Covid-19 vaccination in pregnancy and placental pathology

Objective:To describe and determine the association between Covid-19 vaccination in pregnancy and placental pathology.Methods:Conducted in a tertiary hospital in Medan,Indonesia,from April 30th 2022 to June 30th 2022,this single-center cross-sectional study involved Covid-19 vaccinated and unvaccinated women with singleton full-term pregnancies delivering live fetuses via cesarean section.Maternal characteristics,placental pathologies,and the placental index were documented at enrollment.The association between Covid-19 vaccination status and placental pathology was assessed.Results:The study enrolled 200 pregnant women,including 110 vaccinated women and 90 unvaccinated women.No significant differences were observed in birthweight(P=0.48),placental index(P=0.48),and placental pathology findings[intervillous bleeding(P=0.20),increased syncytial knots(P=0.83),chorangiosis(P=0.13),villous stromal edema(P=0.13),vascular dilation and congestion(P=0.13),and vascular wall thrombus(P=0.71)]between the vaccinated and unvaccinated groups.Conclusions:This study revealed no statistically significant association between Covid-19 vaccination and placental pathology.The findings support the safety of Covid-19 vaccination during pregnancy,in regards to changes of the placental pathology.

Spatially resolved transcriptomic profiling of placental development in dairy cow

The placenta plays a crucial role in successful mammalian reproduction.Ruminant animals possess a semi-invasive placenta characterized by a highly vascularized structure formed by maternal endometrial caruncles and fetal placental cotyledons,essential for full-term fetal development.The cow placenta harbors at least two trophoblast cell populations:uninucleate(UNC)and binucleate(BNC)cells.However,the limited capacity to elucidate the transcriptomic dynamics of the placental natural environment has resulted in a poor understanding of both the molecular and cellular interactions between trophoblast cells and niches,and the molecular mechanisms governing trophoblast differentiation and functionalization.To fill this knowledge gap,we employed Stereo-seq to map spatial gene expression patterns at near single-cell resolution in the cow placenta at 90 and 130 days of gestation,attaining high-resolution,spatially resolved gene expression profiles.Based on clustering and cell marker gene expression analyses,key transcription factors,including YBX1 and NPAS2,were shown to regulate the heterogeneity of trophoblast cell subpopulations.Cell communication and trajectory analysis provided a framework for understanding cell-cell interactions and the differentiation of trophoblasts into BNCs in the placental microenvironment.Differential analysis of cell trajectories identified a set of genes involved in regulation of trophoblast differentiation.Additionally,spatial modules and co-variant genes that help shape specific tissue structures were identified.Together,these findings provide foundational insights into important biological pathways critical to the placental development and function in cows.

Maternal supplementation with n-3 fatty acids affects placental lipid metabolism, inflammation, oxidative stress, the endocannabinoid system, and the neonate cytokine concentrations in dairy cows

Background The placenta plays a crucial role in supporting and influencing fetal development.We compared the effects of prepartum supplementation with omega-3(n-3)fatty acid(FA)sources,flaxseed oil(FLX)and fish oil(FO),on the expression of genes and proteins related to lipid metabolism,inflammation,oxidative stress,and the endocannabinoid system(ECS)in the expelled placenta,as well as on FA profile and inflammatory response of neonates.Late-pregnant Holstein dairy cows were supplemented with saturated fat(CTL),FLX,or FO.Placental cotyledons(n=5)were collected immediately after expulsion,and extracted RNA and proteins were analyzed by RTPCR and proteomic analysis.Neonatal blood was assessed for FA composition and concentrations of inflammatory markers.Results FO increased the gene expression of fatty acid binding protein 4(FABP4),interleukin 10(IL-10),catalase(CAT),cannabinoid receptor 1(CNR1),and cannabinoid receptor 2(CNR2)compared with CTL placenta.Gene expression of ECS-enzyme FA-amide hydrolase(FAAH)was lower in FLX and FO than in CTL.Proteomic analysis identified 3,974 proteins;of these,51–59 were differentially abundant between treatments(P≤0.05,|fold change|≥1.5).Top canonical pathways enriched in FLX vs.CTL and in FO vs.CTL were triglyceride metabolism and inflammatory processes.Both n-3 FA increased the placental abundance of FA binding proteins(FABPs)3 and 7.The abundance of CNR1 cannabinoid-receptor-interacting-protein-1(CNRIP1)was reduced in FO vs.FLX.In silico modeling affirmed that bovine FABPs bind to endocannabinoids.The FLX increased the abundance of inflammatory CD44-antigen and secreted-phosphoprotein-1,whereas prostaglandin-endoperoxide synthase 2 was decreased in FO vs.CTL placenta.Maternal FO enriched neonatal plasma with n-3 FAs,and both FLX and FO reduced interleukin-6 concentrations compared with CTL.Conclusion Maternal n-3 FA from FLX and FO differentially affected the bovine placenta;both enhanced lipid metabolism and modulated oxidative stress,however,FO increased some transcriptional ECS components,possibly related to the increased FABPs.Maternal FO induced a unique balance of pro-and anti-inflammatory components in the placenta.Taken together,different sources of n-3 FA during late pregnancy enhanced placental immune and metabolic processes,which may affect the neonatal immune system.

The Hidden Side of the Story between the Placenta and Preeclampsia: Preliminary Results of a Prospective Cohort of Pregnant Women in Cameroon

Introduction: Pre-eclampsia is a complication of pregnancy that generally occurs in the third trimester. It is associated with a maternal and foetal mortality rate of around 27%. In view of the grim picture painted by this condition for both mother and newborn, studies have been carried out into the early detection of patients at risk of developing pre-eclampsia. These make it possible to introduce pregnancy-specific monitoring and preventive strategies to reduce the incidence of the condition. Objective: To establish the link between placental ultrasound characteristics and the onset of pre-eclampsia. Methodology: A multicentre prospective cohort study was conducted in two hospitals in Yaoundé, namely the Yaoundé Gynaecological Obstetrics and Paediatrics Hospital and the Nkolndongo Health and Social Animation Centre, in the gynaecology and radiology departments over a period of 11 months, from October 2022 to August 2023. It included pregnant women who had undergone obstetric ultrasound between 12 and 18 weeks’ gestation. In addition to routine obstetric ultrasound, we performed obstetric Doppler measurements in these patients. The resistance index of the left and right uterine arteries, the umbilical artery and the placental volume were the characteristics sought. At the end of this examination, two groups were formed: cases (pathological Doppler group) and controls (normal Doppler group). Blood pressure and urine dipstick were taken at each antenatal visit until delivery, then during the immediate postpartum period and finally at 7 days, 21 days and 42 days after delivery. Results: Sixty-seven (67) patients were included. Of these, 35 (47.8%) had pathological Dopplers. Sixteen patients had arterial hypertension associated with proteinuria and were therefore labelled as pre-eclampsia (PE). This gives a prevalence of 23.9%. Fifteen (42.8%) of these patients belonged to the exposed group and one to the unexposed group. The mean IR of the pre-eclampsia patients was significantly higher than that of the patients without pre-eclampsia;respectively 0.74 ± 0.096 and 0.49 ± 0.097 for the right uterine arteries and 0.71 ± 0.13 and 0.52 ± 0.089 for the left uterine arteries. We found that an increase in the uterine artery resistance index was significantly associated with the onset of pre-eclampsia, with a relative risk of 13.7 and a p value Conclusion: Abnormal Doppler ultrasound between 12 and 18 weeks of amenorrhoea had good overall sensitivity for predicting pre-eclampsia. Among the Doppler indices, the uterine artery resistance index was the only one significantly associated with pre-eclampsia.

Balloon displacement during caesarean section with pernicious placenta previa: A case report

BACKGROUND For the past few years,preventive interventional therapy has been widely used domestically and overseas,bringing great benefits to pregnant women at high-risk for complications,such as pernicious placenta previa(PPP)and placenta accreta.Nevertheless,there are still few reports on surgical complications related to interventional therapy,and its safety should be a concern.CASE SUMMARY We report a 36-year-old pregnant woman with PPP who underwent balloon implantation in the lower segment of the abdominal aorta before caesarean section.However,the balloon shifted during the operation,which damaged the arterial vessels after filling,resulting in severe postpartum haemorrhage in the patient.Fortunately,after emergency interventional stent implantation,the pa-tient was successfully relieved of the massive haemorrhage crisis.CONCLUSION It seems that massive postoperative bleeding has been largely avoided in preventive interventional therapy in high-risk pregnant women with placenta-related diseases,but surgical complications related to intervention therapy can also cause adverse consequences.It is equally important for clinical doctors to learn how to promptly identify and effectively treat these rare complications.

Dietary supplementation with 0.4%L-arginine between days 14 and 30 of gestation enhances NO and polyamine syntheses and water transport in porcine placentae

Background:Most embryonic loss in pigs occurs before d 30 of gestation.Dietary supplementation with L-arginine(Arg) during early gestation can enhance the survival and development of conceptuses(embryo/fetus and its extraembryonic membranes) in gilts.However,the underlying mechanisms remain largely unknown.Methods:Between d 14 and 30 of gestation,each gilt was fed daily 2 kg of a corn-and soybean-meal based diet(12% crude protein) supplemented with either 0.4% Arg(as Arg-HCl) or an isonitrogenous amount of L-alanine(Control).There were 10 gilts per treatment group.On d 30 of gestation,gilts were fed either Arg-HCl or L-alanine 30 min before they were hysterectomized,followed by the collection of placentae,embryos,fetal membranes,and fetal fluids.Amniotic and allantoic fluids were analyzed for nitrite and nitrate [NOx;stable oxidation products of nitric oxide(NO)],polyamines,and amino acids.Placentae were analyzed for syntheses of NO and polyamines,water and amino acid transport,concentrations of amino acid-related metabolites,and the expression of angiogenic factors and aquaporins(AQPs).Results:Compared to the control group,Arg supplementation increased(P < 0.05) the number of viable fetuses by 1.9 per litter,the number and diameter of placental blood vessels(+ 25.9% and + 17.0% respectively),embryonic survival(+ 18.5%),total placental weight(+ 36.5%),the total weight of viable fetuses(+ 33.5%),fetal crown-to-rump length(+ 4.7%),and total allantoic and amniotic fluid volumes(+ 44.6% and + 75.5% respectively).Compared to control gilts,Arg supplementation increased(P < 0.05) placental activities of GTP cyclohydrolase-1(+ 33.1%) and ornithine decarboxylase(+ 29.3%);placental syntheses of NO(+ 26.2%) and polyamines(+ 28.9%);placental concentrations of NOx(+ 22.5%),tetrahydrobiopterin(+ 21.1%),polyamines(+ 20.4%),c AMP(+ 27.7%),and c GMP(+ 24.7%);total amounts of NOx(+ 61.7% to + 96.8%),polyamines(+ 60.7% to + 88.7%),amino acids(+ 39% to + 118%),glucose(+ 60.5% to + 62.6%),and fructose(+ 41.4% to + 57.0%) in fetal fluids;and the placental transport of water(+ 33.9%),Arg(+ 78.4%),glutamine(+ 89.9%),and glycine(+ 89.6%).Furthermore,Arg supplementation increased(P < 0.05) placental m RNA levels for angiogenic factors [VEGFA120(+ 117%),VEGFR1(+ 445%),VEGFR2(+ 373%),PGF(+ 197%),and GCH1(+ 126%)] and AQPs [AQP1(+ 280%),AQP3(+ 137%),AQP5(+ 172%),AQP8(+ 165%),and AQP9(+ 127%)].Conclusion:Supplementing 0.4% Arg to a conventional diet for gilts between d 14 and d 30 of gestation enhanced placental NO and polyamine syntheses,angiogenesis,and water and amino acid transport to improve conceptus development and survival.

Placental Abruption Following Snakebites Envenomation: A Case Report and Literature Review

Background: Snakebite envenomation in pregnancy is uncommon. It can lead to a poor outcome in both the mother and the fetus. We describe our approach to envenomation in pregnancy based on the currently available evidence. Case: We reported two case of snakebite in the third trimester of pregnancy having caused placental abruption with expelling a fresh still born baby and a live baby. In both cases, consumption coagulopathy occurred. managed by polyvalent anti-snake and blood transfusion. Their investigations became normal and they were discharged of hospitalization. Conclusion: Snakebite envenomation in pregnant is a maternal and fetal emergency. Treatment must be quick and well adapted.

Abdominal Pregnancy with Hemorrhagic Placenta: About a Case at the Mother and Child Health Center of Zinder

Background: In developing countries maternal mortality and morbidity are most often due to the late to consult, poverty and ignorance. Added to this is, the under-medicalization of the health system. The objective of study is to report a case of late consultation and its consequences and make recommendations to improve: case of abdominal pregnancy with hemorrhagic placenta at the Health and Mother Center (CSME) in Zinder/Niger. Clinical Observation: We describe a case of abdominal pregnancy with hemorrhagic placenta in a 24-year-old woman, without profession, resident in the city of Zinder with a low economic level, consulted for abdomino-pelvic pain. She had a notion of amenorrhea for 5 months without any consultation made. She was pale, feverish and had abdominal pain. Ultrasound revealed a 23-week-old fetus and an empty uterus. The diagnosis was abdominal pregnancy. A laparotomy was performed and a The morbidity was hysterectomy and anemia. The postoperative period course was complicated with anemia. The patient was cured on the 9th day with a good vital prognosis. Conclusion: Abdominal pregnancy occurred in a patient who presented a risk factor. Ultrasound was the key diagnostic test. Surgery was the treatment of choice and the prognosis depends on the earliness of the consultation. Community awareness and early consultation with health services can improve the prognosis of abdominal pregnancy.

Our Experience of Childbirth Complications: A Case of Placenta Percreta

We present our own experience management in pregnant women with placenta percreta. For the timely diagnosis of placenta accreta or placenta percreta, it is recommended to conduct ultrasound and Magnetic Resonance Imaging (MRI) studies in women with placenta previa and a history of caesarean section. Objective signs of placenta accreta, identified before delivery, make it possible to make the right decision about delivery and minimize complications in the mother and newborn. A coordinated interdisciplinary approach to these complex cases and early resuscitation with blood products are critical factors in the successful management of patients affected by this disease.

SHER Grade IIIb Placenta Abruptio Complicating Severe Superimposed Pre-Eclampsia at 19 WA: A Case Report

The placenta abruptio is an extremely serious pathology which involves the maternal-fetal prognosis. We report the case of a 19-year-old patient who consulted for abdominopelvic pain associated with heavy vaginal bleeding on 19SA in a context of arterial hypertension. The symptomatology suddenly worsened with the onset of hemorrhagic shock, which prompted an emergency hysterotomy. The diagnosis of placenta abruptio grade III b of SHER was evoked. Uterine atony was objectified intraoperatively and uterine compression by the B-Lynch technique was performed. The evolution of the patient was favorable after a stay of 5 days in intensive care.

Bovine Placental Bioactive Proteins Preparation and Efficacy Evaluation

Taking the qualified bovine placenta as the research object,a series of pure physical separation and extraction processes such as tissue fragmentation,ultrasound,freeze-thawed,centrifugation and filtration were used to prepare the bovine placental bioactive proteins.The results of protein concentration showed that bovine placental bioactive proteins prepared in this study could reach(11.33±2.09)mg/mL under optimal experimental condition.The determination of specific components showed that there were abundant exosome like vesicles in the product with particle size ranging from 30 to 150 nm,pie structure under transmission electron microscope and expressing CD9,CD63 and TSG101 by western blot detection.The results of cell efficacy evaluation showed that bovine placental bioactive proteins could significantly promote the proliferation of human skin fibroblasts and had anti-inflammatory effect via down-regulating IL-6 and TNF-αexpressionin RAW264.7 cells.

膜状胎盘19例临床妊娠结局分析

目的 探讨膜状胎盘发病机制及对妊娠结局的影响。方法 检索2010年4月至2021年6月甘肃省妇幼保健院产前检查并住院终止妊娠的170 621例孕妇的临床资料,选取其中产前超声诊断并经产后病理证实的19例膜状胎盘或部分性膜状胎盘病人作为研究对象。查阅病历收集19例孕妇的年龄、孕次、孕周、超声检查资料、胎儿宫内生长情况、终止妊娠的孕周、分娩方式、产前及产后出血情况及围产儿结局等资料进行回顾性分析。结果 膜状胎盘的发生率0.011 1%(19/170 621),其中既往有刮宫史12例、胎儿生长受限的16例、羊水过少15例、15例出现脐动脉血流异常、11例出现产前出血、引产经阴道分娩16例、剖宫产3例;围产儿17例死胎分娩、2例新生儿存活。结论 膜状胎盘可导致早产、流产、胎死宫内、羊水过少、胎儿宫内生长受限等严重不良围产儿结局,也可导致产前及产后大量出血,对于膜状胎盘孕妇,需要制定合理的诊疗方案,早诊断,早干预。

子痫前期患者循环PLGF水平对预测病情及评估母婴结局的价值初探

目的探讨循环胎盘生长因子(PLGF)水平与子痫前期(PE)病情程度及母婴结局、胎盘病理学改变的相关性。方法选取PE患者159例为研究对象,根据终止妊娠孕周分为:PE_(1)组(62例,<34周终止妊娠的PE患者)和PE_(2)组(97例,≥34周终止妊娠的PE患者);选取同期分娩的107例非PE患者作为对照,根据终止妊娠孕周分为:非PE_(1)组(41例,<34周终止妊娠的非PE患者),非PE_(2)组(66例,≥34周终止妊娠的非PE患者)。收集各组孕妇一般资料:年龄、体质量指数(BMI)、入院收缩压、舒张压,24 h尿蛋白定量、孕产次、是否存在胎儿生长受限(FGR)、胎儿宫内窘迫。新生儿一般资料:术中记录是否有羊水粪染、新生儿窒息,新生儿入住新生儿重症监护病房(NICU)天数;检测分娩当日孕妇静脉血PIGF;将患者胎盘行病理检测并评分;胎儿娩出后行脐动脉血气分析并记录酸碱度(p H)、碱剩余(BE)、乳酸(LAC)。结果PE_(1)组和PE_(2)组与相应孕周非PE_(1)和非PE_(2)组年龄、孕次、产次差异无统计学意义;PE_(1)组与PE_(2)组BMI分别高于非PE_(1)、非PE_(2)组,PLGF分别低于非PE_(1)、非PE_(2)组,且PE_(1)组PLGF低于PE_(2)组(P<0.05)。PE_(1)组患者24 h尿蛋白定量、收缩压、舒张压、胎盘异常病理改变评分高于PE_(2)组(P<0.05)。PE_(1)组与PE_(2)组产时羊水粪染、胎儿宫内窘迫情况、脐动脉血p H值差异无统计学意义,与PE_(2)组比较,PE_(1)组新生儿窒息及FGR比例、脐动脉血LAC升高,BE值降低,入住NICU时间延长(P<0.05)。结论PE患者循环PLGF水平降低,PLGF水平在PE病情评估、预测不良妊娠结局方面有一定价值。

不同位置动脉球囊阻断在凶险性前置胎盘术中的应用价值

目的评估不同位置动脉球囊阻断术在凶险性前置胎盘合并胎盘植入剖腹产术中应用临床效果及安全性的对比研究。方法本院2015年9月至2022年8月共有57例经多普勒超声和/或核磁共振证实凶险性前置胎盘合并胎盘植入,在剖腹产术前行动脉球囊阻断术,其中腹主动脉球囊阻断术(A组)26例,髂总动脉球囊阻断术(B组)31例。结果A、B两组合计子宫保有率100%(57/57),剖宫产手术时间、新生儿Apgar评分(1 min、5 min)两组之间差异无统计学意义(P>0.05),A组术中出血量显著低于B两组术中出血量(P<0.05),放射防护安全性方面,A组明显优于B组(P<0.05)。A组分别出现1例球囊回撤失败,B组分别出现1例动脉血栓和1例下肢静脉血栓,两组之间差异无统计学意义(P>0.05)。结论腹主动脉球囊阻断术和髂总动脉球囊阻断术均可降低子宫切除率,保留患者生育功能,但是腹主动脉球囊阻断术中出血量及放射防护安全性均优于髂总动脉球囊阻断术。

妊娠期高血压患者胎盘组织中circRNA 表达差异及其潜在作用机制

目的基于高通量测序检测妊娠期高血压患者与健康产妇胎盘中环状RNA(circRNA)表达差异,探讨妊娠期高血压发病机制。方法选取某三甲医院2018-02至2018-12期间收治的6例患有妊娠期高血压的产妇为研究对象(M组),选择同期的6例健康产妇作为对照组(C组)。采用BWA-MEM将妊娠高血压组患者与健康对照组的胎盘组织质控后测序,使用CIRI2对circRNA鉴定,并确定circRNA来源。利用DEGseq进行circRNA差异表达分析。采用miRanda软件和该物种的miRBase序列来预测circRNA的靶标miRNA,再利用Targetscan数据库预测相应的mRNA。将差异circRNA靶基因进行GO和KEGG富集分析,并导入String在线数据库进行聚类分析,寻找处于网络核心的基因。结果两组共有31个circRNA存在差异,14个下调,17个上调,其中前5个上调circRNA分别是circRNA00809、circRNA00593、circRNA00166、circRNA00184、circRNA00028,前5个下调circRNA分别是circRNA00520、circRNA00714、circRNA02491、circRNA00841、circRNA01454。GO富集分析显示,主要富集的生物学过程为生殖过程;主要富集的细胞组分是胞外区;主要富集的分子功能是电子转移活性。KEGG通路富集中,新陈代谢方面涉及的最多。相互作用网络分析可见,NOTCH1/2处于核心位置。结论胎盘组织中31种circRNA的差异表达与妊娠期高血压相关,其可能主要通过调节物质代谢通路发挥作用,同时NOTCH1/2等基因处于调控网络中心。

腹主动脉球囊阻断术与改良后子宫血管阻断术在胎盘植入性疾病患者再次剖宫产中的应用比较

目的研究预置腹主动脉球囊阻断术与改良后子宫血管阻断术在前置胎盘伴胎盘植入性疾病再次剖宫产中的应用效果。方法选取2016年4月至2022年12月在合肥市妇幼保健院行再次剖宫产手术治疗的前置胎盘伴胎盘植入性疾病的瘢痕子宫患者97例。术前行腹主动脉球囊阻断术48例为对照组,术中行改良后子宫血管阻断术49例为观察组。观察比较两组患者术中、术后情况。结果观察组的术后行双侧子宫动脉栓塞术数、人均住院费用均小于对照组,差异均有统计学意义(P<0.05);两组的术中平均出血量、输注红细胞悬液量、子宫切除率、膀胱破裂率差异无统计学意义(P>0.05)。结论两种手术方式在完全性前置胎盘伴胎盘植入患者的再次剖宫产手术治疗中均能有效减少术中出血,而使用改良后子宫血管阻断术,未出现血管介入手术并发症,无需X线暴露,母儿安全性高,同时降低了住院费用,具有临床推广潜力。

胎盘ULK1表达与自噬及子痫前期的相关性研究

目的比较子痫前期与正常产妇胎盘组织中Unc-51样激酶1(ULK1)表达和自噬水平,分析胎盘ULK1表达与自噬水平及子痫前期病情的相关性。方法选择2021年3月至2023年5月于福建省立医院分娩的25例子痫前期患者作为子痫前期组,同期住院且年龄、产次与分娩方式相配对的25例正常产妇作为对照组。免疫组织化学检测两组产妇胎盘组织中自噬标志蛋白微管相关蛋白1A/1B-轻链3B(LC3B)、苄氯素1(Beclin1)、螯合体1(SQSTM1/p62)和ULK1蛋白的表达水平,实时荧光定量PCR检测胎盘组织ULK1的mRNA表达,电化学发光法检测子痫前期患者外周血可溶性类fms酪氨酸激酶-1(sFlt-1)和胎盘生长因子(PlGF),采用Pearson法分析ULK1表达与sFlt-1/PlGF比值的相关性。结果免疫组织化学检测结果显示,对照组与子痫前期组胎盘均可见LC3B、Beclin1和p62表达,经半定量分析结果显示,子痫前期组产妇胎盘组织的LC3B和Beclin1表达相对量分别为695.32±77.82、534.19±77.60,明显高于对照组的630.11±64.14和438.66±91.71,p62表达相对量为529.66±85.62,明显低于对照组的638.37±127.62,差异均有统计学意义(P<0.05);经实时荧光定量PCR检测结果显示,子痫前期组产妇胎盘组织ULK1的mRNA表达水平1.01±0.13,明显高于对照组的0.86±0.08,差异有统计学意义(P<0.01);子痫前期组外周血PlGF和sFlt-1水平分别为(114.12±21.71)pg/mL和(8274.126±3453.49)pg/mL,sFlt-1/PlGF比值平均为81.94±57.84,经Pearson相关性分析表明,子痫前期组胎盘组织ULK1的mRNA表达水平与外周血sFlt-1/PlGF比值呈正相关(r=0.701,P<0.05)。结论子痫前期患者胎盘组织ULK1的表达水平明显上升,与自噬水平一致,并与子痫前期严重程度密切相关,有望作为子痫前期防治的新靶点。

产前彩超与MRI诊断植入型凶险性前置胎盘的应用价值

目的:探究产前彩超与MRI诊断植入型凶险性前置胎盘的诊断价值。方法:选取2020年1月~2021年6月广西壮族自治区玉林市第一人民医院收治的70例植入型凶险性前置胎盘患者为研究对象,根据诊断方式的不同进行分组,各35例,一组采用产前彩超诊断,另一组采用MRI诊断。两组诊断效果比较。结果:MRI组诊断子宫后壁胎盘植入的灵敏度、特异度高于产前彩超组,差异有统计学意义(P<0.05)。两组诊断胎盘前壁植入灵敏度、特异度、漏诊率、误诊率、诊断符合率差异无统计学意义(P>0.05)。结论:产前彩超与MRI诊断植入型凶险性前置胎盘均具有良好效果,彩超可作为首选,MRI可作为补充、进一步确诊检查手段。

子宫血管缝扎术及宫颈环状缝扎术联合双侧髂内动脉球囊阻断治疗PPP合并胎盘植入效果

目的:探讨凶险性前置胎盘(PPP)合并胎盘植入治疗效果。方法:选取2019年3月-2023年5月本院就诊治疗的PPP合并胎盘植入患者56例临床资料,根据治疗方式不同分为两组,采用子宫血管缝扎术及宫颈环状缝扎术联合双侧髂内动脉球囊阻断治疗为观察组26例,采用单纯双侧髂内动脉球囊阻断治疗为对照组30例,分析两组相关指标。结果:治疗后两组甲胎蛋白及绒毛膜促性腺激素水平均较术前降低,且观察组(82.6±26.3 ng/ml、122.3±56.3 mIU/ml)低于对照组(113.0±41.1 ng/ml、649.5±86.5 mIU/ml),总并发症发生率观察组(3.8%)低于对照组(23.3%)(均P<0.05);两组新生儿Apgar评分(9.6±0.3分、9.3±0.6分)无差异(P>0.05)。观察组住院时间(6.6±1.2d)及住院费用(3.2±0.6)万元均低于对照组(7.9±1.5d)(4.3±1.0)万元(P<0.05)结论:采取子宫血管缝扎与宫颈环状缝扎术、双侧髂内动脉球囊阻断治疗PPP合并胎盘植入可效果更佳,且可降低术后并发症,术后恢复更快,对新生儿未产生不良影响。

凶险性前置胎盘MRI表现及诊断意义

目的探讨凶险性前置胎盘(PPP)核磁共振(MRI)表现及诊断意义。方法回顾性分析67例前置胎盘患者资料,术前均接受MRI检查,经剖宫产术和病理确诊,分析MRI诊断PPP和伴有胎盘植入的诊断效能,观察PPP合并胎盘植入的不同分型诊断结果。结果手术病理诊断PPP患者有60例,非凶险性前置胎盘(nPPP)患者有7例,PPP并发胎盘植入有59例,“金标准”以手术病理诊断结果为准,分析结果显示,MRI诊断PPP的阳性预测值最高,可达96.43%,其次灵敏度可达90.00%%,特异度、精确率则在71.43%、88.06%,阴性预测值最低,为45.45%;MRI诊断PPP并发胎盘植入的阳性预测值最高,可达97.87%,其次特异度可达87.50%,灵敏度、精确率则在77.97%、79.10%,阴性预测值最低,为35.00%;以手术病理诊断PPP合并胎盘植入结果为金标准,MRI的诊断正确率为79.66%,其中粘黏型、植入型及穿透型胎盘植入的诊断正确率分别为50.00%、87.10%及100.00%。结论术前MRI诊断PPP的诊断价值高,能正确评估PPP伴有胎盘植入程度,充分评估胎盘组织与子宫肌层的关系,为产前检查和制定适合治疗方案提供有效信息。