不孕妇女宫颈沙眼衣原体感染的临床观察

目的 :探讨宫颈沙眼衣原体 (CT)感染对生育的影响。方法 :应用聚合酶链反应 (PCR)技术 ,对 2 16对不孕夫妇宫颈分泌物、尿道分泌物进行 CT- DNA检测 ,并观察宫颈 CT感染对围排卵期宫颈粘液葡萄糖含量及性交后试验的影响。结果 :2 16对不孕夫妇衣原体感染的阳性率分别为 :女性 32 .4 % ,男性 30 .1%。宫颈 CT感染妇女围排卵期性交后试验与未感染妇女比较 ,每高倍视野的活精数明显减少 (P<0 .0 5 ) ,围排卵期宫颈粘液葡萄糖含量明显减少 (P<0 .0 1)。经治疗后宫颈 CT转阴的妇女 ,围排卵期性交后试验每高倍视野的活精数明显高于治疗前 (P<0 .0 5 ) ,宫颈粘液的葡萄糖含量亦明显高于治疗前 (P<0 .0 1)。治疗后宫颈 CT持续阳性妇女 ,围排卵期性交后试验与治疗前比较 ,每高倍视野的活精数无明显变化 (P>0 .0 5 ) ,宫颈粘液的葡萄糖含量亦无明显变化 (P>0 .0 5 )。结论 :宫颈 CT- DNA感染是不孕的一个重要因素 ,导致不孕的原因 ,可能与患者宫颈粘液葡萄糖含量降低 ,影响精子在宫颈粘液中的活力有关     

荧光定量PCR检测解脲支原体感染与胎膜早破的关系

目的:探讨解脲支原体(UU)感染与胎膜早破的关系。方法:采用荧光定量PCR检测法分别对50例胎膜早破和50例正常妊娠非胎膜早破妇女的宫颈分泌物、胎盘母面、新生儿咽拭子进行解脲支原体检测。结果:胎膜早破组宫颈分泌物、胎盘母面、新生儿咽拭子中,UU检测率明显高于对照组,两组比较,差异均有显著性(P<0.05)。结论:解脲支原体感染与胎膜早破的发生关系密切。     

妊娠期与非妊娠期人乳头瘤病毒的感染率比较

目的:探讨HPV在不同妊娠时期感染率及基因分型的差别。方法:利用DNA杂交导流技术检测180例妇女妊娠早、中、晚期宫颈分泌物中HPV的表达及基因分型,同时检测180例非妊娠期健康妇女的宫颈分泌物作为对照。结果:180例非妊娠期健康妇女的宫颈标本中,HPV感染率为13%(23/180)。检出高危基因型(HPV16/18/31/52/56型)16例;低危基因型(HPV6/11型)5例;常见亚型(HPV53)2例。在妊娠期妇女的标本中,早、中、晚孕期感染率分别为19%(34/180)、20%(36/180)及32%(58/180)。检出高危基因型(HPV16/18/31/33/52/58/68型)81例;低危基因型(HPV6/11/42型)43例;常见亚性(HPV53/66)4例。其中有多重型感染患者。结论:妊娠期HPV感染率明显高于非妊娠期健康妇女,且感染率随妊娠进展而逐渐上升,其中高危亚型尤为明显,需要引起临床重视。     

2007-2008年北京地区25～54岁已婚妇女子宫颈上皮内瘤变的高危因素分析

目的 探讨北京地区25～54岁已婚妇女宫颈上皮内瘤变(CIN)的高危因素.方法 采用横断面调查方法,于2007年3月至2008年9月,对北京地区12个区县共137个社区内随机抽取的25～54岁已婚妇女6339例进行问卷调查、妇科检查、宫颈细胞涂片液基薄层细胞学检查(TCT)、宫颈分泌物高危型人乳头状瘤病毒(HR-HPV)检测,并对TCT结果异常者行阴道镜下宫颈活组织检查.采用logistic回归分析方法,分析CIN的高危因素及危险度比值比(OR)和95%可信区间(95%CI).结果 6339例妇女中,CIN患病率为5.90%[(374/6339,包括4例鳞状上皮细胞癌(SCC)因例数少,未单独统计].多元回归分析结果显示,HR-HPV感染(95%CI=9.953～15.811)、滴虫性阴道炎病史(95%CI=1.046～2.104)、口服避孕药避孕(95%CI=1.087～1.806)以及年龄＜45岁(95%CI=1.069～1.828)等因素与CIN患病相关.结论 HR-HPV感染是CIN患病的独立危险因素,而滴虫性阴道炎病史、口服避孕药避孕及年龄＜45岁是CIN患病相关危险因素.     

2007-2008年北京地区25～54岁已婚妇女宫颈上皮内瘤变的流行病学现状调查

目的 调查北京地区25～54岁已婚妇女宫颈上皮内瘤变(CIN)的患病现状.方法 采用横断面调查方法,于2007年3月至2008年9月,随机抽取北京地区12个区县共137个社区内25-54岁已婚妇女6339例(其中城区妇女942例,近郊区妇女3000例,远郊区妇女2397例)进行问卷调查、妇科检查、宫颈细胞涂片液基薄层细胞学检查(TCT)、宫颈分泌物高危型人乳头状瘤病毒-(HPV)检测,并对TCT结果异常者行阴道镜下宫颈活组织检查.结果 6339例妇女中,TCT结果异常者占9.58%(607/6339);病理检查诊断为CIN者占5.84%(370/6339),占TCT结果异常者的60.96%(370/607),其中CIN Ⅰ为4.65%(295/6339),CINⅡ为0.80%(51/6339),CINⅢ为0.38%(24/6339);早期浸润癌为0.06%(4/6339).城区妇女宫颈病变的患病率为4.46%(42/942),近郊区妇女为6.27%(188/3000),远郊区妇女为6.01%(144/2397),不同地区妇女宫颈病变的患病率比较,差异无统计学意义(P>0.05).结论 北京地区25～54岁已婚妇女CIN的患病率为5.84%,城区与近、远郊区妇女宫颈病变患病率无差异.     

病原体及巨细胞病毒感染与输卵管妊娠的关系

目的　探讨解脲支原体、沙眼衣原体、巨细胞病毒感染与输卵管妊娠的关系。方法应用PCR技术 ,检测 12 8例输卵管妊娠患者 (观察组 )和 5 0例行附件切除术、无输卵管妊娠史的卵巢囊肿患者 (对照组 )的宫颈分泌物和输卵管组织中解脲支原体、沙眼衣原体、巨细胞病毒DNA。结果(1)观察组 5 6例宫颈分泌物检测出解脲支原体DNA ,阳性率为 4 3 8% ,对照组 10例宫颈分泌物检测出解脲支原体DNA ,阳性率为 2 0 0 % ;观察组 4 8例输卵管组织检测出解脲支原体DNA ,阳性率为37 5 % ,对照组 5例输卵管组织检测出解脲支原体DNA ,阳性率为 10 0 % ;两组比较 ,差异有极显著性 (P <0 0 1) ;(2 )观察组 35例宫颈分泌物检测出沙眼衣原体DNA ,阳性率为 2 7 3% ,对照组 5例宫颈分泌物检测出沙眼衣原体DNA ,阳性率为 10 0 % ;观察组 34例输卵管组织检测出沙眼衣原体DNA ,阳性率为 2 6 6 % ,对照组 3例输卵管组织检测出沙眼衣原体DNA ,阳性率为 6 0 % ;两组比较 ,差异有显著性 (P <0 0 5 ) ;(3)观察组 2 1例宫颈分泌物检测出巨细胞病毒DNA ,阳性率为 16 4 % ,对照组 3例宫颈分泌物检测出巨细胞病毒DNA ,阳性率为 6 0 % ;观察组 2 5例输卵管组织检测出巨细胞病毒DNA ,阳性率为 19 5 % ,对照组 2例输卵管组织检测出巨细胞病     

宫颈巨细胞病毒分泌物与性生活和避孕措施的关系

巨细胞病毒(CMV)可从泌尿生殖道经常分离到。性传播在获得CMV感染方面起着重要作用。为确定与CMV性传播有关的危险因素,对在性传播疾病(STD)诊所就诊的妇女泌尿生殖道CMV分泌物的流行率进行了调查。 调查对象为在STD诊所就诊的妇女。对每一妇女采用标准化访视,骨盆检查,采集宫颈标本作革兰氏染色。宫颈细胞学、病毒学、沙眼衣原体和淋球菌培养。采集阴道标本镜检滴虫和白色念珠菌。采血作血清学检查,取中段尿作病毒培养。用统计学方法进行分析。     

妊娠期和产后妇女宫颈病变筛查研究新进展

近来有研究显示,妊娠期宫颈细胞学异常及人乳头瘤病毒(HPV)感染检出率较高,但分娩后又有一定的自然消退率和进展率。HPV感染易致宫颈细胞学异常,另有研究指出多个性伴侣、初次性生活早、多产次、社会经济地位低下、非白种人、吸烟均是宫颈细胞学异常的高危因素。妊娠期妇女宫颈存在特异性生理改变易导致诊断误差。目前专门针对妊娠期妇女宫颈筛查新方法的研究甚少,仍是使用与非妊娠妇女相同的筛查方法,如液基细胞学、传统巴氏涂片(Pap Smear)、HPV DNA检测。而各项指南对妊娠妇女宫颈病变筛查时机和间隔的选择仍有争论,有待进一步大规模研究。     

检测胎儿型纤维连接蛋白用于诊断胎膜早破

应用ＡＢＣ抗体凝集素夹心斑点免疫法，对３０例正常妇女血浆、５０例正常孕妇宫颈分泌物和８０例胎膜早破孕妇宫颈分泌物，进行纤维连接蛋白（Ｆｎ）岩藻糖化异质体检测。结果：胎膜早破孕妇宫颈分泌物中Ｆｎ岩藻糖化异质体检出阳性纺为９５．０％，正常孕妇为６．０％。提示：胎儿型Ｆｎ对诊断胎膜早破有较高的敏感性。为胎膜早破的诊断提供了一个新方法。     

HIV感染妇女CIN1的自然转归

在人免疫缺陷病毒(HIV)感染妇女中,生殖道人乳头瘤病毒(HPV)感染普遍,使HIV感染妇女患宫颈上皮内瘤样病变(CIN)风险增加。研究观察HIV感染妇女CIN1的自然转归和相关因素。这项多中心、前瞻性研究中,对HIV感染及非HIV感染妇女进行宫颈细胞学和HPV检测,对HIV感染者选用抗病毒药物治疗。研究对象每年做2次宫颈细胞学检查,如有非典型增生或CIN病情进展,做阴道镜检查。选择CIN1病变妇女观察其自然转归。剔除病例包括已行子宫切除、宫颈治疗、CIN2、CIN3或宫颈癌患者。结果:1994年11月～2002年9月801例HIV感染妇女中,307例(38%)…     

对人工流产妇女细菌性阴道病的临床流行病学调查

目的　研究自愿终止早孕门诊人工流产妇女中细菌性阴道病 (BV)的发生率及相关因素。方法　采用BVblueTM测定方法对 2 0 0 2年 6～ 9月北京友谊医院妇产科门诊 4 5 2例人工流产妇女的阴道分泌物进行BV检测。结果　BV总阳性率 15 2 7% ,BV感染率在女性年龄、职业、文化程度、阴道分泌物性状、阴道清洁度等组中差异有显著性意义 (P <0 0 5 )。结论　建议将阴道BV检测列为人工流产术前常规检测项目。     

Antibodies to Chlamydia trachomatis in sera of women with recurrent spontaneous abortions.

OBJECTIVE: The relationship between high-titer immunoglobulin G antibodies to Chlamydia trachomatis and recurrent spontaneous abortions was evaluated. STUDY DESIGN: Sera from the female partners of 258 couples with unexplained infertility, no history of chlamydial infection, and negative cervical cultures were diluted 1:128 and tested for immunoglobulin G antibodies to Chlamydia trachomatis. A subset of patients was also tested for antibodies to cytomegalovirus, cardiolipin, nuclear antigens, lactoferrin, and spermatozoa. RESULTS: Seven (41%) of 17 women with three abortions and 6 (60%) of 10 women with four abortions had chlamydial antibodies as opposed to 20 (13.5%) of 148 with no abortions, 6 (12.8%) of 47 with one abortion, and 4 (12.1%) of 33 with two abortions (p < 0.01). The incidence of > or = 3 spontaneous abortions was 31.8% among women with high-titer chlamydial antibodies and 7.5% among women who had seronegative results (p < 0.001). There was no relation between any of the other antibodies and > or = 3 abortions or antibodies to Chlamydia trachomatis. CONCLUSION: High-titer immunoglobulin G antibody to Chlamydia trachomatis was associated with recurrent spontaneous abortions. The mechanism may involve reactivation of a latent chlamydial infection, endometrial damage from a past chlamydial infection, or an immune response to an epitope shared by a chlamydial and a fetal antigen.     

Müllerian abnormalities in fertile women and recurrent aborters

Ninety-six women with recurrent first-trimester spontaneous abortions underwent hysterosalpingography to rule out müllerian abnormalities, both congenital and acquired. Results were compared with those in 96 women who had undergone hysterosalpingography before artificial insemination by donor and subsequently had a full-term, normal delivery. The patients with two recurrent, consecutive abortions had müllerian abnormalities similar to those in women with three consecutive abortions; however, they had different müllerian abnormalities than did the control group. Congenital and acquired malformations seen most often in patients with recurrent abortions were septate, arcuate and bicornuate uteri and incompetent cervical os. Pelvic examination did not discriminate between patients with recurrent abortions and the control group.     

A longitudinal study on different models of postabortion care in Tanzania

OBJECTIVE: To identify women having unsafe abortions and elucidate whether an acceptable follow-up rate among these women can be retrieved. STUDY POPULATION: One thousand three hundred and fifty-seven women attended Temeke Municipal Hospital, Dar es Salaam with an abortion-related diagnosis. METHODS: Women having unsafe abortions were identified by an empathetic dialogue, offered a contraceptive service and asked to return for follow-up. Three different ways of achieving follow-up information were tested. In phase 1, a combination of hospital-based and home-based interviews was utilized, in phase 2, an additional 1-month control visit was added to the protocol, and in phase 3, the contraceptive counseling and service was provided by technically well-skilled counselors. RESULTS: Seven hundred and eighty-eight women were identified as having had unsafe abortions and 491 women as spontaneous abortions. Women having unsafe abortions were younger, more often single and of higher parity than women having spontaneous abortions. The follow-up rate achieved varied from 47%-72%, being lowest in phase 1 and highest in phase 3. The two most common reasons for loss to follow-up were the interviewer's inability to locate the respondent's house either because of an unspecific or a remote address (58%) and migration (29%). CONCLUSION: If hospital-based and confidential home-based interviews are used combined and if the women having unsafe abortions are counseled by technically well-skilled counselors, it is possible to achieve a reasonable follow-up rate among women having unsafe abortions.     

宫颈糜烂不孕患者应用射频自凝刀治疗术后宫颈黏液和妊娠率的改善

目的:探讨宫颈糜烂不孕患者应用射频自凝刀治疗后宫颈黏液和妊娠率的改变。方法:宫颈糜烂不孕患者62例,依其宫颈糜烂程度分为3组:轻度糜烂组(n=8)、中度糜烂组(n=38)、重度糜烂组(n=16)。应用射频自凝刀治疗术治疗,术前行宫颈黏液评分。治疗后随访1年,评价宫颈黏液和妊娠的情况。结果:射频自凝刀治疗总有效率为100%。轻度、中度、重度组的痊愈率分别为100%、94.7%和87.5%。62例患者治疗后宫颈黏液评分与治疗前的比较有显著提高(P<0.01),宫颈黏液性状明显改善。在随访期内,3例妊娠早期流产,9例在孕,4例分娩,妊娠率为21%。结论:射频自凝刀治疗术能改善宫颈糜烂不孕患者的宫颈黏液性状和妊娠率。     

Prevention of Rh immunization after delivery and abortion

Out of 845 Rh-negative parturients with Rh-positive children, 515 (60.64%) accepted the application of IgG-anti D serum. The rest refused it, because they had two or more children. Out of 82 Rh-negative pregnant women who had spontaneous abortion, 30 (36.58%) were covered by the IgG-anti D prophylaxis. Artificial abortion was applied in 3148 Rh-negative women, of whom 178 (5.60%) took IgG-anti D serum. Following spontaneous and artificial abortions IgG-anti D was applied mainly in women with no children or with one child. Parity influenced the application of prophylaxis and in artificial abortions also the fact that in these cases women were to pay for the preparation. The control was carried out in the subsequent pregnancy: after delivery only one Rh immunization (0.19%) has so far been recorded--none, however, after spontaneous and artificial abortions.     

Incidence of spontaneous abortion following artificial insemination by donor

This study examines the frequency of spontaneous abortions in pregnancies achieved by artificial inseminations with donor semen (AID), with special respect to the use of cryopreserved semen and ovulation induction with clomiphene citrate. The abortion rate was found to be similar in AID series using frozen semen to those using fresh semen, nor was the rate increased in composite AID series (both fresh and frozen semen) when compared with the rate of spontaneous abortions in the general population. When clomiphene was used, the abortion rate was increased only in groups of anovulatory and irregularly ovulating women. Those AID series where all women treated are given clomiphene show no increase in abortion rates. The discussion is focused on factors that influence the abortion rate and on possible etiological factors.     

Etiologic factors and subsequent reproductive performance in 195 couples with a prior history of habitual abortion

A diagnostic screening program was applied to 195 couples with a prior history of habitual abortion (i.e., three or more consecutive abortions). Abnormalities were identified in 110 (56%) of the couples. Such identification was significantly more frequent in couples with primary habitual abortion than in couples with secondary habitual abortion (p less than 0.001) and also more frequent in couples with second-trimester abortions than in those with first-trimester abortions (p approximately equal to 0.01). The abnormalities most commonly observed were anomalies of the uterine body (15%), endometrial infections (15%), and cervical incompetence (13%). Hormonal dysfunctions were detected in 5%, and there were chromosomal aberrations in 3% of the couples. The women in the group showing abnormalities were offered surgical or medical treatment, and 80% of those who subsequently conceived carried their pregnancies to term. Among the couples with no abnormal findings, women receiving specific antenatal counseling and psychological support had a pregnancy success rate of 86%, as compared to a success rate of 33% observed in women who were given no specific antenatal care (p less than 0.001).     

A study comparing previous induced abortion rates in populations of newly delivered women and infertile women

OBJECTIVE: For years, induced abortions (IA) have been deemed responsible for altered fertility. The implication of various mechanisms including tubal infertility, intra-uterine adhesions, spontaneous abortion, ectopic pregnancy, cervical incompetence, shortened gestations, and any psychological trouble leading to anovulation has been raised. Though many authors find no evidence of an increased risk on fertility for women, whose IA is not complicated by infection, it might sometimes be insinuated that infertility is the consequence of previous abortion. Thus, we compared the rate of patients with any prior IA in a population of newly delivered women and in women ongoing IVF. PATIENTS AND METHODS: A retrospective study was conducted at Sèvres hospital, comparing two populations of women, newly delivered women (n=1738) between January 1st and December 31st 2005, and women ongoing IVF at the same period (n=430). We reported the number of previous medical or surgical induced abortions and compared it in both groups. Another analysis compared these rates, among two subgroups of women with one or more prior pregnancy (secondary infertility (n=148), and secondary gestation (n=1088). RESULTS: The rate of prior IA was not different in the two populations. In the IVF group, 13% (n=56) had undergone one or more IA, versus 16.7% (n=291) in the newly delivered group (P=0.06). Among women with previous pregnancy, 37.8% (56) women of the IVF group had undergone one or more previous IA, versus 26.7% (291) of the newly delivered women (P=0.007). DISCUSSION AND CONCLUSION: As expected by literature data on IA and fertility, rates of prior induced abortions were not different in the population of fertile women versus infertile. However, women with one or more previous pregnancy are more likely to have undergone previous IA in the IVF group than in the newly delivered group, possibly due to a bias of age. More data are requested to eliminate linkage between IA and infertility.     

Resectoscope or Versapoint for hysteroscopic metroplasty.

OBJECTIVE: To assess the feasibility, safety, and reproductive outcome of hysteroscopic metroplasty using the Versapoint device compared with the resectoscope using the Collins loop. METHODS: Sixty-three women diagnosed with partial septate uterus were included in the study. Forty-two women underwent hysteroscopic metroplasty using Versapoint and 21 women had the procedure using the resectoscope. Operating time, complications, pregnancy rate, and mode of delivery were recorded. Data were analyzed with the Mann-Whitney test. RESULTS: Operating time was 20.5 min for the resectoscope group and 15.4 min for the Versapoint group (P<0.05). Pregnancy rate, delivery rate, and spontaneous abortions were similar in both groups. CONCLUSION: Operative hysteroscopy with Versapoint does not require cervical dilation, thus avoiding cervical incompetence, cervical lacerations, and uterine perforation. The Versapoint technique is a safe and effective alternative to the resectoscope. It could be used predominantly in nulligravida women, especially in those with cervical canal stenosis.