妊娠病理状态下胎儿血氧代谢的变化及其临床管理

正成人氧代谢通过肺部直接与外界进行氧气交换,而胎儿血氧代谢通过胎盘屏障实现氧气交换。胎儿氧供依赖于充足的母体含氧量、子宫-胎盘及胎盘-胎儿血流以及富氧血的正常分布。胎盘血流、母体-胎儿间的氧分压差以及氧含量(母体的携氧能力)、胎盘血氧弥散面面积及弥散膜的厚度是胎儿氧代谢的决定因素。影响母体携氧及胎盘-胎儿血氧交换等的妊娠病理状况均可影响胎儿血氧代谢。1胎儿氧代谢生理生理条件下,胎儿静脉血(富氧血)氧分压不     

母体免疫在妊娠成立中的作用

妊娠与一般的同种移植反应不同。胎儿不直接与母体接触,母儿之间有胎盘存在。但是胎盘是一个不完全的屏障,母体的免疫细胞能直接作用于胎儿。为阐明母体如何对胎盘即绒毛组织进行免疫调控而使胎儿不被母体排斥的机理已成为热点。现有两种观点:①妊娠时母体免疫机能低下。妊娠中逐渐增加的性甾体激素和hCG抑制免疫,母体NK细胞活性低下。但免疫系统对同种移植物仍有排斥反应。②免疫亲向理论主张母体积极的免疫应答促进绒毛组织     

胎儿、胎盘功能检查的进展

胎盘是介于母体与胎儿之间的一个重要器官,其功能十分复杂,至今仍有很多问题尚待解决。但简单说来,可以认为胎盘的功能就是为了维持胎儿在母体的正常发育,是胎儿的呼吸、消化吸收、排泄作用的器官。为了完成这些功能,胎盘自身产生很多激素和蛋白质、酶等。而且胎盘还具有一定的屏障功能,即胎盘可以选择性的使一些有害物质,如细菌,不能通过胎盘以保护胎儿。不     

妊娠期母体/胎儿皮质醇的代谢及调节

皮质醇是妊娠期母体代谢与胎儿发育代谢不可缺少的物质.母体内与胎体内的皮质醇浓度梯度提示,胎盘是阻止母体皮质醇到达胎儿的屏障,11β-羟基类固醇脱氢酶(11β-HSD)在这个屏障中起主导作用.在妊娠不同阶段,皮质醇代谢与调节存在差异.母体的皮质醇能在妊娠中晚期通过胎盘.多种因素会影响11β-HSD的活性,进而影响皮质醇在母体与胎儿间的代谢调节.     

胎儿死亡的胎盘病理

人类胎盘是一个妊娠期的临时器官,对胎儿发育和正常妊娠的维持起重要作用。妊娠期间,胎盘在母体和胎儿间建立沟通的桥梁,为胎儿提供营养物质,进行气体交换和废物清除,并建立免疫耐受环境,保障半异体胎儿不被母体排斥;胎盘还可作为妊娠期重要的内分泌器官,协调胎儿发育及母体多器官的妊娠适应性应答。胎盘发育不良往往导致胎儿生长异常及多种妊娠并发症,严重情况下可导致胎儿死亡。文章阐述了生理状况下人类胎盘的结构和功能,描述了因胎儿生长受限(FGR)、子痫前期(PE)、妊娠期糖尿病(GDM)等造成胎儿死亡的胎盘病理特征,进而展望通过靶向胎盘干预妊娠期疾病的可能前景。     

妊娠期母体／胎儿皮质醇的代谢及调节

皮质醇是妊娠期母体代谢与胎儿发育代谢不可缺少的物质。母体内与胎体内的皮质醇浓度梯度提示,胎盘是阻止母体皮质醇到达胎儿的屏障,11β-羟基类固醇脱氢酶（11β—HSD）在这个屏障中起主导作用。在妊娠不同阶段,皮质醇代谢与调节存在差异。母体的皮质醇能在妊娠中晚期通过胎盘。多种因素会影响11β—HSD的活性,进而影响皮质醇在母体与胎儿问的代谢调节。     

胎盘功能不全

前言胎盘在胚胎学上为胎儿的附属物,胎儿介胎盘与母体紧密连接,并以此进行呼吸作用、排泄作用及吸取营养等以维持生命及发育。因此,若胎盘功能异常,可造成胎儿发育不良乃至异常,出现死胎及围产期死亡。所谓胎盘功能不全系指:“由于母体或胎儿方面的原因导致胎儿宫内环境的恶化,     

胎肾功能对胎儿发育的意义

对于胎几正常发育必须有明显的水代谢即胎儿、羊水与母体之间的水代谢,而胎尿分泌到羊水内具有很大的作用。这种代谢机制和生理作用虽然已研究得很多,但尚未彻底查明。水通过位于母体和胎儿血液交换途径上的全部半透膜进行交换。半透膜有:胎盘薄膜、绒毛膜、羊膜,覆盖在胎儿内测表面和脐带上的膜以及胎儿皮肤。水交换主要途径是经过母体胎盘至胎儿,胎儿通过排尿至羊水,羊水通过绒毛羊膜至母体。此外,在胎儿与羊水之间还进行被胎儿吸收的液体     

镜像综合征——胎儿水肿引申的诊断

<正>镜像综合征(mirror syndrome)是指伴随着胎儿和胎盘水肿出现母体水肿的一类疾病,其病因及发病机制目前尚不清楚。临床表现与子痫前期相似,但将二者完全鉴别尚有一定的难度,胎儿或胎盘及母体水肿、胎盘/胎儿质量比值的升高、母体的血液稀释以及病情发展的不均衡是其显著的临床特点。提高临床医生对此种疾病的认识,进一步寻找胎儿水肿的病因,判断是否有宫内治疗的价值和机会是关系母儿预后的关键步骤。     

胎儿窘迫的病因研究

庄依亮教授 胎儿窘迫是指胎儿在宫内缺氧引起的危急状态,主要表现为低氧血症和酸中毒,这是由于胎盘气体交换受到干扰所致.胎儿宫内缺氧有急性与慢性之分.但胎盘气体交换受损往往是由于母体或胎儿通过胎盘的循环     

Anonymous and non-anonymous gamete and embryo donations: pros and cons

Consequences of legal restrictions concerning gamete and embryo donation have been increasingly discussed during the last three decades, partly dependent upon the fact that assisted reproductive technologies have opened up new medico-technical possibilities. In the present communication we want to elucidate some of the problems and consequences of a Swedish law from 1985 requiring that all sperm donors should be non-anonymous. A similar law was passed in 2003 for oocyte donation. Such legal restrictions do not seem to be in the interest of the infertile couple who, to a large extent, seek treatment abroad where the laws are more liberal or non-restrictive (reproductive tourism). Whether or not the Swedish law is in the best interest for the offspring remains to be seen.     

Adiposity and Endometriosis Severity and Typology

Study ObjectivePrior research has collectively shown that endometriosis is inversely related to women's adiposity. The aim of this study was to assess whether this inverse relationship holds true by disease severity and typology.DesignCross-sectional study among women with no prior diagnosis of endometriosis.SettingFourteen clinical centers in Salt Lake City, UT, and San Francisco, CA.PatientsA total of 495 women (of which 473 were analyzed), aged 18–44 years, were enrolled in the operative cohort of the Endometriosis, Natural History, Diagnosis, and Outcomes (ENDO) Study.InterventionsGynecologic laparoscopy/laparotomy regardless of clinical indication.Measurements and Main ResultsParticipants underwent anthropometric assessments, body composition measurements, and evaluations of body fat distribution ratios before surgery. Surgeons completed a standardized operative report immediately after surgery to capture revised American Society for Reproductive Medicine staging (I–IV) and typology of disease (superficial endometriosis [SE], ovarian endometrioma [OE], and deep infiltrating endometriosis [DIE]). Linear mixed models, taking into account within-clinical-center correlation, were used to generate least square means (95% confidence intervals) to assess differences in adiposity measures by endometriosis stage (no endometriosis, I–IV) and typology (no endometriosis, SE, DIE, OE, OE + DIE) adjusting for age, race/ethnicity, and parity. Although most confidence intervals were wide and overlapping, 3 general impressions emerged: (1) women with incident endometriosis had the lowest anthropometric/body composition indicators compared with those without incident endometriosis, (2) women with stage I or IV endometriosis had lower indicators compared with women with stage II or III, and (3) women with OE and/or DIE tended to have the lowest indicators, whereas women with SE had the highest indicators.ConclusionOur research highlights that the relationship between women's adiposity and endometriosis severity and typology may be more complicated than prior research indicates.     

Blood lead and cadmium and birth weight among sub-arctic and arctic populations of Norway and Russia

BACKGROUND: Delivering women and their newborns in the Kola Peninsula of Russia and the neighboring arctic area of Norway were studied to explore relationships between maternal cadmium and lead status and birth weight as a pregnancy outcome. METHODS: Life-style information, maternal blood and cord blood specimens were collected from 50 consecutive mother-infant pairs from hospital delivery departments in three Russian and three Norwegian communities. Pregnancy outcomes were verified by consulting medical records. Lead and cadmium were determined in the blood samples by electrothermal atomic absorption spectrometry. RESULTS: The median blood-cadmium concentration for the Russian mothers was 2.2 nmol/L (n = 148) versus 1.8 nmol/L in the Norwegian group (n = 114, p = 0.55). A weak association was observed between maternal cadmium and amount smoked (r = 0.30, p<0.001); no correlation was found between maternal blood cadmium and birth weight. The corresponding maternal lead values were 0.14 (Russia) and 0.06 micromol/L (Norway), p<0.001. The latter lead concentration constitutes one of the lowest adult population values reported to date. Maternal and cord blood lead levels were strongly correlated (r = 0.88, p<0.001). In a multivariate linear regression model, maternal blood lead was recognized as a negative explanatory variable (p<0.05) for birth weight and child's body mass index (BMIC), with or without adjustment for gestational age. A similar association was suggested by ANOVA-analysis of maternal blood lead by quartiles. CONCLUSION: Maternal blood-lead level as an environmental factor is an apparent predictor of low birth weight and BMIC. It reduced substantially the contribution of a country factor in explaining the observed differences in birth weight.     

Reproductive and menstrual factors and risk of peritoneal and ovarian endometriosis

OBJECTIVE: Between 1987 and 1989 data were collected to evaluate risk factors for pelvic endometriosis. DESIGN: A case-control study was conducted on 241 cases with laparoscopically or laparotomically confirmed peritoneal or ovarian endometriosis consecutively admitted to three teaching hospitals in Northern Italy. The control group consisted of 437 women admitted to hospitals for acute conditions covering similar catchment areas. RESULTS: Compared with nulliparous women, the risk of endometriosis decreased with increasing number of births: the point estimates were 0.4 and 0.3, respectively, for those with one and two or more births (X2(1) trend = 50.3, P less than 0.001). No relation emerged with age at first birth and spontaneous miscarriages. Relative to women whose menarche occurred at age 11 or younger, the risk of endometriosis was slightly lower in those who experienced later menarche, but the trend in risk was not significant. Women with irregular menstrual cycles showed a lower frequency of the disease (relative risk, 0.3; 95% confidence interval, 0.2 to 0.5). The role of various factors was largely similar for different disease locations (ovary, peritoneum, and both) and indication for diagnostic surgery (sterility, pelvic pain, and other reasons). CONCLUSIONS: This study found that parity and irregular/long menses lower the risk of endometriosis. These findings were similar in different subgroups of disease location and indication for surgery, giving strong evidence of the consistency of the general results.