血清妊娠相关血浆蛋白A在诊断异常妊娠中的临床意义

目的:探讨血清妊娠相关血浆蛋白A(PAPP-A)在诊断异常妊娠中的临床意义,分析其与异常妊振的关系。方法:选取299例5~13周的正常早孕妇为正常早孕组,同期选取稽留流产86例,先兆流产54例,异位妊娠76例为异常妊娠组,用酶联免疫吸附试验(ELASA)测定两组受试者的血清PAPP-A水平,分析两组受试者各个孕周内的血清PAPP-A水平的差异。结果:稽留流产孕妇在各个孕周内(9~13周)的血清PAPP-A水平显著低于同孕周内正常早孕孕妇(t值分别为9.500,8.113,3.511,9.538,8.504,P值均0.05);稽留流产孕妇总的平均血清PAPP-A水平亦低于常早孕孕妇(t=3.651,P值均0.05);异位妊娠孕妇在各个孕周内(9~13周)的血清PAPP-A水平显著低于同孕周内正常早孕孕妇(t值分别为7.976,9.030,9.941,11.625,14.079,12.569,P值均0.05),异位妊娠孕妇总的平均血清PAPP-A水平亦低于常早孕孕妇(t=28.168,P值均0.05);先兆流产孕妇(除孕8周)与正常早孕妊娠血清PAPP-A水平比较无显著统计学意义。结论:血清PAPP-A水平在异常妊娠如异位妊娠、稽留流产中显著降低,可作为诊断异位妊娠、稽留流产及先兆流产辅助诊断的生物学指标。     

Plasma copper concentrations in pathological pregnancies.

Copper is an essential element required for the formation of many enzymes with important roles in the human body. During pregnancy, the maternal serum copper concentration is increased due to the higher levels of ceruloplasmin that are the result of elevated oestrogen levels. The aim of this work was to investigate maternal plasma copper concentrations in relation to various pathological conditions during pregnancy. A total of 319 maternal plasma samples were analysed: 103 taken from women in the first trimester, 73 in the second trimester, 99 in the third trimester of pregnancy and 44 at delivery. The plasma concentration of copper during each trimester of normal pregnancy was taken as a reference value. Group comparisons performed by analysis of variance (ANOVA) followed by Dunnett test indicated substantially lower plasma concentrations of copper in pathological conditions diagnosed during the first trimester of pregnancy (spontaneous abortion, threatened abortion, missed abortion and blighted ovum). No significant differences in maternal plasma blood copper concentrations were found in pathological conditions (threatened abortion, threatened preterm delivery and pyelonephritis) diagnosed in the second trimester of pregnancy. Significant differences in plasma copper concentrations were found in the third trimester, for which finding the Dunnett test indicated the cholestasis group to be responsible. Except for twin pregnancy, a tendency to higher plasma copper concentrations, however not statistically significant, was observed in other pathological conditions during the third trimester (gestosis, intrauterine growth retardation, preterm labour).     

Dydrogesterone in threatened abortion: pregnancy outcome

OBJECTIVE: To determine whether therapy with dydrogesterone in threatened abortion during the first trimester of pregnancy will improve pregnancy outcome. DESIGN: Prospective open study. SUBJECTS: Pregnant women presenting to the obstetric and gynaecology clinic admitting center with vaginal bleeding before 13 weeks gestation were evaluated for entry into the study. Women were excluded if they had a history of recurrent miscarriage. METHOD: Eligible subjects were randomized to receive either dydrogesterone 40 mg stat dose followed by 10 mg twice a day for one week or conservative therapy. RESULTS: One hundred and 54 women were recruited. There was no statistically significant differences between the two groups with regard to pre-treatment status. The continuing pregnancy success rate was significantly (p=0.037) higher in women treated with dydrogesterone (95.9%) compared with women who received conservative treatment (86.3%). The odds ratio of the success rate between dydrogesterone treatment and non-treatment was 3.773 (95% confidence interval: 1.009-14.108). CONCLUSION: Corpus luteal support with dydrogesterone has been shown to reduce the incidence of pregnancy loss in threatened abortion during the first trimester in women without a history of recurrent abortion.     

孕酮，CA125及TNF-alpha水平与先兆流产的关系

目的：探讨孕酮，CA125 及TNF-alpha水平与先兆流产发生的关系。方法：选择2014 年2 月-2015 年2 月在我院诊断并接受治 疗的先兆流产患者60 例，根据妊娠结局不同，将患者分为完成妊娠组和终止妊娠组。另选取同期顺利分娩的产妇作为对照组。比 较三组研究对象血清孕酮，CA125 及TNF-琢水平。结果：先兆流产患者血清孕酮水平低于对照组，而CA125 及TNF-alpha水平高于 对照组，差异具有统计学意义（P<0.05）；先兆流产终止妊娠组血清孕酮水平低于完成妊娠组，而CA125 及TNF-alpha水平高于完成 妊娠组，差异具有统计学意义（P<0.05）。孕酮，CA125 及TNF-alpha水平是先兆流产发生的影响因素（P<0.05）。结论：孕酮水平低， CA125 及TNF-alpha水平高是先兆流产发生的危险因素。临床应给予高度重视，积极采取有效的保胎治疗，避免不良妊娠结局。     

Alpha-fetoprotein in Abortion

The clinical value of maternal serum alpha-fetoprotein (AFP) as a guide to the outcome of threatened abortion was assessed. After the thirteenth week of gestation, abortion occurred more frequently (10/12) in women with abnormal serum AFP levels than in those (2/12) whose AFP concentrations were within the normal range. Low levels were present in women with blighted ovum and high concentrations were associated with intrauterine fetal death. In legal first and second trimester abortions, the circulating maternal AFP levels in postabortion samples were often higher than before abortion, irrespective of whether abortion was performed instrumentally or induced with prostaglandins. Maternal serum AFP levels provide a new means for prediction of the outcome of threatened abortion.     

先兆早产、胎膜早破、妊娠期糖尿病及正常妊娠女性阴道菌群分布的比较

目的:比较先兆早产、胎膜早破、妊娠期糖尿病及正常妊娠女性阴道菌群分布情况。方法:选择2016年6月至2018年6月在苏州大学附属第二医院妇产科住院的妊娠女性806例,其中先兆早产组206例,胎膜早破组234例,妊娠期糖尿病组156例,正常妊娠组210例。记录四组女性异常阴道菌群检出率及异常阴道菌群分布情况。结果:四组女性的年龄、孕周比较无统计学差异(P>0.05)。先兆早产组、胎膜早破组异常阴道菌群检出率高于妊娠期糖尿病组、正常妊娠组(P<0.05),而妊娠期糖尿病组、正常妊娠组异常阴道菌群检出率比较无统计学差异(P>0.05)。先兆早产组、妊娠期糖尿病组白色假丝酵母菌检出率高于胎膜早破组、正常妊娠组(P<0.05),先兆早产组、胎膜早破组阴道加德纳菌检出率高于妊娠期糖尿病组、正常妊娠组(P<0.05),先兆早产组无乳链球菌检出率高于胎膜早破组、妊娠期糖尿病组、正常妊娠组(P<0.05),胎膜早破组大肠埃希菌检出率高于先兆早产组、妊娠期糖尿病组、正常妊娠组(P<0.05)。结论:妊娠女性阴道感染以白色假丝酵母菌、大肠埃希菌、无乳链球菌、阴道加德纳菌为主,且先兆早产、胎膜早破女性阴道致病菌感染率较高,妊娠期糖尿病女性阴道白色假丝酵母菌的感染率较高。     

Abortion experience among obstetric patients at Korle-Bu Hospital, Accra, Ghana

Hospital admissions for complications of abortion have been increasing in Africa, indicating a rise in the incidence of abortion. In all pregnant women ever admitted to Korle-Bu hospital in Accra, Ghana, the chance that the outcome of their last pregnancy was an induced abortion decreased as the number of previous pregnancies increased. Women with higher levels of education were more likely to have their 1st pregnancy terminated in an induced abortion. Younger women were more likely than older women at each level of education to have an induced abortion terminate a 1st pregnancy. The use of contraceptives during the last pregnancy interval increased with the level of education of the woman and the number of previous pregnancies. Contraceptive use was also highest among women whose last pregnancy outcome was an induced abortion. The mean pregnancy interval decreased with increasing number of previous pregnancies for both women who used and who did not use contraceptives during their last pregnancy interval. But the mean pregnancy interval was higher among women who used contraceptives. It appears that the abortion experience in this region of Africa is most common in lower parity young women with high levels of education who desire to delay a 1st birth or to space births. This is in contrast in Latin America and other developing countries in which abortion is used mainly by older, married, urban women to limit family size. Contraceptive use in this region of Africa is low, indicating the need for more family planning programs and increasing use of existing programs.     

Cytochemical evaluation of sperm and lymphocyte DNA content after treatment with 5N HCl

Summary In situ as well as extra situm cytochemical methods were used to investigate why the observed Feulgen-DNA value of sperm versus lymphocyte cells is lower than expected.After treatment with 5N HCl, in situ experiments involving the GCA reaction and the UV cytophotometry showed the loss of DNA in sperm nuclei to be 12% more than that in lymphocyte nuclei.Extra situm study of sperm and lymphocytes treated with 5N HCl showed the phosphate and DABA contents of sperm to be 35% and 23%, respectively, less than those of lymphocytes.The data suggest that sperm chromatin is much more sensitive than somatic chromatin to HCl depolyrization during the Feulgen reaction, and this can tentatively be attributed to the protein complement of sperm chromatin.Supported by a Grant from the Ministero Pubblica Istruzione     

Importance de la qualité du sperme

The semen quality and sperm chromatin alteration have added a new dimension to the evaluation of male factors in repeated spontaneous abortion (RSA). The aim of the study was to evaluate the importance of the sperm quality in RSA conjugal partners. In RSA group, when husbands sperm having more 50% of normal forms and more 50% of native DNA, the paternal lymphocytes injection may lead to a positive immunization. However, no benefit of immunotherapy between conjugal partners if the conventional semen parameters and chromatin quality were altered. Our data indicates that among the vast array of male factors, sperm morphology and chromatin quality seems to be an important criterion to conceive or maintain pregnancy of women with a RSA.     

血清P、β-HCG联合检测预测和治疗先兆流产的临床研究

目的：探讨血清孕酮与B-HCG联合检测在预测早期先兆流产预后及其治疗的临床价值。方法：对340例早期先兆流产患者血清P与B-HCG进行检测,并与追踪到的妊娠结局进行分析。结集：血清P值〉25ng／ml、血β-HCG〉50mIU／ml患者66例占19．4％,经绝对卧床休息,未用药治疗,均胚胎发育正常;血清P值在15．94-25ng／ml、血β-HCG10-50mlU／ml患者170例占50％,经口服黄体酮与HCG针保胎治疗后均胚胎发育正常;血清P值〈15．94ng／ml、血β-HCG〈10mIU／ml患者78例占22．9％,终止妊娠者均可见清除宫内组织物中几乎不见新鲜绒毛并伴有不同程度的陈旧性出血;血清孕酮与β-HCG上升不同步患者26例占7．6%,均最终难免流产。结论：联合检测血清孕酮与β-HCG可以预测先兆流产患者妊娠结局,对于指导治疗具有重要的临床价值,既避免不必要的药物干预及经济负担,又能起到提高保胎治疗的成功率。绒毛膜促性腺激素配伍口服天然黄体酮治疗由黄体功能不全引发的早期先兆流产,均能改善先兆流产患者的预后,且对母儿无不良影响,安全有效。     

Maternal Th1- and Th2-type reactivity to placental antigens in normal human pregnancy and unexplained recurrent spontaneous abortions.

Spontaneous abortion is the most common complication of pregnancy, but the etiology of a significant proportion of abortions is still unknown. We have examined the production of Th1- and Th2-type cytokines by women with unexplained recurrent spontaneous abortion (RSA) since it appears that successful murine pregnancy occurs in a Th2-dominant situation and that Th1-type immunity is associated with pregnancy failure. We have compared maternal reactivity toward placental antigens in women with a history of successful pregnancy with that in women with a history of RSA. This was done by coculturing maternal peripheral blood mononuclear cells (PBMC) with autologous placental cells and also by stimulating maternal PBMC with antigens from a choriocarcinoma cell line of trophoblastic origin. We detected significantly greater levels of the Th2 cytokines IL-6 and IL-10 in normal pregnancy compared to unexplained RSA and significantly higher levels of the Th1 cytokine IFN-gamma in RSA compared to normal pregnancy. These results suggest that women with normal pregnancy have a higher Th2 bias, while women with a history of RSA evince a bias toward Th1-type reactivity.     

Cytochemical evaluation of sperm and lymphocyte DNA content after treatment with 5 N HCl

In situ as well as extra situm cytochemical methods were used to investigate why the observed Feulgen-DNA value of sperm versus lymphocyte cells is lower than expected. After treatment with 5 N HCl, in situ experiments involving the GCA reaction and the UV cytophotometry showed the loss of DNA in sperm nuclei to be 12% more than that in lymphocyte nuclei. Extra situm study of sperm and lymphocytes treated with 5 N HCl showed the phosphate and DABA contents of sperm to be 35% and 23%, respectively, less than those of lymphocytes. The data suggest that sperm chromatin is much more sensitive than somatic chromatin to HCl depolymerization during the Feulgen reaction, and this can tentatively be attributed to the protein complement of sperm chromatin.     

Placental Lactogen Levels as Guide to Outcome of Threatened Abortion

The clinical value has been assessed of circulating placental lactogen levels as a pointer to the outcome in a patient with vaginal bleeding in early pregnancy. By using a semiautomated radioimmunoassay the normal range of values for the first and second trimesters has been established. In patients admitted with vaginal bleeding after the eighth week of gestation estimation of plasma human placental lactogen showed that patients with low levels were those in whom the abortion was completed during the first admission. Women whose pregnancies continued normally or who aborted after their first discharge from hospital had normal levels. In a small group sampled before the onset of bleeding but who later aborted the mean levels were lower than normal. This simple and inexpensive test can indicate those women in whom abortion is inevitable and could be used to reduce substantially the length of hospital stay in this common complication of early pregnancy.     

Suicides after pregnancy in Finland, 1987-94: register linkage study.

OBJECTIVE: To determine rates of suicide associated with pregnancy by the type of pregnancy. DESIGN: Register linkage study. Information on suicides in women of reproductive age was linked with the Finnish birth, abortion, and hospital discharge registers to find out how many women who committed suicide had had a completed pregnancy during her last year of life. SETTING: Nationwide data from Finland. SUBJECTS: Women who committed suicide in 1987-94. RESULTS: There were 73 suicides associated with pregnancy, representing 5.4% of all suicides in women in this age group. The mean annual suicide rate was 11.3 per 100,000. The suicide rate associated with birth was significantly lower (5.9) and the rates associated with miscarriage (18.1) and induced abortion (34.7) were significantly higher than in the population. The risk associated with birth was higher among teenagers and that associated with abortion was increased in all age groups. Women who had committed a suicide tended to come from lower social classes and were more likely to be unmarried than other women who had had a completed pregnancy. CONCLUSIONS: The increased risk of suicide after an induced abortion indicates either common risk factors for both or harmful effects of induced abortion on mental health.     

Human placental myeloperoxidase in miscarriage

The activity of myeloperoxidase (MPO) was studied in chorionic and placental tissues of women with miscarriage. The MPO level reached the maximum during the first trimester both in normal pregnancy and in the case of spontaneous abortion. During gestation, the MPO level decreased in the placental tissues independently of the enzyme location. The MPO levels in the placenta during the first and second trimesters were higher in the case of spontaneous abortion than in an uncomplicated pregnancy. In the third trimester, the MPO level in the placenta was significantly lower in the case of miscarriage than in normal pregnancy ending with childbirth at term. The results suggest a close correlation between the MPO level in the placenta and the possible pregnancy outcome.     

Transplacental transmission of BK virus in human.

The prevalance and distribution of BK virus antibody in women during pregnancy and the occurrence of transplacental transmission of BK virus was determined by measurement of IgM antibody in the serum. Sera were collected from 63 nonpregnant women, 71 women who had experienced spontaneous abortion, 80 in the first trimester of pregnancy and the same 80 at delivery. Umbilical cord blood was also taken at delivery. Hemagglutination inhibition (HI) tests for BK virus used the micromethod of Gardner. Results indicate that a significant level of HI antibody was present in 70% of sera from all 4 experimental groups. This showed that BK virus infection was not limited to cases of spontaneous abortion. Of the 80 pregnant mothers, 6 showed a 4-fold or greater HI antibody seroconversion to BK virus after delivery. Of these 6 seroconversion patients, sensitive antibody was detected in 3 umbilical cords. Umbilical cords of those without seroconversion had no sensitive antibody. As evidenced by 2-NE-sensitive antibody, BK virus infections were also recognized in 6 of 71 women who aborted, 4 of 80 in the first trimester of pregnancy and 2 collected after delivery. The 2-ME-sensitive antibody was not found in any of 63 samples from nonpregnant women. Data indicate that 2-ME-sensitive antibody was present only in sera of women during pregnancy and after abortion. It may be possible that BK virus persists in a latent form in many healthy women and becomes activated during pregnancy.     

Medroxyprogesterone acetate therapy in early pregnancy has no apparent fetal effects

Medroxyprogesterone acetate (MPA; Provera) was given orally to 449 women from the 5th to 7th week of pregnancy until at least the 18th week. Data are recorded from two treatment groups (recurrent abortion and threatened abortion) and are compared to a matched series. A total of 1,016 pregnancies are included in the study, and all patients were recruited from a subfertile population conceiving from a range of infertility treatments. Early pregnancy wastage was high throughout the groups and was significantly elevated (43%; P less than .001) in those women who had vaginal bleeding in early pregnancy. The study focuses on the question of potential teratogenicity of progestagens administered in the first trimester. There were 15/366 (4.1%) infants with congenital abnormalities in the MPA-treated group and 15/428 in the untreated group (3.5%). The difference was not significant, and MPA is considered to have no embryopathic risk, nor is it likely to retain an abnormal fetus that might otherwise abort. It appears that MPA is a safe drug to use in pregnancy although the question of efficacy has not been addressed in this report. Considering other recent negative epidemiologic studies with regard to teratogenicity, we add to the conclusion that MPA cannot be demonstrated to have a measurable teratogenic risk and certainly does not present a risk for congenital heart disease and limb reduction defects.     

Influence of past reproductive performance on risk of spontaneous abortion.

OBJECTIVE--To investigate the incidence of spontaneous abortion in a population of women in order to establish their risk of spontaneous abortion and the obstetric factors predisposing to it. DESIGN--Prospective study of women recruited by radio and poster appeal and from hospital outpatient clinics. SETTING--English provincial community. PATIENTS--630 Women from the general population intending to become pregnant. INTERVENTIONS--The viability of the pregnancy was assessed by abdominal ultrasonography before completion of the eighth week, and the assessment was repeated if vaginal bleeding occurred. MAIN OUTCOME MEASURE--Spontaneous abortion or live births in women with or without a previous history of spontaneous abortion. RESULTS--The overall incidence of clinically recognisable spontaneous abortion before 20 weeks of gestation was 12% (50/407 pregnancies). The risk of spontaneous abortion in each category of patient was classified with respect to the patient''s past reproductive performance and found to be influenced greatly by her previous obstetric history. In primigravidas and women with a history of consistently successful pregnancies the incidences of abortion were low (5% (4/87) and 4% (3/73) respectively), whereas women with only unsuccessful histories had a much greater risk of aborting the study pregnancy (24% (24/98)), even when their sole pregnancy had ended in abortion (20% (12/59)). The outcome of the last pregnancy also influenced the outcome of the study pregnancy; only 5% of women (5/95) whose previous pregnancy had been successful aborted, whereas the incidence of loss of pregnancy among women whose last pregnancy had aborted was 19% (40/214). CONCLUSIONS--A knowledge of the patient''s reproductive history is essential for the clinical assessment of her risk of spontaneous abortion. As the most important predictive factor for spontaneous abortion is a previous abortion, the outcome of a woman''s first pregnancy has profound consequences for all subsequent pregnancies.     

Abortion-seeking behaviour among Nigerian women

This study used data from a community-based survey to examine women's experiences of abortion in Nigeria. Fourteen percent of respondents reported that they had ever tried to terminate a pregnancy, and 10% had obtained an abortion. The majority of women who sought an abortion did so early in the pregnancy. Forty-two percent of women who obtained an abortion used the services of a non-professional provider, a quarter experienced complications and 9% sought treatment for complications from their abortions. Roughly half of the women who obtained an abortion used a method other than D&C or MVA. The abortion prevalence and conditions under which women sought abortions varied by women's socio-demographic characteristics. Because abortion is illegal in Nigeria except to save the woman's life, many women take significant risks to terminate unwanted pregnancies. Reducing the incidence of unwanted pregnancy and unsafe abortion can significantly impact the reproductive health of women in Nigeria.     

Cell-mediated immunity in human pregnancy: Changes in lymphocyte reactivity during pregnancy and postpartum.

The function of thymus-dependent lymphocytes (T lymphocytes) was studied in women during pregnancy and labor and postpartum by evaluating the blastogenesis of peripheral lymphocytes, which were stimulated with phytohemagglutin-P (PHA-P) in both whole-blood semimicroculture and purifed lymphocyte culture. Data from 353 random samples (203 women) and 50 serial specimens from 10 women revealed that PHA-P induced-lymphocyte blastogenesis was significantly (p less than 0.005) reduced during pregnancy and labor but rapidly returned to normal several days after artificial termination in the early stage of pregnancy as well as after full-term delivery. These results indicate that the T-lymphocyte function in maternal peripheral blood is depressed by causes related to pregnancy. It seems very likely that depressed T-lymphocyte function during pregnancy is caused by inhibitory factors in the blood plasma derived from the feto-placental unit. Questions relating to the inhibitory factors in maternal plasma are discussed.