Objective
To analyze the delivery mode and pregnancy outcome in the old pregnant and lying-in women with scar uterus.
Methods
A total of 300 cases of elderly scar uterus pregnant and lying-in women treated in Jinan Maternal and Child Health Care Hospital from January 2015 to December 2018 were selected as observation group, and 300 cases of non-scarring uterus and pregnant women in the same age group were selected and included in the control group. The complications, outcome of the delivery, perinatal conditions and postpartum complications of the two groups were compared.
Results
There was no significant difference between the incidence of placenta and placenta between the two groups (P>0.05). The incidence of urinary disease, premature rupture of membranes and premature delivery were significantly higher than those in the control group (P 0.05). The rate of cesarean section, macrosomia and low birth weight in the observation group was significantly higher than that in the control group (P<0.05). The incidences of late postpartum hemorrhage, puerperal infection, wound healing and uterine restoration in the observation group were significantly higher than those in the control group (P<0.05).
Conclusions
Pregnancy complications and caesarean section in elderly women with scar uterus are high, while the risk of post-partum complications is high during the re-delivery, and the post-natal recovery is slow, for this pregnant and lying-in women, we should strengthen the monitoring and take effective preventive measures for the maintenance of mother-to-child safety.
Key words:
Scar uterus; Pregnancy outcome; Delivery mode
BackgroundCervical insufficiency can lead to preterm birth and neonatal mortality. Emergency cervical cerclage is a surgical intervention aimed at preventing preterm birth in patients with cervical insufficiency. However, some patients may experience cerclage failure. This study aimed to identify the risk factors associated with cerclage failure and develop a predictive nomogram model for patients with cervical insufficiency undergoing emergency cervical cerclage.MethodsData of 200 patients who underwent emergency cervical cerclage for cervical insufficiency were retrospectively analyzed. Patients were categorized into successful and failed groups based on their ability to take the infant home. Univariate and multivariate logistic regression analyses were performed to identify risk factors for cerclage failure. A nomogram model was developed based on multivariate logistic regression results, and its performance was assessed using receiver operating characteristic curves, calibration plots, and decision curve analysis (DCA).ResultsUnivariate logistic regression analysis identified 11 potential risk factors for cerclage failure, including the presence of polycystic ovary syndrome (PCOS), vaginitis, cervical dilation, preoperative C-reactive protein, routine vaginal lavage after cervical cerclage, delivery, gestational age, extended days, chorioamnionitis, intrauterine infection, cervical laceration, and premature rupture of membranes. Multivariate logistic regression analysis revealed that PCOS, cervical dilation after cervical cerclage were independent risk factors for cerclage failure while routine vaginal lavage was a protective factor against failure. The nomogram predictive model demonstrated an area under the curve value of 0.975, indicating excellent discriminatory ability. The calibration plot showed good consistency between the nomogram predictions and actual observations. DCA demonstrated the strong clinical applicability of the nomogram.ConclusionsThis study successfully identified risk factors associated with emergency cervical cerclage failure in patients with cervical insufficiency and developed a predictive nomogram model. This model can assist clinicians in making informed decisions and accurately predicting the risk of cerclage failure in these patients.
Octave analysis is widely used in acoustics. Traditional bandpass filtering based octave analysis algorithms could not meet today's real time high resolution analysis requirements because of the huge number bandpass filters they would need. To resolve this problem, a digital algorithm without using bandpass filtering is introduced in this paper. This algorithm is realized in frequency-domain and could be easily implemented on common DSP (Digital Signal Processing) systems. According to the experiments conducted on a digital dynamic signal analyzer based on DSP chips, this algorithm could meet the requirements of multi-channel real time octave analysis.
Abstract Background Initial telomere length (TL) in newborns is the major determinant for TL in later life while TL in newborn/early-life predicts long-term health and lifespan. It is important to identify key factors that affect telomere homeostasis throughout embryonic development for precision interventions to maintain optimal TL in fetus/prenatal infants. SARS-CoV-2 has caused a widespread global pandemic of COVID-19, but it remains unclear whether maternal SARS-CoV-2 infection impairs prenatal telomere homeostasis. Methods We recruited 413 normally delivered newborns whose mothers were either non-infected or infected with SARS-CoV-2 during different trimesters of pregnancy (otherwise healthy). Telomere length (TL) in cord blood (CB) was assessed using qPCR. CB and maternal blood were analyzed for cytokine levels. Placental senescence was determined using senescence-associated β-galactosidase staining. Results Control (non-infected maternal) newborn TL was significantly longer than that from maternal infection (1.568 ± 0.340 vs 1.390 ± 0.350, P = 0.005). Such shorter TL was observed only if maternal infection of SARS-CoV-2 occurred in the first and second trimesters of pregnancy (1.261 ± 0.340 and 1.346 ± 0.353, P < 0.0001 and 0.001, respectively). There were no differences in TL between controls and infection at the third trimester (1.568 ± 0.340 vs 1.565 ± 0.329, P > 0.05). Across the first trimester, there was a positive correlation between newborn TL and gestational weeks with maternal infection, suggesting that the earlier maternal infection occurs, the worse effect is taken on fetal telomere homeostasis. Placental senescence coupled with the downregulated expression of telomerase reverse transcriptase was significantly more frequent from the maternal infection at the first trimester. There were no differences in IL-6, C reactive protein and other cytokine levels in CB and maternal serum or placentas. Conclusions Maternal SARS-CoV-2 infection at the first and second trimesters leads to significantly shorter TL and earlier infection causes much more severe TL damage. The infection-mediated cell senescence and other histopathological abnormalities result in defective placental function through which fetal telomere homeostasis is impaired. Thus, vaccination against COVID-19 should be done in advance for women who plan pregnancy.
N6-methyladenosine (m6A) is the most prevalent modification in eukaryotic mRNA and potential regulatory functions of m6A have been shown by mapping the RNA m6A modification landscape. m6A modification in active gene regulation manifests itself as altered methylation profiles. The number of reports regarding to the profiling of m6A modification and its potential role in the placenta of preeclampsia (PE) is small. In this work, placental samples were collected from PE and control patients. Expression of m6A-related genes was investigated using quantitative real-time PCR. MeRIP-seq and RNA-seq were performed to detect m6A methylation and mRNA expression profiles. Gene ontology (GO) functional and Kyoto encyclopedia of genes and genomes (KEGG) pathway analyses were also conducted to explore the modified genes and their clinical significance. Our findings show that METTL3 and METTL14 were up-regulated in PE. In total, 685 m6A peaks were differentially expressed as determined by MeRIP-seq. Altered peaks of m6A-modified transcripts were primarily associated with nitrogen compound metabolic process, positive regulation of vascular-associated smooth muscle cell migration, and endoplasmic reticulum organisation. The m6A hyper-methylated genes of Wnt/β-catenin signalling pathway, mTOR signalling pathway, and several cancer-related pathways may contribute to PE. We also verified that the significant increase of HSPA1A mRNA and protein expression was regulated by m6A modification, suggesting m6A plays a key role in the regulation of gene expression. Our data provide novel information regarding m6A modification alterations in PE and help our understanding of the pathogenesis of PE.
Changes of micro-ribonucleic acid-182 (miR-182) level in cases of intrauterine infection were investigated to explore the association between miR-182 level change and brain injury in premature infants. A total of 257 preterm infants born in obstetrics department of Jinan Maternity and Child Care Hospital from February 2015 to February 2017 were enrolled in this study. These preterm infants were divided into infected group (n=113) and uninfected group (n=144) based on pathological diagnosis results. Quantitative polymerase chain reaction (qPCR) was employed to detect miR-182 level in amniotic fluid. Bregmatic sagittal and coronal plus lateral fontanel craniocerebral ultrasound, craniocerebral computed tomography (CT) and craniocerebral magnetic resonance imaging examinations were conducted in these preterm infants within one week after birth, and the results were recorded. The relationship between intrauterine infection and brain injury in premature infants was analyzed, and the association of miR-182 level with brain injury was explored. According to pathological diagnoses, brain injury was found in 61 of 113 infants in the infected group, with an incidence rate of 54.0%; and 28 of 144 infants in uninfected group, with an incidence rate of 19.4%; among them, 3 had placental infection caused by intrauterine infection in pregnant women, and all preterm infants had brain damage. Risk value of brain injury in premature infants due to intrauterine infection was hazard ratio (HR) = 2.2611, χ2=33.798, P<0.02. Infected group had a higher miR-182 level in comparison with uninfected group, and the difference in miR-182 level between infected group and uninfected group was statistically significant (P<0.05). Intrauterine infection can lead to an increase in miR-182 level; growth in miR-182 level is closely related to brain injury in premature infants.
The clinical significance of hsa-mir-1247 and hsa‑mir-1269a expression in ectopic pregnancy due to salpingitis was investigated. Eighty patients with ectopic pregnancy diagnosed by ultrasonography who were admitted to Jinan Maternity and Child Care Hospital from January 2012 to May 2012 were enrolled in this study. To the observation group were assigned 35 patients whose ectopic pregnancy was due to salpingitis. The remaining 45 patients whose ectopic pregnancy was due to reasons other than endometriosis were assigned to the control group. Moreover, 32 healthy pregnant women were enrolled in this study at the same time as the healthy control group. Compared with the healthy control group, hsa-mir-1247 and hsa-mir-1269a were downregulated and upregulated, respectively, in patients with ectopic pregnancy (p<0.05). The difference was even more marked in patients with ectopic pregnancy due to salpingitis (p<0.05). The expression levels of hsa-mir-1247 and hsa‑mir-1269a were negatively correlated, and the correlation coefficient r and p-value was -0.667 and 0.006, respectively. Abnormal expression of hsa-mir-1247 and hsa-mir-1269a may be risk factors for ectopic pregnancy. Abnormal expression of hsa-mir-1247 and hsa-mir-1269a found in patients with ectopic pregnancy due to salpingitis may be used as biomarkers of ectopic pregnancy.
Preeclampsia (PE) is a severe pregnancy complication characterized by hypertension and proteinuria. PE poses a substantial threat to the health of both mothers and fetuses, and currently, there is no definitive treatment available. Recent studies have indicated that the transcription factor GATA1 may be implicated in the pathological processes of PE, but the underlying mechanism remains elusive. NTRK2/cGMP–PKG signaling pathway plays a crucial role in regulating the function and polarization of macrophages, which are key immune cells at the maternal–fetal interface. This study aims to investigate the role of GATA1 in the pathogenesis of PE, with a specific focus on how GATA1-regulated TrkB/cGMP–PKG signaling in macrophages and its dysregulation contribute to the development of preeclampsia. By employing THP-1 cells, co-culture systems of THP-1 cells and HTR-8/Svneo, HPVECs and Sprague–Dawley (SD) rats, in conjunction with gene knockdown and overexpression techniques, we explored the effects of GATA1 on the TrkB/cGMP–PKG signaling pathway. Transcriptomic sequencing, bioinformatics analysis, animal experiments, and clinical sample collection were conducted to validate the role of GATA1 in PE. Knockdown of GATA1 mitigated the symptoms of PE, and this effect was reversed by overexpression of TrkB. In comparison with the control group, the proportion of M2 cells elevated significantly in the sh-GATA1 group (P < 0.001). In addition, the protein expressions levels of TrkB, cGMP, and PKG were significantly decreased in the sh-GATA1 group were significantly decreased compared with those in the control group (P < 0.001, P < 0.001, P < 0.001, P < 0.05, respectively). Moreover, knockdown of GATA1 significantly promoted the migration rate and blood vessel formation of HTR-8/Svneo cells (P < 0.001, P < 0.05, respectively) which inhibited by overexpression of NTRK2 (P < 0.05, P < 0.01, respectively). The study demonstrated that knockdown of GATA1 modulates M2 polarization of macrophage through the TrkB/cGMP–PKG signaling pathway, influencing the progression of PE. In addition, significant associations between GATA1 and the TrkB/cGMP–PKG signaling pathway were identified in the transcriptomic data from PE patient placentas.
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