孕晚期女性阴道菌群与妊娠结局的相关性

分析不同妊娠结局女性孕晚期阴道菌群,探索阴道菌群变化与妊娠结局的相关性。

收集厦门市第五医院收治的妊娠期女性阴道分泌物,筛选排除后,纳入不良妊娠组14例,正常妊娠组17例。采用高通量测序法对阴道菌群16S rDNA V3−V4区进行测序;采用QIIME2软件分析阴道菌群的组成和多样性指标;采用PCoA主坐标分析菌群β多样性差异;采用LEfSe比较不同妊娠结局女性阴道微生物差异,获得具有统计学意义的菌群标志物,并对差异菌群做相关性分析。

在菌群组成方面,厚壁菌门、乳杆菌属比例在正常妊娠组中显著增加,放线菌门、双歧杆菌属比例在不良妊娠组中显著升高（均P＜0.05）。在多样性方面,两组的α多样性差异无统计学意义（P＞0.05）,正常妊娠组β多样性较高,不良妊娠组的菌群相似度较高（均P＜0.05）。LEfSe分析结果显示,正常妊娠组阴道乳杆菌属丰度显著升高,不良妊娠组加德纳菌属、双歧杆菌属和梭菌目丰度显著增加。相关性分析表明,乳杆菌目与梭菌目比例呈负相关。

与正常妊娠组相比,不良妊娠组女性阴道菌群存在多样性下降、乳杆菌丰度下降的趋势,同时双歧杆菌、加德纳菌、梭菌等厌氧菌丰度增加。

     

Reduced progesterone metabolites in human late pregnancy

In this review, we focused on the intersection between steroid metabolomics, obstetrics and steroid neurophysiology to give a comprehensive insight into the role of sex hormones and neuroactive steroids (NAS) in the mechanism controlling pregnancy sustaining. The data in the literature including our studies show that there is a complex mechanism providing synthesis of either pregnancy sustaining or parturition provoking steroids. This mechanism includes the boosting placental synthesis of CRH with approaching parturition inducing the excessive synthesis of 3beta-hydroxy-5-ene steroid sulfates serving primarily as precursors for placental synthesis of progestogens, estrogens and NAS. The distribution and changing activities of placental oxidoreductases are responsible for the activation or inactivation of the aforementioned steroids, which is compartment-specific (maternal and fetal compartments) and dependent on gestational age, with a tendency to shift the production from the pregnancy-sustaining steroids to the parturition provoking ones with an increasing gestational age. The fetal and maternal livers catabolize part of the bioactive steroids and also convert some precursors to bioactive steroids. Besides the progesterone, a variety of its 5alpha/beta-reduced metabolites may significantly influence the maintenance of human pregnancy, provide protection against excitotoxicity following acute hypoxic stress, and might also affect the pain perception in mother and fetus.     

妊娠中晚期孕妇阴道菌群紊乱的改变对不良妊娠结局的影响

目的探讨妊娠中晚期孕妇阴道菌群紊乱的改变对不良妊娠结局的影响。方法选取产科门诊就诊的妊娠28-34周的患者150例。根据检查结果将其分为菌群正常组48例和菌群失常组102例。观察并对比两组患者的不良妊娠结局。结果 102例菌群失常患者中滴虫6例,假丝酵母菌67例,衣原体17例,淋菌2例,细菌性阴道病10例。假丝酵母菌感染率明显高于其他致病菌(P0.05)。菌群失常组患者早产、胎膜早破、剖宫产、产褥感染发生率分别为15.69%、22.55%、35.29%和18.63%,均明显高于菌群正常组的4.17%、8.33%、18.75%和6.25%(P0.05)。菌群失常组患者新生儿黄疽、新生儿感染和低出生体重儿发生率分别为24.51%、21.57%、16.67%,均明显高于菌群正常组的10.42%、8.33%、4.17%(P0.05),在胎儿窘迫的发生率方面两组比较差异无统计学意义(P0.05)。结论妊娠中晚期阴道菌群紊乱中以假丝酵母菌感染发生率最多,与不良妊娠结局密切相关,增加了早产、胎膜早破、剖宫产、产褥感染、新生儿黄疸、新生儿感染和低出生体重儿等与不良妊娠结局的发生率。     

高龄孕妇妊娠晚期心电图与妊娠结局的关系

目的：观察妊娠晚期孕妇的异常心电图变化和妊娠结局。方法：妊娠晚期孕妇按年龄分为35岁以上组和35岁以下组,行心电图检查,统计各型异常心电图发生率,记录妊娠、分娩结局及是否出生低体重儿。结果：妊娠晚期35岁以上组孕妇异常心电图发生率显著高于35岁以下组（P〈0．05）;其中,卵段改变、心律失常发生率前者显著高于后者（P〈0．05）;各型心律失常中,前者窦性心动过缓、室性早搏的发生率显著高于后者（P〈0．05）,而窦性心动过速的发生率明显低于后者（P〈0．05）。心电图异常者35岁以上组妊娠丢失率明显高于35岁以下心电图正常和异常组（P〈0．05）;35岁以上孕妇心电图异常组早产发生率高于心电图正常组（P〈0．05）;心电图异常35岁以上组新生儿低体重发生率显著高于心电图正常35岁以下组（P〈0．05）。结论：高龄孕妇妊娠晚期易发生心律失常、心肌缺血等异常心电图,异常心电图高龄孕妇易发生妊娠丢失、早产及分娩低体重婴儿。     

Thermal skin reference values in healthy late pregnancy

Digital thermal imaging has been employed in medicine for over 50 years. However, its use has been focused on vascular, musculoskeletal and neurological conditions, while other potential applications, such as obstetrics, have been much less explored.     

Interaction of late pregnancy and lactation in rats.

The effect of pregnancy on lactation was studied during the third week of lactational pregnancy in postpartum pregnant rats with a delay in implantation of only 1 day (1d-LP rats). In an experimental design in which the suckling litter was prevented from consuming solid food, lactational performance was estimated by weighing the ten-pup suckling litters on days 16-21 of lactation or by measuring maternal weight loss after a nursing spell on day 21. In 1d-LP rats, food consumption as well as lactational performance was lower than it was in nonpregnant lactating rats (L rats) and pregnant-lactating rats with a normal long delay of implantation of at least 6 days (LP rats). The time spent by the pups sucking at the nipples was not different among the three groups, but the number of milk ejections was diminished in 1d-LP dams. Restriction of daily food supply during days 16 to 21 of lactation diminished lactational performance more strongly in 1d-LP rats than it did in L rats; 1d-LP rats conserved protein stores and mobilized fewer minerals than did L rats. The weight and composition of the litter in vitro were not affected by the food restriction. In pregnant-lactating rats (LP and 1d-LP rats), the number of early resorptions was increased in comparison with pregnant rats, showing that lactation can affect the earlier stages of pregnancy. It was concluded that late pregnancy does not affect nursing behaviour, but suppresses lactation by restricting maternal food intake and mobilization of maternal stores. Measurements in serum indicate a causative role for oestradiol, but not for leptin.     

Activities of uterine muscles from rats in late pregnancy

Although it has been reported that, in the uterine wall of rats at term, gap junctions between fibers of the same muscle layer are responsible for synchronized strong contractions, much less attention has been paid to the interaction between muscle layers. To learn about the relationship between the two uterine muscles of rats in late pregnancy, we developed a technique to do simultaneous monitoring of activities in two muscle layers. Using rectangular muscle strips, the electrical activity in one layer was measured with an intracellular microelectrode while the mechanical activity of the other layer was recorded through a force transducer. In some of the uterine wall strips prepared from animals on gestation day 15 and 16, interaction between longitudinal and circular muscle layers was observed. However, well coordinated activities of these two muscles did not occur until the morning of gestation day 21 and continued toward delivery. Usually, coordination presented as paired contractions, one in the circular muscle and the other in the longitudinal muscle. While these pairs of contractions appeared regularly, they also kept similar intervals. Sometimes, coordination presented as a continuous appearance of groups of three contractions, one in one layer and two in the other. Coordinating contractions of uterine muscles is considered to be beneficiary to the propelling of fetuses toward the cervix during parturition.     

妊娠晚期阴道B族链球菌的感染对肠道菌群和妊娠结局的影响

目的探究妊娠晚期阴道B族链球菌(group B Streptococcus,GBS)的感染对肠道菌群和妊娠结局的影响。方法选取2018年3月至2019年11月大连市中心医院孕检并分娩的妊娠妇女744人为对象,调查并统计B族链球菌的感染率;筛选有和没有B族链球菌感染妊娠妇女各47人,调查不良妊娠结局的发生率;选取信息匹配的妊娠晚期阴道B族链球菌感染和未感染的妊娠妇女,采集粪便样本,提取菌群DNA,用16S rDNA方法分析菌群变化。结果744名妊娠妇女中B族链球菌检出49例,感染率为6.59%;B族链球菌感染组总的不良妊娠发生比例为76.6%,正常组发生比例为27.7%(χ^2=5.491,P<0.05)。B族链球菌感染组妊娠妇女胎膜早破(χ^2=16.177,P<0.01)、难产(χ^2=21.134,P<0.01)和羊水异常(χ^2=22.989,P<0.05)的发生率与未感染组比较显著增高。B族链球菌感染组妊娠妇女肠道菌群发生显著变化。结论妊娠晚期阴道B族链球菌的感染可能引起肠道菌群紊乱,增加不良妊娠结局。     

Insulin action during late pregnancy in the conscious dog

Our aim was to assess the magnitude of peripheral insulin resistance and whether changes in hepatic insulin action were evident in a canine model of late (3rd trimester) pregnancy. A 3-h hyperinsulinemic (5 mU.kg(-1).min(-1)) euglycemic clamp was conducted using conscious, 18-h-fasted pregnant (P; n = 6) and nonpregnant (NP; n = 6) female dogs in which catheters for intraportal insulin infusion and assessment of hepatic substrate balances were implanted approximately 17 days before experimentation. Arterial plasma insulin rose from 11 +/- 2 to 192 +/- 24 and 4 +/- 2 to 178 +/- 5 microU/ml in the 3rd h in NP and P, respectively. Glucagon fell equivalently in both groups. Basal net hepatic glucose output was lower in NP (1.9 +/- 0.1 vs. 2.4 +/- 0.2 mg.kg(-1).min(-1), P < 0.05). Hyperinsulinemia completely suppressed hepatic glucose release in both groups (-0.4 +/- 0.2 and -0.1 +/- 0.2 mg.kg(-1).min(-1) in NP and P, respectively). More exogenous glucose was required to maintain euglycemia in NP (15.2 +/- 1.3 vs. 11.5 +/- 1.1 mg.kg(-1).min(-1), P < 0.05). Nonesterified fatty acids fell similarly in both groups. Net hepatic gluconeogenic amino acid uptake with high insulin did not differ in NP and P. Peripheral insulin action is markedly impaired in this canine model of pregnancy, whereas hepatic glucose production is completely suppressed by high circulating insulin levels.     

Maternal thyroid function in early and late pregnancy.

Thyroid function was investigated during and after pregnancy in 12 healthy euthyroid women. During pregnancy, serum total T4 (TT4) levels were significantly elevated and nearly stable, while thyroxine-binding globulin (TBG) levels progressively increased till the 7th month. A slight elevation, though not significant, of free T4 (fT4) was recorded in early pregnancy. In the following months, fT4, free T3 (fT3) and the T4/TBG ratio progressively diminished, reaching a plateau at the 7th month. Serum TSH levels, measured by an ultrasensitive immunofluorometric assay, were comparable to postpartum values during the first trimester and showed a moderate upward trend with the progression of pregnancy. The evaluation of 24-hour TSH profiles was performed in 5 women during the first trimester of pregnancy. In all women, the circadian rhythm of TSH was present with a normal nocturnal surge, though anticipated in 1 case. In summary (1) during the first trimester of pregnancy, the increased thyroid activity does not seem to be only sustained by pituitary TSH which remains unmodified; the negative correlation between TSH and hCG levels might suggest that hCG also stimulates the gland to increase thyroid hormone output, and the presence of a normal TSH circadian rhythm indicates that the central mechanism of neuroregulation of the pituitary-thyroid axis is preserved in early pregnancy, and (2) in late pregnancy, a marked decrease in free thyroid hormone fractions is accompanied by serum TSH levels still in the normal range, indicating a modification of thyroid homeostasis which might recognize various etiological factors.