The localization and distribution of mRNAs and antigens of tissue type(t)and urokinasetype(u)plasminogen activator(PA)plus their corresponding inhibitors type-1(PAI-1)and type-2(PAI-2)were studied in human and rhesus ...The localization and distribution of mRNAs and antigens of tissue type(t)and urokinasetype(u)plasminogen activator(PA)plus their corresponding inhibitors type-1(PAI-1)and type-2(PAI-2)were studied in human and rhesus monkey placentae by in situ hybridization andimmunofluorencence We haye demonstrated that(1)plasmjnogen activators(tPA and uPA),and theirinhibitors(PAl-1 and PAl-2)for both mRNAs and proteins in most cases,co-localized fn the same areas.hut with different extent,In human and rhesus menkey placentae:(2)All the molecules,tPA.uPA.PAI-1,and PAl-2 and their mRNAs were identified in the wall of blood vessels of villi stem and decidua,extravillous cytotrophoblast cells of basal plate between Rohr's and Nitabuch's striace,trophoblast shelland decidual gland cells as well as eytotrophoblast cells of villi.However,tPA and PAI-1 were found tobe more evident in the regions adjacent to abscission planes from the maternal tissue,while uPA andPA1-2 concentrated mainly in villous trophoblast and extravillous trophoblast cells;(3)Distribution ofthe mRNAs of the 4 genes is generally consistent with the immunofluorescent pattern of thecorresponding antigens.however,no expressien of the mRNAs.but their proteins w'as observed insyncytiotrophoblast cells of villi;(4)The patterm of distribution and synthesis of the aetivators andinhibitors coincides with the distribution of fibrin-like molecules:(5)The distribution pattern of themRVAs and their proteins was similar in monkey and human placentae.no spcies-difference wasdemonstrated.The data suggest that the activators and the inhibitors described here interact at avariety of crucial physiological stages of pregnancy.They may interact in tightly restricted locations tothe matrix fibrinoids in rather short ranges and at specifie times,particularly during early and latepregnaney,to promote healthy gestation.It is possible that failure of the local control over the systemmay be important in failure of implantation and premature rupture of membranes.We new proposethat the location of these molecules gives the system potential in the control over establishment of utero-fetal blood circulation and placentatiton in the first two trimesters of gestation and abscission during thethird stage of labour,and predict a role in the pathology of abrupie placenta and retained placenta)products.展开更多
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 e...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.展开更多
It has been demonstrated that there are multiple opioid receptors in the brain of animals and men. The relationship between various subtype receptors and their physiological functions and the true biochemical basis ab...It has been demonstrated that there are multiple opioid receptors in the brain of animals and men. The relationship between various subtype receptors and their physiological functions and the true biochemical basis about the subtypes are the most important topics by neurobiologists. Cros’s laboratory first reported that human placenta contained unique specific k opioid binding sites. Later, Ahmed made further progress.展开更多
Background Previous evidence suggests that methionine(Met)consumption can promote placental angiogenesis and improve fetal survival.To investigate the mechanisms by which increased levels of Met as hydroxyl-Met(OHMet)...Background Previous evidence suggests that methionine(Met)consumption can promote placental angiogenesis and improve fetal survival.To investigate the mechanisms by which increased levels of Met as hydroxyl-Met(OHMet)improve placental function,forty sows were divided into four groups and fed either a control diet,or diets supplemented with 0.15%OHMet,0.3%OHMet or 0.3%Met(n=10).Placentas were collected immediately after expulsion,and extracted proteins were analyzed by tandem mass tag based quantitative proteomic analysis.Results We found that 0.15%OHMet consumption significantly increased placental vascular density compared with the control.Proteomic analysis identified 5,136 proteins,87 of these were differentially expressed(P<0.05,|fold change|>1.2).Enriched pathways in the Kyoto Encyclopedia of Genes and Genomes for 0.15%OHMet vs.control and 0.15%OHMet vs.0.3%OHMet were glutathione metabolism;for 0.15%OHMet vs.0.3%Met,they were NOD-like receptor signaling and apoptosis.Further analysis revealed that 0.15%OHMet supplementation upregulated the protein expression of glutathione-S-transferase(GSTT1)in placentas and trophoblast cells compared with the control and 0.3%OHMet groups,upregulated thioredoxin(TXN)in placentas and trophoblast cells compared with the 0.3%OHMet and 0.3%Met groups,and decreased reactive oxygen species(ROS)levels in trophoblast cells compared with other groups.In contrast,sows fed 0.3%OHMet or 0.3%Met diets increased placental interleukin 1βlevels compared with the control,and upregulated the protein expression of complex I-B9(NDUFA3)compared with the 0.15%OHMet group.Furthermore,homocysteine,an intermediate in the trans-sulphuration pathway of Met,damaged placental function by inhibiting the protein expression of TXN,leading to apoptosis and ROS production.Conclusion Although dietary 0.15%OHMet supplementation improved placental angiogenesis and increased antioxidative capacity,0.3%OHMet or 0.3%Met supplementation impaired placental function by aggravating inflammation and oxidative stress,which is associated with cumulative homocysteine levels.展开更多
Placenta abnormalities,which are collectively termed as placenta accreta spec-trum(PAS),are increasing globally in the female population due to the large nu-mber of cesarean sections performed worldwide.PAS represents...Placenta abnormalities,which are collectively termed as placenta accreta spec-trum(PAS),are increasing globally in the female population due to the large nu-mber of cesarean sections performed worldwide.PAS represents a rare but life-threatening occurrence that can lead to an increased risk of postpartum hemorr-hage due to the abnormal infiltration of the chorionic villi in the uterine wall up to the adjacent structures.Performing a prophylactic occlusion of the iliac arteries for a brief amount of time using balloon-occlusion endovascular catheters in patients with PAS can help control unwanted blood losses during cesarean delivery or postpartum demolition surgery.The aim of this narrative minireview was to pro-vide an overview of the aspects about prophylactic occlusion with endovascular balloons in patients with PAS and to analyze current evidence on this topic.In particular,this minireview included an overview of indications,patient selection,type of materials and devices used,technical advice and suggestions,clinical outcomes,and complications to give every interventional radiologist as well as every gynecologist and midwife all the information that is needed to address this particular condition in a safe and prompt manner.展开更多
Background Progressive oxidative stress easily occurs as a result of a gradual increase in the intensity of maternal metabolism due to rapid foetal development and increased intensity of lactation.However,studies on t...Background Progressive oxidative stress easily occurs as a result of a gradual increase in the intensity of maternal metabolism due to rapid foetal development and increased intensity of lactation.However,studies on the effects of processive oxidative stress on nutrient transport in the placenta have received little attention.The present study was conducted on sows at 85 days of gestation to study the effects of pterostilbene(PTE)on maternal oxidative stress status and placental nutrient transport.Results PTE increased the antioxidant capacity and immunoglobulin content in mothers’blood and milk,reduced the level of inflammatory factors,and improved the nutrient content of milk.PTE also reduced sow backfat loss and the number of weak sons,and increased piglet weaning weight and total weaning litter weight.We subsequently found that PTE enhanced placental glucose and fatty acid transport and further affected glycolipid metabolism by increasing the expression of LAL,PYGM,and Gbe-1,which activated the PI3K phosphorylation pathway.Moreover,PTE addition altered the relative abundance of the Firmicutes,Proteobacteria,Parabacillus,and Bacteroidetes-like RF16 groups in sow faeces.PTE increased the levels of acetate,propionate,butyrate and isovalerate in the faeces.Conclusions These findings reveal that the addition of PTE during pregnancy and lactation mitigates the effects of processive oxidative stress on offspring development by altering maternal microbial and placental nutrient trans-port capacity.展开更多
Imprinted genes play a key role in regulating mammalian placental and embryonic development.Here,we generated glutaminyl-peptide cyclotransferase-knockout(Qpct^(-/-))mice utilizing the clustered regularly interspaced ...Imprinted genes play a key role in regulating mammalian placental and embryonic development.Here,we generated glutaminyl-peptide cyclotransferase-knockout(Qpct^(-/-))mice utilizing the clustered regularly interspaced short palindromic repeats(CRISPR)/CRISPR-associated protein 9(Cas9)platform and identified Qpct as a novel anti-angiogenic factor in regulating mouse placentation.Compared with Qpct^(+/+)mice,placentae and embryos(Qpct^(-/+)and Qpct^(-/-))showed significant overgrowth at embryonic Day 12.5(E12.5),E15.5,and E18.5.Using single-cell transcriptome analysis of 32309 cells from Qpct^(+/+)and Qpct^(-/-)mouse placentae,we identified 13 cell clusters via single-nucleus RNA sequencing(snRNA-seq)(8880 Qpct^(+/+)and 13577 Qpct^(-/-)cells)and 20 cell clusters via single-cell RNA sequencing(scRNA-seq)(6567 Qpct^(+/+)and 3285 Qpct^(-/-)cells).Furthermore,we observed a global up-regulation of pro-angiogenic genes in the Qpct^(-/-)background.Immunohistochemistry assays revealed a notable increase in the number of blood vessels in the decidual and labyrinthine layers of E15.5 Qpct^(-/+)and Qpct^(-/-)mice.Moreover,the elevation of multiple pairs of ligand-receptor interactions was observed in decidual cells,endothelial cells,and macrophages,promoting angiogenesis and inflammatory response.Our findings indicate that loss of maternal Qpct leads to altered phenotypic characteristics of placentae and embryos and promotes angiogenesis in murine placentae.展开更多
[ Objective ] The aim of the research was to reveal the mechanism of Yizhikang powder treatment on dairy cattle with retained placenta from the hemorheological perspective. [ Method] Dairy cattle with retained placent...[ Objective ] The aim of the research was to reveal the mechanism of Yizhikang powder treatment on dairy cattle with retained placenta from the hemorheological perspective. [ Method] Dairy cattle with retained placenta were treated with oral administration of Yizhikang powder. And their hemorheological indexes were measured and compared with the corresponding indicators of pre-administration group, healthy group, and control group （sick but untreated）.[ Result] There was large decrease amplitude in the indexes （whole blood viscosity, plasma viscosity, whole blood viscosity reduction viscosity, ESR, ESR equation K value, fibrinogen content, platelet aggregation rate, RBC deformability IF value） of treated dairy cattle with retained placenta. By t test, the indexes, except hematocrit, decreased significantly after treatment （P〈0.05） and reached the status of post partum healthy cows. The hemorheological indexes didn＇t change significantly in the control group before and after treatment. [ Conclusion] Yizhikang powder could significantly improve blood flow state and reduced the occurrence of qi stagnation and blood stasis in perinatal period.展开更多
Yaks live in Qinghai-Tibet Plateau （4 km above sea level）, and the nutrient components of their placenta were determined, including 17 kinds of amino acids and 11 kinds of trace elements. The results showed that the...Yaks live in Qinghai-Tibet Plateau （4 km above sea level）, and the nutrient components of their placenta were determined, including 17 kinds of amino acids and 11 kinds of trace elements. The results showed that there are abundant amino acids and trace elements in the placenta of yak, equal to that of human and deer, indicating some medical and nutritional value of yak placenta.展开更多
Background: Resveratrol, a plant phenol, affords protection against inflammation and oxidative stress. The objective of this study was to investigate the effects of dietary resveratrol supplementation during pregnancy...Background: Resveratrol, a plant phenol, affords protection against inflammation and oxidative stress. The objective of this study was to investigate the effects of dietary resveratrol supplementation during pregnancy and lactation on the antioxidant status of sows and piglets and on antioxidant gene expression and pathway in placenta.Methods: Forty sows were allotted to 2 dietary treatments 20 d after breeding. Sows were fed a control diet and a control diet with 300 mg/kg resveratrol. Oxidative stress biomarkers and antioxidant enzymes were measured in the placenta, milk, and plasma of sows and piglets. Antioxidant gene expression and protein expression of Kelch-like ECH-associated protein 1-Nuclear factor E2-related factor 2(Keap1-Nrf2), nuclear factor kappa B-p65(NFκB-p65) and sirtuin1(Sirt1) were quantified in the placenta.Results: Dietary resveratrol increased the litter and piglets weaning weights. Antioxidant status in the milk, placenta and plasma of sows and piglets was partially improved by dietary resveratrol. In placenta, Nrf2 protein expression was increased and Keap1 protein expression was decreased by dietary resveratrol. The m RNA expression of antioxidant genes including catalase(CAT), glutathione peroxidase 1(GPX1), GPX4, superoxide dismutase 1(SOD1)and heme oxygenase 1(HO1), and phase 2 detoxification genes, including glutamate-cysteine ligase modifier(GCLM), microsomal glutathione S-transferase 1(MGST1) and UDP glucuronosyltransferase family 1 member A1(UGT1 A1), was increased by dietary resveratrol. Dietary resveratrol also increased Sirt1 and phosphorylated NFκB-p65 protein expression in the placenta. We failed to observe any influences of dietary resveratrol on pro-inflammatory cytokine levels, including those of interleukin 1β(IL-1β), IL-6, IL-8 and tumor necrosis factor α(TNF-α). However, we observed that the m RNA expression of IL-8 in placenta was reduced by maternal resveratrol. In addition, dietary resveratrol showed interactive effects with day of lactation on activities of SOD and CAT and levels of malonaldehyde(MDA) and hydrogen peroxide(H2 O2) in milk.Conclusions: Dietary resveratrol supplementation during pregnancy and lactation improves the antioxidant status of sows and piglets, which is beneficial to the reproductive performance of sows. Dietary resveratrol regulates placental antioxidant gene expression by the Keap1-Nrf2 pathway and Sirt1 in placenta.展开更多
Human placenta-derived mononuclear cells （MNC） were isolated by a Percoll density gradient and cultured in mesenchymal stem cell （MSC） maintenance medium. The homogenous layer of adherent cells exhibited a typical...Human placenta-derived mononuclear cells （MNC） were isolated by a Percoll density gradient and cultured in mesenchymal stem cell （MSC） maintenance medium. The homogenous layer of adherent cells exhibited a typical fibroblastlike morphology, a large expansive potential, and cell cycle characteristics including a subset of quiescent cells. In vitro differentiation assays showed the tripotential differentiation capacity of these cells toward adipogenic, osteogenic and chondrogenic lineages. Flow cytometry analyses and immunocytochemistry stain showed that placental MSC was a homogeneous cell population devoid of hematopoietic cells, which uniformly expressed CD29, CD44, CD73, CD105, CD166, laminin, fibronectin and vimentin while being negative for expression of CD31, CD34, CD45 and m-smooth muscle actin. Most importantly, immuno-phenotypic analyses demonstrated that these cells expressed class Ⅰ major histocompatibility complex （MHC-I）, but they did not express MHC-Ⅱ molecules. Additionally these cells could suppress umbilical cord blood （UCB） lymphocytes proliferation induced by cellular or nonspecific mitogenic stimuli. This strongly implies that they may have potential application in allograft transplantation. Since placenta and UCB are homogeneous, the MSC derived from human placenta can be transplanted combined with hematopoietic stem cells （HSC） from UCB to reduce the potential graft-versus-host disease （GVHD） in recipients.展开更多
Major depression during pregnancy is a common psychiatric disorder that arises from a complex and mul- tifactorial etiology. Psychosocial stress, sex, hormones, and genetic vulnerability increase the risk for triggeri...Major depression during pregnancy is a common psychiatric disorder that arises from a complex and mul- tifactorial etiology. Psychosocial stress, sex, hormones, and genetic vulnerability increase the risk for triggering mood disorders. Microglia and toll-like receptor 4 play a crucial role in triggering wide and varied stress-induced responses mediated through activation of the inflammasome; this leads to the secretion of inflammatory cytokines, increased serotonin metabolism, and reduction of neurotransmitter availability along with hypothalamic-pituitary-adrenal axis hyperactivity. Dysregulation of this intricate neu- roimmune communication network during pregnancy modifies the maternal milieu, enhancing the emergence of depressive symptoms and negative obstetric and neu- ropsychiatric outcomes. Although several studies have clearly demonstrated the role of the innate immune system in major depression, it is still unclear how the placenta, the brain, and the monoaminergic and neuroendocrine systems interact during perinatal depression. Thus, in the present review we describe the cellular and molecular interactions between these systems in major depression during preg- nancy, proposing that the same stress-related mechanisms involved in the activation of the NLRP3 inflammasome in microglia and peripheral myeloid cells in depressed patients operate in a similar fashion in the neuroimmune placenta during perinatal depression. Thus, activation of Toll-like receptor 2 and 4 signaling and the NLRP3 inflammasome in placental immune cells may promote a shift of the Thl/Th2 bias towards a predominant Thl/Thl7 inflammatory response, associated with increased secretion of pro-inflammatory cytokines, among other secreted autocrine and paracrine mediators, which play a crucial role in triggering and/or exacerbating depressive symptoms during pregnancy.展开更多
Objective To evaluate the efficacy and safety of uterine artery embolization(UAE) in the management of primary postpartum hemorrhage associated with placenta accreta. Methods We retrospectively reviewed the medical re...Objective To evaluate the efficacy and safety of uterine artery embolization(UAE) in the management of primary postpartum hemorrhage associated with placenta accreta. Methods We retrospectively reviewed the medical records of patients with placenta accreta between January 2010 and August 2014. Totally 18 women(mean age 30.8±4.2 years) of primary massive postpartum hemorrhage with diagnosis of placenta accrete received treatment of UAE after delivery. Images of DSA and medical records were reviewed. Technical success was defined as control of bleeding after embolization. The complications, control of hemorrhage and recurrent bleeding of the placenta left inside the uterus were retrospectively collected for assessment. Results All patients underwent transcatheter embolization of bilateral uterine arteries. The technical success rate of embolization was 100%. Bleeding was controlled in 17 of 18 patients(94%) during follow-up period(median 18 months, 3-31months) without further bleeding recurred. One patient with placenta percreta undertook an emergent hysterectomy along with surgical bladder repair after UAE because of persistent uterine bleeding. Eight patients had postembolization syndrome and no other complications occurred. Conclusion Uterine artery embolization is an effective and safe treatment for the management of primary postpartum massive hemorrhage associated with placenta accreta.展开更多
Diabetes mellitus(DM)is a health condition characterized by hyperglycemia over a prolonged period.There are three main types of DM:DM type 1(DM1),DM2 and gestational DM(GDM).Maternal diabetes,which includes the occurr...Diabetes mellitus(DM)is a health condition characterized by hyperglycemia over a prolonged period.There are three main types of DM:DM type 1(DM1),DM2 and gestational DM(GDM).Maternal diabetes,which includes the occurrence of DM1 and DM2 during pregnancy or GDM,increases the occurrence of gesttional complications and adverse fetal outcomes.The hyperglycemic intrauterine environment affects not only the fetus but also the placental development and function in humans and experimental rodents.The underlying mechanisms are still unclear,but some evidence indicates alterations in trophoblast proliferation,apoptosis and cell cycle control in diabetes.A proper coordination of trophoblast proliferation,differentiation and invasion is required for placental development.Initially,increased expression of proliferative markers in junctional and labyrinth zones of rat placentas and villous cytotrophoblast,syncytiotrophoblast,stromal cells and fetal endothelial cells in human placentas is reported among diabetics.Moreover,reduced apoptotic index and expression of some apoptotic genes are described in placentas of GDM women.In addition,cell cycle regulators including cyclins and cyclin-dependent kinase inhibitors seem to be affected by the hyperglycemic environment.More studies are necessary to check the balance between proliferation,apoptosis and differentiation in trophoblast cells during maternal diabetes.展开更多
This prospective study was conducted to assess the rate of resolution of second trimester placenta previa in women with anterior placenta and posterior placenta, and that in women with and without previous cesarean se...This prospective study was conducted to assess the rate of resolution of second trimester placenta previa in women with anterior placenta and posterior placenta, and that in women with and without previous cesarean section. In this study, placenta previa was defined as a placenta lying within 20 mm of the internal cervical os or overlapping it. We recruited 183 women diagnosed with previa between 20+0 weeks and 25+6 weeks. They were grouped according to their placenta location(anterior or posterior) and history of cesarean section. Comparative analysis was performed on demographic data, resolution rate of previa and pregnancy outcomes between anterior group and posterior group, and on those between cesarean section group and non-cesarean section group. Women with an anterior placenta tended to be advanced in parity(P=0.040) and have increased number of dilatation and curettage(P=0.044). The women in cesarean section group were significantly older(P=0.000) and had more parity(P=0.000), gravidity(P=0.000), and dilatation and curettage(P=0.048) than in non-cesarean section group. Resolution of previa at delivery occurred in 87.43% women in this study. Women with a posterior placenta had a higher rate of resolution(P=0.030), while history of cesarean section made no difference. Gestational age at resolution was earlier in posterior group(P=0.002) and non-cesarean section group(P=0.008) than in anterior group and cesarean section group correspondingly. Placenta location and prior cesarean section did not influence obstetric outcomes and neonatal outcomes. This study indicates that it is more likely to have subsequent resolution of the previa when the placenta is posteriorly located for women who are diagnosed with placenta previa in the second trimester.展开更多
Objective This study aims to investigate the correlation of an ultrasonic scoring system with intraoperative blood loss(IBL) in placenta accreta spectrum(PAS) disorders.Methods A retrospective cohort study was conduct...Objective This study aims to investigate the correlation of an ultrasonic scoring system with intraoperative blood loss(IBL) in placenta accreta spectrum(PAS) disorders.Methods A retrospective cohort study was conducted between January 2015 and November 2019.Clinical data for patients with PAS have been obtained from medical records. Generalized additive models were used to explore the nonlinear relationships between ultrasonic scores and IBL. Logistic regressions were used to determine the differences in the risk of IBL ≥ 1,500 m L among groups with different ultrasonic scores.Results A total of 332 patients participated in the analysis. Generalized additive models showed a significant positive correlation between score and blood loss. The amount of IBL was increased due to the rise in the ultrasonic score. All cases were divided into three groups according to the scores(low score group: ≤ 6 points, n = 147;median score group: 7-9 points, n = 126;and high score group: ≥ 10 points, n = 59). Compared with the low score group, the high score group showed a higher risk of IBL≥ 1,500 m L [odds ratio, 15.09;95% confidence interval(3.85, 59.19);P ≤ 0.001] after a multivariable adjustment.Conclusions The risk of blood loss equal to or greater than 1,500 m L increases further when ultrasonic score greater than or equal to 10 points, the preparation for transfusion and referral mechanism should be considered.展开更多
基金supported by WHO/Rockefeller Foundaton(RF9602078)the Welcome Trust(058659/2/99/2)+2 种基金the Royal Society of UK(RL/ART/CAN/JPQ7681)National Natural Science Foundationof China(39911130503)Chinese Academy of Seiences(KJ952-J1-603).
文摘The localization and distribution of mRNAs and antigens of tissue type(t)and urokinasetype(u)plasminogen activator(PA)plus their corresponding inhibitors type-1(PAI-1)and type-2(PAI-2)were studied in human and rhesus monkey placentae by in situ hybridization andimmunofluorencence We haye demonstrated that(1)plasmjnogen activators(tPA and uPA),and theirinhibitors(PAl-1 and PAl-2)for both mRNAs and proteins in most cases,co-localized fn the same areas.hut with different extent,In human and rhesus menkey placentae:(2)All the molecules,tPA.uPA.PAI-1,and PAl-2 and their mRNAs were identified in the wall of blood vessels of villi stem and decidua,extravillous cytotrophoblast cells of basal plate between Rohr's and Nitabuch's striace,trophoblast shelland decidual gland cells as well as eytotrophoblast cells of villi.However,tPA and PAI-1 were found tobe more evident in the regions adjacent to abscission planes from the maternal tissue,while uPA andPA1-2 concentrated mainly in villous trophoblast and extravillous trophoblast cells;(3)Distribution ofthe mRNAs of the 4 genes is generally consistent with the immunofluorescent pattern of thecorresponding antigens.however,no expressien of the mRNAs.but their proteins w'as observed insyncytiotrophoblast cells of villi;(4)The patterm of distribution and synthesis of the aetivators andinhibitors coincides with the distribution of fibrin-like molecules:(5)The distribution pattern of themRVAs and their proteins was similar in monkey and human placentae.no spcies-difference wasdemonstrated.The data suggest that the activators and the inhibitors described here interact at avariety of crucial physiological stages of pregnancy.They may interact in tightly restricted locations tothe matrix fibrinoids in rather short ranges and at specifie times,particularly during early and latepregnaney,to promote healthy gestation.It is possible that failure of the local control over the systemmay be important in failure of implantation and premature rupture of membranes.We new proposethat the location of these molecules gives the system potential in the control over establishment of utero-fetal blood circulation and placentatiton in the first two trimesters of gestation and abscission during thethird stage of labour,and predict a role in the pathology of abrupie placenta and retained placenta)products.
基金supported by Agriculture and Food Research Initiative Competitive Grant no.2014–05142 from the USDA National Institute of Food and Agriculture.
文摘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.
文摘It has been demonstrated that there are multiple opioid receptors in the brain of animals and men. The relationship between various subtype receptors and their physiological functions and the true biochemical basis about the subtypes are the most important topics by neurobiologists. Cros’s laboratory first reported that human placenta contained unique specific k opioid binding sites. Later, Ahmed made further progress.
基金financially supported by the Adisseo Innovation Research Center for Nutrition and Health(060–2222319005)Natural Science Foundation of Sichuan(2023NSFSC1135)National Natural Science Foundation of China(31972603)。
文摘Background Previous evidence suggests that methionine(Met)consumption can promote placental angiogenesis and improve fetal survival.To investigate the mechanisms by which increased levels of Met as hydroxyl-Met(OHMet)improve placental function,forty sows were divided into four groups and fed either a control diet,or diets supplemented with 0.15%OHMet,0.3%OHMet or 0.3%Met(n=10).Placentas were collected immediately after expulsion,and extracted proteins were analyzed by tandem mass tag based quantitative proteomic analysis.Results We found that 0.15%OHMet consumption significantly increased placental vascular density compared with the control.Proteomic analysis identified 5,136 proteins,87 of these were differentially expressed(P<0.05,|fold change|>1.2).Enriched pathways in the Kyoto Encyclopedia of Genes and Genomes for 0.15%OHMet vs.control and 0.15%OHMet vs.0.3%OHMet were glutathione metabolism;for 0.15%OHMet vs.0.3%Met,they were NOD-like receptor signaling and apoptosis.Further analysis revealed that 0.15%OHMet supplementation upregulated the protein expression of glutathione-S-transferase(GSTT1)in placentas and trophoblast cells compared with the control and 0.3%OHMet groups,upregulated thioredoxin(TXN)in placentas and trophoblast cells compared with the 0.3%OHMet and 0.3%Met groups,and decreased reactive oxygen species(ROS)levels in trophoblast cells compared with other groups.In contrast,sows fed 0.3%OHMet or 0.3%Met diets increased placental interleukin 1βlevels compared with the control,and upregulated the protein expression of complex I-B9(NDUFA3)compared with the 0.15%OHMet group.Furthermore,homocysteine,an intermediate in the trans-sulphuration pathway of Met,damaged placental function by inhibiting the protein expression of TXN,leading to apoptosis and ROS production.Conclusion Although dietary 0.15%OHMet supplementation improved placental angiogenesis and increased antioxidative capacity,0.3%OHMet or 0.3%Met supplementation impaired placental function by aggravating inflammation and oxidative stress,which is associated with cumulative homocysteine levels.
文摘Placenta abnormalities,which are collectively termed as placenta accreta spec-trum(PAS),are increasing globally in the female population due to the large nu-mber of cesarean sections performed worldwide.PAS represents a rare but life-threatening occurrence that can lead to an increased risk of postpartum hemorr-hage due to the abnormal infiltration of the chorionic villi in the uterine wall up to the adjacent structures.Performing a prophylactic occlusion of the iliac arteries for a brief amount of time using balloon-occlusion endovascular catheters in patients with PAS can help control unwanted blood losses during cesarean delivery or postpartum demolition surgery.The aim of this narrative minireview was to pro-vide an overview of the aspects about prophylactic occlusion with endovascular balloons in patients with PAS and to analyze current evidence on this topic.In particular,this minireview included an overview of indications,patient selection,type of materials and devices used,technical advice and suggestions,clinical outcomes,and complications to give every interventional radiologist as well as every gynecologist and midwife all the information that is needed to address this particular condition in a safe and prompt manner.
基金Natural Science Foundation of Heilongjiang Province(YQ2022C014)National Natural Science Foundation of China(32302768).
文摘Background Progressive oxidative stress easily occurs as a result of a gradual increase in the intensity of maternal metabolism due to rapid foetal development and increased intensity of lactation.However,studies on the effects of processive oxidative stress on nutrient transport in the placenta have received little attention.The present study was conducted on sows at 85 days of gestation to study the effects of pterostilbene(PTE)on maternal oxidative stress status and placental nutrient transport.Results PTE increased the antioxidant capacity and immunoglobulin content in mothers’blood and milk,reduced the level of inflammatory factors,and improved the nutrient content of milk.PTE also reduced sow backfat loss and the number of weak sons,and increased piglet weaning weight and total weaning litter weight.We subsequently found that PTE enhanced placental glucose and fatty acid transport and further affected glycolipid metabolism by increasing the expression of LAL,PYGM,and Gbe-1,which activated the PI3K phosphorylation pathway.Moreover,PTE addition altered the relative abundance of the Firmicutes,Proteobacteria,Parabacillus,and Bacteroidetes-like RF16 groups in sow faeces.PTE increased the levels of acetate,propionate,butyrate and isovalerate in the faeces.Conclusions These findings reveal that the addition of PTE during pregnancy and lactation mitigates the effects of processive oxidative stress on offspring development by altering maternal microbial and placental nutrient trans-port capacity.
基金supported by the National Natural Science Foundation of China(No.32271165)the Interdisciplinary Project in Ocean Research of Tongji University(No.2022-2-ZD-02),China.
文摘Imprinted genes play a key role in regulating mammalian placental and embryonic development.Here,we generated glutaminyl-peptide cyclotransferase-knockout(Qpct^(-/-))mice utilizing the clustered regularly interspaced short palindromic repeats(CRISPR)/CRISPR-associated protein 9(Cas9)platform and identified Qpct as a novel anti-angiogenic factor in regulating mouse placentation.Compared with Qpct^(+/+)mice,placentae and embryos(Qpct^(-/+)and Qpct^(-/-))showed significant overgrowth at embryonic Day 12.5(E12.5),E15.5,and E18.5.Using single-cell transcriptome analysis of 32309 cells from Qpct^(+/+)and Qpct^(-/-)mouse placentae,we identified 13 cell clusters via single-nucleus RNA sequencing(snRNA-seq)(8880 Qpct^(+/+)and 13577 Qpct^(-/-)cells)and 20 cell clusters via single-cell RNA sequencing(scRNA-seq)(6567 Qpct^(+/+)and 3285 Qpct^(-/-)cells).Furthermore,we observed a global up-regulation of pro-angiogenic genes in the Qpct^(-/-)background.Immunohistochemistry assays revealed a notable increase in the number of blood vessels in the decidual and labyrinthine layers of E15.5 Qpct^(-/+)and Qpct^(-/-)mice.Moreover,the elevation of multiple pairs of ligand-receptor interactions was observed in decidual cells,endothelial cells,and macrophages,promoting angiogenesis and inflammatory response.Our findings indicate that loss of maternal Qpct leads to altered phenotypic characteristics of placentae and embryos and promotes angiogenesis in murine placentae.
基金Supported by Science and Technology Key Projects of Xinjiang Pro-duction and Construction Corps (2006GG22)~~
文摘[ Objective ] The aim of the research was to reveal the mechanism of Yizhikang powder treatment on dairy cattle with retained placenta from the hemorheological perspective. [ Method] Dairy cattle with retained placenta were treated with oral administration of Yizhikang powder. And their hemorheological indexes were measured and compared with the corresponding indicators of pre-administration group, healthy group, and control group （sick but untreated）.[ Result] There was large decrease amplitude in the indexes （whole blood viscosity, plasma viscosity, whole blood viscosity reduction viscosity, ESR, ESR equation K value, fibrinogen content, platelet aggregation rate, RBC deformability IF value） of treated dairy cattle with retained placenta. By t test, the indexes, except hematocrit, decreased significantly after treatment （P〈0.05） and reached the status of post partum healthy cows. The hemorheological indexes didn＇t change significantly in the control group before and after treatment. [ Conclusion] Yizhikang powder could significantly improve blood flow state and reduced the occurrence of qi stagnation and blood stasis in perinatal period.
文摘Yaks live in Qinghai-Tibet Plateau （4 km above sea level）, and the nutrient components of their placenta were determined, including 17 kinds of amino acids and 11 kinds of trace elements. The results showed that there are abundant amino acids and trace elements in the placenta of yak, equal to that of human and deer, indicating some medical and nutritional value of yak placenta.
基金supported by the National Key Research and Development Plan of China(2016YFD0501207)the China Agriculture Research System(CARS-36)the National Basic Research Program(2012CB124703)
文摘Background: Resveratrol, a plant phenol, affords protection against inflammation and oxidative stress. The objective of this study was to investigate the effects of dietary resveratrol supplementation during pregnancy and lactation on the antioxidant status of sows and piglets and on antioxidant gene expression and pathway in placenta.Methods: Forty sows were allotted to 2 dietary treatments 20 d after breeding. Sows were fed a control diet and a control diet with 300 mg/kg resveratrol. Oxidative stress biomarkers and antioxidant enzymes were measured in the placenta, milk, and plasma of sows and piglets. Antioxidant gene expression and protein expression of Kelch-like ECH-associated protein 1-Nuclear factor E2-related factor 2(Keap1-Nrf2), nuclear factor kappa B-p65(NFκB-p65) and sirtuin1(Sirt1) were quantified in the placenta.Results: Dietary resveratrol increased the litter and piglets weaning weights. Antioxidant status in the milk, placenta and plasma of sows and piglets was partially improved by dietary resveratrol. In placenta, Nrf2 protein expression was increased and Keap1 protein expression was decreased by dietary resveratrol. The m RNA expression of antioxidant genes including catalase(CAT), glutathione peroxidase 1(GPX1), GPX4, superoxide dismutase 1(SOD1)and heme oxygenase 1(HO1), and phase 2 detoxification genes, including glutamate-cysteine ligase modifier(GCLM), microsomal glutathione S-transferase 1(MGST1) and UDP glucuronosyltransferase family 1 member A1(UGT1 A1), was increased by dietary resveratrol. Dietary resveratrol also increased Sirt1 and phosphorylated NFκB-p65 protein expression in the placenta. We failed to observe any influences of dietary resveratrol on pro-inflammatory cytokine levels, including those of interleukin 1β(IL-1β), IL-6, IL-8 and tumor necrosis factor α(TNF-α). However, we observed that the m RNA expression of IL-8 in placenta was reduced by maternal resveratrol. In addition, dietary resveratrol showed interactive effects with day of lactation on activities of SOD and CAT and levels of malonaldehyde(MDA) and hydrogen peroxide(H2 O2) in milk.Conclusions: Dietary resveratrol supplementation during pregnancy and lactation improves the antioxidant status of sows and piglets, which is beneficial to the reproductive performance of sows. Dietary resveratrol regulates placental antioxidant gene expression by the Keap1-Nrf2 pathway and Sirt1 in placenta.
基金This study was supported by a grant from National Natural Science Foundation of China(No.30271245)Hi-Tech Research and Development Program of China(863 Program)(No.2003AA205170)+1 种基金National Basic Research Program of China(973 Program)(No.G 1999054302)a grant from Bejing Gynecology and Obstetrics Hospital Affiliate of Capital University of Medical Sciences.
文摘Human placenta-derived mononuclear cells （MNC） were isolated by a Percoll density gradient and cultured in mesenchymal stem cell （MSC） maintenance medium. The homogenous layer of adherent cells exhibited a typical fibroblastlike morphology, a large expansive potential, and cell cycle characteristics including a subset of quiescent cells. In vitro differentiation assays showed the tripotential differentiation capacity of these cells toward adipogenic, osteogenic and chondrogenic lineages. Flow cytometry analyses and immunocytochemistry stain showed that placental MSC was a homogeneous cell population devoid of hematopoietic cells, which uniformly expressed CD29, CD44, CD73, CD105, CD166, laminin, fibronectin and vimentin while being negative for expression of CD31, CD34, CD45 and m-smooth muscle actin. Most importantly, immuno-phenotypic analyses demonstrated that these cells expressed class Ⅰ major histocompatibility complex （MHC-I）, but they did not express MHC-Ⅱ molecules. Additionally these cells could suppress umbilical cord blood （UCB） lymphocytes proliferation induced by cellular or nonspecific mitogenic stimuli. This strongly implies that they may have potential application in allograft transplantation. Since placenta and UCB are homogeneous, the MSC derived from human placenta can be transplanted combined with hematopoietic stem cells （HSC） from UCB to reduce the potential graft-versus-host disease （GVHD） in recipients.
基金supported by the National Institute of Perinatology,Mexico City(234560)FONSEC SSA/IMSS/ISSSTE 2015-1(261435)
文摘Major depression during pregnancy is a common psychiatric disorder that arises from a complex and mul- tifactorial etiology. Psychosocial stress, sex, hormones, and genetic vulnerability increase the risk for triggering mood disorders. Microglia and toll-like receptor 4 play a crucial role in triggering wide and varied stress-induced responses mediated through activation of the inflammasome; this leads to the secretion of inflammatory cytokines, increased serotonin metabolism, and reduction of neurotransmitter availability along with hypothalamic-pituitary-adrenal axis hyperactivity. Dysregulation of this intricate neu- roimmune communication network during pregnancy modifies the maternal milieu, enhancing the emergence of depressive symptoms and negative obstetric and neu- ropsychiatric outcomes. Although several studies have clearly demonstrated the role of the innate immune system in major depression, it is still unclear how the placenta, the brain, and the monoaminergic and neuroendocrine systems interact during perinatal depression. Thus, in the present review we describe the cellular and molecular interactions between these systems in major depression during preg- nancy, proposing that the same stress-related mechanisms involved in the activation of the NLRP3 inflammasome in microglia and peripheral myeloid cells in depressed patients operate in a similar fashion in the neuroimmune placenta during perinatal depression. Thus, activation of Toll-like receptor 2 and 4 signaling and the NLRP3 inflammasome in placental immune cells may promote a shift of the Thl/Th2 bias towards a predominant Thl/Thl7 inflammatory response, associated with increased secretion of pro-inflammatory cytokines, among other secreted autocrine and paracrine mediators, which play a crucial role in triggering and/or exacerbating depressive symptoms during pregnancy.
文摘Objective To evaluate the efficacy and safety of uterine artery embolization(UAE) in the management of primary postpartum hemorrhage associated with placenta accreta. Methods We retrospectively reviewed the medical records of patients with placenta accreta between January 2010 and August 2014. Totally 18 women(mean age 30.8±4.2 years) of primary massive postpartum hemorrhage with diagnosis of placenta accrete received treatment of UAE after delivery. Images of DSA and medical records were reviewed. Technical success was defined as control of bleeding after embolization. The complications, control of hemorrhage and recurrent bleeding of the placenta left inside the uterus were retrospectively collected for assessment. Results All patients underwent transcatheter embolization of bilateral uterine arteries. The technical success rate of embolization was 100%. Bleeding was controlled in 17 of 18 patients(94%) during follow-up period(median 18 months, 3-31months) without further bleeding recurred. One patient with placenta percreta undertook an emergent hysterectomy along with surgical bladder repair after UAE because of persistent uterine bleeding. Eight patients had postembolization syndrome and no other complications occurred. Conclusion Uterine artery embolization is an effective and safe treatment for the management of primary postpartum massive hemorrhage associated with placenta accreta.
文摘Diabetes mellitus(DM)is a health condition characterized by hyperglycemia over a prolonged period.There are three main types of DM:DM type 1(DM1),DM2 and gestational DM(GDM).Maternal diabetes,which includes the occurrence of DM1 and DM2 during pregnancy or GDM,increases the occurrence of gesttional complications and adverse fetal outcomes.The hyperglycemic intrauterine environment affects not only the fetus but also the placental development and function in humans and experimental rodents.The underlying mechanisms are still unclear,but some evidence indicates alterations in trophoblast proliferation,apoptosis and cell cycle control in diabetes.A proper coordination of trophoblast proliferation,differentiation and invasion is required for placental development.Initially,increased expression of proliferative markers in junctional and labyrinth zones of rat placentas and villous cytotrophoblast,syncytiotrophoblast,stromal cells and fetal endothelial cells in human placentas is reported among diabetics.Moreover,reduced apoptotic index and expression of some apoptotic genes are described in placentas of GDM women.In addition,cell cycle regulators including cyclins and cyclin-dependent kinase inhibitors seem to be affected by the hyperglycemic environment.More studies are necessary to check the balance between proliferation,apoptosis and differentiation in trophoblast cells during maternal diabetes.
基金supported by grants from National Natural Science Foundation of China(Nos.30672243 and 81200354)Hubei Provincial Population and Family Planning Commission of China(No.JS-20130017)Huazhong University of Science and Technology(No.2013YGYL016)
文摘This prospective study was conducted to assess the rate of resolution of second trimester placenta previa in women with anterior placenta and posterior placenta, and that in women with and without previous cesarean section. In this study, placenta previa was defined as a placenta lying within 20 mm of the internal cervical os or overlapping it. We recruited 183 women diagnosed with previa between 20+0 weeks and 25+6 weeks. They were grouped according to their placenta location(anterior or posterior) and history of cesarean section. Comparative analysis was performed on demographic data, resolution rate of previa and pregnancy outcomes between anterior group and posterior group, and on those between cesarean section group and non-cesarean section group. Women with an anterior placenta tended to be advanced in parity(P=0.040) and have increased number of dilatation and curettage(P=0.044). The women in cesarean section group were significantly older(P=0.000) and had more parity(P=0.000), gravidity(P=0.000), and dilatation and curettage(P=0.048) than in non-cesarean section group. Resolution of previa at delivery occurred in 87.43% women in this study. Women with a posterior placenta had a higher rate of resolution(P=0.030), while history of cesarean section made no difference. Gestational age at resolution was earlier in posterior group(P=0.002) and non-cesarean section group(P=0.008) than in anterior group and cesarean section group correspondingly. Placenta location and prior cesarean section did not influence obstetric outcomes and neonatal outcomes. This study indicates that it is more likely to have subsequent resolution of the previa when the placenta is posteriorly located for women who are diagnosed with placenta previa in the second trimester.
基金supported by The Capital health Development Research Project [2020-1-4039]Key Program for Clinical Projects of Hospital [BYSY2018002]。
文摘Objective This study aims to investigate the correlation of an ultrasonic scoring system with intraoperative blood loss(IBL) in placenta accreta spectrum(PAS) disorders.Methods A retrospective cohort study was conducted between January 2015 and November 2019.Clinical data for patients with PAS have been obtained from medical records. Generalized additive models were used to explore the nonlinear relationships between ultrasonic scores and IBL. Logistic regressions were used to determine the differences in the risk of IBL ≥ 1,500 m L among groups with different ultrasonic scores.Results A total of 332 patients participated in the analysis. Generalized additive models showed a significant positive correlation between score and blood loss. The amount of IBL was increased due to the rise in the ultrasonic score. All cases were divided into three groups according to the scores(low score group: ≤ 6 points, n = 147;median score group: 7-9 points, n = 126;and high score group: ≥ 10 points, n = 59). Compared with the low score group, the high score group showed a higher risk of IBL≥ 1,500 m L [odds ratio, 15.09;95% confidence interval(3.85, 59.19);P ≤ 0.001] after a multivariable adjustment.Conclusions The risk of blood loss equal to or greater than 1,500 m L increases further when ultrasonic score greater than or equal to 10 points, the preparation for transfusion and referral mechanism should be considered.
