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02 December 2014, Volume 30 Issue 12 Previous Issue    Next Issue

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Pernicious placenta previa and accrete left in situ: how to estimate and manage postpartum. ZHANG Xue-mei，QI Hong-bo. 2014, 30(12): 918-921.  DOI: 10.7504/fk2014110102 Abstract ( )   PDF (950KB) ( )   Abstract:Placenta left in situ is one of conservative management for placenta previa and accrete. It can reduce the rate of hysterectomy, transfusion and disseminated intravascular coagulation (DIC). It is an increasingly concerned problem that how the obstetricians decide to leave the placenta in situ and manage post-partum situation in time.

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The value of magnetic resonance imaging in evaluating pernicious placenta previa. SUN Wei,LU Zai-ming,GUO Qi-yong. 2014, 30(12): 921-923.  DOI: 10.7504/fk2014110103 Abstract ( )   PDF (950KB) ( )   Abstract:Pernicious placenta previa means that the placenta overlies uterine scar after previous cesarean section.Because of its high incidence of placenta invasion ，pernicious placenta previa has become one of the main causes of prenatal，intrapartum and postpartum hemorrhage.In the past，ultrasound has been regarded as the first choice of prenatal diagnosis，but magnetic resonance imaging (MRI) has its own benefits，especially when ultrasound diagnosis is not clear or is difficult to diagnose.The future development is towards functional placental MRI.Placental MRI has become an important complementary method for evaluation of placental disorders.

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The value of ultrasound in the diagnosis of pernicious placenta previa. WU Qing-qing. 2014, 30(12): 923-926.  DOI: 10.7504/fk2014110104 Abstract ( )   PDF (1244KB) ( )   Abstract:The pernicious placenta previa is a main threat to maternal and child health and it is an important cause for postpartum hemorrhage. The ultrasound is the key method to diagnose it . It can be detected by 2D and 3D ultrasound and blood flow imaging. The purpose of this article is to outline the diagnosis value of ultrasound technology in pernicious placenta previa.

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Expectant management on pernicious placenta previa. GE Zhi-ping,SUN Li-zhou,XU Hao-qin. 2014, 30(12): 926-928.  DOI: 10.7504/fk2014110105 Abstract ( )   PDF (928KB) ( )   Abstract:With the increasing clinical cesarean section rate, the incidences of pernicious placenta previa were also significantly increased. According to the advances of clinical diagnosis and treatment of pernicious placenta previa, it was suggested expectant management be used for small gestational age, fetal immaturity and no-bleeding or slight vaginal bleeding pregnant women,including inhibition of uterine contractions,promotion of fetal lung maturity, prevention and treatment of anemia, strengthening fetal monitoring, prolonging gestational weeks and elective delivery by caesarean section,in order to improve the fetal and maternal prognosis.

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Interventional radiology in women with pernicious placenta previa. HE Xiao-ju, LIU Huai. 2014, 30(12): 928-932.  DOI: 10.7504/fk2014110106 Abstract ( )   PDF (977KB) ( )   Abstract:Pernicious placenta previa refers to placenta praevia in the presence of a previous uterine scar, attached to the scar and often associated with placenta accreta. Interventional radiology can reduce the blood loss and the need for caesarean hysterectomy. Interventional radiology with trans-catheter balloon occlusion or arterial embolisation is a recognised technique for the management of intractable obstetric haemorrhage, but the complications and long-term side effects should be paid attention to.

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Intraoperative hemostatic techniques of complicated placenta increta. LIN Li. 2014, 30(12): 932-935.  DOI: 10.7504/fk2014110107 Abstract ( )   PDF (962KB) ( )   Abstract:The cesarean section surgery with the placenta accreta is complex and difficult. The main purpose of operation is to avoid massive hemorrhage, loss of organ and maternal death. Operating features include the abdominal incision and uterine incision selection, individualized treatment of placenta, conservative surgical method and hysterectomy. The indications should be strictly controlled,operating procedures should be standardized and application should beflexible in various processing methods in order to obtain the best clinical effect.

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Clinical strategies for pernicious placenta accreta with invasion of the bladder. JIANG Yu-lin,LIU Jun-tao. 2014, 30(12): 935-938.  DOI: 10.7504/fk2014110108 Abstract ( )   PDF (946KB) ( )   Abstract:With the increase of the advanced age of pregnancy, and the increase in the number of pregnancy with prior cesarean section, pernicious placenta previa complicated with placenta implantation has become one of the relatively common serious complications. Among them, the most difficult situation is the clinical treatments for placenta previa complicated with placenta accreta which penetrates into the bladder wall, commonly known as "placenta accreta penetration into the bladder". In this paper, based on the collection of recent related cases report and literature review, we summarized key points of the preoperative diagnosis of placenta previa with penetration into the bladder, preparation of the surgery, different operation methods and conservative treatment. So far, there have been no agreed clinical guidelines or standard of diagnosis and treatment for such cases;instead the individualized strategy of clinical treatment is often emphasized. The bottom line is to ensure the safety and life quality of pregnant woman,and the principle is to focus on fetal survival, decrease bleeding during the operation, and protect the fertility as muchas possible. Prevention and early identification are the main aspect of clinical process. Correct surgery strategies with full evaluation and preparations before the surgery is the key to the success of the treatment.

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The management of pernicious placenta previa with stillbirth and lethal fetal malformations. LIAO Yi-ni,YING Hao. 2014, 30(12): 939-940.  DOI: 10.7504/fk2014110109 Abstract ( )   PDF (914KB) ( )   Abstract:Pernicious placenta previa threats maternal health and life. Although the rate of pernicious placenta previa with stillbirth or lethal fetal malformations is very low, it is a great threat to the safety of pregnant women and a great challenge to the obstetricians in clinical management. Now it is lack of clinical proven standard, so here we discuss the prenatal procedure and intrapartum treatment.

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Potential effects of abnormal placental location on gestational hypertension-preeclampsia. DONG Yi-nuo，LU Yi，QUAN Si-jie，YING Hao. 2014, 30(12): 941-944.  DOI: 10.7504/fk2014110110 Abstract ( )   Abstract： Objective To discuss whether abnormal placental location influences the incidence of gestational hypertension-preeclampsia.Methods A retrospective research was performed on the pregnant women with abnormal placental location (study group = 813 cases) and the normal ones (control group = 813 cases) from Jan.2010 to Dec.2012.Compare the incidence of gestational hypertension-preeclampsia,placental adherence and fetal growth restriction (FGR)between the two groups.Results 1.There was a statistical difference in the incidence of gestational hypertension-preeclampsia between the study group and the control group (4.4% vs.8.1%,P<0.05).The incidence of gestational hypertension-preeclampsia of placenta previa was lower than that of low-lying placenta (AOR 0.36,95%CI 0.15~0.86) ,while both of them were entirely lower than that of the control group (2.8% vs.8.1%,5.1% vs.8.1%,P<0.05).2.Compared to the control group,the low-lying placenta reduced the risk of gestational hypertension (AOR 0.5,95%CI 0.3~0.9) and so did the placenta previa (AOR 0.27,95%CI 0.09~0.83).3.Compared to the control group,the placenta previa decreased the risk of preeclampsia by 87% (AOR 0.13,95%CI 0.04~0.48) but the incidence of preeclampsia didnf changed significantly in low-lying placenta (2.8% vs.3.7%，P>0.05).The incidence of preeclampsia in the placenta previa was even lower than that in low-lying placenta (AOR 0.25,95%CI 0.07~0.89).4.Those with placental adherence manifest a lower incidence of gestational hypertension-preeclampsia than those without placental adhesions,but the difference was no statistical significance (4.1% vs.4.5%,P>0.05).5.There was no significant difference on the incidence of fetal growth restriction.Conclusion Abnormal placental location,especially placenta previa,may decrease the incidence of gestational hypertension-preeclampsia.

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A systematic review of analytical studies on relationship between caffeine intake during pregnancy and spontaneous abortion. CAO Hui-juan, LIU Jian-ping. 2014, 30(12): 945-950.  DOI: 10.7504/fk2014110111 Abstract ( )   Abstract： Objective To investigate the relationship between caffeine intake during pregnancy and spontaneous abortion. Methods Based on the searching results of five databases in January 2014, our research included the analytical studies which observed the relationship between caffeine intake during pregnancy and spontaneous abortion. Two researchers independently screened the literature and extract data. The methodological quality of the included studies was evaluated according to Newcastle-Ottawa Scale (NOS scale). Revman5.2 software was employed for data analysis. Effect value of dichotomous data was represented as odds ratio (OR) and their 95% confidence interval (CI), statistical heterogeneity between studies were detected using the I2 test. Meta-analysis was conducted if the heterogeneity among studies was within the permissible range. Results Seven case-control studies and seven cohort studies (a total of 149,474 pregnant women) were included in the review. NOS scores varied from 7 to 8 points. The results of individual studies for caffeine-induced miscarriage were;not uniform;however,the meta-analysis of seven included studies showed the risk of caffeine intake during pregnancy might cause spontaneous abortion , and the degree of risk would increase when the amount of daily caffeine intake increased (>300 mg/d) (OR = 1.35, 95% CI: 1.27~1.44, P<0.00001). Conclusions Findings from this systematic review strongly suggest that drinking caffeinated beverages daily during pregnancy, especially

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Effect comparison of different conservative treatments for cesarean scar pregnancy. NI Juan, QIU Ya-Fen. 2014, 30(12): 951-953.  DOI: 10.7504/fk2014110112 Abstract ( )   Abstract： Objective To compare the outcomes of two different conservative treatments for cesarean scar pregnancy. Methods Retrospective analysis of 51 patients with cesarean scar pregnancy admitted to our hospital from January 2009 to December 2012. Thirty patients received systemically methotrexate injection combined with dilation and curettage (chemotherapy group);21 patients underwent uterine artery embolization in combination with local injection of methotrexate followed by dilation and curettage (intervention group). Treatment effect (success rates), blood loss during operation, hospitalization stay, time for blood β-HCG recovery and adverse effect were compared between two groups. Results The success rate of conservative treatment in intervention group (95.2%) was higher than that of chemotherapy group (56.7%) (P<0.05). The hospitalization stay in intervention group [（11.8±2.7）d] was shorter than that of chemotherapy group[(23.2±5.2)d](P<0.05). Meanwhile, the incidence of adverse effect in intervention group (71.4%) was higher than that of chemotherapy group (13.3%)(P＜0.05). No significant differences were observed in blood loss and time for blood β-HCG recovery between these two groups (P＞0.05). Conclusion Systemically methotrexate injection combined with dilation and curettage is effective in cesarean scar pregnancy treatment, but uterine artery embolization in combination of local injection of methotrexate followed by dilation and curettage is more effective with shorter hospitalization stay.

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The effect mechanism of methotrexate resistant human choriocarcinoma JEG-3 cells via ROS-mediated JNK/P62 activation. SHEN Yun*，XIAO Chang-ji，YU Shan，GONG Mei-xuan，ZHAO Jing，XIANG Yang. 2014, 30(12): 954-957.  DOI: 10.7504/fk2014110113 Abstract ( )   Abstract： Objective To explore the effect mechanism of methotrexate resistance in human choriocarcinoma JEG-3 cell lines. Methods Human choriocarcinoma JEG-3 cell lines，and methotrexate resistant choriocarcinoma JEG-3 (JEG/MTXR) cell lines were used in our present study.P62 protein and mRNA were evaluated after exposure to methotrexate (0.02 μg/L) for 72 h in both cells by western blotting or RT-PCR. Cell Oxygen Species (ROS) level was evaluated using FACS by DCFH-DA method.P62 proteins were analyzed by western blotting after exposure to ROS inhibition MnTmPyP in methotrexate treated JEG-3/MTXR cells.P62 was knockdown by P62-siRNA in MTXR/JEG-3 cell lines，and cell apoptosis was evaluated by western blotting and flow cytometry analysis.Results We found that P62 protein level was upregulated by either western blot analysis or RT-PCR in JEG-3/MTXR cell lines. Further investigation demonstrated that P62 activation was mediated by ROS，while ROS inhibitor MnTmPyP could decrease the level of P62.Silencing of P62 gene expression by siRNA facilitated the cleavage of apoptosis related protein PARP，and the upregulation of apoptotic rate （14.4±1.02 for JEG-3 vs. 9.1±1.34 for JEG/MTXR）by FACS in methotrexate-resistant choriocarcinoma JEG-3 cells.Conclusion ROS-mediated P62 activation is involved in the effect mechanism of the development of methotrexate resistance in choriocarcinoma JEG-3 cells.

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Study on different in vitro maturation treatments for PCOS patients. LI Xiao-feng,CAI Su-fen,GONG Fei. 2014, 30(12): 958-961.  DOI: 10.7504/fk2014110114 Abstract ( )   Abstract： Objective To compare the clinical outcomes among different IVM protocols for PCOS patients.Methods PCOS patients in our hospital from Jan.2010 to Dec.2012.were divided into three groups retrospectively.Group A(n=140).routine IVM; Group B(n=152),low dose gonadotrophin stimulating IVM and Group C(n=505),long protocol group.The clinical outcomes of these three groups were compared.Results (1) The clinical pregnancy rates of group B and C showed no significant differences and were significantly higher than group A.(2) The endometrial thickness on the day of HCG injection of group B was more than A.（3）The quality embryos rates of three groups had significant differences.(4)The dose of Gn for group A and B was statistically less than C.(5)There was no OHSS in group A or B;the severe OHSS rate in group C was 2.18%.Conclusions IVM can avoid occurance of OHSS.Routine IVM after the low dosage stimulation of Gn after downregulation can obtain similar clinical pregnancy rate to long protocol IVF.IVM is a safer and effective method for PCOS patients.

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Comparison of two anticoagulant therapy regimens during pregnancy for patients with prosthetic mechanical heart valve:a Meta-analysis. FAN Jin*，LUO Xin*，FAN Yi，SHEN Yuan*, LIU Yun-qi，ZHANG Xi,XU Zhe. 2014, 30(12): 962-968.  DOI: 10.7504/fk2014110115 Abstract ( )   Abstract：Objective To compare the effects of anticoagulant regimen of oral anticoagulant (VKA) throughout pregnancy compared with that of low molecular weight heparin/unfractionated heparin in the first trimester and oral anticoagulant thereafter for patients with prosthetic mechanical heart valve.Methods Relevant researches reported before October 2013 were identified in a number of electronic databases and analyzed with software RevMan 5.0 and R2.13.0. Results     Ten studies of anticoagulant regimen were identified. Pooled estimates revealed significant reductions in maternal major thromboembolic events (odds ratio OR: 0.33,95%CI: 0.19~0.57), increase in fatal wastege  (OR: 1.56,95%CI: 1.11~2.20) with oral anticoagulant throughout pregnancy,as comparing with low molecular weight heparin/unfractionated heparin in the first trimester and oral anticoagulant thereafter.The rate of preterm infants and low-birthweight infants infants increased a little.Conclusion    We advocate an individualized anticoagulation strategy that takes into account thromboembolic risk, economic condition and therapeutic compliance for patients with prothetic mechanical heart valve.

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Expression of GILZ and Ki-67 in epithelial ovarian carcinoma and its clinical implication. CHANG Miao-miao, ZOU Zhong-wen, TAN Shuang. 2014, 30(12): 969-972.  DOI: 10.7504/fk2014110116 Abstract ( )   Abstract： Objective To determine the expression and significance of GILZ and Ki-67 in epithelial ovarian cancer. Methods The expression of GILZ and Ki-67 protein was assayed by means of SP immunohistochemical staining in 45 cases of epithelial ovarian cancer, 19 cases of benign ovarian cystoadenoma and 12 cases of normal ovarian tissue. The relativity between GILZ and Ki-67 was analyzed and relevant clinical factors were also analyzed.Results （1）The expression rate of GILZ and Ki-67 in 45 cases of epithelial ovarian cancer was 57.78％and 46.67％, significantly higher than that in 19 cases of benign ovarian cystoadenoma(15.79％ and 0) and 12 cases of normal ovarian tissue(0and 0); (2)The expression of GILZ and Ki-67 were not related to patients’ age, histologic subtypes, clinical stage, lymph node transfer, ascites and response to chemotherapy(P>0.05). (3)There was a positive correlation between GILZ and Ki-67.Conclusions   (1)GILZ and Ki-67 expression in ovarian cancer is higher, suggesting that GILZ and Ki-67 play an important role in development and incidence of ovarian cancer.（2）The relationship between GILZ and Ki-67 suggests that GILZ may promote the tumor through high-regulating cell proliferation,whose high expression level can be used as a judgment of ovarian malignanay degree and disease progression.(3) The joint detection of GILZ and Ki-67 can help judge clinical diagnosis, treatment and prognosis in cancer patients.

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Analysis of prenatal diagnosis results of amniotic fluid cell chromosome in 3495 fetuses. LI Jian, LUO Jian-yun, QI Hong-bo, LI Chun-lei. 2014, 30(12): 973-976.  DOI: 10.7504/fk2014110117 Abstract ( )   Abstract： Objective To explore the relationship between fetal chromosomal abnormality and various prenatal diagnosis indications. Methods After obtaining informed consents, amniocentesises were implemented with the guidance of ultrasound in 3495 second trimester pregnant women at high risk (16~21+6W). Amniotic fluids were extracted and amniotic fluid exfoliated cells were cultured and harvested for chromosome karyotype analysis. The relationship between various prenatal diagnosis indications and fetal chromosomal karyotype abnormality was analyzed. Results Totally 3494 cases of amniotic fluid cell were successfully cultured and the success rate was 99.97%.A total of 120 cases of abnormal karyotypes were detected and the abnormality rate was 3.43% (120/3494), including 70 cases of chromosome number abnormalities, 31 cases of chromosome structural abnormalities and 19 cases of other abnormalities. In various prenatal diagnosis indications, 47 cases were found with abnormal karyotypes in 1498 cases of advanced birth maternal age(≥35 years), the abnormal rate was 3.14%;there were 38 cases in 1560 cases of Down’s high-risk, the rate was 2.44%;there were 30 cases in 38 cases of high risk in non-invasive fetal trisomy test, the rate was 78.95%. Compared with the advanced birth maternal age and Down’s high-risk, the rate of abnormal karyotypes in high risk in non-invasive fetal trisomy test was of significant difference(P<0.05). Conclusion The combination of various prenatal diagnosis indications for amniocentesis and amniotic fluid cell chromosome karyotype analysis in high-risk pregnant women can effectively improve the detection rate of fetal chromosomal disease and reduce the incidence of birth defects.

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A clinical pathological study of adenomatoid tumors of uterus:report of 59 cases. WANG Chen-yu*，YANG Hai-feng，LUO Jin-qi*，DING Pei-kun*，YANG Si-cong*，YANG Yuan-zhong，LI Chu-tian. 2014, 30(12): 977-980.  DOI: 10.7504/fk2014110118 Abstract ( )   Abstract： Objective To investigate the clinical and pathological characteristics of uterine adenomatoid tumor.Methods    The clinical information，histopathology features and immunohistochemistry results of 59 cases of uterine adenomatoid tumor were collected to study their clinical and pathological characteristics. Results    The average age of the 59 cases was 39.8±8.6 years. There were a variety of clinical symptoms in 59 cases and the principal symptom was abnormal menstruation，while most of the cases were complicated by other uterine and ovary diseases. The average diameter of uterine adenomatoid tumors was(2.7±1.9)cm .The uterine adenomatoid tumors  were positive in CK AE1/AE3,Vimentin and Calretinin with immunohistochemistry. A part of cases were HBME-1 positive. Conclusions  There’s evidence that adenomatoid tumor of uterus originates in mesothelium. Adenomatoid tumor of uterus can be misdiagnosed in clinical and pathological examination,which should be differentiated from other tumors carefully. Immunohistochemistry plays a great role in diagnosing the disease.

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Clinical analysis of uterine rupture during pregnancy after previous cesarean section in 10 cases. LI Ling,YU Xin，LANG Jing-he. 2014, 30(12): 981-983.  DOI: 10.7504/fk2014110119 Abstract ( )   Abstract： Objective To analyze the clinical characteristics and preventive measures of the uterine rupture during the pregnancy after previous cesarean section. Methods Data of 10 patients diagnosed with uterine rupture after previous cesarean section from January 1990 to December 2013 in Peking Union Medical Collage Hospital were analyzed retrospectively.Results Among the 10 patients,4 complete uterine were diagnosed and 6 with incomplete uterine rupture were diagnosed respectively.Of all the patients that were diagnosed with complete uterine rupture,the mean gestational weeks was（27+6±9+4）weeks;the shortest interval between this and last cesarean section was 21 months.All of them were premature ,and complained lower abdominal pain when arriving at the hospital. Of the patients that were diagnosed with incomplete uterine rupture ,the mean gestational week was（36+4±5+2）weeks,the shortest interval between this and last cesarean section was 12 months.Most of them were mature and did not have the complaint of abdominal pain.Conclusions    Pregnancy with a history of previous cesarean section is a high risk factor for uterine rupture.As a result，during the whole pregnancy,the obstetrician should keep an eye on the gravida who has a history of previous cesarean section and intensify the supervision and the monitoring of the gestation.