Preventive and therapeutic effect of N-Acetyl-L-cysteine on infection-associated preterm labor in mice

Objective: To study the preventive and therapeutic effect of N-Acetyl-L-cysteine on infection-associated preterm labor in mice. Methods: A total of 66 C57BL/6 inbred strain pregnant mice were selected and randomly divided into groups A, B and C, with 22 cases in each group. Group A, B and C were regarded as model group, prevention group and treatment group, respectively. The model of infection-associated preterm labor was built by intraperitoneal injection of Escherichia coli. Ten mice of each group were taken and observed the preterm birth rates and live birth rates, respectively. Three mice of each group were killed at 3 h, 6 h, 12 h and 24 h after building the model. Their uterus tissues were collected and the expressions of the AP-1 and MCP-1 in those tissues were assayed with immunohistochemical method and the expressions of NF- kappa Bp65 and TNF- protein in the placenta tissues of those mice were also detected with immunohistochemical method. Results: The pretem: birth rates of mice in groups B and C were significantly lower than that in group A, while their live birth rates were distinctly higher than that in group A (P<0.05); the expressions of the AP-1 and MCP-1 in the uterus tissues and NF- kappa Bp65 and TNF- protein in the placenta tissues of mice in groups B and C were evidently lower than those in group A (P<0.05); the comparison of the expressions of the NF- kappa Bp65 and TNF- between group B and C showed no statistical differences (P>0.05). Conclusions: N-Acetyl-L-cysteine can lower the incidence rate of infection-associated preterm labor by prohibiting the activation of the protein AP-1/MCP-1 and decreasing the expression of NF- kappa Bp65 and TNF- in the pregnant tissues of premature mice to reduce the inflammatory reactions.

Accurate preterm labor diagnosis using a CD55-TLR4 combination biomarker model

We previously demonstrated immune activation in the maternal peripheral circulation associated with preterm labor (PTL). There was an elevation in WBC mRNA of anti-inflammatory complement decay-accelerating factor (CD55) and the innate-immune response activating toll-like receptor 4 (TLR4). These findings suggested that collectively, these two molecules might serve as useful biomolecules to aid in the diagnosis of PTL. In this study, we used a combined marker approach to determine whether a dual marker model utilizing both CD55 and TLR4 mRNA levels to classify PTL would increase diagnostic accuracy compared to either molecule alone. Two methods were evaluated;a linear discriminant (LD) method and a distribution free (DF) method, in order to find the optimal linear combination of TLR4 and CD55 data to diagnose PTL accurately. Our results indicated that a combined CD55-TLR4 dual marker model could provide statistically significant improve- ments compared to CD55 or TLR4 single marker models for PTL classification performance.

Prevention and not merely prediction of preterm labor and delivery

Different methods have been proposed to screen for preterm labor and delivery; most of these aim to pre-dict the risk that preterm delivery is going to take place. However, interesting though this knowledge might be, knowing the future is of no use when no changes can be made. Recent publications have suggested new and exciting modalities to actually diminish the frequency of preterm birth in patients selected by transvaginal cervical length measurement; these modalities include vaginal progesterone and vaginal pessaries. Although promising, many questions remain to be answered; not least about the long term outcome for both neonates and mothers, but also on the eventual introduction of such strategies to the general obstetric population. One of the main problems that urgently needs clarifcation is how we are going to offer this best of medicine to those needing it most： deprived and socially isolated women who have the highest risk for preterm laborand delivery, probably not due to any congenital cervi-cal problems, but to a combination of environmental, microbiological and social factors, including transgen-erational poverty and deprivation.

Comparison of PAMG-1 and phIGFBP-1 Tests for the Prediction of Preterm Delivery in Patients with Preterm Labor

Objective: To compare PAMG-1 and phIGFBP-1 tests in predicting impending spontaneous preterm delivery within 7 days upon presentation in pregnant women with symptoms of preterm labor. Study Design: From September 2014 to April 2015 women with singleton gestation, symptoms of preterm labor, GA 22 - 35, participated in this prospective cohort study upon admission. Recruited patients had intact membranes and a minimal cervical dilatation of ≤3 cm. Vaginal swabs for phIGFBP-1 and PAMG-1 were taken in addition to routine treatment. Biochemical test results were blinded and had no effect on management of patients. Results: A total of 96 patients were screened for inclusion into the trial;57 met the inclusion criteria for final analysis. The PAMG-1 test was positive in 5.7% of patients, while phIGFBP-1 test was positive in 29.8% of patients. The prediction of spontaneous preterm delivery within 7 days of admission in patients with a cervical length Conclusion: Our study supports the high negative predictability of biochemical tests to rule out spontaneous preterm labor in patients with a short cervix. However, our study strongly suggests that the PAMG-1 test is more accurate for predicting imminent spontaneous preterm delivery as compared to phIGFBP-1. These findings can significantly reduce economic burden caused by unnecessary admission and treatment of patients suspected of preterm labor. Such a reduction in the use of corticosteroids and tocolytics would lead to a reduction in the short and long term health effects associated with the use of therapeutic drugs like corticosteroids, antibiotics and tocolytics.

“Dermal Nitroglycerin Patch” in Treatment of Preterm Labour

Although preterm birth is the delivery before 37 + 0 weeks of gestation, the majority of prema-turity-related complications occur before 33 + 0 weeks of gestation. The need of today is to select the best agent out of the broad spectrum of available tocolytic agents, for providing maximum benefit to unfortunate sufferers of prematurity. The study aims to assess the role of “Dermal Nitroglycerin Patch” in treatment of preterm labour. Method: Study conducted in Department of Obstetrics & Gynecology, NIMS Medical College & Hospital, Jaipur from July 2014-December 2014. A prospective randomized study of 50 women of preterm labor was enrolled after informed consent. Patients were given dermal nitroglycerin patch as tocolytic agent according to study protocol. Result: 1) Results of NTG PATCH are comparable with other tocolytic drugs in terms of successful tocolysis;2) Maternal and fetal outcome is favourable in cases of NTG PATCH USE in preterm labour;3) Side effect profile was also better with NTG Patch. Conclusion: This randomized prospective study lends support to the proportion that Transdermal Nitroglycerine (NTG Patch) may be promising safe, effective, well tolerated, cost effective and non invasive method of tocolysis.

The Combination of the Fetal Fibronectin Bedside Test and Cervical Length in Preterm Labor Is Useful for Prediction of Preterm Birth

Objective: To determine the value of fetal fibronectin (FFN), cervical length (CL) measurement and their combination as binary predictors for preterm birth (PB) in women with preterm labour (PTL) between 24 + 0 and 34 + 0 weeks. Methods: One hundred fifty-nine patients with signs of PTL (singleton pregnancies (SP) = 125, twin pregnancies (TP) = 34) were evaluated in a retrospective study. Inclusion criteria were contractions > 4/20 min, intact membranes, no bleeding. The cut-off was ≥50 ng/ml for FFN and ≤20 mm for CL measured by transvaginal ultrasound. The primary outcome variable was delivery within 7 days from admission. Results: We evaluated 125 SPs and 34 TPs. In SPs, both methods had a sensitivity of 80%;the specificity was 82% for FFN, and 50% for CL. For the combination of both tests sensitivity was 80% and specificity 88%. In TPs, the sensitivity of both tests was lower (FFN 33%, CL 67%) but the combination of both tests represented the highest result for specificity (77% compared to 68% for FFN alone and 32% for CL alone). Conclusion: The combination of FFN and CL in PTL results in a significant higher specificity in SPs. In TPs the performance of the tests is less accurate.

The Effect of Oral Nifedipine versus Parenteral Magnesium Sulfate and Ritodrine for Tocolysis in Patients with Threatened Preterm Labor: A Randomized Controlled Trial

Background: Preterm labor is a serious cause of neonatal morbidity and mortality. This study aims to compare the effects of nifedipine, Magnesium sulfate and ritodrine as tocolytic drugs in patients presented with threatened preterm labor. Patients and Methods: The current study was randomized controlled trial conducted in Sohag Teaching Hospital between November 2015 and September 2016. Patients were divided into: Group A: 101 patients received intravenous ritodrine infusion;Group B: 101 patients received intravenous magnesium sulfate;Group C: 101 patients received oral nifedipine. Different maternal and neonatal outcomes were assessed. Results: The baseline criteria were homogenous among the study groups with no statistically significant differences. There is no difference between each other group regarding the need for additional tocolysis or the rate of recurrence of labour pains. Nifedipine was associated with the least length of hospital stay. There is no difference between all groups regarding the rate of preterm delivery before full steroid dose (p > 0.05). However, nifedipine group was the least one in the rate of occurrence of preterm delivery within 7 days from initiation of tocolytic therapy. Similarly, nifedipine group was associated with higher gestational age at delivery and significant prolongation of pregnancy than the other groups. Conclusion: Oral nifedipine use was associated with less recurrence of labor pains, less need for additional tocolysis, less duration of hospital stay, and more patient satisfaction in patients with threatened preterm labour.

Role of Vaginal Progesterone in Prevention of Preterm Labor in Women with Previous History of One or More Previous Preterm Births

Objective: To evaluate whether prophylactic administration of 200 mg vaginal progesterone can reduce the incidence of preterm birth in women with documented history of preterm birth Setting: Obstetrics and Gynecology Department, Zagazig University Hospital, Egypt. Methods: Ninety patients with previous history of preterm birth prior to 37 week presenting with singleton pregnancy between 20 - 24 weeks were randomly allocated to receive either the progesterone 200 mg vaginal suppository or no treatment. Results: The incidence of preterm labor before 37 weeks of gestation was significantly lower in the study group than in the control group (22.2% vs. 53.3%) especially in earlier gestational ages. While, the mean birth weight was significantly higher in the study group than in control group (2872.67 ± 565.76 gm vs. 2487.78 ± 742.40 gm). The neonatal morbidities and mortality associated with preterm labor were significantly lower in the study group than in the control group as shown by lower incidence of neonatal RDS (13.3% vs. 31.1%;P = 0.043) and lower incidence of the need for NICU admission (15.6% vs. 35.5%;P = 0.03). Conclusion: Administration of prophylactic vaginal progesterone (200 mg, daily) can significantly reduce the rate of preterm birth before 37, 32 and 28 wks of gestation among women with previous spontaneous preterm birth. In addition, the rates of RDS and admission to NICU were significantly decreased among infants of women assigned to progesterone treatment. Also, there was an additional benefit of vaginal progesterone for prevention of preterm birth in women who had prior spontaneous preterm birth and cervical length 25 mm.

Cervical Length Estimation and Cervicovaginal Fluid for Placental <i>α</i>-Microglobulin 1 Testing to Screen Women Had Threatened Preterm Labor for Time till Spontaneous Labor

Objectives: Evaluation of diagnostic performance of rapid testing of cervico-vaginal fluid (CVF) for fetal fibronectin (FFN) and placental α-microglobulin 1 (PAMG-1) as screening of women presented by threatened preterm labor (TPTL) with intact membranes for duration till getting spontaneous labor (SL). Patients & Methods: 37 women presenting with TPTL underwent CVF samplings before digital examination and then underwent transvaginal ultrasonography for estimation of cervical length (CL). All women received fluid and anxiolytic therapy and if uterine contractions persisted, all had received tocolytic therapy with oral nifedipine or intravenous magnesium sulphate according to requirements. Incidence of SL within Results: Incidence of SL was 13.5%, 35.2% and 51.3% within 48-hr, 2 - 7 and 7 - 14 days, respectively. Duration till labor after sampling was positively correlated with CL, while was negatively correlated with positive FFN and PAMG-1 tests. Positive FFN test had high specificity, while positive PAMG-1 test had high sensitivity for labor within 7 days. Regression analysis defined short CL and positive PAMG-1 test as significant predictors for short duration till SL. ROC curve analysis defined short cervix and positive PAMG-1 test as significant predictors for labor within 48-hr and within 2 - 7 days respectively and combined negative PAMG-1 test and CL of 20 - 25 mm were significant predictors for labor within 7 - 14 days. Conclusion: PAMG-1 test had high specificity, if positive, for predicting SL and high NPP, if negative, for excluding labor within 7 days, so it can be used as rapid adjuvant to clinical evaluation to help management decision-making. Moreover, PAMG-1 test is recommended screening test for being easy-to-use bedside test, provides rapid results, can be used after vaginal exam and coitus and does not require a speculum examination or specialized equipment to analyze results.

The association of fFN testing on hospital admissions for preterm labor

Objective: To determine if the use of fetal fibronectin (fFN) testing has affected hospital admissions for preterm labor. Methods: ICD-9 and CPT codes from all admissions to Brigham & Women’s Hospital between January 1, 1995 and December 31, 2010 were evaluated. Data recorded included total deliveries, admissions for preterm labor (PTL) without delivery, length of stay (days) for PTL admissions, preterm deliveries, and number of fFN tests performed. The data was evaluated using a Wilcoxon test of trend and least squares regression. Results: Fetal fibronectin testing was introduced mid-year 2001. As a percentage of total deliveries, the number of admissions for PTL without delivery decreased from 3.97% in 1995 to 2.16% in 2010

Diagnostic Accuracy of PremaQuick versus Actim Partus in Prediction of Preterm Labor in Symptomatic Women within 14 Days

Background: Preterm labor (PTL) remains a major source of neonatal morbidity, and mortality. Currently the trans-vaginal cervical length (TVCL), and/or cervico-vaginal fetal fibronectin (fFN) are the common diagnostic tools used for prediction of PTL. Consequently, many women and their fetuses are exposed unnecessarily tocolysis and hospital admission. Objectives: This study was designed to compare the diagnostic accuracy of PremaQuick versus Actim Partus in prediction of PTL in symptomatic women within 14 days. Patients and Methods: Two-hundred and twenty women (220) were included in this comparative prospective study and classified into two groups: 110 women with threatened preterm labor (TPTL) in the study group, and 110 controls (no TPTL). Women included in the study were subjected to: through history, collection of the cervico-vaginal fluid (CVF) samples for assessment by PremaQuick and Actim Partus tests, followed by trans-vaginal cervical length (TVCL) assessment. Studied women managed according to the hospitals protocol, with follow-up weekly in the obstetrics outpatients’ clinic after discharge from the hospital until delivery. The main outcome measures the diagnostic accuracy of PremaQuick versus Actim Partus in prediction of PTL in symptomatic women within 14 days of admission. Results: PremaQuick test was significantly more specific with higher positive predictive value (PPV) in prediction of PTL in symptomatic women within 14 days (95.5% and 89.6%;respectively) compared to CL 25 mm (56.3% and 54.6%;respectively), (P = 0.02 and 0.03;respectively). In addition, PremaQuick test was significantly more sensitive with higher positive predictive value (PPV) in prediction of PTL in symptomatic women within 14 days (39.8% and 89.6%;respectively) compared to Actim Partus (13.9% and 55.5%;respectively), (P = 0.001 and 0.01;respectively). The Odds ratio and the relative risk for prediction of PTL in symptomatic women within 14 days were significantly high for PremaQuick compared to the CL 25 mm, and Actim Partus. Conclusion: PremaQuick test seems to be the best complementary test to the CL 25 in prediction of PTL in symptomatic women within 14 days. PremaQuick test compensates the low specificity and low PPV of the CL 25 mm in prediction of PTL.

5<i>β</i>-Dihydroprogesterone and Human Preterm Labor

We previously investigated the progesterone metabolite 5β-dihydroprogesterone (5βDHP) in relation to human parturition at term, demonstrating that peripheral venous concentrations decrease in association with the onset of spontaneous labour. In this study our aim was to determine if 5βDHP concentrations were lower in women presenting in spontaneous preterm labour than in controls matched for gestational age. Blood samples were obtained from women presenting in spontaneous preterm labour (n = 20). The diagnosis was made on the presence of regular contractions and cervical effacement and dilatation of at least 3 cms. All women in the preterm labour group delivered before 37 weeks gestation. Blood samples were then obtained from controls, closely matched for gestational age with uncomplicated pregnancies. The preterm labour group was further stratified by cause into three groups, chorioamnionitis (n = 5), abruption (n = 4) and idiopathic (n = 11). Following organic solvent extraction, steroids were separated by HPLC and 5βDHP quantified by radioimmunoassay. Women in the idiopathic preterm labour group were found to have significantly lower circulating concentrations of 5βDHP than controls

剖宫产后阴道试产在无阴道分娩史妇女早产中的应用

目的探讨剖宫产后阴道试产(TOLAC)在无阴道分娩史的妇女早产中的应用。方法回顾性纳入2018年1月至2022年6月在本院接受TOLAC的无阴道分娩史且因早产住院的116名孕妇。根据TOLAC是否成功将研究对象分为TOLAC成功组(n=89)和TOLAC失败组(n=27)。采用最小绝对收缩和选择算子(LASSO)回归筛选TOLAC成功率相关变量,并构建TOLAC成功率预测模型,采用一致性指数(C-index)对预测模型进行内部验证。结果TOLAC成功组及TOLAC失败组的入院时宫颈扩张、入院时宫颈消失、破膜时间比较差异均有统计学意义(t=3.382、3.377、2.027,P<0.05),两组间的入院时硬膜外镇痛、Bishop评分<4、引产、胎膜早破、催产素给药比例比较差异均有统计学意义(χ^(2)值分别为3.517、8.024、14.111、6.570、4.038,P<0.05)。共纳入9个变量(入院时宫颈扩张、入院时宫颈消失、硬膜外镇痛、Bishop评分<4、引产、胎膜早破、破膜时间、催产素给药、分娩时宫颈扩张)用于LASSO回归筛选TOLAC成功率预测变量。应用列线图显示TOLAC成功率模型的预测因子:入院时宫颈扩张(OR=1.11,95%CI:1.04~1.19,P=0.003),引产(OR=0.89,95%CI:0.79~1.00,P=0.049),催产素给药(OR=0.71,95%CI:0.58~0.88,P=0.002),胎膜早破(OR=3.27,95%CI:2.49~4.45,P<0.001),Bishop评分<4(OR=0.33,95%CI:0.17~0.62,P=0.001)和硬膜外麻醉(OR=2.92,95%CI:1.42~6.48,P=0.005)。内部验证的结果显示以C指数衡量的TOLAC成功率的预测准确性为0.89。结论该模型对无阴道分娩史的早产妇女是否可行剖宫产后阴道试产的评估,有一定指导意义。

先兆早期早产孕妇近期分娩的风险预测

目的:探索先兆早期早产(妊娠28~33+6周)孕妇近期(1周内)分娩的Cox比例风险预测模型的建立。方法:收集2021年1月至2022年12月川北医学院附属医院产科收治的293例妊娠28~33+6周先兆早期早产患者的临床资料进行回顾性分析。依据患者自住院后近期(1周内)是否分娩,分为分娩组(n=88)和未分娩组(n=205)。收集人口学资料、专科情况及临床生化指标,比较各观察指标在两组中的差异。采用Cox多因素分析筛选变量,再据此构建Cox比例风险预测模型,计算风险比(HR)。利用C-指数来检验模型的预测能力,绘制列线图可视化展示Cox比例风险预测模型,采用校准曲线来检验模型预测结果与实际情况的一致性。结果:分娩组平均年龄30.2±5.0岁,平均延长妊娠时间61.3±47.5 h。分娩组与未分娩组比较,患者入院时体质量指数(BMI)、产次>1次、患妊娠期糖尿病或糖尿病合并妊娠(GDM/PGDM)、胎方位异常、入院时有规律宫缩、入院时阴道清洁度≥Ⅲ度、入院时白细胞总数≥10×10^(9)/L及入院时子宫颈长度<20 mm的患者比例,差异有统计学意义(P<0.05)。多因素Cox回归分析,入院时BMI>30 kg/m^(2)(HR 2.178,95%CI 1.208~3.928,P=0.010)、产次>1次(HR 3.095,95%CI 1.759~5.447,P<0.001)、入院时有规律宫缩(HR 3.447,95%CI 2.216~5.362,P<0.001)、入院时子宫颈长度<20 mm(HR 3.594,95%CI 2.289~5.646,P<0.001)以及入院时白细胞总数≥10×10^(9)/L(HR 2.124,95%CI 1.352~3.335,P=0.001)是先兆早期早产孕妇近期(1周内)分娩的独立危险因素;将以上5个指标纳入预测模型,其C-指数为0.797(95%CI 0.750~0.844),提示模型的预测能力好。绘制校准图提示模型预测结果与实际结果的一致性较好。结论:入院时BMI>30 kg/m^(2)、产次>1次、入院时有规律宫缩、入院时子宫颈长度<20 mm以及入院时白细胞总数≥10×10^(9)/L的先兆早期早产孕妇易于近期内(1周内)发生早产,基于上述危险因素构建的Cox比例风险预测模型具有一定的准确度,可用于指导临床工作者提前采取相应的干预措施,避免或降低患者发生近期早产的可能,改善母婴结局。

孕中期多普勒超声测量子宫动脉血流对自发性早产的预测价值

目的:探讨孕中期多普勒超声测量子宫动脉血流参数对孕妇自发性早产的预测价值。方法:回顾性分析2022年12月—2023年5月于百色市人民医院分娩的74例自发性早产孕妇(早产组),以及同期55例足月分娩孕妇(足月产组)的临床资料。两组均接受多普勒超声测量,比较两组收缩期峰值流速、阻力指数(RI)、搏动指数、脐动脉收缩期峰值流速/舒张期流速,分析其中差异有统计学意义的数值对自发性早产的预测价值。结果:两组收缩期峰值流速、搏动指数、脐动脉收缩期峰值流速/舒张期流速比较,差异无统计学意义(P>0.05);早产组RI高于足月产组,差异有统计学意义(P=0.033)。受试者工作特征曲线显示,RI诊断自发性早产的曲线下面积为0.610,预测价值中等,对应截断值为0.545,灵敏度为67.6%,特异度为58.2%(P=0.033)。结论:多普勒超声测量子宫动脉RI值对预测自发性早产具有一定价值,但仍需要结合其他指标或临床症状等进行判断。

Managing Vogt–Koyanagi–Harada disease during pregnancy with steroid pulse therapy:A case report

BACKGROUND High-dose steroid administration is a common initial therapeutic approach for Vogt–Koyanagi–Harada disease(VKH).Nonetheless,administering substantial doses of steroids to pregnant women necessitates meticulous consideration due to the potential impacts on the mother and fetus.We present a case wherein steroid pulse therapy was administered to a patient who developed VKH during the late stages of pregnancy.CASE SUMMARY The patient was a 26-year-old nulliparous woman.At 33 weeks and 1 day of her pregnancy,she experienced a decline in visual acuity and noticed metamorphopsia in her left eye.Examination revealed bilateral serous retinal detachment,leading to VKH diagnosis.A collaborative effort involving the departments of ophthalmology,internal medicine,and neonatology was initiated.Steroid pulse therapy was administered at 34 weeks and 1 day of pregnancy under hospital supervision.Complications,such as threatened preterm labor and gestational diabetes,emerged,necessitating the initiation of oral ritodrine hydrochloride and insulin therapy.Then,serous retinal detachment was resolved,and visual acuity was restored.Labor pains initiated 32 days post-initiation of steroid pulse therapy(at 38 weeks and 4 days of gestation),culminating in a normal delivery.Mother and newborn experienced an uneventful puerperal course and were discharged from the hospital on the 5th day following delivery.CONCLUSION VKH management in pregnancy requires multidisciplinary coordination,emphasizing collaboration with ophthalmologists and specialists in internal medicine and neonatology.

劳动教育融入“医学术语学”课程的研究

劳动教育是我国社会主义大学教育的重要内容,具有树德、增智、强体、育美的综合育人价值,在培养社会主义建设者和接班人方面发挥着重要作用。本文探讨了“医学术语学”课程开展劳动教育的意义,剖析了劳动教育实施过程中面临的问题与存在的不足,提出“医学术语学”课程开展劳动教育的路径和方法。

血清AGEs、IL-6和PCT在预测孕妇早产和胎膜早破中的应用价值

目的探讨血清糖基化终末产物(AGEs)、白介素-6(IL-6)、降钙素原(PCT)在预测孕妇早产和胎膜早破中的应用价值。方法本研究采用回顾性的方法,选取2020年1月至2023年12月邢台市中心医院收治的胎膜早破产妇120例为试验组,另选取同期进行孕检且结果正常的118名孕妇为对照组。比较两组临床资料(年龄、文化程度、产次、流产史、感染、妊娠期高血压、妊娠期糖尿病史、感染)以及血清AGEs、IL-6、PCT水平;采用二元Logistic回归模型分析影响孕妇出现早产和胎膜早破的危险因素;分析AGEs、IL-6、PCT单独及并联检测对孕妇早产和胎膜早破的预测效果。结果两组年龄、文化程度、产次比较差异无统计学意义(P>0.05);两组流产史、感染、妊娠期高血压、妊娠期糖尿病史、感染比较差异有统计学意义(P<0.05)。试验组血清AGEs、IL-6、PCT水平均高于对照组,差异有统计学意义(P<0.05)。二元Logistic回归分析结果显示,感染(有)、血清AGEs(>30μg/mL)、IL-6(>0.463 ng/L)及PCT(>0.5 ng/mL)水平是影响孕妇出现早产和胎膜早破的独立危险因素(P<0.05)。ROC曲线显示,AGEs、IL-6及PCT三者并联检测孕妇早产和胎膜早破的AUC为0.906,明显高于三者单独检测(P<0.05)。结论血清AGEs、IL-6、PCT水平在孕妇早产和胎膜早破的预测中均具有一定价值,且三者并联检测准确性最高,可为临床治疗诊治提供一定参考依据。

单胎妊娠24周前短宫颈孕妇不同治疗方式妊娠结局及早产影响因素分析

目的探讨单胎妊娠24周前短宫颈孕妇不同治疗方式妊娠结局及早产影响因素。方法回顾性选取2020年1月至2022年12月在温州市人民医院接受产前检查或住院,妊娠24周前经阴道或会阴超声测量宫颈长度≤25 mm并接受孕激素治疗的86例单胎孕妇为研究对象。根据宫颈长度分为≤10 mm组24例、>10~20 mm组24例、>20~25 mm组38例,每组根据治疗方式不同又分为对照组(仅黄体酮软胶囊治疗)、宫颈环扎组(黄体酮软胶囊联合宫颈环扎术治疗)、子宫托+宫颈环扎组(黄体酮软胶囊联合子宫托+宫颈环扎术治疗);比较相同宫颈长度组内3种治疗方式孕妇妊娠结局及新生儿结局,采用多因素logistic回归分析妊娠24周前短宫颈孕妇早产的影响因素。结果在宫颈长度≤10 mm组内,宫颈环扎组、子宫托+宫颈环扎组妊娠延长时间、分娩孕周以及新生儿体重均大于对照组(均P<0.05),<28周分娩比例以及新生儿死亡率均低于对照组(均P<0.05);但宫颈环扎组与子宫托+宫颈环扎组妊娠结局及新生儿结局比较差异均无统计学意义(均P>0.05)。在宫颈长度>10~20 mm组内,宫颈环扎组、子宫托+宫颈环扎组新生儿死亡率均低于对照组(均P<0.05),宫颈环扎组羊膜腔感染率高于对照组、子宫托+宫颈环扎组(均P<0.05),子宫托+宫颈环扎组新生儿体重均大于对照组、宫颈环扎组(均P<0.05);3种治疗方式妊娠延长时间,分娩孕周,<28、34、37周分娩比例以及新生儿不良结局比较差异均无统计学意义(均P>0.05)。在宫颈长度>20~25 mm组内,3种治疗方式孕妇妊娠结局及新生儿结局比较差异均无统计学意义(均P>0.05)。宫颈长度(OR=0.919,P=0.016)是妊娠24周前短宫颈孕妇早产的独立保护因素,羊膜腔感染(OR=7.064,P<0.001)是妊娠24周前短宫颈孕妇早产的独立危险因素。结论宫颈长度是妊娠24周前短宫颈孕妇早产的独立保护因素,羊膜腔感染是独立危险因素。妊娠24周前宫颈长度≤10 mm的单胎孕妇采用宫颈环扎术或子宫托+宫颈环扎术能改善妊娠结局及新生儿结局,而宫颈长度>10 mm的单胎孕妇,不同治疗方式对妊娠结局及新生儿结局影响不大。

生物工程原理在宫颈重塑及自发性早产中的应用进展

宫颈的机械功能对正常妊娠过程至关重要。在正常妊娠期间,宫颈显著软化,顺应性增加,从而维持妊娠并允许成功分娩,异常的宫颈重塑被认为是导致自发性早产的原因之一。目前,自发性早产的预测手段十分有限,临床工作中最常应用的是经阴道超声测量宫颈管长度。随着生物工程的发展,其相关技术应用于科学研究并进一步在临床工作中进行实践成为可能。主要总结了电阻抗图谱、超声剪切波弹性成像、弥散张量成像、宫颈抽吸、拉曼光谱等生物工程原理技术在预测自发性早产、建立宫颈重塑模型中的应用,以及应用生物相容性水凝胶等新型材料在预防自发性早产发生中的探索。