治疗孕妇牙周病对早产及低出生体重儿的影响

目的:比较孕妇牙周病治疗组与非治疗组对早产及低出生体重儿的影响。方法:收集在我院妇幼保健科建卡孕妇(妊娠4～5个月)816例,患牙周病者有489例,312名同意治疗为观察组,177名拒绝治疗为对照组,记录两组孕妇妊娠30周后的牙周状况及分娩后低出生体重儿和早产发生的情况。结果:治疗组的菌斑指数、探诊深度、出血指数和临床附着丧失均明显低于对照组,有统计学意义(P<0.05);治疗组低出生体重儿及早产与对照组相比明显降低,有统计学意义(P<0.05)。结论:孕妇牙周病的治疗可降低早产及低出生体重儿的发生率,是优生优育不可忽视的因素。     

496例双胎妊娠合并贫血与妊娠结局的分析

目的探讨双胎妊娠合并贫血对妊娠结局的影响。方法将496例双胎妊娠分为两组,妊娠合并贫血者(贫血组)共321例,其余175例为对照组,对两组病例的妊高征、产前出血、产后出血、早产、胎膜早破发生率与平均孕周、平均出生体重分别进行对照分析。结果贫血组妊高征、产后出血、早产、胎膜早破发生率显著高于对照组,且贫血严重程度与妊高征、产后出血发生率呈正相关,与平均孕周呈负相关。两组新生儿平均出生体重差异无统计学意义,但重度贫血病例的新生儿平均出生体重量与对照组比较,差异有统计学意义。结论双胎妊娠合并贫血时各种并发症发生率成倍增加,特别是重度贫血对孕产妇和围生儿有严重的威胁。     

宫颈上皮内瘤变或早期浸润性宫颈病变保守治疗的产科结局

保守疗法常用于治疗发生在年轻妇女的宫颈上皮内瘤变和镜下浸润性子宫颈癌。一个欧洲的研究小组回顾和分析了17项研究，调查这些保守治疗措施对患者以后生育能力和妊娠结局的影响。冷刀法与早产、低出生体重和剖腹产术等有显著相关性，转化区大环切与早产和胎膜早破也具有显著相关性，激光锥形切除术虽也有类似的不良影响但不具显著性。     

辅助生殖技术中多胎妊娠减胎术后妊娠结局的比较

目的比较多胎妊娠减胎术后不同保留胎儿数对出生结局的影响。方法回顾性分析208例辅助生殖技术(ART)所获多胎妊娠行减胎术患者资料,其中157例为三胎减为双胎(减为双胎组),51例为多胎减为单胎(减为单胎组;包括三胎减为单胎25例,双胎减为单胎26例),另选同期ART双胎妊娠未行减胎术611例(未减双胎组)、单胎妊娠760例(未减单胎组)作为对照。比较各组新生儿出生结局及妊娠期并发症情况。结果多胎减胎术后子代出生缺陷未显著增加(P0.05);与单胎妊娠比较,双胎妊娠(包括减胎和未减胎)显著增加早产率、低出生体重儿率(P0.05);减胎术后双胎妊娠早产率、低出生体重儿率显著高于未减双胎者(分别为56.69%vs.45.34%、57.79%vs.44.77%,P0.05)。结论虽然ART后多胎妊娠减胎术并不增加子代的出生缺陷,但是仍然应该控制多胎妊娠、减少减胎术的干预,提高ART助孕的安全性。     

体外受精-胚胎移植后三胎妊娠减胎术结局分析

目的分析早期选择性减胎术对妊娠并发症和新生儿的影响,评价其安全性。方法收集本中心2000年1月至2003年2月经体外受精胚胎移植(IVF ET)和卵胞浆内单精子注射(ICSI)受孕的三胎妊娠减灭为双胎妊娠35例(A组)及同期双胎妊娠166例(B组)。比较两组妊娠期并发症、剖宫产率、围产期死亡率、新生儿畸形率、平均出生体重及孕周。结果两组自然流产率、妊娠高血压综合征发生率、分娩率、剖宫产率、早产率、围产期死亡率、畸形率、平均出生孕周差异均无显著性;胎膜早破率和先兆早产率A组分别为30%、7.7%,B组分别为13%、56%,两组比较差异有显著性(P<0.05);平均出生体重A组(2410.8±570.0)g,明显低于B组(2560.9±530.6)g(P<0.05)。结论三胎妊娠早期选择性减胎术后胎膜早破和先兆早产率明显升高,胎儿存在低出生体重可能性。因此,预防多胎妊娠,限制胚胎移植数目,仍然是辅助生育技术实施过程中不可忽视的问题。     

环境因素对低出生体重儿发生率的影响

目的探讨影响低出生体重儿发生的环境因素，从而在孕早期采取有效的干预措施预防低出生体重儿的发生。方法采用病例对照研究方法选择896例新生儿，于出生后24h对其母亲进行问卷调查和收集病史资料，按新生儿体重情况分为早产低出生体重儿组（早产组）、足月小样儿组和对照组。结果单因素分析显示，三组新生儿父亲吸烟、饮酒、不良情绪、孕前接触油漆、孕前6个月每日看电视时间与使用计算机时间及新生儿母亲被动吸烟、孕期每日看电视时间与使用计算机时间9个因素比较，差异有显著性意义（P〈0．05，P〈0．01）；Logistic回归模型一（早产组与对照组）结果显示：新生儿父亲吸烟、不良情绪、孕前接触油漆尤其能增加早产的相对危险度；Logistic回归模型二（足月小样儿组与对照组）结果显示：新生儿父亲吸烟、孕前6个月每日看电视时间、不良情绪，新生儿母亲被动吸烟增加足月小样儿发生的相对危险度。结论环境因素与低出生体重闻存在密切相关性，护理人员提供适宜的孕前保健与孕期健康教育是预防低出生体重儿发生的重要干预手段。     

孕期PM2.5暴露对子代出生体重影响的研究进展

PM2.5是空气污染物的重要组成部分,其对全身各系统器官都会产生不同的危害。孕期PM2.5暴露会导致胚胎先天畸形、早产、胎儿出生体重异常等不良妊娠结局,严重时导致新生儿死亡。大量流行病学研究表明,孕期PM2.5暴露与子代出生体重变化之间存在相关性。PM2.5可能通过血管重构、炎症、氧化应激、免疫、表观遗传等机制影响胎儿的出生体重,但其作用机制尚不清楚。另外也应该考虑在高浓度的PM2.5环境下,人类外出活动减少等主观社会行为因素对胎儿出生体重的影响。目前尚无明确的药物防治以减轻或预防PM2.5所致的健康危害。控制环境PM2.5污染仍是有效预防PM2.5暴露导致各种不良妊娠结局的重要举措。     

3例超低出生体重儿的护理体会

超低出生体重儿是指胎龄<32周,出生体重≤1000 g的早产儿.在新生儿中,超低出生体重儿的死亡率最高.随着围生医学的发展,早产并低体重儿的存活率已有较大提高,但进一步提高他们的存活率及质量,仍是儿科医务工作者极为关注的问题,经过多年临床实践证明,护理质量的高低对极低出生体重儿的存活率影响很大.2007年1月至2008年11月我科收治早产超低体重儿3例,下面介绍超低出生体重儿的护理体会.     

妊娠期甲状腺功能亢进症和抗甲状腺药物治疗对新生儿低出生体重的影响

目的探讨妊娠期间甲状腺功能亢进症(甲亢)和抗甲状腺药物(ATDS)治疗对新生儿低出生体重(LBW)的影响。方法对1983年1月1日至2003年12月31日住院分娩的妊娠合并甲亢的100例及其新生儿101例进行回顾性分析。根据母亲孕期甲状腺功能(甲功)、开始服用ATDs时间进行分组,对LBW的发生率、特点及其相关的危险因素进行分析,着重于妊娠甲亢和ATDs对LBW的交互作用。结果母亲孕晚期甲亢时,新生儿平均出生体重显著低于甲功正常和甲功恢复正常组(P<0.05);孕晚期开始服用ATDs,新生儿平均出生体重显著低于孕早中期开始用药组(P<0.001)。孕晚期甲亢、孕晚期开始服用ATDs早产儿和早产LBW率均显著增加,且二者对早产儿、早产儿LBW存在正交互作用(L.R Chisq为19.328和7.486,P=0.0001和0.0237)。孕晚期甲亢和孕晚期开始服用ATDs,发生LBW、早产儿和早产LBW的危险性显著增加。结论妊娠期间甲亢,特别是孕晚期甲亢和孕晚期才开始ATDs治疗,可导致LBW,尤其是早产LBW率增加。     

82例IVF-ET前行腹腔镜下宫颈环扎患者妊娠结局的回顾性分析

目的分析孕前腹腔镜下宫颈环扎(LTCC)患者行体外受精-胚胎移植(IVF-ET)的妊娠结局,比较该类患者卵裂期胚胎移植和囊胚移植对妊娠结局的影响。方法收集2017年1月至2019年3月因不孕症合并宫颈机能不全(CI)在本中心行孕前LTCC术后实施IVF-ET的82例患者资料,根据移植胚胎种类不同分为卵裂期胚胎组(n=20)和囊胚组(n=62)。统计患者术后妊娠结局,比较两组间活产率、HCG阳性率、临床妊娠率、胚胎种植率、异位妊娠率、流产率、早产率、分娩孕周和子代出生情况(包括新生儿出生体重、性别比例和出生缺陷)差异。结果82例CI患者前次平均妊娠终止时间为20.68±3.44周,行LTCC术后,移植卵裂期胚胎和囊胚平均分娩孕周分别为37.70±1.42周和38.11±1.07周。卵裂期胚胎组和囊胚组移植后活产率分别为50%和45.16%,两组间差异无统计学意义(P>0.05)。囊胚组的HCG阳性率(74.19%vs.50%)和流产率(33.33%vs.0.00%)均显著高于卵裂期胚胎组(P<0.05),两组间临床妊娠率、胚胎种植率、异位妊娠率、早产率和平均分娩孕周差异均无统计学意义(P>0.05)。两组新生儿出生体重、性别比例及出生缺陷的差异均无统计学意义(P>0.05)。结论不孕症合并宫颈机能不全者孕前行LTCC术有较好的妊娠结局,且移植卵裂期胚胎和囊胚最终活产率相似。     

Declining trends in conception rates in recent birth cohorts of native Danish women: a possible role of deteriorating male reproductive health

Recent findings of poor semen quality among at least 20% of normal young men in Denmark prompted us to use unique Danish registers on births and induced abortions to evaluate a possible effect of the poor male fecundity on pregnancy rates among their presumed partners--the younger cohorts of women. We have analysed data from the Danish birth and abortion registries as well as the Danish registry for assisted reproduction (ART) and defined a total natural conception rate (TNCR), which is equal to fertility rate plus induced abortion rate minus ART conception rate. A unique personal identification number allowed the linkage of these databases. Our database included 706,270 native Danish women born between 1960 and 1980. We used projections to estimate the fertility of the later cohorts of women who had not yet finished their reproduction. We found that younger cohorts had progressively lower TNCR and that in terms of their total fertility rate, the declining TNCR is compensated by an increasing use of ART. Our hypothesis of an ongoing birth cohort-related decline in fecundity was also supported by our finding of increasing and substantial use of ART in the management of infertility of relatively young couples in the later cohorts. Furthermore, the lower rates of induced abortion among the younger birth cohorts, often viewed as a success of health education programs, may not be fully explained by improved use of contraception. It seems more likely that decreased fecundity because of widespread poor semen quality among younger cohorts of otherwise normal men may explain some of the observed decline in conception rates. This may imply increasing reproductive health problems and lower fertility in the future, which is difficult to reverse in the short term. The current and projected widespread use of ART in Denmark may be a sign of such an emerging public health problem.     

OHSS高风险全胚冷冻后FET时机对妊娠结局的影响

目的探讨OHSS高风险患者全胚冷冻后冻融胚胎移植(FET)的时机。方法回顾性分析2014年6月至2018年12月于西北妇女儿童医院生殖中心接受IVF/ICSI-ET治疗,因OHSS高风险而全胚冷冻的患者共2060例。根据取卵日距第1次FET日的时间长短分为两组:时间间隔≤40 d为立即FET组,共196例;时间间隔>40 d为延迟FET组,共1864例。对比分析两组间的妊娠结局及新生儿体重。结果两组间女方年龄、BMI、不孕类型及不孕年限、Gn总量、优质胚胎数、扳机日雌激素水平等基线资料的差异均无统计学意义(P>0.05);两组间胚胎种植率、临床妊娠率、流产率、活产率、早产率、单胎及双胎新生儿出生体重、异常出生体重发生率等指标差异均无统计学意义(P>0.05);Logistic回归分析显示,延迟FET对活产率、胚胎种植率、临床妊娠率、流产率无显著性影响(P>0.05)。调整影响妊娠结局的混杂因素,包括女方年龄、女方BMI、移植胚胎个数及移植胚胎类型后,延迟FET对活产率[OR=1.104,95%CI(0.813,1.502),P=0.536]、胚胎种植率[OR=0.907,95%CI(0.641,1.283),P=0.569]、临床妊娠率[OR=0.892,95%CI(0.634,1.275),P=0.529]、流产率[OR=0.924,95%CI(0.575,1.496),P=0.750]的影响仍不显著。两组新生儿出生体重及异常体重新生儿的发生率间差异无统计学意义(P>0.05)。结论因OHSS高风险而全胚冷冻患者,取卵术后首次月经来潮即可开始准备内膜进行FET,延迟FET并不能改善妊娠结局。     

Hypernatraemia induced by sodium polystyrene sulphonate (Kayexalate) in two extremely low birth weight newborns

Hyperkalaemia is a life-threatening electrolyte disorder that can occur in the first week of life in almost 50% of preterm infants with a birth weight less than 1000 g [extremely low birth weight (ELBW)]. Serum potassium values higher than 7 mmol x l-1 are associated with cardiac arrhythmias and an increased incidence of intraventricular haemorrhage and periventricular leucomalacia. Therapeutic options to treat this dangerous imbalance comprise calcium gluconate, insulin plus glucose, albuterol/salbutamol inhalation. Administration of cation-exchange resin such as sodium polystyrene sulphonate (Kayexalate) is effective in lowering plasma potassium, although complications following oral or rectal administration are reported in newborns. We describe two ELBW infants affected by hyperkalaemia, treated with Kayexalate, who developed serious hypernatraemia, that has never been reported before in preterm infants.     

Spinal anesthesia in an extremely low birth weight infant

A case of spinal anesthesia in an extremely low birth weight male infant (body weight of 930 g at time of surgery) is presented. He was born prematurely at a gestational age of 27 weeks because of a placenta tumor and had to undergo inguinal herniotomy at 34 weeks postconceptional age. He had bronchopulmonary dysplasia and oxygen supply was still required because of frequent deterioration of oxygen saturation. Spinal anesthesia was performed successfully without any complications. Relevant aspects concerning the technique and management of spinal anesthesia in preterm infants are discussed.     

卵裂期与囊胚期胚胎移植妊娠安全性和出生性别比的比较

目的探讨卵裂期和囊胚期胚胎移植对妊娠安全性及出生性别比的影响。方法回顾性分析2012年8月至2015年8月在我院行助孕治疗的19 684个周期的临床资料,根据胚胎移植时间及方式的不同进行分组:卵裂期胚胎移植组(D3组,13 968个周期)和囊胚移植组(D5组,5 716个周期),D3组又分为D3鲜胚组(13 566个周期)和D3冻胚组(402个周期);D5组分为D5鲜胚组(153个周期)和D5冻胚组(5 563个周期)。分别比较各组的妊娠结局及出生男/女性别比情况。结果 D3组的移植胚胎数显著高于D5组(P0.05),但临床妊娠率、胚胎种植率、活产率均显著低于D5组(P0.05),出生男/女性别比亦显著低于D5组(P0.05),多胎率、流产率、早产率、围生儿死亡率和低出生体重儿率则显著高于D5组(P均0.05);D3鲜胚组的胚胎种植率显著低于D5鲜胚组(P0.05),多胎率、流产率、早产率和低出生体重儿率显著高于D5鲜胚组(P均0.05);D3冻胚组的临床妊娠率、胚胎种植率、剖宫产率和活产率显著低于D5冻胚组,流产率则显著高于D5冻胚组(P均0.05);D3鲜胚组的临床妊娠率、胚胎种植率和活产率显著低于D5冻胚组(P0.05),出生性别比亦显著低于D5冻胚组(P0.05),多胎率、流产率、早产率、剖宫产率、围生儿死亡率、胎儿畸形发生率、低出生体重儿率则显著高于D5冻胚组(P均0.05)。结论囊胚移植在移植较少胚胎的情况下,仍可获得较高的种植率、临床妊娠率和活产率,同时降低多胎率,且不增加过期产、巨大儿和胎儿畸形的风险。但其可能会提高出生男/女性别比,其对性别比的长远影响尚需进一步深入研究。     

Obesity and preterm birth: additive risks in the progression of kidney disease in children

Preterm birth is associated with decreased nephron mass and obesity that may impact on kidney disease progression in later life. Our objectives were to examine the relative risks of obesity and preterm birth on the progression of kidney disease in children. In a retrospective cohort study, 80 (44 obese and 36 non-obese) patients with proteinuric kidney disease were studied for disease progression and glomerular histomorphometry. Of the obese, 22 had been born at term (Obese-T) and 22 had been preterm (Obese-PT). Seventeen non-obese children with focal glomerular sclerosis, born at term (NO-FSGS), and 19 non-obese preterm (NO-PT) children, served as controls. Insulin resistance as measured by the homeostatic model assessment (HOMA-IR) was elevated in all obese children. Obese-PT patients had increased risk of renal demise during childhood when compared with Obese-T children [hazard ratio 2.4; 95% Confidence interval (95% CI) 1.1 to 7.1; P = 0.04]. In obese children, although proteinuria often exceeded nephrotic range, average levels of serum albumin remained normal. Preterm patients were more likely to have reduced renal mass (odds ratio 4.7; P = 0.006), but obesity was not a factor. Renal histomorphometry showed glomerulomegaly in obese patients, regardless of birth weight. Obesity and preterm birth appear to impose additive risks for progression of kidney disease in childhood.     

When birth comes early: Effects on nephrogenesis

Preterm birth (birth prior to 37 completed weeks of gestation) may occur at a time when the infant kidney is very immature and nephrogenesis is often ongoing. In autopsied preterm human kidneys and in a baboon model of preterm birth it has been shown that nephrogenesis continues after preterm birth, with a significant increase in the number of glomerular generations and number of nephrons formed within the kidney after birth. Of concern, however, morphologically abnormal glomeruli (with a cystic Bowman's space) are often observed; the abnormal glomeruli are only located in the outer renal cortex, suggesting that it is the recently formed glomeruli (perhaps those formed in the extra‐uterine environment) that are affected. The proportion of abnormal glomeruli within the renal cortex differs between infants with some kidneys appearing normal whereas others are severely affected. This suggests that it may be haemodynamic factors and/or factors in the neonatal care of the infant that lead to the glomerular abnormalities. Indeed, the haemodynamic transition at birth where there is a marked increase in systemic blood pressure and renal blood flow are likely to lead to injury of glomerular capillaries, although further studies are required to elucidate this. In order to optimize renal health at the beginning of life in the preterm infant, it is imperative in future studies to gain an understanding of the causes of the glomerular abnormalities in the preterm neonate.     

Pregnancy and Renal Transplantation: A Case Report of the Risk of Antibody Induction Against Partner Antigens

Renal transplantation has provided women of childbearing age with increased fertility and the possibility of successful pregnancy outcomes. Approximately 14,000 births among women with transplanted organs have been reported worldwide, but pregnancy complications have been frequent: spontaneous or therapeutic abortion, preterm birth, low birth weight, and intrauterine growth restriction. Herein we have described a case of an acute rejection episode in a renal transplant recipient, occurring 6 months after successful delivery, despite the fulfillment of all European best practice guidelines criteria and the maintenance of adequate immunosuppression. Our case demonstrated that even a presumably low-risk patient can face worsening of renal function during or after pregnancy. Acute immune activation is uncommon but may occur in late-onset fashion. Despite adequate levels of maintenance immunosuppression, there is a risk of developing antibodies against the partner or the donor, causing acute renal immune damage.     

Anaesthetic considerations for the management of very low and extremely low birth weight infants

The opportunities for very low birth weight infants (birth weight < 1500 g) and extremely low birth weight infants (birth weight < 1000 g) to undergo surgery are increasing. These infants are prone to prematurity-related morbidities including respiratory distress syndrome, intraventricular haemorrhage, periventricular leukomalacia, retinopathy of prematurity, patent ductus arteriosus and necrotising enterocolitis. Evidence is accumulating that preterm infants are also sensitive to pain and stress. The pharmacokinetics of drugs in preterm infants is not fully understood but smaller doses of anaesthetic drugs are usually required in preterm infants compared to term infants and older children and their effects last longer due to low clearance rates and longer elimination half-lives. Key anaesthetic considerations are (i) inspired oxygen concentration that should be adjusted to avoid hyperoxia, (ii) haemodynamic parameters that should be kept stable and (iii) prevention of hypothermia by using adequate measures to keep the infants warm. These precautions must be continuously taken during the operation and the transport to and from the operating theatre.