The Preliminary Research On The Change Of Placental Blood Flow And Apoptosis Of Placental Cells With The Intrahepatic Cholestasis Of Pregnancy

Objective: To study the change of the fetal PI,RI,S/D of Umbilical artery and placental bed artery through Color Doppler ultrasonography,in order to enhance antepartum surveillance of intrahepatic cholestasis of pregnancy in the susceptibility to result in adverse pregnancy outcome and also to study the expression of Caspase-3 mRNA , Survivin mRNA in human placenta with intrahepatic cholestasis of pregnancy . Methods: Women were randomly selected in the First Affiliated Hospital of Suzhou University between January 2007 and December 2007.There were 40 cases in normal groups and 22 cases in ICP groups. ICP groups were then graded into mild ICP and severe ICP based on diagnosis standards. Color Doppler ultrasound was used to detect flow velocity frequency spectrogram of the 62 cases umbilical artery and placental bed artery. The indices measured included Pulsatility Index (PI), Resistance Index (RI), systolic maximum velocity /diastolic minimum velocity(S/D).The quantitative expression of Caspase-3 mRNA and Survivin mRNA in human placenta with intrahepatic cholestasis of pregnancy was detected by real-time PCR.Results:1.The results of colour Doppler ultrasound: there was statistically significant difference(P<0.01) in PI and RI of the placental bed artery in severe ICP groups(PI:0.68±0.14,RI:0.49±0.07) compared with normal groups(PI:0.42±0.10,RI: 0.34±0.06 ) and mild ICP groups(PI:0.51±0.16, RI: 0.39±0.09). There was no statistically significant difference(P>0.05) in PI,RI,and S/D of the umbilical artery in ICP groups compared with normal group(sP>0.05). There was no significant difference in PI,RI of the placental bed artery in mild ICP groups compared with normal groups (P >0.05).2. The results of RT-PCR: The expression of Caspase-3mRNA in severe ICP (4.34±1.18)group was significantly higher compared to the normal group(1.43±1.34)(P<0.05).But there was no difference in its expression levels between the mild(1.71±1.38)and normal(1.43±1.34)groups(P>0.05). Also there was significant difference in the expression of Caspase-3mRNA between the mild and severe ICP groups(P<0.05). There was no statistically significant difference in the expression levels of Survivin mRNA between the mild, severe and normal groups(P>0.05) . Conclusion: 1. Doppler ultrasound to detect flow velocity frequency spectrogram in placental bed artery in ICP groups was a sensitive index, which can be used as an important diagnostic tool along with the other methods for surveillance of fetal wellbeing.The changes of RI and PI in placental bed arteries presented earlier than those in the umbilical arteries.2. On the gene aspect, Caspase-3 may be an important control gene in the apoptosis of placental cells in ICP, which may effectively explain, to some extent, the changes in the placenta and adverse pregnancy outcome because of the apoptosis .3. The study of Color Doppler and the apoptosis of placenta in ICP may contribute to the intensive antepartum survillence and offer a theoretical base for a reasonable medical treatment .