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OBJECTIVE To examine whether serum procalcitonin (PCT) is useful for differentiating acute pyelonephritis (APN) from asymptomatic bacteriuria and acute cystitis during pregnancy. METHODS A multicenter prospective observational study was conducted to compare serum white blood cell (WBC) counts, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, and PCT level among pregnant women with asymptomatic bacteriuria, acute cystitis, and APN and healthy pregnant women (controls). Utility of WBC count, ESR, CRP, and PCT biomarkers for the prediction of APN during pregnancy were measured. RESULTS Area under the curve (AUC) values of PCT, CRP, ESR, and WBC count for predicting asymptomatic bacteriuria were 0.576, 0.628, 0.542, and 0.532, respectively; those for predicting acute cystitis were 0.766, 0.735, 0.681, and 0.597, respectively; and those for predicting acute pyelonephritis 0.859, 0.763, 0.711, and 0.732, respectively. Compared with the other inflammatory markers used to predict APN, PCT exhibited the highest AUC (0.859 [95% confidence interval (CI) 0.711-0.935]). A cutoff value of >0.25 ng/ml had a sensitivity of 87% and a specificity of 79%. CONCLUSION Serum PCT can be a valuable addition to existing methods of differentiating asymptomatic bacteriuria, acute cystitis, and APN during pregnancy and can facilitate the early identification of APN during pregnancy.

To investigate the relationship between the extremely preterm birth and chorioamnionitis based on Chinese population. Retrospective analysis was performed to evaluate 164 cases hospitalized in Fujian Provincial Maternity and Children’s Hospital during 1st January 2017 and 31th June 2018. The clinical symptoms of the participators were recorded and the laboratory tests were performed. The incidence of the extremely preterm birth was 0.7 % accounting for 7.2 % in the total premature birth. The positive rate of the extremely preterm birth related with chorioamnionitis was 72 % and the positive rates in clinic and histological chorioamnionitis were 5.5 % and 66.5 %, which were significantly higher than those in early preterm birth, moderate preterm birth and late preterm birth. Histologic chorioamnionitis cases have no clinical symptoms. The positive rates of increased white blood cells count, neutrophils count and increased level of C-reactive protein in histological chorioamnionitis are 37.6 %, 39.4 %, 64.2 % and 0 % respectively, which are significantly lower than those in clinic chorioamnionitis (88.9 %, 100 %, 100 %, 11.1 %, respectively, p

Xiu-Qiong Zheng,1,* Jian-Ying Yan,1 Rong-Li Xu,1,* Xue-Chun Wang,1 Xian Chen,2 Ke-Hua Huang1 1Department of Obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou 350001, People’s Republic of China; 2Department of Obstetrics, Fujian Obstetrics and Gynecology Hospital, Fuzhou 350000, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jian-Ying Yan; Rong-Li XuDepartment of Obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, No. 18, Daoshan Road, Gulou District, Fuzhou 350001, People’s Republic of ChinaTel +86 591 87505886Email yanjy362015@163.com; xulirong88_doc@163.comObjective: The present study aims to discuss the clinical features, treatment, and prognosis of fetal sacrococcygeal teratomas (SCTs) to improve the standard of diagnosis and treatment.Methods: The clinical data of 15 pregnant females with fetal SCT, admitted to Fujian Maternity and Child Health Hospital from January 2013 to January 2020, were retrospectively analyzed with respect to clinical characteristics, imaging features, complications, treatment options, and pregnancy outcomes.Results: The 15 cases of fetal SCT were all detected by color ultrasonography. There were two cases of cystic tumors and 13 cases of solid cystic tumors. In terms of tumor blood supply, there was one case without blood flow signal, eight cases with little blood flow signal, and six cases with abundant blood flow. At the time of delivery, there were two cases with a tumor diameter less than 5 cm, five cases with a diameter of 5− 10 cm, and eight cases with a diameter of more than 10 cm. In terms of tumor shape and location, there were two cases of type I, ten cases of type II, and three cases of type III. There were six cases with an increased fetal heart to chest ratio, four cases of fetal edema, three cases of placental edema, four cases of excessive amniotic fluid, one case of insufficient amniotic fluid, three cases of fetal distress, one case of stillbirth, two cases of gestational diabetes mellitus, two cases of mirror syndrome, and two cases of postpartum hemorrhage. According to the pathological diagnosis, there were seven cases of mature teratoma, seven cases of immature teratoma, and one case of mixed germ cell tumor. There were six cases of induced delivery, nine cases of cesarean section, one case of premature birth, and two cases of mild neonatal asphyxia.Conclusion: Fetal SCT was generally diagnosed by prenatal ultrasonography. The tumor blood supply, growth rate, size, nature of the tumor, clinical type, pathology, and maternal-fetal complications are all closely correlated with the prognosis. The timing and manner of the termination of pregnancy should be determined on the basis of the pregnant female, the fetus, and the tumor.Keywords: fetus, sacrococcygeal, teratoma, therapy, prognosis

Background This paper investigated how second- and third-trimester gestational weight gain relates to perinatal outcomes among normal weight women with twin pregnancies in Fujian, China. Methods A retrospective study examining the medical records of 931 normal weight twin-pregnant women was conducted in Fujian Maternity and Child Health Hospital from 2014 to 2018.The 2nd and 3rdtrimester weekly weight gain rates were calculated, and women were categorized as gaining below, within, or above the 2009 Institute of Medicine (IOM) recommended rates. The association between the trimester-specific weight gain rate and perinatal outcome was determined by traditional regression analysis among groups. Results A total of 25.9%, 19.8% and 54.3% of women had rates of weight gain across the 2nd and 3rd trimesters less than, greater than or within the recommended rates respectively. Multivariate logistic regression analysis showed that weight gain greater than the recommended rate in the 2nd trimester was associated with a decreased risk of preeclampsia (aOR:0.489,95%CI:0.289 ~ 0.974). Weight gain less than the recommended rate of weight gain in the 3rd trimester was associated with increased risks of premature delivery(aOR:2.079, 95%CI:1.467 ~ 2.968), gestational diabetes mellitus (aOR: 2.048, 95%CI:1.411 ~ 2.971), intrahepatic cholestasis syndrome (aOR:3.015,95%CI: 1.058 ~ 8.587), pre-labour rupture of membrane (aOR: 1.708,95%CI: 1.169 ~ 2.493), average twin birth weight rd trimester was associated with increased risks of premature delivery (aOR:1.589,95%CI:1.428 ~ 2.951) and gestational hypertension (aOR:2.137,95% CI:1.034 ~ 4.415) as well as preeclampsia (aOR:2.246, 95%CI:1.462 ~ 3.452). The stratified analysis of weight gain in the 3rd trimester showed that there was no significant difference in the incidence of adverse pregnancy outcomes compared to the 2nd trimester weight gain groups. Conclusions While this study showed that a gestational weight gain rate above or below the recommendation in the 3rd trimester was associated with some adverse maternal and neonatal outcomes, further prospective and multicentre studies are required to explore alternate ranges of gestational weight gain rates in twin pregnancies.

Background: At present, most pregnant with preeclampsia choose direct cesarean section. Whether cesarean section after vaginal trial affects the outcome of mother and child and its related risk factorsIt are still unclear. The purpose of this study is to investigate the risk factors and maternal-neonatal outcomes in severe preeclampsia patients who undergo transfer-cesarean section during vaginal labor. Methods: For this retrospective study, patient with severe preeclampsia data from 2015 to 2019 was collected. Study participants were women with severe preeclampsia having a cesarean section during week 34 and 41 of gestation.The population was classified into three groups: patients with severe preeclampsia had cesarean section directly, patients with severe preeclampsia had vaginal deliveries and patients with severe preeclampsia who sufferred from transfer-cesarean section in the vaginal labor. The demographic variables and maternal-fetal outcomes were collected and analyzed. Results: (1) 34%(553/1626) severe preeclampsia had labor induction or natural labor and the ratio of transfer-cesarean section after trial of labor was 39% (216/553) . (2)There was a greater incidence of postpartum haemorrhage (7.7% versus 4.5%),the need for blood transfusion (2.4% versus 0.6%) and more than 7 days of hospitalization (10.4% versus 0.6%) in patients submitted to direct caesarean section compared with vaginal delivery.Apgar score at 5 min Conclusion: Vaginal delivery can be recommended to pregnants with severe preeclampsia as long as there are no contraindications for vaginal delivery. Attempting but failing vaginal delivery would not increase the complications of mother and neonates,but fetal monitoring and labor evaluation should be strengthen during the process of labor.

Background Perioperative neurocognitive disorder (PND) is the progressive deterioration of cognitive function after surgery. The purpose of this study was to observe the effect of preoperative pain on inflammatory factors and neuronal apoptosis in the hippocampus of rats. Methods 36 adult male Sprague-Dawley rats were randomly divided into 4 groups: the control group, the pain group, the pain+operation group, and the operation group. 6 days before the surgery, the rats received cognitive training, and the cognitive evaluation was carried out on the1, 3 and 7th days after the surgery. The rats were killed on the first, third and seventh days after the surgery (n = 3 rats/day). The cognitive function of rats was evaluated by the Morris Water Maze (MWM), and the expression levels of the pro-inflammatory cytokines interleukin 6(IL-6), Interleukin 1β(IL-1β)and Tumor Necrosis Factor-α(TNF-α), Acetylcholine(Ach)and Cyclic Adenosine monophosphate(cAMP), protein kinase A(PKA)and gamma-aminobutyric acid type A receptors(GABAA) in the hippocampus were measured on the 1st, 3rd and 7th days after the operation. Results Our results showed that the pain model rats exhibited impaired behavior on the first day (P< 0.001), and this lasted until the 7th day after the operation (P≤0.002 and P≤0. 001, respectively). Preoperative pain model rats showed a higher level of apoptosis than that shown by the simple operation rats. On the 1st, 3rd and 7th days after the operation, the protein content of IL-1β, IL-6 and TNF-α in the pain operation group was increased compared to that in the simple operation group (P

Aim To study the function of free fatty acid (FFA) in maternal serum and advanced glycation end products (AGE) in maternal serum, umbilical cord blood and in the placenta of women with pre-eclampsia. Methods Sixty women with pre-eclampsia and 60 normal pregnant women as controls participated in this study. Women with pre-eclampsia were divided into an early-onset group and late-onset group, with 30 normal pregnant women as the early control group and 30 as the late control group. Competitive enzyme-linked immunosorbent assay was used to measure AGE in maternal serum and umbilical cord blood. Western blotting was performed to analyze AGE in the placenta. Improved copper agent colorimetry was performed to measure FFA in maternal serum. Results Mean AGE in maternal serum in the early-onset and late-onset pre-eclampsia groups was significantly higher than in the control groups. Mean concentration of umbilical cord blood AGE was significantly higher in the early-onset and late-onset pre-eclampsia groups when compared with the control groups. On western blot the level of placental AGE in the early-onset and late-onset pre-eclampsia groups was significantly higher than in normal placenta. Serum FFA in the early-onset and late-onset pre-eclampsia groups was higher than in healthy pregnant women. Maternal serum FFA in the early-onset and late-onset pre-eclampsia groups correlated positively with maternal serum AGE (r = 0.764 and r = 0.774, P

To study the function of free fatty acid (FFA) in maternal serum and advanced glycation end products (AGE) in maternal serum, umbilical cord blood and in the placenta of women with pre-eclampsia.Sixty women with pre-eclampsia and 60 normal pregnant women as controls participated in this study. Women with pre-eclampsia were divided into an early-onset group and late-onset group, with 30 normal pregnant women as the early control group and 30 as the late control group. Competitive enzyme-linked immunosorbent assay was used to measure AGE in maternal serum and umbilical cord blood. Western blotting was performed to analyze AGE in the placenta. Improved copper agent colorimetry was performed to measure FFA in maternal serum.Mean AGE in maternal serum in the early-onset and late-onset pre-eclampsia groups was significantly higher than in the control groups. Mean concentration of umbilical cord blood AGE was significantly higher in the early-onset and late-onset pre-eclampsia groups when compared with the control groups. On western blot the level of placental AGE in the early-onset and late-onset pre-eclampsia groups was significantly higher than in normal placenta. Serum FFA in the early-onset and late-onset pre-eclampsia groups was higher than in healthy pregnant women. Maternal serum FFA in the early-onset and late-onset pre-eclampsia groups correlated positively with maternal serum AGE (r = 0.764 and r = 0.774, P 0.05).AGE and FFA, which are upregulated in pre-eclampsia, are likely to be involved in pre-eclampsia through some common mechanism.

To investigate the relationships between concentrations of free fatty acid (FFA) in maternal serum and oxidative damage levels in placental mitochondria and preeclampsia (PE).A total of 60 women with PE and 60 normal pregnant women as control participated in this study. All were admitted to Fujian Maternity and Child Health Hospital for delivery from August 2010 to May 2011. Patients with PE were divided into early-onset group (n = 30, presented at34 weeks of gestation) and late-onset group (n = 30, presented at ≥ 34 weeks of gestation), with 30 normal pregnant women as early control group (34 weeks of gestation) and 30 as late control group (≥ 34 weeks of gestation). Improved copper agent colorimetry was used to detect FFA in maternal serum. Ultraviolet colorimetry was used to detect glutathione peroxidase (GPX) and catalase (CAT) activity in maternal placenta and malondialdehyde (MDA) and permeability transition (PT) pore in placental mitochondria. Total superoxide dismutase (SOD) assay kit-WST was used to detect SOD activity in placenta. Real-time fluorescent quantitative PCR was used to detect mitochondrial DNA (mtDNA) expression in placenta.(1) Maternal serum FFA was (1.6 ± 0.5) mmol/L in early-onset PE group and (1.5 ± 0.4) mmol/L in late-onset PE group, significantly elevated as compared to (1.0 ± 0.5) mmol/L in early control group and (0.9 ± 0.5) mmol/L in late control group (P0.05). However, no significant difference was found between early-onset and late-onset PE groups (P0.05). (2) The mean placental GPX, CAT and SOD activity were significantly decreased in the early-onset PE group [(47 ± 6), (19 ± 5), (62 ± 13) U/mg] and late-onset PE group [(67 ± 6), (20 ± 4), (96 ± 17) U/mg] as compared to late control group [(80 ± 3), (55 ± 3), (123 ± 19) U/mg], respectively (P0.05). (3) The mean placental mitochondria MDA was significantly elevated in the early-onset PE group [(115 ± 22) nmol/mg] and late-onset PE group [(90 ± 17) nmol/mg] as compared to late control group [(52 ± 11) nmol/mg, P0.05]. The mean absorption value that present the permeability of placental mitochondria PT pore was significantly elevated in the early-onset PE group (0.086 ± 0.013) and late-onset PE group (0.069 ± 0.014) as compared to late control group (0.052 ± 0.012, P0.05). The mean placental mtDNA expression was significantly elevated in the early-onset PE group (3.0 ± 0.7) and late-onset PE group (2.8 ± 0.7) as compared to late control group (2.6 ± 0.6, P0.05). (4) The mean placental mitochondria MDA concentration correlated positively with the concentrations of FFA in maternal serum in the early-onset PE group (r = 0.703, P0.05) and late-onset PE group (r = 0.457, P0.05), and negatively with placental antioxidant enzyme in the early-onset PE group (r = -0.652, -0.787, -0.952; P0.05) and late-onset PE group (r = -0.378, -0.689, -0.854; P0.05).Increased FFA in maternal serum and high levels of oxidative damage in placental mitochondria may be involved in the pathogenesis of preeclampsia. Increased FFA in serum and decreased activity of antioxidant enzyme in placenta may contribute to oxidative damage levels in placental mitochondria in women with PE.

To investigate the change of adipocyte fatty acid-binding protein (FABP4) in maternal serum and umbilical cord blood and FABP4 mRNA placental expression in patients with preeclampsia (PE).A total of 60 women with PE and 60 normal pregnant women as control participated in this study.All are admitted to Fujian Maternity and Children Health Hospital for delivery from December 2008 to October 2009. Patients with PE were divided into early-onset group (n = 30, presented at ≤ 34 weeks of gestation) and late-onset group (n = 30, presented at34 weeks of gestation), with 30 normal pregnant women as early control group (≤ 34 weeks of gestation) and 30 as late control group (34 weeks of gestation). Enzyme-linked immunosorbent assay (ELISA) was used to detect FABP4, fasting serum glucose, fasting insulin (FINS) in maternal serum and FABP4 in umbilical cord blood. Real-time fluorescent quantitative reverse transcription PCR was used to detect placental FABP4 mRNA expression. Furthermore, clinical and biochemical parameters were recorded, such as body mass index (BMI), systolic pressure (SP), diastolic pressure (DP), mean arterial pressure (MAP), total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL), high density lipoprotein (HDL), creatinine (Cr), uric acid (UA), glomerular filtration rate (GFR), 24 hours urine protein in pregnant women and neonatal weight.(1) Maternal serum FABP4 was (176 ± 9) ng/L in early-onset PE group and (170 ± 9) ng/L in late-onset PE group, significantly elevated as compared to (81 ± 13) ng/L in early control group and (94 ± 15) ng/L in late control group. (2) Mean maternal FINS, homeostasis model of assessment for insulin resistence index (HOMA-IR) were significantly elevated in the early-onset PE group and late-onset PE group as compared to control groups, respectively. (3) Mean placental FABP4 mRNA expression were significantly elevated in the early-onset PE group and late-onset PE group as compared to late control group. However, no significant difference was found in placental FABP4 mRNA expression between early-onset and late-onset PE groups. (4) Mean umbilical cord blood FABP4 concentrations were significantly decreased in the early-onset PE group and late-onset PE group as compared to late control group. Furthermore, umbilical cord blood FABP4 concentration correlated negatively with maternal serum FABP4 level and placental FABP4 mRNA expression, but positively with neonatal weight. (5) Mean maternal serum FABP4 concentrations correlated positively with placental FABP4 mRNA expression, TG, FINS, HOMA-IR, Cr, UA; and negatively with HDL, GFR.Increased FABP4 expression in maternal serum and placenta may be involved in the pathogenesis of preeclampsia. Increased FABP4 mRNA expression in placenta may contribute to high serum FABP4 level in women with PE.

To determine the expression of adiponectin mRNA in omental and subcutaneous adipose tissues and serum levels of adiponectin in pregnant women complicated with pre-eclampsia (PE) in order to find out its association with the pathogenesis of PE.The expression of adiponectin mRNA in omental and subcutaneous adipose tissue of 49 women with severe PE, which were divided into early-onset group (n = 24, presented ator= 34 weeks of gestation) and late-onset group (n = 25, presented at34 weeks of gestation), and 30 healthy pregnant women (control), who presented to Fujian Maternity and Child Health Hospital for prenatal care from September 2007 to July 2008, were determined by real-time fluorescent quantitative reverse transcription PCR. The maternal serum level of adiponectin was detected by enzyme-linked immunosorbent assay for all subjects.(1) The levels of serum adiponectin in the early-onset and late-onset severe PE groups were (5.9 +/- 2.7) and (7.9 +/- 2.8) mg/L, which were significantly lower than that of the control (11.2 +/- 4.2) mg/L, respectively (P0.01), and the level in the early-onset group was lower than in the late-onset group (P0.05). (2) Among the early-onset, late-onset PE group and the controls, significant difference was found between any two groups of the three in the adiponectin mRNA expression in omental adipose tissue (0.56 +/- 0.17, 0.69 +/- 0.23 and 1.00 +/- 0.22, P0.01), but not in the subcutaneous adipose tissue (0.90 +/- 0.19, 0.93 +/- 0.23 and 1.00 +/- 0.16, P0.05). (3) The adiponectin mRNA expressions in the subcutaneous and omental adipose tissue were positively correlated with the maternal serum level of adiponectin in all groups (P0.05). (4) The omental adiponectin mRNA levels were negatively correlated with maternal serum triglyceride levels in all of the three groups (r = -0.610, -0.659, -0.446, respectively, and all P0.05). Negative correlation was also found between the omental adiponectin mRNA level and the prepregnant body mass index in the control group (r = -0.436, P0.05).Decreased maternal serum adiponectin level may be involved in the pathogenesis of pre-eclampsia and also may contribute to the reduced expression of adiponectin in the omental adipose tissue.

To evaluate the efficacy and safety of motherwort (herba leonuri/leonurus heterophyllus sweet) injection for preventing postpartum hemorrhage after caesarian section.The prospective study was designed as a randomized and single blind multi-center research matched with positive agent as controls from Apr 2007 to Aug 2007. 440 women underwent caesarian section (CS) indicated by obstetric factors were enrolled from 15 teaching hospitals in China and assigned into three groups: group of motherwort: 147 cases were administered by motherwort 40 mg uterine injection during CS and 20 mg intramuscular injection per 12 hours 3 times after CS; group of motherwort+oxytocin: 144 cases were administered by motherwort 40 mg and oxytocin 10 U uterine injection during CS and motherwort 20 mg intramuscular injection per 12 hours 3 times after CS and group of oxytocin: 149 cases were administered by oxytocin 10 U uterine injection and oxytocin 10 U+5% glucose 500 ml intravenously injection during operation and oxytocin 10 U intramuscular injection per 12 hours 3 times after CS. The following clinical parameter were collected and analyzed: (1) The amount of blood loss during operation, at 2, 6, 12, 24, 48 hours after operation. (2) The total amount of blood loss in 24 hours after CS and the incidence of postpartum hemorrhage. (3) The change of level of hemoglobin (Hb) and counting of red blood cell (RBC) from prepartum to postpartum. (4) Adverse reaction.(1) The mean amount of blood loss during operation were (368+/-258) ml in group of motherwort, (255+/-114) ml in group of motherwort+oxytocin and (269+/-141) ml in group of oxytocin, which exhibited significant difference among three groups (P0.01). Meanwhile, no statistical different amount of blood loss among three groups were observed at 2, 6, 12, 24, 48 hours after CS. (2) The amount of blood loss of postpartum at 24 hours were (480+/-276) ml in group of motherwort, (361+/-179) ml in group of motherwort+oxytocin, (381+/-179) ml in group of oxytocin, which showed significant difference among 3 groups (P0.01). (3) The incidence of postpartum hemorrhage were 32.0% (47/147) in group of motherwort, 11.1% (16/144) in group of motherwort+oxytocin, and 18.8% in (28/149) in group of oxytocin. When comparing the lowest rate of postpartum blood loss in group of motherwort+oxytocin and the highest rate in group of motherwort, it displayed statistical difference (P0.01). (4) The decreased level of RBC and Hb were shown that RBC (0.3+/-0.5)x10(12)/L and Hb (9+/-13) g/L in group of motherwort, RBC (0.2+/-0.4)x10(12)/L and Hb (6+/-10) g/L in group of motherwort+oxytocin and RBC (0.2+/-0.4)x10(12)/L and Hb (7+/-30) g/L in group of oxytocin respectively. However, the comparison of different value of RBC and Hb in group of oxytocin and motherwort+oxytocin showed significant difference (P0.05). (5) Two cases with allery reaction was observed.It is safe and efficacious that combined use of motherwort injection and oxytocin was to prevent postpartum hemorrhage during or after caesarian section.