胎儿骶尾部巨大未成熟畸胎瘤1例

<正>1病例报告患者,27岁,因停经31周,胎儿畸形拟行引产术,于2016年1月19日入山东大学齐鲁医院。患者孕14周超声检查发现胎儿骶尾部包块,约2 cm×3 cm×3 cm大小,实性,之后未再进行超声检查动态监测包块大小。孕30周于当地医院超声检查示:胎儿符合孕周,胎儿骶尾部向外突出一边界清楚的不均质囊实性肿物,大小约17.4 cm×14.2 cm×13.6 cm,其内血流     

未成熟畸胎瘤术后应用促性腺激素释放激素激动剂保护卵巢化疗后自然妊娠1例

1病历摘要患者27岁,4年前(当时未婚)主诉"急性下腹痛"就诊于外院。当时超声提示右卵巢增大约16cm×14cm×6.5cm,囊实相间,肿瘤内实质部分9.5cm×7.9cm,可见较丰富血流信号;肿瘤标记物AFP800.2μg/L、CA12588kU/     

子宫外产时处理联合产房外科治疗胎儿颈部巨大淋巴管瘤1例

患者24岁。于2008-10-06因“孕2产0,妊娠37 4周;胎儿颈部囊性包块”入院。病史:患者自然流产1次,本次孕早期因先兆流产保胎治疗,孕24周,三维彩超发现胎儿颈部一2.7cm×4.4 cm×1.7cm囊性包块。孕30周行脐血穿刺,细胞培养染色体未见异常;孕31 4周磁共振(MR I)提示胎儿颈部淋巴管     

足月妊娠合并双侧卵巢浆液性囊腺癌1例

患者25岁,孕1产0,因停经36周,产检发现双侧卵巢肿块3个月余于2005-03-26入院。末次月经2004-07-13,预产期2005-04-21。平素体健,月经规则。孕前未行妇科检查。于孕3个月建卡,妇检无特殊。孕5个月时查超声提示双侧卵巢囊实性包块,左侧9cm×8cm×8cm,右侧10cm×9cm×8cm;胎儿发育各项结果均在正常范围。血清CA125890kU/L,患者自觉无明显不适。建议严密监护下继续妊娠,并动态监测CA125水平。按期正规产检,动态监测CA125水平缓慢下降,至孕34周时为624kU/L,超声提示双侧卵巢肿块持续存在。孕36周收住入院,复查CA125480kU/L,超声左侧卵巢囊…     

双胎中期妊娠合并急腹症腹腔镜联合手术1例

1病例报告患者,30岁,因孕16+5周突发右上腹疼痛,伴恶心、呕吐于2011年1月22日入院。患者停经8周妇科B超检查提示:双胎妊娠,盆腔囊性肿物,大小为10cm×13cm×6cm,未治疗。孕16+5周突发右上腹疼痛,伴恶心、呕吐来我院就诊。患者平     

胎儿腹壁淋巴囊肿一例

一、临床资料患者 2 6岁 ,食品售货员 ,孕 2产 0 ,宫内妊娠 39周 ,因胎膜早破于 2 0 0 2年月 11日 10日就诊于我院。平素月经规律 ,末次月经 2 0 0 2年 2月 10日 ,停经 17周自觉胎动 ,定期在外院进行产前检查 ,孕 2 4 5周时行B起检查 :双顶径 6 4cm ,发现胎儿腹壁囊性占位病变 4 2cm× 4 0cm ,内为不匀质回声 ,有包膜 ,建议上级医院就诊。 10d后于北京一家三级医院再次行B超检查 ;于胎儿右下前腹壁见 5 1cm× 3 0cm× 1 0cm无回声、有分隔有包膜的囊性肿物。以后曾两次复查B超此囊肿未见明显长大 ,孕期平顺 ,一直于地区医院行产前检…     

一对夫妇连续四次妊娠Meckel综合征患儿

孕妇及其丈夫均34岁,身体健康,妊5产0,2001年第1次妊娠人工流产,第2次妊娠后于2007年1月孕21周时发现胎儿多发畸形在外院引产.胎儿尸体解剖结果:女婴,左侧硬腭裂,未达牙槽突,枕后部见一囊,体积7 cm×5 cm× 3 cm,囊内可见棕褐色液体流出,枕部颅骨缺损,直径为0.8 cm,颈椎部分裂开,心脏瓣膜位置正常,左肾体积6.2 cm× 3.5 cm× 4.5 cm,右肾体积2.5 cm×2.5 cm×2.4 cm,双肾切面均为均匀一致的海绵状.     

早孕合并卵巢黄体囊肿蒂扭转保守手术治疗2例

1 病例报告 例1,患者30岁,因停经55天,右下腹疼痛21小时于2009年4月4日入院.G<,2>P<,0>.1年前因"异位妊娠"外院行右侧输卵管切除.查体:生命体征平稳,腹软,无压痛、反跳痛.妇科检查:子宫孕7周大小,质软,无压痛,右侧附件区扪及一7cm×6 cm囊性包块,边界清,可活动,近宫角处有压痛,无反跳痛.血常规:WBC 18.22×10<'9>/L,中性粒细胞0.849,Hb128g/L.超声检查提示:宫内妊娠7周(胚芽存活),右侧附件区混合性包块8.8 cm×4.8 cm,盆腔积液2.2 cm.余检查正常.     

33卷10期疑难病案答案

正1术前诊断(1)子宫壁间囊性肿物性质待查:子宫肌瘤囊性变?囊性子宫腺肌病?子宫肌壁囊肿?子宫肉瘤囊性变?(2)轻度贫血。2病例特点及鉴别诊断2.1病例特点患者36岁育龄期女性,平素月经规律,经量稍多,无痛经;病史仅有经间期阴道流血1次。超声检查提示子宫壁囊性肿物6.4 cm×5.7 cm×4.6 cm,周界欠光滑;诊刮子宫内膜病理无特殊,血清肿瘤标志物均正常范围;妇科检查子     

胎儿骶尾部畸胎瘤的产前诊断和预后影响因素分析

目的探讨胎儿骶尾部畸胎瘤(SCT)的产前诊断和预后因素。方法回顾性分析2014年1月至2021年9月就诊于浙江大学医学院附属妇产科医院并经产前超声诊断(诊断孕周≤28周)为胎儿SCT且继续妊娠的孕妇41例, 分析其产前影像学特征和妊娠结局, 包括肿瘤体积与胎儿体重比(TFR)、肿瘤实性部分占比、肿瘤生长速率(TGR)、是否存在胎儿水肿、胎盘增厚以及羊水过多。采用受试者工作特征(ROC)曲线分析确定TFR、TGR预测胎儿不良结局的临界值。结果 (1)41例妊娠SCT胎儿孕妇的超声诊断孕周为(24.2±2.9)周(范围:18～28周), 其中1例孕22周进展为胎儿水肿引产, 1例孕29周发生胎儿宫内死亡引产, 39例继续妊娠直至分娩。39例继续妊娠的孕妇中, 1例因妊娠晚期发生恶性羊水过多、胎儿心胸比增大于孕31周行剖宫产术, 1例因胎儿心力衰竭于孕32周行剖宫产术, 1例因胎儿心力衰竭合并水肿于孕32周行剖宫产术;其余36例均于新生儿出生后3周内行手术切除肿瘤, 预后均良好。(2)妊娠28周前TFR>0.12可预测胎儿预后不良, 敏感度为100.0%, 特异度为86.1%, 曲线下...     

Uterine Inversion as a Result of a Large Prolapsed Carcinosarcoma of the Uterus

BackgroundUterine inversion is most commonly seen in labour and delivery. However, it can be associated with uterine tumours, including gynaecologic malignancy.CaseIn a 66-year-old woman, uterine inversion identified at laparotomy that was found to be associated with uterine carcinosarcoma (malignant mixed mesodermal tumour) represents an unusual presentation. Surgical approach necessitated a vertical hysterotomy to amputate and deliver the uterine tumour.ConclusionUterine inversion in gynaecologic oncology may be associated with sarcoma or malignant mixed mesodermal tumour. This can represent a diagnostic and surgical challenge and should be considered.     

A genetic variant in pre-miR-27a is associated with a reduced cervical cancer risk in southern Chinese women

Objective

MicroRNAs (miRNAs) play critical roles in cervical carcinogenesis. Common single nucleotide polymorphisms (SNPs) in pre/pri-miRNAs may change their property through altering miRNAs expression and/or maturation. Here we aimed to investigate the influence of three common SNPs in pre/pri-miRNAs (pri-miR-26a-1 rs7372209, pre-miR-27a rs895819 and pri-miR-100 rs1834306) on individual susceptibility to cervical cancer.

Methods

We genotyped these three polymorphisms in 103 cervical cancer cases and 417 cancer-free female subjects using polymerase chain reaction–ligation detection reaction (PCR–LDR) method. Unconditional logistic regression analysis was utilized to estimate the association between these polymorphisms and the risk of cervical cancer.

Results

In a logistic regression analysis, we found that the rs895819 polymorphism in pre-miR-27a exhibited a significant effect on cervical cancer risk; T allele (OR = 0.68, 95% CI = 0.49–0.95, P = 0.025), and CT (OR = 0.33, 95% CI = 0.15–0.74, P = 0.007) or TT (OR = 0.33, 95% CI = 0.15–0.72, P = 0.006) genotype were associated with the decreased risk, compared to C and CC respectively. As we used further genotype association models, we found a similar trend of the association in additive (OR = 0.70, P = 0.041) and recessive model (OR = 0.33, P = 0.004). We did not detect any association of the other two SNPs in pri-miR-26a-1 (rs7372209) and pri-miR-100 (rs1834306) with cervical cancer risk.

Conclusion

Our study provides the first evidence that the miR-27a rs895819 polymorphism is associated with a decreased risk of cervical cancer in southern Chinese women.     

Assisted hatching in assisted reproduction: a state of the art

The World Health Organization estimates that one in six couples experience some delay in conception and an increasing number require treatment by the assisted conception (AC) procedures of in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).The implantation rate of embryos resulting from in vitro fertilization cycles is generally less than 20%. The exposure of oocytes and embryos to the artificial conditions of in vitro culture may have negative effects on the embryo’s ability to undergo normal hatching, resulting in low rates of implantation following IVF and embryo transfer. Human embryos resulting from superovulation develop more slowly in vitro compared to embryos in vivo, manifest a relatively high degree of cytogenetic abnormalities and undergo cellular fragmentation. Artificially disrupting the zona pellucida is known as assisted hatching (AH) and there is some evidence that embryos that have undergone zona manipulation for assisted hatching tend to implant one day earlier than unhatched embryos. A variety of techniques have since been employed to assist embryo hatching, including partial mechanical zona dissection, zona drilling and zona thinning, making use of acid tyrodes, proteinases, piezon vibrator manipulators and lasers. This review will consider the impact of IVF conditions on zona pellucida physiology, zona hardening, different techniques of assisted hatching, who may benefit from assisted hatching and potential hazards.     

Call for a More Specific Diagnosis of Infant of a Diabetic Mother to Optimize Neonatal Care

Hyperglycemia is the diagnostic feature of diabetes mellitus (DM), and during pregnancy, hyperglycemia has numerous serious implications for organogenesis and fetal growth. Each type of DM has different neonatal implications based on pathogenesis, length of disease, and comorbidities. Currently, limited attention is given to the woman’s type of DM when evaluating risks for neonates. The diagnosis of infant of a diabetic mother is not sufficient because of the varying pathophysiology of diabetes classifications and associated neonatal outcomes. By expanding the diagnosis to include the woman’s classification and glucose control, maternity and neonatal care providers could develop plans of care based on potential neonatal outcomes, including anticipatory guidance for families. In this commentary, we propose a more specific diagnosis, rather than infant of a diabetic mother, to better serve these infants.     

Prenatal diagnosis of mosaicism for trisomy 7 in a single colony at amniocentesis in a pregnancy with a favorable outcome

ObjectiveWe present prenatal diagnosis of mosaicism for trisomy 7 in a single colony at amniocentesis with a favorable outcome.Case reportA 40-year-old woman underwent amniocentesis at 17 weeks of gestation because of advanced maternal age. Amniocentesis revealed a result of 47,XY,+7[1]/46,XY[26]. In 27 colonies of cultured amniocytes, all five cells in one colony had trisomy 7, while the rest 26 colonies had a normal karyotype. The parental karyotypes were normal. Repeat amniocentesis was performed at 19 weeks of gestation. Interphase fluorescence in situ hybridization (FISH) was applied on the uncultured amniocytes, and the result showed trisomy 7 signals in 4% (3/75 cells) of the uncultured amniocytes compared with 1.4% (1/70 cells) in the normal control. Uniparental disomy (UPD) 7 was excluded by polymorphic DNA marker analysis. The cultured amniocytes at repeat amniocentesis had a karyotype of 46,XY. Prenatal ultrasound findings were unremarkable. A healthy 3332-g male baby was delivered at 38 weeks of gestation. The karyotype of cord blood lymphocytes was 46,XY. The boy was phenotypically normal at age 8 months at follow-up. No trisomy 7 signal could be detected in the postnatal FISH analysis of the urinary cells.ConclusionMosaicism for trisomy 7 in a single colony at amniocentesis without UPD 7 can be associated with a favorable outcome.     

妊娠期糖尿病产后发展为2型糖尿病的相关因素研究进展

妊娠期糖尿病（GDM）是产科常见并发症,会增加妊娠风险。由于生活方式和饮食结构的改变,GDM发病率逐年上升。大部分GDM患者产后短期内血糖会恢复正常,但生活中远期发生2型糖尿病（T2DM）的风险并未降低,GDM妇女已经成为日后发生糖尿病、代谢综合征的潜在危险人群。GDM发展为T2DM的相关危险因素很多,如高龄、肥胖和糖尿病家族史,另外空腹血糖水平、孕期胰岛素治疗、早发型GDM也逐渐被重视。通过认识GDM发展为T2DM的相关危险因素和包括临床特征、生化指标、基因等多种早期预测标志物,预测T2DM发生的风险,以利于提高公众风险意识及GDM妇女产后随访,可以提前进行生活方式干预或药物治疗,预防和延缓T2DM的发生,改善健康结局。     

Unbound cortisol in umbilical cord plasma and maternal plasma: a reinvestigation

Unbound cortisol was assayed in maternal and cord plasma. A method was used in which experimental conditions are carefully selected to approach as closely as possible the in vivo situation.¹ In maternal plasma at term, the proportion of unbound cortisol (9.7 ± 1.5%) (mean ± SE) was identical to that of normal nonpregnant women (9.7 ± 0.4%). However, the concentration of unbound cortisol was 3-fold higher at term (46.0 ± 5.9 ng/ml) than that in nonpregnant women (14.2 ± 1.0 ng/ml). During labor an increase was observed, and at birth the proportion (and concentration) of unbound cortisol was extremely high varying between 17.0 ± 0.8% (92.3 ± 7.4 ng/ml) and 20.9 ± 1.4% (130.4 ± 17.9 ng/ml) (spontaneous and induced vaginal deliveries, respectively). In cord plasma at term and before labor (fetuses delivered by elective cesarean section), the proportion of unbound cortisol was high (29.1 ± 1.3 %) but its concentration (9.6 ± 1.1 ng/ml) was only slightly lower than that observed in normal adults. Labor had an important stimulatory effect as observed in cases of vaginal delivery after spontaneous labor (proportion of unbound cortisol 35.1 ± 1.2%, concentration of unbound cortisol 15.4 ± 1.35 ng/ml, respectively). No difference was observed between spontaneous and provoked labor since similarly high values of unbound cortisol were found in cord plasma after oxytocin-induced labor followed by vaginal delivery (36.2 ± 1.4% and 23.0 ± 5.2 ng/ml).     

A Stepwise Approach to Laparoscopic Excision of a Noncommunicating Rudimentary Horn

Study Objective

To demonstrate our approach to laparoscopic excision of a noncommunicating rudimentary horn (AmericanSociety for Reproductive Medicine classification II(b), European Society of Human Reproduction and Embryology/European Society of Gynaecological Endoscop classification class U4a).