剖宫产指征10年变化分析

目的 探讨刮宫产指征变化及剖宫产率变化与围产儿死亡率关系。方法 选择10年间剖宫产病例，分析剖宫产指征变化及剖宫产率变化与围产儿死亡率。结果 剖宫产率逐年上升，在指征变化中，头盆不称、胎儿持续宫内窘迫占第一、二位，社会因素不断上升，而围产儿死亡率趋于平稳。结论 剖宫产率升高，围产儿死亡率无明显下降，剖宫产指征中社会因素不断上升，值得进一步探讨。     

剖宫产率与围产儿死亡率的关系

对北京妇产医院１９８０年１月１至１９９２年１２月３１日行剖宫产术的孕妇１１８５５７例及同期围产儿死亡１１４０例进行回顾性分析。结果表明：在此期间平均剖宫产率为２５．０％，平均围产儿死亡率为１５．２‰。向１９８５年起剖宫产率明显升高，但围产儿死亡率并未相的下降。剖宫产分娩的早期新生儿死亡高于阴道分娩。提示：提高剖宫产率并不一定能使围产儿死亡率降低。     

10年手术产率及新生儿情况变化

目的：探讨手术产率、剖宫产适应症的变化及手术产儿的情况。结果：剖宫产率及其适应症发生了明显的变化，而阴道助产率无明显改变，手术产新生儿的死亡率及窒息率均明显下降。结论：剖宫产率升高与手术技术不断提高，对母儿比较安全， 在一定程度上降低了围产儿的死亡比， 但围产儿死亡比的下降不能仅靠增加剖宫产率， 应着重于围产医学的发展及产科质量的提高。     

剖宫产上升原因分析

<正>近年来,剖宫产率居高不下,统计结果显示:我乡剖宫产率已由2007年的21.1%上升到2011年的38%,大大超过了世界卫生组织规定剖宫产率15%以下的要求。在严格掌握医学指征的情况下,剖宫产能有效的降低孕产妇及围产儿的死亡率。但当围产儿的死亡率降低到一定限度时,即使再提高剖宫产率围产儿死亡率也不会继续下降。剖宫产可增加出血和感染,并可发生意外损伤、羊水栓塞和麻醉意外而危及产妇,因而应严格掌握手术适应证。以期达到降低剖宫产率的目的。     

北京市延庆县医院5年孕足月剖宫产率及指征分析

目的探讨剖宫产率及剖宫产指征的变化和对围产儿死亡率的影响,寻找降低剖宫产率的方法。方法回顾性总结北京市延庆县医院2008年1月至2012年12月住院分娩的病历资料,分析剖宫产率及剖宫产指征变化的各项相关数据和围产儿死亡率的关系。结果 1剖宫产率逐年下降[2012年剖宫产率(39.03%)与2008年(53.94%)相比,P0.05];2剖宫产指征中以社会因素为指征的剖宫产率通过医护人员的努力得到了有效的控制而下降,随着剖宫产率的下降,产程异常为指征的剖宫产比例增加;3围产儿死亡率趋于稳定,并未随着剖宫产率的下降而升高,2012年围产儿死亡率(3.17‰)与2008年(2.93‰)相比,差异无统计学意义(χ2=0.04,P0.05)。结论提高助产技术及加强孕期宣教,可进一步降低剖宫产率。     

剖宫产率和适应症的分析

本文综述了８０￣９０年代初剖宫产率的变化及与适应症的关系。近年来，剖宫产率不断上升，但围产儿死亡率并未因此而进一步降低，目前行剖宫产手术的前几种病因为：难产、剖宫产史、臀位和胎儿窘迫，还有一些社会因素和少见因素。     

剖宫产对儿童身心发育的影响

我国剖宫产率从20世纪八十年代末开始出现明显上升趋势,有些地方甚至已超过60%,黄醒华等研究[1-3]发现导致剖宫产率升高的原因是多方面的,但其中社会因素剖宫产不断上升,已成为剖宫产前三位原因之一;然而剖宫产术为有创性技术,需要有严格的手术指征和适应证,鲁小红等[4-5]的研究提示剖宫产率升高到一定比例后并不能使孕产妇和围产儿死亡率及患病率进一步降低,反而会有所升高;     

剖宫产率及剖宫产指征14年变化研究

目的：探讨剖宫产率及剖宫产指征的变化和对围生儿病死率的影响。方法：选择14年间剖宫产病例820例，分析剖宫产率及剖宫产指征变化、各项相关数据和围生儿病死率的关系。结果：①剖宫产率逐年上升；②在剖宫产指征变化中，难产因素、胎儿窘迫持续在第1、2位，社会因素占第3位，并显示逐年升高；③围生儿病死率逐年趋于稳定。结论：剖宫产率升高，在一定范围内降低了围生儿病死率，但剖宫产率升高到20以上时，围生儿病死率并不随之下降。     

10年间剖宫产率及指征变化与围生儿死亡率的关系

目的：探讨剖宫产率及剖宫产指征变迁对围生儿死亡率的影响。方法：对10年间剖宫产病例资料进行回顾性分析。结果：1992－1996年剖宫产率为36．50％，显著低于1997－2001年的47．78％，两者比较，差异有极显著性（P＜0．01）。在剖宫产指征中，妊娠并发（合并）症始终处于第1位，社会因素上升为第2位，难产为第3位，胎儿窘迫为第4位。围生儿死亡率1992－1996年为17．88‰，1997-2001年为22．23‰，两者比较，差异无显著性（P＞0．05）。结论：剖宫产率升高在一定范围内降低了围生儿死亡率，但随着剖宫产率的进一步升高，围生儿死亡率并未随之下降。因此，应合理掌握剖宫产指征，降低剖宫产率。     

全国剖宫产学术研讨会纪要

剖宫产指征近年来,国内的剖宫产率有日益升高之趋势,而围产儿死亡率并没有相应降低,北京、上海等地的报告指出:尽管剖宫产率由50年代的1～2%至80年代后期上升到20～30%左右,但围产儿死亡率并没有相应的下降。故对于如何适当的掌握剖宫产指征,使既有利于减少围产儿死亡,又利于降低剖宫产并发症是十分重要的,与会代表们就剖宫产指征问题进行了充分而热烈地讨论,结论如下:一、明确指出掌握剖宫产指征并不是为降低剖宫产率,而是在掌握指征情况下,适时地进行手术从而达到有利母婴健康之目的。因为剖宫产率之高低,因素是多源的,例如初产妇,年龄30岁以上者均属影响因素之一,而当前社会因素的影响确实存在,值得重视。在我国剖宫产率之高低相差很大,高者个别单位可达     

Triple marker screening for trisomy 21, trisomy 18 and open neural tube defects in singleton pregnancies of native Japanese pregnant women

OBJECTIVE: To report the results of prenatal triple marker screening on a population of Japanese pregnant women. METHODS: From April 1994 through March 1999, a total of 32,925 native Japanese women with singleton pregnancies requested a triple marker-screening test. Multiples of the median values for 3 markers and individual risks for each patient were calculated following adjustment for the Japanese weight correction factor. The risk cut-off values used for Down syndrome (T21), open spina bifida (OSB) and trisomy 18 (T18) were 1: 295, 1: 290, and 1: 100, respectively. Follow-up information was collected postpartum and statistically analyzed. RESULTS: Detection rates (DR) of T21 for women less than 35 years, over 35 years and overall were 58, 94, and 83%, respectively. DR of T18 for women less than 35 years, over 35 years and overall were 75, 79, and 79%, respectively. DR of open neural tube defects (ONTD) was 100%. CONCLUSIONS: The first cumulative data of an intervention program and prospective follow-up studies in Japan have proven to be similar to other published reports. Individual risk values were calculated for each pregnancy for T21, T18 and ONTD. This screening program is more effective than age-dependent screening for detecting T21, T18 and ONTD pregnancies.     

妊高征患者血中补体活化与内皮细胞损伤关系的研究

目的：探讨妊高征患者补体活化与血管内皮细胞损伤之间的关系。方法：采用双抗体夹心酶联免疫吸附法（ＥＬＩＳＡ），检测３５例妊高征患者（妊高征组）和２０例正常孕妇（正常妊娠组）外周血和胎盘后血中补体Ｃ１ｑ、Ｂ因子（ＢＦ）和Ｃ１抑制物（Ｃ１－ＩＮＨ）含量的变化。以Ｐｅｒｃｏｌ密度梯度法分离并计数两组外周血循环内皮细胞（ＣＥＣ）的数量，并对ＣＥＣ与血中Ｃ１ｑ的变化进行了相关分析。结果：（１）妊高征时，血中Ｃ１ｑ含量下降，而ＢＦ和Ｃ１－ＩＮＨ水平升高。这种变化在胎盘后血较外周血更加明显；（２）妊高征时，ＣＥＣ数量明显增加；（３）妊高征时，ＣＥＣ水平与血中Ｃ１ｑ含量呈负相关。结论：补体活化的经典途径和替代途径以及补体调节蛋白都参与了妊高征的发生和发展；补体活化与妊高征血管内皮细胞损伤有关。     

The Impact of Antenatal Screening for Down Syndrome in Western Australia: 1980–1994

Summary: Since the early 1970s, women in Western Australia have been screened for fetal Down syndrome risk on the basis of maternal age. Women 35 years of age or more at delivery, were offered fetal karyotyping with genetic diagnostic testing via amniocentesis or chorionic villus sampling. An increase in the prevalence of Down syndrome of 3.9% per year (95% confidence interval: 1.8-6.0%) was observed between 1980 and 1994, almost all of which was accounted for by increased maternal age. In 1991, a maternal serum screening (MSS) programme for Down syndrome was first implemented in Western Australia and has since evolved with 6 separate laboratories providing Down risk assessment in 1994. The gradual introduction of MSS programmes had little discernible impact until 1994, when 38% of Down syndrome fetuses were ascertained as a result of increased-risk MSS tests and the birth prevalence of Down syndrome decreased significantly. In this report, we review antenatal screening programmes and their impact on the birth prevalence of Down syndrome in Western Australia.     

Postpartum sterilization choices made by HIV-infected women

OBJECTIVE: To assess if HIV-infected women made different choices for postpartum sterilization after implementation of the Pediatric AIDS Clinical Trials Group protocol 076 (November 1, 1994) compared to before implementation. STUDY DESIGN: A retrospective cohort study in which medical records were reviewed to obtain demographic, obstetric and HIV-related data from January 1993 through December 2002. HIV-infected women who completed a pregnancy by birth or abortion were divided into two comparison groups: "Pre-076" and "Post-076". The primary outcome was sterilization by postpartum tubal ligation.Results. Forty-two women (74%) in the Pre-076 group chose sterilization compared to 139 of 310 women (45%) in the Post-076 group (unadjusted OR 3.44, 95% CI 1.83, 6.47). Seventy-one percent of women younger than 21 years of age in the Pre-076 Group chose sterilization compared with only 35% of women younger than 21 years in the Post-076 group (p = 0.0136). Similarly, 78% of primiparous women chose sterilization after their first pregnancy in the Pre-076 group, compared to 14% in the Post-076 group (p < 0.001). CONCLUSIONS: Since the implementation of PACTG 076 protocol in November 1994, fewer HIV-infected women chose postpartum sterilization. The typical woman who now chooses postpartum sterilization is less likely to be young or primiparous than those who chose sterilization before PACTG Protocol 076 implementation.     

1990-2007年4223例子宫颈癌住院患者的调查分析

目的 分析不同时期宫颈癌住院患者的发病年龄、临床病理特征及治疗方式的变化,以期为宫颈癌的治疗策略提供参考.方法 对1990年1月至2007年11月在江西省妇幼保健院住院、接受初次治疗的4223例宫颈癌患者的l临床和病理资料进行回顾性分析,以2000年为分界点将宫颈癌患者分为1990--1999年(A组)和2000--2007年(B组),比较不同时期宫颈癌患者发病年龄、临床病理特征及治疗方式的变化.结果 (1)A组宫颈癌患者平均发病年龄为54.4岁,B组平均发病年龄降至47.2岁.A组≤35岁宫颈癌患者的构成比为4.77%(89/1865),B组≤35岁者构成比增加至11.75%(277/2358),两组比较,差异有统计学意义(P<0.01).(2)A组Ⅱ a期及以下宫颈癌患者的构成比为14.32%(267/1865),Ⅱ b期及以上者构成比为85.68%(1598/1865);B组Ⅱ a期及以下者构成比增加至40.75%(961/2358),Ⅱ b期及以上者构成比降至59.25%(1397/2358);两组分别比较,差异均有统计学意义(P<0.01).(3)A组宫颈鳞癌、腺癌、腺鳞癌以及其他类型癌的构成比分别为88.42%、7.77%、1.88%和1.93%;B组分别为88.97%、8.02%、1.78%和1.23%.两组分别比较,差异均无统计学意义(P>O.05),鳞癌仍是主要的病理类型.(4)A组单纯放疗是主要治疗方式,构成比为75.28%,化疗(包括单纯化疗、化疗+其他治疗方式)的比例为10.89%;B组同步放化疗转变为主要治疗方式,构成比为35.79%,单纯手术的比例增加至19.47%.结论 1990--2007年宫颈癌发病呈年轻化趋势,早期宫颈癌患者增多,化疗在宫颈癌的治疗中已越来越显示出其重要的地位.     

Panniculectomy to facilitate gynecologic surgery in morbidly obese women.

OBJECTIVE: To determine whether abdominal panniculectomy done in conjunction with pelvic surgery in morbidly obese women is safe and useful. METHODS: Twenty morbidly obese women had excision of large abdominal panniculi in conjunction with pelvic surgery at New Hanover Regional Medical Center between November 1994 and September 1998. Panniculectomy was to improve surgical exposure and to decrease the incidence of wound necrosis, infection, and dehiscence among those high-risk women who all had chronic intertrigo in the skin folds under their panni. RESULTS: The women were 38-65 years old (mean 51 years) and weighed 202-475 pounds (mean 305 pounds). Their body mass indices were 35-76 (mean 51.5). Three women had superficial partial wound dehiscence, which was treated successfully with office debridement. There were no pulmonary emboli or operative deaths. CONCLUSION: Abdominal panniculectomy is safe and useful in morbidly obese women.     

Cervical intraepithelial neoplasia III: long-term outcome after cold-knife conization with clear margins

OBJECTIVE: To evaluate the long-term outcome of patients with severe cervical intraepithelial neoplasia or squamous cell carcinoma in situ (CIN III) after cold-knife conization with clear margins. METHODS: A total of 4417 women (mean age 36, range 18-72 years) with histologically confirmed CIN III had cold-knife conization with clear margins at our institution between 1970 and 1994. All patients were followed up with colposcopy, cytology, and pelvic examination for a mean of 18 years (range 5-30years). RESULTS: New high-grade squamous intraepithelial lesions (SILs) (CIN II and III) developed in 15 (0.35%) patients (mean age 35, range 25-65 years) after a median of 107 (range 40-201) months. A total of 4402 (99.65%) patients (mean age 36, range 18-72 years) were free of high-grade SILs after a mean follow-up of 18 (range 5-30) years. High-grade glandular intraepithelial lesions developed in two (0.05%) patients 14 and 17 years after conization. Twelve (0.3%) patients had metachronous vulvar intraepithelial neoplasia (VIN) grade III or vaginal intraepithelial neoplasia (VAIN) grade III, and one (0.02%) patient had invasive vaginal carcinoma 10 years after conization. CONCLUSION: Cold-knife conization with clear margins was an adequate method to definitively treat CIN III.     

Long-term follow-up after quinacrine sterilization in Vietnam. Part I: interim efficacy analysis

Objective: To determine the long-term efficacy of nonsurgical sterilization with quinacrine.

Design: Observational cohort study.

Setting: Rural provinces in northern Vietnam.

Patient(s): Two thousand seven hundred and nine women who had quinacrine insertions between 1989 and 1993.

Intervention(s): Interviews in 1994, 1995, and 1996 and review of available medical records. Pregnancy rates were corrected for problems in detecting and confirming pregnancies.

Main Outcome Measure(s): Pregnancy rates.

Result(s): Over 90% of women were interviewed at least once. Uncorrected cumulative pregnancy rates were 12.9% at 5 y after two insertions and 27.3% after one insertion. Effectiveness varied by age group: the partially corrected pregnancy rates after two insertions were 6.8% in women 35 or older at the time of insertion and 13.0% in women under 35. A subgroup of women who received oral papaverine at the time of quinacrine insertion had lower pregnancy rates, with a cumulative uncorrected rate of 5.3% at 4 years among women of all ages.

Conclusion(s): Efficacy of quinacrine appears reasonable for two insertions of quinacrine in women 35 and older. It may be possible to improve efficacy by the use of papaverine or the Hieu insertion technique.     

卵巢正常反应不孕症患者体外受精不同长方案促排卵效果的研究

目的探讨卵巢正常反应不孕症患者体外受精/卵胞质内单精子显微注射(IVF/ICSI)促排卵时应用口服避孕药(OC)长方案和黄体中期长方案的促排卵效果及临床结局。方法选择接受长方案IVF/ICSI助孕的卵巢正常反应患者共4 677个周期;根据年龄分为≤35岁组和35岁组,不方便超声监测排卵或自然周期超声监测卵泡不破裂的患者共2 762个周期,应用OC长方案(OC组);自然周期超声监测正常排卵的患者共1 915个周期,应用黄体中期长方案(黄体中期组);常规行IVF/ICSI,比较上述不同年龄人群2种促排卵方案的临床和实验室相关指标。结果 (1)OC组促性腺激素(Gn)启动日雌二醇(E2)[≤35岁组:(24.63±10.62)ng/L,35岁组:(24.24±10.40)ng/L]和促黄体生成素(LH)水平[≤35岁组:(0.92±0.59)IU/L,35岁组:(0.82±0.66)IU/L]均明显低于黄体中期组[≤35岁组:(25.89±12.80)ng/L,35岁组:(25.71±10.93)ng/L;≤35岁组:(1.37±0.59)IU/L,35岁组:(1.01±0.70)IU/L](P0.05);(2)OC组人绒毛膜促性腺激素(h CG)注射日E2水平[≤35岁组:(4 143.8±2 769.9)ng/L,35岁组:(3 597.5±2 160.4)ng/L]和因卵巢过度刺激综合征(OHSS)行全胚冷冻率(≤35岁组:9.1%,35岁组:10.2%)均明显高于黄体中期组[≤35岁组:(3 850.8±2 092.4)ng/L,35岁组:(3 213.4±1 804.5)ng/L;≤35岁组:4.9%,35岁组:5.9%](P0.05),但h CG注射日的内膜厚度[≤35岁组:(10.75±2.25)mm,35岁组:(10.47±2.38)mm]却明显小于后者[≤35岁组:(11.62±2.43)mm,35岁组:(11.09±2.68)mm](P0.05);(3)在年龄35岁的OC组Gn总用量[(3 775.4±1 200.0)IU]和使用时间[(13.5±2.2)d]明显高于黄体中期组[(3 516.9±1 156.1)IU,(12.4±2.2)d](P0.05);(4)2种降调节方案患者的获卵数、ICSI成熟卵数、双原核(2PN)受精率、平均移植胚胎数、优质胚胎率和早期流产率均无明显差异(P0.05),但OC组的着床率(≤35岁组:41.4%,35岁组:25.5%)和临床妊娠率(≤35岁组:55.7%,35岁组:37.5%)明显小于黄体中期组(≤35岁组:46.7%,35岁组:31.4%;≤35岁组:65.6%,35岁组:46.9%)(P0.05)。结论 (1)OC长方案可加深垂体抑制,尤其是35岁的高龄患者需增加Gn用量才能达到与黄体中期长方案相似的促排卵效果;(2)OC长方案可能通过影响子宫内膜厚度及容受性而降低着床率和临床妊娠率;(3)OC长方案使h CG注射日E2水平更高,易诱发OHSS的发生。故对卵巢功能正常的不孕患者,IVF/ICSI助孕时尽量选择黄体中期长方案。     

经阴道注水腹腔镜盆腔粘连松解术治疗不孕症的临床观察

目的 探讨经阴道注水腹腔镜盆腔粘连松解术(THLPA)治疗不孕症的安全性和有效性.方法 自2007年5月至2008年9月,对30例不孕患者进行THLPA,术中同时行输卵管染色通液术及宫腔镜检查与宫腔镜输卵管口插管通液术.盆腔粘连评分按照美国生育学会(AFS)1985年修订的子宫内膜异位症分期法(r-AFS)标准进行.按总分将盆腔粘连分为轻度粘连(24例,1～9分)、中度粘连(5例,10～19分)、重度粘连(1例,≥20分).记录手术时间与术后离院时间、盆腔粘连评分与粘连松解情况、输卵管通畅性、并发症及术后妊娠情况.结果 (1)THLPA:除7条输卵管近端周围的少量薄膜粘连未松解,5个卵巢的固有韧带处的少量薄膜粘连未松解外,其余所有盆腔薄膜粘连均被松解.全部患者中有4个卵巢存在致密粘连,未能松解.(2)输卵管通畅性:输卵管染色通液术中发现,35条输卵管近端阻塞,经宫腔镜输卵管口插管通液术治疗后,有21条(60%,21/35)输卵管被疏通,另有4条(11%,4/35)输卵管部分被疏通.(3)手术时间:轻度、中度和重度粘连患者的总手术时间分别为(32±6)、(52±6)和83 min,其中THLPA时间分别为(11±5)、(35±7)和62 min.(4)离院时间:全部患者的术后离院时间为120～175 min.无并发症发生.(5)妊娠率:术后随访(15.8±4.3)个月,妊娠率为45%(13/29),1例失访.结论 THLPA可行、有效、安全、不需住院,非常适用于经阴道注水腹腔镜检查中发现的薄膜粘连、特别是轻度盆腔粘连的治疗.