莪术止孕作用的实验研究

本文报告应用小白鼠、大白鼠及家兔进行止孕作用筛选实验,发现4种药物有止孕作用,其中莪术油止孕效果较显著。小白鼠经腹腔和皮下注射600～900毫克/公斤莪术油,其抗着床与抗早孕效果为70～90%;大白鼠腹腔注射复方莪术油的抗早孕效果为77%;家兔腹腔注射80毫克/公斤莪术油的抗着床效果为80%,经阴道注药400毫克/公斤的抗着床效果为100%。     

米非司酮配伍米索前列醇治疗稽留流产35例临床观察

随着药物流产广泛使用于终止早早孕和孕10～16周的妊娠,近年来,药物流产在特殊流产领域中也已大量使用。稽留流产是临床上较难处理的一种类型。由于胚胎组织有时可能机化,与子宫壁紧密粘连,造成刮宫术困难,易于子宫穿孔,再次刮宫率也增高。传统上多采用口服大剂量己烯雌酚后行钳刮术,曾有报道口服米非司酮和米索后再行钳刮。我院采用米非司酮配伍米索前列醇治疗稽留流产,使组织物自然排出,取得了满意效果,现分析报告如下。资料与方法一、诊断标准胚胎或胎儿在宫内已死亡尚未自然排出者称稽留流产[1]。二、研究方法1.资料来源　收集我院1997…     

早期药物流产胚胎组织用于亲子鉴定1例

正对于早期药物流产胎儿用于亲权关系鉴定的案例近年文献报道较少,而在实际法医物证鉴定工作中,药物流产胚胎用于检材的案例却逐年增多。通常医院妇产科在进行早期药物流产时往往不考虑流产物作为法医学生物检材使用,一般对流产物不需做进一步的筛选,甚至有些流产者在家中排出流产物,这就给需要用早期药物流产胚胎作为法医学亲权鉴定生物检材带来不便,增加了获取有效检材的难度。本文以实际工作中遇到的案件鉴定经验为例,对早期药物流产胚胎用作法医学     

复方孕素重Ⅰ号对大鼠、兔的胚胎毒性和致畸性研究

本研究用Sprague Dawley大鼠和New Zealand兔检测复方孕素1号的胚胎毒性和致畸性。复方孕素1号以0.3、1.5、3.0mg/kg/d 剂量分别在大鼠怀孕第6～15天和兔怀孕第8～17天给药。结果表明,复方孕素1号高剂量组(10倍于临床剂量)的怀孕大鼠全部流产,中、低剂量组的孕鼠死胎率分别为14.15%和9.70%。兔各剂量组的胚胎吸收率、死胎率分别为37.5%、12.5%和20.0%、10%,与对照组比较差异非常显著(p<0.01)。提示复方孕素1号似能诱发孕鼠和孕兔的胚胎死亡,具有一定的胚胎毒性。     

160例早孕妇女药物流产后阴道流血情况分析

目的提高药物流产的成功率，缩短阴道流血时间，减少阴道出血量。方法对我院门诊1998年元月至2002年12月160例停经49天内，要求药物终止妊娠的早孕妇女，给予米非司酮25mg，一日二次，连服三天；米索前列醇片0．6mg顿服。结果一般胚胎于服完药后8小时内脱落，部分病人可推至第二天、第三天。孕妇怀孕时间越短，B超检查孕囊越小，孕次越少，孕妇年龄越小，药物流产效果越好。结论医生在实施药物流产前要综合考虑妇女怀孕时间、年龄、孕次等因素，才能达到较好的效果。     

体位干预对45例后屈子宫早孕药物流产效果的影响

目的：研究观察体位干预对后屈位子宫早孕药物流产效果的影响。方法：选择停经7周内自愿流产早孕妇女,经妇科检查为后屈子宫,随机选取45例作为观察组,在流产过程中予以体位干预,同期选取38例早孕后屈子宫为对照组,予常规药物流产,自由体位。观察两组药物流产效果。结果：观察组孕囊排出时间、腹痛时间及程度、出血量明显少于对照组,且观察组药流不全,出血率明显低于对照组。结论：在早孕后屈位子宫药物流产过程中进行体位干预,可以缩短孕囊排出时间、减少出血量及减轻病人痛苦,临床值得一用。     

早早孕吸宫止孕术

<正> 目前国内外使用的早早孕终止方法颇多,如:各种抗早孕药物、催经止孕或吸经止孕术研究等。1972年Karmen 制成塑料吸管及吸简后,应用者渐多。国内大连计划生育研究所制成了CZ 型催经止孕器。国内外吸经对象多在6～7周或在5周以后,效果不够满意。国内外文献对停经36天内的早早孕进行诊断后行吸宫止孕术尚未见报道。我科于1980年初对停经36天内的对象应用放射免疫定量法测定血液hCG,计409例。自1982年初用改良极快速1(1/2)小时血hCG 放免定性法,计1000例。三年来共测停经26～36天之间的对象1409例。以血hCG>20ng/ml 为阳性,属妊娠。共作505例吸宫止孕术。经分析研究,探讨其安全性,证实是具有早、快、准的优点而受欢迎的一种止孕方法。     

先兆流产的预后判定及管理

先兆流产的顶后主要取决于胚胎或胎儿的发育是否正常,其次是导致先兆流产的各种环境因素能否(?)到及时地控制与纠正。孕卵染色体异常或早期胚胎(?)毒物、药物、放射线或子宫内感染等因素的影响而发生严重畸形或死亡,成为妊娠废物,刺激子宫收缩而流产,这是重要的自然淘汰现象,占早期流产的半数以上。非胚胎自身原因引起的先兆流产,如母体黄体功     

不明原因早期流产患者蜕膜中单核/巨噬细胞TNF-α活性的变化

早期自然流产是指妊娠１２周内胚胎自动脱离母体而排出。母方内分泌功能失调、子宫病变、遗传性疾病或其它全身性疾病、创伤、接触放射线及有害物质、病原微生物感染、滥用药物;父方染色体、精液异常是主要致病因素。在排除这些因素的情况下,仍有一些妊娠妇女发生流产,称之为不明原因早期自然流产。在人正常妊娠过程中,胚胎作为一种半同种异体抗原组织,却未受母体排斥而存活,这与蜕膜组织中正常的免疫微环境有着一定的关系。尤其是孕１２周内的妊娠早期,胎盘与母体紧密联系还未完全建立时,蜕膜微环境对胚胎的生长发育尤为重要。研究…     

寿胎丸对复发性流产小鼠蜕膜组织中螺旋动脉改变及怀孕结局的影响

目的：通过观察寿胎丸对复发性流产（RSA）小鼠蜕膜组织子宫螺旋动脉改变及怀孕结局的影响,探讨其保胎的作用机制。方法：以CBA/J雌鼠×BALB/c雄鼠建立正常怀孕小鼠模型（12只）,CBA/J雌鼠×DBA/2雄鼠建立RSA小鼠模型（43只）,RSA小鼠按怀孕先后顺序随机分为RSA模型对照组（11只）、寿胎丸低剂量组（11只）、寿胎丸中剂量组（11只）及寿胎丸高剂量组（10只）,于孕第4～9天灌胃给药,孕14 d处死孕鼠,计数吸收胚胎数,计算各组胚胎吸收率,光镜下观察各组蜕膜组织中螺旋动脉生理性改变的发生率,并测量螺旋动脉的管腔直径及管壁厚度,透射电镜下观察蜕膜组织中螺旋动脉超微结构。结果：RSA模型对照组胚胎吸收率高于正常怀孕模型组（29.49% vs. 4.55%,χ2=18.887,P=0.000）。寿胎丸低、中、高剂量组的胚胎吸收率比RSA模型对照组均降低（均P＜0.05）。RSA模型对照组蜕膜组织中子宫螺旋动脉生理性转变率低于正常怀孕模型组（11.90% vs. 44.68%, χ2=11.522,P=0.001）。RSA模型对照组蜕膜组织中子宫螺旋动脉平均管腔直径及管壁厚度均低于正常怀孕模型组（P＜0.05）。寿胎丸高剂量组子宫螺旋动脉生理性转变发生率增高,管腔扩张,管壁厚度变薄（均P＜0.05）。结论：寿胎丸可能通过促进RAS小鼠蜕膜组织中子宫螺旋动脉生理性重铸发挥保胎作用。     

昆明山海棠提取物对大、小白鼠的抗生育作用及机理初探

昆明山海棠提取物灌胃,对小白鼠抗着床、抗早孕有非常显著或显著的作用。正交L_4(2~3)实验优选的抗早早孕方案对大白鼠效果非常显著(P<0.001),且量效相关重现性好;仅用口服剂量的1/19～1/15弱。宫内注入效果亦显著。组织细胞形态学观察证实:给药第1天即能抑制桑椹胚的发育或致坏死,妊第6天可见坏死解体的胚或部分已被吸收。解体胚周围蜕膜化差,黄体却无异样,该提取物无雌激素、抗雌激素、孕激素及抗孕激素活性,流产的始动机理也不依赖前列腺素,不干扰母体的内分泌。     

Gram-negative bacterial LPS induced poor uterine receptivity and implantation failure in mouse: alterations in IL-1beta expression in the preimplantation embryo and uterine horns

Genito-urinary tract or systemic infections of the gram-negative bacteria in pregnant women, causes abortions, preterm labor, and several other perinatal complications. LPS is the most potent antigenic component of the gram-negative bacterial cell wall and is known to modulate the expression of various proinflammatory cytokines. Here we investigate the role of the soluble form of IL-1 i.e., IL-1beta in the 'minimum dose' of LPS induced pregnancy loss in mice. Uterine cross-sections on each day of the preimplantation period of pregnancy were examined histopathologically for finding out LPS induced changes in the uterine preparation for embryo implantation. The expression of IL-1beta in the various stages of the preimplantation period of pregnancy was studied by RT-PCR in the embryos and the uterine horns of the LPS treated and normal pregnant mice. We found that LPS significantly alters the proliferation of the glandular epithelium, luminal epithelium and stroma during the preimplantation period. We also found large infiltration of macrophages into the uterine horns of the LPS treated animals. The level and pattern of IL-1beta expression in the preimplantation embryos and uterine horns were also altered in LPS treated animals. These observations indicate that LPS can alter the uterine preparation for blastocyst implantation, which could be due to the change in the IL-1beta expression in the uterine horns. However, a change in the expression pattern of IL-1beta in the preimplantation embryos underlines the significance of this molecule in LPS induced pregnancy loss or implantation failure in mouse.     

Gravid hysterectomy following history of recurrent ruptured uterus: case report

The risk of uterine rupture and its associated morbidities increases as the incidence of cesarean deliveries increases. There is little evidence guiding the management of pregnancy termination in patients with a history of uterine rupture. A 21-year-old woman with a history of a classical cesarean delivery and four subsequent uterine ruptures presented for termination of pregnancy at 17 weeks and 2 days. Ultrasound study noted anterior wall implantation of the placenta covering the classical cesarean scar as well as the subsequent cesarean section scars. A scheduled gravid hysterectomy was performed to complete the pregnancy termination and avoid recurrent uterine rupture. Pathological examination revealed marked attenuation and fibrosis of the anterior uterine wall with diffuse placenta accreta and focal placenta percreta justifying the decision for hysterectomy in this young patient. We therefore suggest that gravid hysterectomy rather than dilatation and evacuation should be considered for pregnancy termination in patients with history of recurrent uterine rupture and suspicion for abnormal placentation.     

Localization of immunoglobulins in the mouse uterus, embryo, and placenta during the second half of pregnancy

Throughout the second half of pregnancy in mice there were many plasma cells containing immunoglobulins A (IgA) and G (IgG) in the uterine endometrium. There was intense staining of IgA in uterine glands at all stages, but little staining of IgG. The staining of both immunoglobulins (Igs) in the luminal epithelium was moderate to dark on day 11, slight on day 14, and increased from day 16 to term. From day 14 to term the endometrium exhibited folds or villi around each placenta. The cores of the villi contained many plasma cells of both isotypes, and the staining of extracellular Igs in the villous cores was darker than in nonvillous endometrium. Both Igs were detected in the uterine lumen, and in visceral and parietal yolk sac endoderm cells at all stages. Near term, the staining of Igs in the visceral yolk sac was darkest in the peripheral villous portion adjacent to the endometrial villi. From day 14 to term IgG was present in the visceral yolk sac mesenchyme and embryo, consistent with its transfer from the uterine lumen to the embryo via the vitelline circulation. In contrast, IgA was not detected in yolk sac mesenchyme until day 19, when only slight staining was observed, and IgA was never detected in the embryo. Most trophoblast giant cells contained both Igs on day 11. During the remainder of pregnancy, there was staining of both Igs in labyrinthine trophoblast and in a few giant cells adjacent to the parietal yolk sac on the placenta, but there was negligible staining in the spongiotrophoblast region. Our observations suggest that the local immune system in the mouse uterus may protect the embryo during the second half of pregnancy by secreting anti-microbial immunoglobulins A and G into the uterine lumen surrounding the visceral yolk sac, and may at the same time contribute to the transfer of maternal IgG to the embryo via the yolk sac and vitelline circulation.     

The clinical and pathological study of induced abortion by Yuanhuacine film in 12-16 week pregnancy]

Yuanhuacine film was used in a clinical study involving 133 cases of termination of 12-16 week pregnancies. The youngest in the group was 14 and the oldest 46. 84 were multipara and the 47 were primipara. 127 women, 95.5% of all the cases, had successful abortion including 85.8% who used Yuanhuacine once. The time span between the drug administration and the start of uterine contraction averaged 7.5 hours with the shortest 35 minutes and the longest 26 hours. The time span to the expulsion of the embryos averaged 23.5 hours ranging from 4 to 60 hours. Expulsion of placenta was recorded in 127 cases, in which 83 had complete expulsion, 39 had partial expulsion and 5 had placenta retained in the uterus. The embryos and placenta of 30 cases were studied. Bleeding and swelling was observed in the brain membrane and organs of internal system. The decidua cells of placenta had already died. No trauma of uterus, and no complication in the process of abortion was observed. The study results indicated that the use of Yuanhuacine film in induced abortion has a higher success rate and fewer side effects in comparison with the uterine injection of the same drug. Bleeding, trauma of uterine wall, and complication may occur in the surgical procedure of 12-16 week abortion. Using Yuanhuacine film in this period is a better alternative. The high proportion of placenta retention in the abortion procedure was due to the reason that the placenta is still immature and the separation from uterus can be difficult.     

Uterine rupture in midtrimester abortion. A complication of gemeprost vaginal pessaries and oxytocin. Case report

The 1st reported case of uterine rupture in pregnancy termination associated with the administration of gemeprost and oxytocin involved a 24-year-old UK women with 3 previous uncomplicated pregnancies. Pregnancy termination, performed at 16 weeks of gestation, involved the insertion of 1 mg gemeprost vaginal pessaries into the posterior fornix at 3-hour intervals. A total dose of 5 mg of gemeprost was administered in the 1st 24 hours. Another treatment course was instituted the following day, and the patient's cervix remained closed despite the onset of contractions and slight vaginal bleeding. During the 2nd course of 5 pessaries, the patient also received 4 15 mg doses of intramuscular papaveretum. On the 3rd day, a intrauterine pregnancy was visible on ultrasound scan, but no fetal heartbeat was detected. A total dose of 50 IU of oxytocin was then administered over a 22-hour period. The diagnosis of uterine rupture was made on day 4 when vaginal examination revealed a large bulging lower uterine segment anteriorly and a closed cervix posteriorly. The patient's hemoglobin concentration had fallen from an admission value of 11.4 g/dl to 6.5 g/dl. Laparotomy revealed a large left broad ligament hematoma extending anteriorly into which the fetus had been extruded. Total abdominal hysterectomy was required. The uterine rupture is assumed to have occurred during the 2nd course of gemeprost. The absence of previously reported cases of gemeprost-associated uterine rupture may reflect the rarity of this method of pregnancy termination in the 2nd trimester.     

Maternal and fetal hemodynamic effects of diazoxide.

Effects of diazoxide on systemic and uterine hemodynamics as well as on fetal circulation and blood respiratory gases were investigated in chronically instrumented pregnant sheep. Diazoxide was administered intravenously either to the ewe or directly to the fetus in doses calculated on the basis of body weight. Transfer of drug across placenta was also investigated. Results showed that: a) when injected into the mother, there was consistent hypotensive effect with increased cardiac output and decreased systemic vascular resistance; uterine blood flow might not change or might decrease slightly with moderate hypotension; when maternal systemic arterial pressure fell to critical closing pressure level, uterine flow decreased significantly; but despite these maternal changes, the fetal circulatory functions were not significantly altered; b) when injected into the fetus in doses up to 15 mg/kg, diazoxide failed to alter fetal circulation appreciably; c) diazoxide crossed the placenta when injected intoeither mother or fetus according to a definite gradient; fetal levels were always lower than maternal levels because of rapid loss of the drug by the fetus; d) moderate maternal and fetal hyperglycemia occurred after drug administration.     

Technical research on termination of early pregnancy]

The research on contraceptives for embryogenesis and pregnancy termination by applying prostaglandins and Chinese medicinal herbs has now achieved great acclaim both at home and abroad. However, these achievements cannot be considered satisfactory as of yet because the time necessary for abortion is great, and the embryo cannot be evacuated so completely. In particular, during the early stages of pregnancy, menstrual induction and pregnancy termination with drugs cannot be considered ideal. However, when utilizing a capillary mechanical method, a simple sweeping and absorbing operation is performed in the uterine cavity 2-10 days after menstruation. The uterus internal membrane can be peeled off, thus physiologically interrupting the pregnancy. The embryo can thus be eliminated at the earliest stage and the induction of menstruation and cessation of pregnancy can be brought about quickly. From the clinical observations made on 200 cases selected at random out of 1400 cases and controls, it is shown that abortion time is shortened, and that the embryo is eliminated thorougly. This occurs faster, results in less bleeding, and less discomfort, and without side effects. Therefore, it may be regarded as a safe, reliable new technology for the earliest pregnancy termination. (author's modified)     

The fate of drugs in pregnancy

The response of mother and fetus/neonate to drugs administered to the pregnant woman is determined largely by drug disposition and elimination within and between mother and fetus. Physiological changes occurring in pregnancy may result in reduced plasma protein binding, an increase in the apparent volume of distribution, and more rapid metabolic and renal clearance of certain drugs than are usually found in non-pregnant women. The consequences are relevant for the peak concentration of drug achieved after a single dose, the half-life of the drug, and the drug concentration to which the fetus is exposed via the placenta. Drugs whose dosage may need to be altered in pregnancy include most anticonvulsants, lithium, digoxin, certain beta-blockers, ampicillin and cefuroxime; for drugs which have not been specifically investigated, no generalizations are possible. Very few drugs given in pregnancy fail to cross the placenta and, as a rule, drug molecules not bound to plasma protein diffuse along a concentration gradient to establish and maintain an equilibrium. Because movement of drug molecules is bidirectional, the placenta is the main portal of exit from, as well as entry to, the fetus. The pharmacological response of the fetus to drugs which it receives depends mainly on the unbound concentration of drug in fetal blood--unwanted effects seldom occur if the maternal dose is correct; exceptions include tetracycline, antithyroid drugs, coumarin anticoagulants, aspirin, indomethacin and cerebral depressant drugs (opiates, barbiturates and phenothiazines). The total (bound plus unbound) drug concentration on the fetal side of the placenta is usually lower than on the maternal side except where differences in blood pH and/or protein binding lead to 'trapping' of drug in the fetus; the latter phenomenon may prove hazardous after birth because of the neonate's limited capacity to eliminate drugs by metabolism and excretion.     

孕中期前置胎盘状态引产相关问题

孕中期中央性前置胎盘状态引产过去一直作为阴道分娩的绝对禁忌证,现在随着中央性前置胎盘状态临床诊治经验的积累,对有医学指征或要求引产的孕中期中央性前置胎盘状态患者,可选择药物引产、减胎后引产、子宫动脉栓塞辅助下引产和剖宫产等终止妊娠方式。每种引产方式均有产后出血、引产失败(剖宫产除外)等风险,在引产过程中均需严密观察、做好输血、输液及急诊手术的准备,尽可能提高引产成功率和减少并发症的发生。