| BackgroundThe main factors of this phenomenon are the development of society and the progress of medicine,but the consequence is to increase the economic burden of society and family,and also cause the waste of health resources.In addition,with the full implementation of China's two child policy,the number of women of subsequent pregnancy with uterine scar was gradually increase,the attendant problems such as placenta previa,placenta increta are becoming increasingly prominent.Studies have shown that abnormal labor process is the most common cause of rising cesarean section rate.1954,Friedman system depicted partogram by assessing 500 primiparas labor data from New York Sloane Hospital.The partogram has been in use for over half a century.However,in recent years,with the rapid development of human society,on the one hand the level of perinatal medicine has been continuously improved;appeared new technologies such as labor analgesia,usage of oxytocin and method of abortion have also changed.On the other hand,women's own situation has also undergone great changes,mainly reflected in health awareness,childbirth age,pre-pregnancy weight,weight gain during pregnancy,fetal weight,pregnancy complications and comorbidities,etc.At the same time,the evidence of evidence based medicine on the change of natural birth process has been published.2014,Chinese Medical Association Obstetrics and Gynecology branch Obstetrics group issued the "Expert consensus on new process standards and processes(2014)",aimed at ensuring the safety of the mother and children,reduce the intervention of delivery,promote natural childbirth.Xie Xing,Wen Li Gou editor of the eighth edition of the textbook-"Obstetrics and Gynecology",the birth process part has made the following minor changes,the current international trend is that the cervix expansion to 4 cm as the starting point for the active period,and does not advocate excessive intervention the birth process before cervix expansion to 6 cm,the stagnation of active period is cervix stop expansion>4h.The basis for the establishment and maintenance of pregnancy is the mother's immune tolerance to the fetus carrying father antigen,its essence is that the immune cells between mother and fetus showed low reactivity to placental trophoblast cells.The past studies suggest that the mechanism of immune tolerance is because of the presence of placental anatomy barrier makes the maternal and fetal blood circulation completely separate,so as to avoid the fetal allogeneic antigen into the maternal blood circulation,causing immune rejection.However,the present study considers that this is an immune barrier problem,involving the immune response to the antigens of deciduas-maternal immune function cells with fetal trophoblast cell membrane.At present,there are more research on the immune active cells,including natural killer cells,natural killer T cells,CD4+CD25+ regulatory cells and so on,in pregnancy,the changes in the content of these immunoreactive cells and in the function of secreting cytokines are involved in the construction of the immune environment of the maternal fetal interface,so as to maintain the pregnancy.The mother-fetal immune balance interface was constructed by these immune active cells exists Th2 bias,with high secretory Th2 type cytokine IL-4(Interleukin-4),IL-10(Interleukin-10),and low secretory Th2 type cytokines IFN-?(Interferon-?),TNF-?(Tumor necrosis factor-?).When the balance is broken,the immune rejection of the embryo will occur,which leads to the occurrence of adverse pregnancy outcome.Study show,when the onset of labor stepmother body Th balance was changed,may be related to the mechanism of the labor start.In summary,how to judge whether puerpera entered the birth process or the active period,how to judge the turning point of cervix expansion in labor,and whether it is necessary to reenact the new production process plans or new production process standards,these are issues worthy of consideration for obstetric workers.At the same time,the significance of the changes of the immune active cells and their functions in the maintenance of pregnancy and the onset of labor was discussed.In the first part of this study,we analyzed the birth process of 2675 natural childbirth primipara in Maternal and Child Health Hospital of Anhui Province in 2014,to explore the change of production process curve,in order to guide clinical.The second part is to investigate the contents of CD4+CD25+Treg cells,NK cells and NKT cells and the secretion of NKG2A/NKG2D and CD 16 in peripheral blood and decidua of women in the non-pregnant stage,early stage of pregnancy,late stage of pregnancy,and after labor onset.Meanwhile,the Th factor secreted by immune active cells was also studied,to understand the changes in the content and function of immunocompetent cells in vivo during pregnancy progress and after delivery onset,and the correlation between these changes and pregnancy maintenance and labor onset.This research was divided into two parts:Part ?:the delivery status of Maternal and Child Health Hospital of Anhui Province in 2014 and evaluation of the labor curvePart ?:the research of the level and function of immunocompetent cells during pregnancyPart IThe delivery status of Maternal and Child Health Hospital of Anhui Province in 2014 and evaluation of the labor curveObjective:1.Investigation of delivery status in Maternal and Child Health Hospital of Anhui Province in 2014.2.Analysis labor curve of normal pregnant women.3.To investigate the effect of labor analgesia on the duration of labor in pregnant women.Methods:1.Access to all the information of pregnant women in Maternal and Child Health Hospital of Anhui Province from January 2014 to December,analysis of the delivery present situation of pregnant women in 2014.2.Select pregnant woman with perfect information in Maternal and Child Health Hospital of Anhui Province from January 2014 to December,a total of 2675 cases.According to whether labor analgesia,they were divided into non-labor analgesia group 1523 cases and labor analgesia group 1152 cases.By analysis the selected pregnant women's duration of labor,to draw partogram,to study the effect of labor analgesia on duration of labor.Results:1.Investigation on the present situation of pregnant women in our hospital in 2014In 2014,there were 17663 cases of pregnant women in Maternal and Child Health Hospital of Anhui Province,vaginal delivery in 9944 cases,vaginal delivery rate 56.3%,cesarean delivery in 7719 cases,cesarean delivery rate 43.7%,the first cesarean section rate 65.7%,labor analgesia was used in 6347 of all trial production women(11293 cases),labor analgesia rate 56.2%,instrumental delivery in 208 of all vaginal delivery,instrumental delivery rate 2.1%,oxytocin use in labor 3157 cases,oxytocin use in labor rate 31.7%.2.The labor curveUse regression analysis of repeated measurement data.Time for horizontal coordinate,after active period the degree of cervix expansion for vertical coordinate,the labor curve of two groups were drawn.No matter whether use of labor analgesia or not,labor curve showed a slow upward trend.There was no obvious difference between the two curves(P>0.05).3.Analysis of the first stage time of labor and the starting point of the active periodFrom 4cm to 5cm the cervix expansion duration of ninety-fifth percentile is 4 hours;from 5cm to 6cm is 3.9 hours.After cervix expansion to 5cm,the expansion showed accelerated trend.Labor analgesia group and non labor analgesia group,the median duration of cervix expansion was similar to that of the ninety-fifth percentile(P>0.05).Take the cervix expansion speed>1.2cm/h as the sign of enter active period,analysis of 2675 cases of vaginal delivery unipara,the results showed that there were 59 cases active period starting point is located at 2 cm(2.2%),575 cases at 3 cm(21.5%),768 cases at 4 cm(28.7%),650 cases at 5 cm(24.3%),404 cases at 6cm(15.1%),155 cases at 7cm(5.8%),64 cases at 8cm(2.4%).Further statistics cervix expansion to 4cm,5cm and 6cm,the cumulative rate number of pregnant women in the active stage of labor was 52.4%,76.7%and 91.8%.4.Analysis of the second stage of laborFrom the cervix completely open to the fetal birth,in labor analgesia group the median duration of the second stage is 0.9h,the ninety-fifth percentile is 2.4h,and in non labor analgesia group is 0.5h and 1.6h,analgesia group was significantly greater than the non labor analgesia group.The difference was statistically significant(Z value was 17.58,P<0.01).5.Descent of fetal presentationWe further statistical the corresponding relationship between fetal presentation and cervix dilatation,results show:when the cervix dilated 5cm,the fetal presentation was located-1?cm.when the cervix dilated 7cm,the fetal presentation was located 0?+1cm.when the cervix dilated 9cm,the fetal presentation was located +1?+2cm.ConclusionProduction curve of pregnant women with primary vaginal delivery showed a slow upward trend,after cervix expansion to 5cm,the expansion showed accelerated trend.Labor analgesia does not significantly affect the first stage of labor,but prolonged the second stage of labor.Part ?The research of the level and function of immunocompetent cells during pregnancyObjective:1.Detection of CD4+CD25+Treg cell,NK cell and NKT cell in peripheral blood and decidua tissue of the human.2.The expression NKG2D,NKG2A and CD 16 on the surface of NK cells,NKT cells was detected.3.To investigate the changes in maternal Th balance during pregnancy and after labor onset.4.To investigate the changes of Th cytokines secreted by NK cells and NKT cells during normal pregnancy and after labor onset.Methods:Randomly selected a total of 126 cases from June 2014 to January in Maternal and Child Health Hospital of Anhui Province,and divided them into 4 groups according to the different time of pregnancy.Among them,40 cases of early pregnancy group,34 cases of late pregnancy group,32 cases of delivery group,20 cases of non-pregnant group,and their peripheral blood and decidua tissue were been taken.Detection the percentage of CD4+CD25+Treg cell,NK cell and NKT cell in peripheral blood and decidua tissue of these patients by flow cytometry,at the same time,the expression of CD 16 and NKG2A/D in there surface and the ability of secreting IFN-?/IL-4 was also detected.Results1.Content changes of CD4+CD25+Treg cells,NK cells and NKT cells in the peripheral blood and decidua of the humanWith the development of pregnancy and the onset of delivery,the content of CD4+CD25+Treg cells in the decidua of the human is gradually decreased(F=64.7,P<0.01);the content of NK cells is also gradually decreased;The content of NKT cells was decreased than in the late pregnancy.With the development of pregnancy and the onset of delivery,the content of CD4+CD25+Treg cells in peripheral blood was gradually decreased(F=113.5,P<0.01);There was no significant difference in the percentage of NK cells in the non pregnant,early pregnancy and late pregnancy.The content of NK cells was significantly increased when the delivery was started(t=8.5 P<0.01).NKT cells percentage content:non pregnancy was 2.3 ± 0.6%,early pregnancy was 4.1 ± 1.0%,the late pregnancy was 2.9 ± 0.8%,and the delivery period was 4.8 ± 1.0%,the percentage of NKT cells showed that the characteristics of the first increase and then decreased,and increased again in the delivery time.2.The situation of CD16,NKG2A,NKG2D secretion of NK cells and NKT cells in the peripheral blood and decidua of the humanWith the development of pregnancy and the onset of delivery,CD 16 was gradually increased,and NKG2A,NKG2D secreted by NK cells were gradually decreased,and NKG2A/D expressed by NKT cells were not changed significantly in decidua.In peripheral blood,the ability of NK cells to secrete CD 16 in non pregnant was the highest,in early pregnant was the lowest,and there was no significant difference in late pregnant and delivery period;with the progress of pregnancy,the ability of NK cells to secrete NKG2A was first increased and then decreased,and the ability of NK cells to secrete NKG2D was decreased at first decreased and then increased.During delivery,the ability of NKT cells in peripheral blood to express NKG2A and NKG2D was increased(P<0.01).3.The conditions of secreting cytokines by mononuclear cells,NK cells and NKT cells in the peripheral blood and decidua of the humanIn decidua,with the development of pregnancy and the onset of delivery,the ability of NK cells secreting IFN-y is gradually increasing,and the ability of secreting IL-4 has no obvious difference in late pregnancy and early pregnancy,but it is significantly higher than that in the period of delivery.In peripheral blood,the ability of mononuclear cells to express IFN-y showed no significant difference in non pregnancy and early pregnancy,with the development of pregnancy and the onset of delivery,its expression increased gradually;the ability to secrete IL-4 in late pregnancy and delivery period was higher than in non pregnant and early pregnancy.With the progress of pregnancy,the ability of NK cells to secrete IFN-y was first decreased and then increased,the ability of NK cells to secrete IL-4 was no significant difference in late pregnant and delivery period,but it was significantly higher than early pregnancy.The ability of NKT cells in peripheral blood to secrete IFN-y and IL-4 showed a significant increase in the period of delivery.Conclusion:1.CD4+CD25+ Treg cells paly an important role in the establishment and maintenance of pregnancy.2.In early pregnancy and delivery,the content and function of NK cells and NKT cells were changed,the maintenance of pregnancy is related to the state of inhibition,while the onset of labor is associated with activation of NK cells and NKT cells;3.In pregnancy,there was a Th2 balance bias in the maternal body,and with the launch of the delivery,Th2 bias shift toward to Thl bias,immunocompetent cells have increased ability to secrete Thl cytokines. |
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