Osteoprotegerin,interleukin and hepatocyte growth factor for prediction of diabetes and hypertension in the third trimester of pregnancy

BACKGROUND Gestational diabetes mellitus(GDM)raises the risk of high blood pressure and may cause a series of life-threatening complications in pregnant women.Screening and management of GDM and gestational hypertension(GH)in pregnancy helps to control and reduce these risks and prevent adverse effects on mothers and their fetuses.Currently,the majority criteria used for screening of diabetes mellitus is oral glucose tolerance tests,and blood pressure test is usually used for the screening and diagnosis of hypertension.However,these criteria might not anticipate or detect all GDM or GH cases.Therefore,new specific predictive and diagnostic tools should be evaluated for this population.This study selected three biomarkers of osteoprotegerin(OPG),interleukin(IL)and hepatocyte growth factor(HGF)for GDM and GH predication and diagnosis.AIM To explore the feasibility of changes in placental and serum OPG,IL and HGF as tools for prediction and diagnosis of diabetes and hypertension in pregnant women.METHODS From January 2018 to January 2019,44 pregnant women with GDM and GH were selected as an observation group,and 44 healthy pregnant women were selected as a control group in the same period.Serum OPG,IL and HGF were compared between the two groups.RESULTS The levels of OPG and HGF in the observation group were lower than in the control group,and the level of IL-1βwas higher in the observation group than in the control group(all P<0.05).Furthermore,OPG and HGF were negatively associated with gestational diabetes and gestational hypertension,while IL-1βwas positively associated with GDM complicated with GH(all P<0.05).CONCLUSION The evaluation of serum OPG,HGF and IL-1βlevels in patients with coexistent gestational diabetes complicated with hypertension can predict the degree of disease and play an important role in the follow-up treatment and prognosis prediction.

Point-of-care ultrasound identifi cation of yolk stalk sign in a case of failed fi rst trimester pregnancy

Emergency physicians are often the first providersto encounter patients with complications in earlypregnancy. Point-of-care （POC） pelvic ultrasound isbeing increasingly used in the evaluation of emergencydepartment （ED） patients with first trimester symptoms.[1]While the initial aim of POC ultrasound in this settingis to confirm an intrauterine pregnancy, a secondarygoal is to differentiate between a normal and abnormalpregnancy. There exist a number of sonographic featuresto suggest a pregnancy is non-viable.

Terminal Pregnancy Complicated by Measles and Premature Labor:a Case Report

Measles infection in pregnant women is a very dangerous clinical condition.Patients usually had complicated pneumonia,and virus could pass through the placenta to the fetus and lead to premature delivery,stillbirth,miscarriage and neonatal measles.In this report,one such case,which was diagnosed by clinical signs and symptoms,clinical and laboratory examination was described.After proper therapeutic treatment,the infection was well-controlled and a baby was born by nature labor.

Maternal Thyroid-Stimulating Hormone Level and Thyroid Peroxidase Antibody Status in the First and Second Trimester of Pregnancy and Their Relationship with the Risk of Gestational Diabetes Mellitus

Objective:To investigate thyroid-stimulating hormone(TSH)levels and thyroid peroxidase antibody(TPOAb)in early pregnancy and to estimate the risk of development of gestational diabetes mellitus(GDM).Methods:The levels of TSH,free thyroxine,free triiodothyronine,and TPOAb were retrospectively evaluated in 2333 pregnant women.All women recruited were divided into groups of TSH high(H),TSH low(L),TSH(H)TPOAb positive(+),TSH(H)TPOAb negative(-),TSH normal(N)TPOAb(+),TSH(L)TPOAb(+),TSH(L)TPOAb(-),and estimated the risk of GDM.Results:TSH level(X^(2)=13.0024,P=0.0015)and TSH combined TPOAb(X^(2)=20.0038,P=0.0012)were correlated to development of GDM.The level of TSH in 95 women was increased,and in 216 women were decreased.Of the 2333 pregnant women,546 patients were diagnosed with GDM,with a prevalence of 23.40%.The prevalence of GDM was 35.78%and 28.70%for the TSH high(H)and TSH low(L)pregnant women,respectively.The increased TSH(P=0.0013,odds ratio:2.09,confidence interval:1.34-3.28)was correlated to increase GDM incidence.TSH(H)TPOAb(+)(n=29),TSH(H)TPOAb(-)(n=58),TSH normal(N)TPOAb(+)(n=265),TSH(L)TPOAb(+)(n=30),TSH(L)TPOAb(-)(n=154)were in this study.The prevalence of GDM was 51.72%,29.31%,23.02%,26.67%,and 29.87%for the TSH(H)TPOAb(+),TSH(H)TPOAb(-),TSH(N)TPOAb(+),TSH(L)TPOAb(+),and TSH(L)TPOAb(-)pregnant women,respectively.Only the TSH(H)TPOAb(+)pregnant women had a significant higher incidence of GDM(P=0.0018,odds ratio:3.63,confidence interval:1.62-8.16).Trimester specific results showed that only second trimester had higher GDM risk either analyze TSH or the combination of TSH and TPOAb.Conclusion:Elevated TSH level and TPOAb positive in the second trimester of pregnancy were correlated to an increased risk of GDM.

Successful Deliveries of Twins from Two Pregnant Women Following Preterm Prelabor Rupture of Membranes in the Early Second-Trimester Pregnancy

The management of preterm prelabor rupture of membranes (PPROM) before 34 weeks of gestation is intractable, due to pulmonary immaturity, many complications, poor pregnancy outcomes. In particular, the pre-viable PPROM (<23 weeks of gestation) is much more difficult to be treated. The clinical recommendation is to terminate the pregnancy as soon as possible. The pregnancy outcomes of PPROM in the early second-trimester of two twin pregnant women in our hospital were reported to explore the treatment protocols. The pregnancies of the two women developed PROM at 12 and 16 weeks of gestation, respectively. After expectant treatment, they were deliveried successfully at 34+6 and 34+4 weeks of gestation, respectively. The assessment of growth and development of infants was normal during the following six months after birth. Therefore, if PPROM occurs in the early second-trimester of pregnancy, the management of PPROM should be individualized, it’s a long process which should include comprehensive communication between patients and families regarding alternative treatment options (including expectant management) and risks and benefits of the procedure. In the absence of spontaneous labor or occurrence of complications that would prompt delivery (intra-amniotic infection, abruptio placenta, cord prolapse), and fetal status is normal, the patients should proceed with expectant treatment, induction of labor is commonly performed in pregnancies with PPROM ≥34 weeks of gestation.

Influence of Vitamin D Level in the Second Trimester of Pregnancy on the Complications of Chinese Pregnant Women and Fetuses

Background:Vitamin D has been found to have more biological effects beyond the traditional research range,which involve in immunoregulation,occurrence,and development of tumor,reproduction,cell differentiation,and so forth.Herein,the influence of Vitamin D level in the second trimester of pregnancy on the Chinese pregnant women and fetal weight was investigated.Methods:Totally 1,612 pregnant women were followed up during the study,the 25-hydroxyvitamin D(25(OH)D)level was measured with ELISA at the 16th gestational week,and the fasting blood glucose was measured with hexokinase method using an automatic biochemistry analyzer at the same time.At week 24,oral glucose tolerance test(OGTT)was performed to test the blood glucose level(fasting blood glucose,1 h and 2 h after oral administration of glucose).Besides,other indices(e.g.,fetal birth weight)were recorded and analyzed by SPSS version 19.0 software.Results:Pearson’s correlation analysis indicated that the serum 25(OH)D had a negative correlation with blood glucose at 1 h after oral glucose administration at week 24 in OGTT(correlation coefficient:−0.03,P=0.01).However,it did not have correlations with the fasting blood glucose at weeks 16 and 24 as well as the blood glucose at 2 h after oral glucose administration at week 24.The Pearson’s correlation analysis was used to analyze the correlation between Vitamin D level in the pregnant women and fetal birth weight,and there was no correlation between them.Conclusion:The Vitamin D level in the second trimester of pregnancy had a negative correlation with blood glucose glucose at 1 h after oral glucose administration and had no correlation with fetal birth weight.

Comparison of the Reference Intervals Used for the Evaluation of Maternal Thyroid Function During Pregnancy Using Sequential and Nonsequential Methods

Background： Maternal thyroid dysfunction is common during pregnancy, and physiological changes during pregnancy can lead to the overdiagnosis of hyperthyroidism and misdiagnosis of hypothyroidism with nongestation-specific reference intervals. Our aim was to compare sequential with nonsequential methods for the evaluation of thyroid function in pregnant women. Methods： We tested pregnant women who underwent their trimester prenatal screening at our hospital from February 2011 to September 2012 for serum thyroid stimulating hormone （TSH） and free thyroxine （FT4） using the Abbott and Roche kits. There were 447 and 200 patients enrolled in the nonsequential and sequential groups, respectively. The central 95% range between the 2.5th and the 97.5th percentiles was used as the reference interval for the thyroid function parameter. Results： The nonsequential group exhibited a significantly larger degree of dispersion in the TSH reference interval during the 2nd and 3rd trimesters as measured using both the Abbott and Roche kits （all P 〈 0.05）. The TSH reference intervals were significantly larger in the nonsequential group than in the sequential group during the 3rd trimester as measured with both the Abbott （4.95 vs. 3.77 mU/L, P 〈 0.001） and Roche kits （6.62 vs. 5.01 mU/L, P〈 0.004）. The nonsequential group had a significantly larger FT4 reference interval as measured with the Abbott kit during all trimesters （ 12.64 vs. 5.82 pmol/L; 7,96 vs. 4.77 pmol/L; 8.10 vs. 4.77 pmol/L, respectively, all P 〈 0.05）, whereas a significantly larger FT4 reference interval was only observed during the 2nd trimester with the Roche kit （7.76 vs. 5.52 pmol/L, P = 0.002）. Conclusions： It was more reasonable to establish reference intervals for the evaluation of maternal thyroid function using the sequential method during each trimester of pregnancy. Moreover, the exclusion of pregnancy-related complications should be considered in the inclusion criteria for thyroid function tests.

Comparison of second-trimester maternal serum free-p-human chorionic gonadotropin and a-fetoprotein between normal singleton and twin pregnancies： a population-based study

Background The second-trimester maternal serum screening in twin pregnancy is still controversial, as the serum marker levels in twins are not as clear as those in singletons. This study aimed to evaluate the relationship between the levels of the second-trimester maternal serum free β-human chorionic gonadotropin （free β-HCG） and a-fetoprotein （AFP） in normal twin and singleton pregnancies and to estimate feasible analysis methods for utilizing these markers in second trimester screening for twin pregnancy. Methods On the basis of a prospective population-based study of second-trimester maternal serum screening, the concentrations of maternal serum AFP and free β-HCG of 195 normal twin pregnancy and 26 512 singleton controls at gestational weeks 15 to 20 were measured by time-resolved fluoroimmunoassay in one laboratory. The levels of markers were compared between the twins and singletons using weight-correction and gestational age-specific model. Results According to the research protocol, 95 communities were randomly sampled, which covered the whole Jiangsu province, the east of China. A total of 26 803 pregnant women （98%）, from the target population accepted prenatal screening for maternal serum AFP, β-HCG detection, and all babies were followed up for at least six months. There were 197 （0.73%） twin pregnancies, of which one case had fetal trisomy 18, and one case with fetal anencephaly. The others were normal twin pregnancy. From a total enrollment of 26 803 women participants, 26 512 women with normal singleton pregnancies were selected as the model controls. The other 291 pregnancies, including trisomy 21, neural tube defect （NTD）, trisomy 18, and other fetal abnormalities, were excluded. No significant differences were found in the medians of gestational age-specific maternal serum free β-hCG and AFP in normal twin pregnancy comparing with twice those in model controls with the exception of the medians for free β-hCG during the 16th gestational week （P=0.012）. Conclusion The weight-correction and gestational age-specific levels of Chinese Han population maternal serum free β-hCG and AFP in normal twins were twice the levels as those in the singleton controls during the 17-19 gestational weeks.

Chronic hypertension superimposed on preeclampsia at 13 gestational weeks： a case report with review

Preeclampsia is represented by hypertension and proteinuria in pregnancy. It usually occurs after 20 gestational weeks. There are few reports on preeclampsia before 20 gestational weeks. In this case, we report a patient with chronic hypertension superimposed with preeclampsia at 13 gestational weeks.

Cervical Length at 28-32 Weeks of Gestation Predicts Preterm Birth

Objective:To evaluate the ability of cervical length(CL)at 28-32 weeks of gestation to predict spontaneous preterm delivery and preterm premature rupture of membranes(PPROM).Methods:It was a retrospective cohort study that vaginal ultrasonography at approximately 28-32 weeks of gestation was performed in 14,953 women between 17-49 years old with singleton pregnancies who delivered after 28 weeks of gestation at the Peking University First Hospital from June 2008 to December 2012.The pregnancy outcomes were followed and the relationship between the CL and preterm delivery or PPROM was assessed.The relative risk was calculated to assess group differences in the likelihood of an event occurring.Results:The overall prevalence of preterm delivery was 5.7%(858/14,953);the incidence for therapeutic preterm delivery was 2.1%(318/14,953),for spontaneous preterm delivery was 0.9%(133/14,953),and for PPROM was 2.7%(407/14,953).Excluding the 318 women who had therapeutic preterm delivery,the relative risk of preterm delivery for women with a CL between 25 mm and<30 mm,between 15 mm and<25 mm,and<15 mm was 3.7,9.3,and 30.2,respectively.The sensitivity,specificity,and positive and negative predictive values of CL<25 mm at 28-32 weeks of gestation as the cut-off value for predicting preterm delivery were 19.8%,97.5%,23.4%,and 96.9%,respectively.For preterm delivery before 35 weeks of gestation,the sensitivity,specificity,and positive and negative predictive values of a CL<25 mm at 28-32 weeks of gestation as the cut-off value were 30.0%,97.2%,11.8%,and 99.1%,respectively.In addition,women with PPROM(n=407)had significantly shorter CL(31.9±7.4)mm at 28-32 weeks of gestation compared that of women without PPROM(34.0±8.3)mm.The incidence of PPROM in women with a CL£25 mm at 28-32 weeks of gestation(19.4%,79/407)was significantly lower than that for women with a CL>25 mm(80.6%,328/407,P<0.05).Conclusion:CL at 28-32 weeks of gestation can predict spontaneous preterm delivery,and is valuable for predicting PPROM.