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Objective: To explore the dynamic changes of D-dimers during pregnancy and early puerperium(within 3 days postpartum). Methods: A retrospective study was performed among 8 367 healthy women who had term singleton delivery in Women's Hospital, School of Medicine, Zhejiang University from January 2007 to December 2014. D-dimers concentrations during pregnancy and early puerprium of all the cases were collected. Data of 21 065 D-dimers tests were assigned to 5 groups according to the time of sampling, including early pregnancy(≤12 gestation weeks), middle pregnancy(12-28 gestation weeks), late pregnancy(>28 gestation weeks), 1 postpartum(within 48 hours postpartum)and 2 postpartum(48- 72 hours postpartum). The D-dimers concentrations in different groups were compared. The effect of delivery mode on D-dimers of early pureperium was analyzed. The correlation between D-dimers and the thromboembolic disease was also explored. In this study, Student's t -test and Wilcoxon rank sum test were used for statistical analysis. D-dimers concentration ≤0.5 mg/L was used as the normal range. Results: (1)D-dimers concentrations during pregnancy were higher than the non-pregnant women( P <0.01), but there was no statistical difference between early pregnancy and late pregnancy( P =0.820). D-dimers concentration in the 1 postpartum group was higher than that of early pregnancy group or late pregnancy group( P <0.01). But in the 2 postpartum group, it was lower than early pregnancy, late pregnancy and 1 postpartum groups.(2)D-dimers in cesarean section cases was significantly higher than in vaginal delivery cases in each period of pregnancy and early pueprium.(3)The 95% CI of D-dimers in early pregnancy, late pregnancy, 48 hours after vaginal delivery, 48- 72 hours after vaginal delivery, ≤48 hours after cesarean section, 48- 72 hours after cesarean section were 0.58-8.28, 0.47-11.52, 1.04-9.59, 0.87-5.22, 1.07-11.58 and 1.00-6.23 mg/L, respectively.(4)In 6 cases with thromboembolic disease, D-dimers was 6.89- 19.89 mg/L, with the mean value of 13.66 mg/L. It was significantly higher than normal range. In 3 cases, all after cesarean section, with lower extremity vein thrombosis within 48 hours postpartum, the D-dimers concentrations, 9.77, 8.65 and 6.89 mg/L respectively, were in the 95% CI of the study population after cesarean section. Conclusions: D-dimers concentration of 0.5 mg/L is not suitable for venous thromboembolism screening during pregnancy. D-dimers concentration in pregnancy and early puerprium is higher than non-pregnancy. It increases in the very early period postpartum and decreases with time. D-dimers should not be a routine screening test to exclude thromboembolic disease in pregnant women without high risk factors and clinical manifestation of thromboembolic disease.

Objective: To explore the clinical significance of prenatal ultrasonic diagnosis of fetal nephrohydrosis and its prognosis., Methods: Prenatal ultrasonography was performed on 9526 women at more than 20 weeks gestation, and 162 women whose anteroposterior diameter of the renal pelvis was > or = 8 mm were included in this study. The grade of fetal nephrohydrosis was classified according to Grignon grading method. The changes in fetal nephrohydrosis were observed regularly until delivery., Results: (1) The incidence of fetal encephalic fluid and Grignon grade: there were 162 fetuses with fetal nephrohydrosis among 9526 fetuses, with an incidence of 1.7%. The numbers of fetuses with Grades 1 to 5 were 71, 59, 7, 3 and 22, respectively. (2) The distribution in gestational weeks of fetal nephrohydrosis: generally, fetal nephrohydrosis was first diagnosed at (33 +/- 5) weeks, and the maximum degree of nephrohydrosis was observed at (36 +/- 3) weeks. One hundred and ten fetuses with nephrohydrosis recovered during the process of gestation, at about (37 +/- 4) weeks. (3) Poor terminations of pregnancy: there were 40 (25%) fetuses with poor terminations among totally 162 cases. Among these 40 fetuses, 3 (27%) were first diagnosed at 20 to 24 weeks within 11 fetuses, 6 (24%) were first diagnosed at 25 to 28 weeks within 20 fetuses, 14 (26%) were first diagnosed at 29 to 32 weeks within 53 fetuses, 11 (23%) were first diagnosed at 33 to 36 weeks within 48 fetuses, and 6 (20%) were first diagnosed at 37 to 40 weeks within 30 fetuses. The results demonstrate that high grade of fetal nephrohydrosis according to Grignon grading method indicates a poorer prognosis of the fetus. (4) Follow-up results: there were 122 (75%, 122/162) live and healthy neonates in total, including 110 neonates whose nephrohydrosis recovered prior to birth and 12 neonates whose nephrohydrosis recovered within 1 week after birth. These neonates all developed well without any urinary sequela within the first 2 years. There were also 20 (12%, 20/162) hydronephrotic neonates who were still diagnosed as nephrohydrosis within 1 week after birth, including 11 fetuses graded below Grignon grade 3, whose nephrohydrosis recovered 3 to 12 months after birth and who developed well without any urinary symptoms., Conclusions: The study demonstrates that hydronephrotic fetuses who are diagnosed at earlier gestational weeks and with higher grading have poorer prognosis. The Grignon grading method can be used in the prenatal evaluation of fetal nephrohydrosis to predict the prognosis of the fetus.

Objective: To discuss the clinical significance of fetal encephalic accumulated fluid revealed by prenatal ultrasonography., Methods: Prenatal ultrasonography was performed on 8426 women at more than 20 weeks' gestation. Totally 150 women with fetal encephalic accumulated fluid more than 5 mm were included in this study. The changes of fetal encephalic accumulated fluid and the associated anomalies were observed regularly every 2 weeks until delivery. The live infants were followed up regularly., Results: The incidence of fetal encephalic fluid was 1.8%, including 72 cases with fluid in the fetal anterior or posterior cornu of unilateral ventricle, 46 cases with accumulated fluid in fetal posterior fossa, 32 cases with fluid in more than 2 sites. Generally, the accumulated fluid in fetal encephalus was first diagnosed at 17 - 40 gestational weeks, with a median of (26 +/- 5) weeks. Most of them were found between 29 - 32 gestational weeks (63 cases, 42.0%), and the maximum amount of accumulated fluid was also found between 29 - 32 weeks (70 cases, 46.7%). Spontaneous regression of intracranial fluid could be seen in 111 fetuses (74.0%). The period of fluid regression ranged from 29 to 40 weeks of gestation, of which the average gestational week was (36 +/- 2) weeks. Additionally, the most frequent period of regression was in the first two thirds of the three trimesters of pregnancy. The incidence of defected infants was 3.8%, 10.2% and 67.4%, respectively, when the amount of accumulated fluid was less than 10 mm, 10 - 14 mm and more than 15 mm. And the accumulated fluid in more than 2 sites was also a risk factor of defected fetuses, with an incidence of 60.0%., Conclusions: Most cases could be diagnosed between 29 - 32 gestational weeks, and the maximum amount of accumulated fluid is also observed in this period. The more fluid in fetal encephalus, the more sites the fluid distributed in, the more defected fetuses or infants would be observed. So in cases of more than 15 mm of fluid, or accumulated fluid in more than 2 sites, anomalies should be observed extremely carefully.