婴健康.羊水栓塞的临床过程极其复杂,临床表现多种多样,其病因及发病机制目前尚不十分明确,免疫反应可能是最重要的病理生理机制,过敏反应、炎症反应及补体反应等均参与其中.据此展开的羊水栓塞血清标志物研究对于预测、早期诊断及防治羊水栓塞具有重要的指导意义,但目前尚缺乏成熟的临床应用.

BACKGROUND/AIMS:To investigate whether abdominal aortic balloon occlusion (ABO) effectively reduces intraoperative hemorrhage in patents with placenta previa increta/increta. METHODS:Forty-three women were diagnosed as placenta previa increta/percreta by ultrasound and MRI. These patients' assessments were taken by their chief physician, and they were under necessity of previous cesarean section as confirmed by the committee of experts during consultation. There was no significant difference in disease risk rating between them in whole process. Although our department provided a more appropriate method, 10 of 43 patients chose intraoperative aortic balloon occlusion (IABO). Other 33 patients who refused that suggestion were considered as control group. Fully informed consents were obtained from all patients in this study group. The intraoperative blood loss, blood transfusion, rate of hysterectomy and complications of mothers and fetus of IABO group and control group were analyzed. RESULTS:The median intraoperative blood loss was 1000 ml in the IABO group compared with 2000 ml in the control group (p < 0.05). The median volume of transfused red blood cells was 1100 ml in the IABO group compared with 2000 ml in the control group (p < 0.05). 33.3% (11/33) patients in the control group had hemorrhagic shock, and one of them suffered from cardiac arrest intraoperatively because of severe bleeding. However, none of these serious events occurred in the IABO group (p < 0.05). The hysterectomy rate was 70% (7/10) in the IABO group and 63.3% (21/33) in the control group (p > 0.05). No IABO-related complications were observed in the mother and fetus. CONCLUSION:IABO is an effective and safe method to control intraoperative blood loss and blood transfusion in patients with placenta previa increta/percreta.

BackgroundThere is a well-documented association between prenatally diagnosed chromosomal uniparental disomy and poor pregnancy outcome.Methods and resultIn this study, we identified an intrauterine growth restricted fetus carrying a maternal UPD 16 with segmental hetero- and isodisomy using the Affymetrix CytoScan HD SNP-array and the UPDtool. We also performed FISH to exclude trisomy mosaicism of chr.16. We then explored the genetic mechanisms of how imprinted genes cause clinical abnormalities. Additionally, we reviewed the mUPD16 literature, compared the clinical phenotypes of our patient with other reported cases, and assessed the loss of autosomal-recessive genes in the regions of homozygosity.ConclusionsConsidering UPD mechanism of potential impact on the function of the placenta, the genetic composition of chromosome 16, and the information previous literature reports, we have reason to believe that UPD16 correlates with IUGR.

Objective To investigate the clinical features of acute fatty liver of pregnancy,and to improve the early diagnosis.Methods The clinical data of 13 patients of acute fatty liver of pregnancy from January 2014 to June 2015 were retrospectively analyzed.Clinical manifest,chemical examination and imaging examination were analyzed.Results The lategestation,upper digestive tract symptom,liver,renal and blood clotting function abnormity were common characteristics of all patients of acute fatty liver of pregnancy,but heightened blood ammonia,blood uric acid and leukocytes or decreased blood glucose and ultrasonic sound abnormity appeared only in proportion of these patients.Conclusions Lategestation,upper digestive tract symptom,liver,renal and blood clotting function abnormity are five capital standard of early diagnosis of acute fatty liver of pregnancy;by knowing this,we can diagnose it early and improve the outcome.

Objective: Recurrent spontaneous abortion (RSA) refers to two or more consecutive spontaneous abortions, and its morbidity is about 1%-1.8% of fertile women. It was to study the role of MAPK/ERK signal pathway in the recurrent miscarriage patients by case-control analysis; Methods: It collected 46 RSA patients, without growing of early embryos, which were constituted in patients group. Matched gestational time and women age, it used the normal Pregnant woman at same period as control group. The mRNA expression of were detected by RT-PCR, the protein expression of were detected by western blot. Calculated its value and found that difference; Result: It could be found the average ERK1/2 expression in tissues of VCT, EVCT and DSC were lower in the RAS patients than that of the control group (P<0.05). The expression of protein ERK and P-ERK was consistent with RNA testing results, under western blot testing. ERK and PERK were at lower expression in villi and deciduas, which suggested it had relationship with recurrent miscarriage; Conclusion: The expression of ERK1/2 mRNA and the relative protein expression of ERK in RSA pathway were lower than normal pregnancy, which indicated MAPK/ERK signal pathway participated in the maintenance of normal pregnancy; the decreased expression of ERK is closely related to RSA disease.

目的 探索无创产前基因检测(NIPT)微缺失微重复综合征(MD)阳性病例的产前诊断以及咨询方法.方法 对NIPT筛查MD阳性的病例进行产前超声检查、遗传咨询并进行有创性产前诊断,送检核型分析以及基因芯片(CMA)或者多重连接探针扩增技术(MLPA)检查,验证NIPT的结果,同时抽取双亲血样进行核型分析以及MLPA.结果 2015年1～5月期间送检1191例NIPT检查,9例MD筛查阳性,其中3例MD筛查阳性病例完成验证检查.NIPT提示18q21.31-q23.23处23M缺失的一例病例,经验证为18q22.3-q23处8.6M的微缺失;另一例NIPT提示9p24.3-9p13.2处36M重复的病例,经验证除了该处有37M左右重复外,另外还有两处5M以下的MD.1例证实为假阳性,该假阳性病例母亲血测序发现有微重复.两名证实MD病例超声检查均发现异常,孕妇选择引产.假阳性病例继续妊娠.结论 NIPT可以筛查较大片段的缺失和重复,但对较小的缺失或重复检出能力欠佳,母体背景可以干扰结果.应建议筛查阳性的病例接受有创性产前诊断取样进行验证.

临床资料<br>　　孕妇，28岁，孕2产1，因“停经33周，超声发现胎儿左右心室肿瘤1 d”至产前诊断门诊就诊。孕早期11～13＋6周超声筛查未见异常，未行唐氏筛查或中孕超声检查。外院晚孕超声检查见右心室一11 mm ×6 mm 强回声结节，遂转本院会诊，超声检查胎儿大小与孕周相符，左右心室多个稍强回声光团，最大约18 mm ×13 mm，边界清楚，形态规则，考虑横纹肌瘤（cardiac rhabdomyoma，CR）可能。孕妇既往体健，家族史无特殊。孕妇自述第1胎为足月顺产女婴，外观发育无异常。

特发性婴儿动脉钙化症（idiopathic infantile arterial calcification, IIAC）是一种以心脏瓣膜、大中动脉内弹力层广泛钙化为特征的罕见遗传性疾病。因心脏功能衰竭，85%的患儿在宫内或出生后6个月内死亡[1-2]。国内外文献报道不足200例[3]，其中产前诊断的病例只15例[1,4-14]。国内于1994年首次报道[15]，目前仅报道5例[15-19]，均为产后尸体解剖或出生后由儿科诊断发现。近期深圳市人民医院收治1例经产前诊断的IIAC病例，现报道如下。

Objective To explore the effect of fiber addition approach on glucose tolerance and lipid profiles in pregnant women with gestational diabetes mellitus( GDM),and to discuss the best nutrition treatment for patients with GDM. Methods The multicenter randomized controlled clinical trial was performed among 180 women diagnosed GDM at 24 ~ 28 weeks of gestation.Subjects were randomly assigned to observation group( n = 90) and control group( n = 90),who were given control diet + fiber addition approach or control diet only for 4 weeks. Fasting blood samples were taken at baseline and after 4 weeks of intervention to measure fasting plasma glucose( FPG),2 h postprandial blood glucose,glycosylated hemoglobin( Hb A1c),et al,the perinatal outcomes were also compared between the two groups. Results There were no significant difference in FPG and HDL between two groups after 4 weeks intervention( P 0. 05). 1 /2 h postprandial blood glucose,Hb A1 c,LDL,TC,TG of observation group[( 9. 60± 1. 71) mmol / L、( 7. 90 ± 1. 48) mmol / L、( 4. 40 ± 0. 7) % 、( 3. 19 ± 0. 49) mmol / L、( 5. 62 ± 1. 21) mmol / L、( 2. 09 ± 0. 48) mmol / L respectively]were lower than those of control group [( 10. 30 ± 1. 68) mmol / L、( 8. 90 ± 1. 65) mmol / L、( 4. 80 ± 0. 8) % 、( 3. 56 ±0. 58) mmol / L、( 6. 13 ± 1. 17) mmol / L、( 2. 57 ± 0. 52) mmol / L respectively]( P 0. 05). There was no significant difference in perinatal outcomes between two groups( P 0. 05). Conclusion Consumption of the fibre pattern for 4 weeks among pregnant women with GDM resulted in beneficial effects on glucose tolerance and lipid profiles compared with the control diet.

病例简介患者,38岁,G2 P1,因“停经33周,下腹坠胀1天,阴道流血4h”于2014年3月31日收入院。2013年11月20日孕14周时空腹血糖及糖化血红蛋白均正常范围。2014年2月9日孕26周OGTT提示三点血糖值分别为3.93、9.47、10.63 mmol/L,诊断为妊娠期糖尿病,予饮食控制,孕期监测血糖控制良好。否认既往慢性病史。2005年11月因臀位行剖宫产术。入院检查：生命体征平稳,血压129/84mmHg；胎心：137次/min；偶有不规则宫缩。彩超示：双顶径77mm,头围283mm,腹围261mm,股骨长56mm,脐动脉A/B值>5。入院诊断：(1)G2P1,宫内孕33周单胎；(2)先兆早产；(3)胎儿生长受限；(4)胎盘-胎儿循环不良；(5)妊娠期糖尿病；(6)疤痕子宫。入院后完善相关检查,糖化血红蛋白5.5%,D二聚体(D-dimer,D-D)2179.37ng/ml(参考范围68~494ng/ml),抗凝血酶-Ⅲ57%(参考范围83%~128%),余未见异常。住院期间予硫酸镁等保胎治疗。入院第4天患者出现持续下腹隐痛,伴少量阴道流血,色鲜红,胎心监护提示频发减速,彩超示胎盘早剥可能,行急诊剖宫产术。术中娩出一活女婴,出生后1、5min Apgar均评分10分,重1230g,羊水血性,量约200ml,胎盘与子宫壁之间有约50g陈旧性积血块,胎盘有约2cm×3cm及3cm×3cm两处早剥面,胎盘重290g。胎盘病理报告：可见纤维化及大片梗死,胎膜绒毛膜层可见多量中性粒细胞浸润。手术顺利,术后患者恢复良好。

目的:探讨脐动脉和桡动脉血气分析对羊水Ⅲ度粪染新生儿胎粪吸入综合征(MAS)的预测价值.方法:选择2010年7月至2012年7月无合并症的足月羊水Ⅲ度粪染新生儿100例作为粪染组.随机选择同期分娩的230例足月妊娠无合并症羊水清的新生儿作为对照组.结果:①粪染组脐动脉血pH 7.21±0.11、HCO322.56±3.47 mEq/L都明显低于对照组7.26±0.07、23.83±2.19 mEq/L,差异有统计学意义(P＜0.01).粪染组脐动脉血PaC0 2 55.74±9.96mmHg、BE-5.44±4.62 mmol/L均明显高于对照组52.94±8.01 mmHg和-3.18±2.51 mmol/L,差异有统计学意义(P＜0.01).②桡动脉血pH＜7.30新生儿MAS发生率为73.08％,与桡动脉血pH ≥7.30新生儿MAS发生率22.97％比较,差异有统计学意义(P＜0.01).以桡动脉血pH＜7.30为异常指标预测MAS发生的阳性预测值为73.08％,敏感性52.77％,特异性89.06％.③粪染组新生儿缺氧缺血性脑病(HIE)6例,均显示脐动脉血pH＜7.10且桡动脉血pH＜7.30.结论:桡动脉血pH＜7.30对预测MAS发生有一定的价值.羊水Ⅲ度粪染胎儿缺氧发生几率明显增高.脐动脉血气pH ＜7.10且桡动脉血pH＜7.30的新生儿发生HIE几率明显升高.

Aim:To study the clinical characteristics of pregnancy combined with epidemic hemorrhag-ic fever (EHF)and the prognosis of the mother and fetus,in order to provide data for clinical diagnosis and therapy of the disease.Methods:7 cases of EHF with pregnancy were analyzed for clinical symp-toms and characteristics.Laboratory tests were carried out for prognosis of the mother and fetus.Results:6 cases exhibited fever symptoms and 5 cases had abnormal bleeding.Laboratory tests showed that all of the 7 cases had thrombocytopenia,coagulation abnormalities,prolonged APTT and TT,elevated activities of liver enzymes,hypokalemia and positive EHF-IgM test.Prognosis:4 of the mothers had fully recov-ered,2 had renal function abnormalities and 1 was dead;2 babies were found healthy,1 premature baby suffered from congenital heart disease and necrotizing enterocolitis,3 fetus were found dead after 7,24, and 27 weeks of gestation,respectively,1 fetus lost contact after 22 weeks of gestation.Conclusion:The mortality is high for both mothers and fetus.Fever and hemorrhage were the main clinical features. Thrombocytopenia,coagulation abnormalities,elevated liver enzyme activities and hypokalemia were the clinical characters of EHF with pregnancy.EHF-IgM is the necessary test for diagnosis.

Objective:To discuss the occurrence and treatment of the perioperative bleeding and serious complications of scar uterus complicated with central placenta previa;and introduce the effect of a new technology of aortic balloon occusion to control intra-operative hemorrhage. Methods:Between Jan. 2005 to Nov. 2013,97 patients of scar uterus complicated with central placenta previa delivered in our hospital,which were divided into 3 groups accord-ing to the placenta attachment:placenta increta group ( 39 cases ) , placenta accreta group ( 18 cases) ,and normal group(40 cases) . 5 patients in placenta increta group accept aortic balloon occlusion during operation to control blood lost. The rate of prenatal bleeding,volume of blood lost intra/peri-operation and transfusion of RBC, serious complications, maternal and neonatal prognosis was analyzed. Results:(1)The rate of prenatal bleeding was 43. 6% in placenta in-creta group,lower than placenta accreta group(67. 7%,P<0. 05)and normal group(75. 5%,P<0 . 05 ) . There was no significance between the late two groups ( P>0 . 05 ) . The average intra-operative blood lost was (1990±1226)ml in placenta increta group,(950±300)ml in placenta accreta group and (625±383)ml in normal group. There was statistically different among each groups (P<0. 01 ). The average peri-operative blood loss was (2208±1409)ml in placenta in-creta group,(1189±822) ml in placenta accreta group,(773±554) ml in normal group. There was statistically different among each groups(P<0. 01). 37 cases(94. 9%) in placenta increta group,16cases(88. 7%) in placenta accrete group and 23 cases(57. 5%) in normal group need blood transfusion. The average volume of RBC transfusion in placneta increta group was (2005±1198)ml,significantly higher than accreta group[(963±393)ml,P<0. 01)]and normal group[(1091±833) ml,P<0. 01]. There was no statistical difference between the later two groups(P>0. 05). (2)The blood lost of the 5 cases in placenta increta group who accept aortic balloon occlusion was much less than the other 34 cases who refused aortic balloon occlusion (media 1000ml vs 2000ml,P<0. 01). (3)26 cases(66. 7%)in placenta increta group and 1 case in accreta group had hysterectomy. ( 4 ) No maternal death. 1 patient in placenta increta group who lost 6000ml blood intra-operation, and underwent cardiac arrest, was successfully saved. 1 serious asphyxia neonate (29 weeks of gestational age) died,all other newborns were healthy. Conclusions:Patients of scar uterus complicated with central placenta previa, have a high rate of placenta increta. The rate of massive blood loss intra/peri operation and hysterecto-my is high. Large volume blood transfusion should be prepared before operation. Aortic balloon occusion is an effective measure to contorl blood lost intra-operation.

OBJECTIVE:Normal pregnancy is characterized by maternal hemodynamic adaptations of cardiovascular system and uterine artery. We aimed to investigate quantitatively the relationship between uterine artery Doppler (Ut AD) ultrasonography and finger photoplethysmography (PPG) in each of the three trimesters.METHODS:Eighty normal pregnancy subjects were recruited from the nulliparous women with uncomplicated singleton pregnancy presenting for a routine ultrasound scan and divided into three groups according to their trimester. Comparative analysis were conducted between Ut AD ultrasonography and finger PPG within and across trimesters, particularly with focus on the relationship between Uterine Artery Resistance Index (UtA RI) and photoplethysmographic reflection index (PPG RI) throughout pregnancy. Additional 10 preeclampsia patients in third trimester were enrolled for comparison.RESULTS:Both UtA RI and PPG RI were markedly decreased with gestation in normal pregnancy and generally consistent with each other in trend. The preeclampsia patients of third trimester were significantly higher in both indices, even more than normal pregnancy subjects of first trimester.CONCLUSIONS:The results of this study revealed clear relationship between UtA RI and PPG RI throughout pregnancy which could be exploited to enhance the potential ability in early recognition of pathophysiologic process in maternal adaptation and prediction of complicated pregnancy.

目的 体外模拟子痫前期胎盘缺氧的低氧环境培养滋养细胞,研究低氧对滋养细胞骨桥蛋白(osteopontin,OPN)表达的影响,以进一步深入研究OPN在子痫前期发病机制中的作用.方法 利用气体混配缺氧装置(QT-MTX-3)模拟子痫前期的发生发展过程,配置不同氧浓度,采用细胞免疫组化和实时荧光定量PCR检测人胎盘绒毛膜癌滋养细胞系BeWo细胞在不同氧浓度下OPN蛋白及其mRNA的表达.结果 ①在不同氧浓度的环境下,显微镜观察BeWo细胞的生长情况,发现其对低氧反应敏感,细胞形态发生明显的改变.②细胞免疫组化检测结果显示:OPN在各组BeWo细胞中均有表达,其免疫反应产物主要表达定位于胞质和胞膜中;缺氧24 h各组的OPN蛋白表达无明显变化;但低氧48 h后,低氧组OPN蛋白的表达水平均明显下降,且2%O2组OPN蛋白下降更显著.③实时荧光定量PCR检测结果表明低氧对滋养细胞OPN mRNA的表达影响呈现出浓度时间依赖性,即随着氧浓度的降低和低氧时间的延长,OPN mRNA的表达呈显著下降趋势.结论 低氧使BeWo细胞OPN的表达降低,且呈浓度时间依赖性,类似于OPN在子痫前期胎盘组织的表达随病情加重而进一步降低,这可能是子痫前期胎盘中缺氧对滋养细胞功能影响的重要机制之一.

Objective To evaluate the expression of placental vascular endothelial growth factor of twin pregnancies with selective intrauterine growth restriction (sIUGR) and its high risk factors.Methods There were 590 cases of twins delivered in Shenzhen People' s Hospital,including 42 cases of monochorionic diamnionic (MCDA) twins with sIUGR (case group) and 47 cases of dichorionic (DC) twins with sIUGR (control group A).Other 42 cases of MCDA twins without IUGR(control group B) were randomly selected.Placental weight and cord insertion were recorded at deliveries.The expression of vascular endothelial growth factor (VEGF) in human placenta was evaluated by immunohistochemistry.Results The incidence of perinatal death in the case group was higher than that in the control group (17.8％ vs 6.4％ vs 1.2％,P ＜ 0.01).The rate of velamentous cord insertion were 48.8％,10.6％ and 14.3％ in the case,control A and B groups,respectively (P ＜ 0.01).The mean placental weight of the big and small twins were (521 ± 149)g vs (258 ± 53)g in the case group.As for the sIUGR cases,the expression of VEGF in the placental tissue at the big babies' share were much higher than those of the small ones'.Conclusion The perinatal mortality was higher in MCDA sIUGR twins than those in DC twins or uncomplicated MC twins.The risk factors of MCDA sIUGR include unequal placental sharing,velamentous cord insertions and low expression of placenta VEGF.