A randomized control trial on interruption of HBV transmission in uterus

Objective To study the interruptive effect of hepatitis B virus (HBV) specific immunolobulin (HBIG) before delivery in attempt to prevent intrauterine transmission of HBV.Methods Nine hundred and eighty HBsAg carrier pregnant women were randomly divided into HBIG group and control group. Each subject in the HBIG group received 200 IU or 400 IU of HBIG intramuscularly at 3, 2 and 1 month before delivery. The subjects in the control group did not receive any specific treatment. All newborn infants received 100 IU of HBIG intramascularty after venous blood samples were taken at birth and 2 weeks after birth, followed by 30 μg plasma-derived HB vaccine or 5 μg recombinant yeast-derived hepatitis B vaccine at 1, 2 and 7 months of age. Blood tests were performed for all the lying-in women and their neonates. Blood specimens were tested for HBsAg and HBeAg by enzyme immunoassay. All infants were followed up for 1 year.Results In the HBIG group, 491 neonates were born to 487 HBV carrier mothers; and in the control group, 496 neonates were born to 493 HBV carrier mothers. The rates of intrauterine transmission in the two groups were 14.3% and 5.7% respectively (χ2=20.280, P<0.001), and the rates of chronic hepatitis B in the two groups were 2.2% and 7.3% respectively (χ2=13.696, P<0.001). The high risk factors of intrauterine HBV infection included HBsAg HBeAg double positive and HBV DNA positive in the peripheral blood of pregnant women.Conclusion HBV infection in the uterus may be interrupted by injecting multiple intramuscular HBIG injections before delivery without causing any side-effects.     

Effects of Cesarean Section on Infant Health in China： Matched Prospective Cohort Study

Objective To compare the medical outcomes of infants delivered by cesarean section with those of infants delivered vaginally. Methods A total of 301 healthy women with cesarean section and a matched control group of 301 women delivered vaginally were identified at three district-level hospitals in Shanghai from May 2001 to February 2003. Two groups were matched according to their medical indications for cesarean section. Their infants were assessed at delivery, 1 month, 6 month and 1 year after birth. Results The incidence of neonatal complications and infant morbidities at all measurement occasions did not differ significantly between groups. Rehospitalization was found to be more likely among infants delivered by cesarean section in the first month after birth. However, there was no difference between two groups in the incidence of rehospitalization in the first year after birth. Cesarean section was also associated with a higher risk of infant diarrhea (adjusted relative risk=1.25, 95% CI: 1.01, 1.56). Conclusion Infants did not have health benefits from cesarean section if the pregnancy was at low risk.     

Pregnancy Outcomes of Repeat Cesarean Section in Peking Union Medical College Hospital

Objective To evaluate the effect of elective repeat cesarean section on the maternal and neonatal outcomes. Methods A retrospective clinic- and hospital-based survey was designed for comparing the maternal and neonatal outcomes of elective repeat cesarean section [RCS group （one previous cesarean section） and MRCS group （two or more previous cesarean sections）] and primary cesarean section （FCS group） at Peking Union Medical College Hospital from January 1998 to December 2007. Results The incidence of repeat cesarean section increased from 1.26% to 7.32%. The mean gestational age at delivery in RCS group （38.1±1.8 weeks） and MRCS group （37.3±2.5 weeks） were significantly shorter than that in FCS group （38.9±2.1 weeks, all P〈0.01）. The incidence of complication was 33.8% and 33.3% in RCS group and MRCS group respectively, and was significantly higher than that in FCS group （7.9%, P〈0.05）. Dense adhesion （13.5% vs. 0.4%, OR=7.156, 95% CI： 1.7-30.7, P〈0.01） and uterine rupture （1.0% vs. O,P〈0.05） were commoner in RCS group compared with FCS group. Neonatal morbidity was similar among three groups （P〉0.05）. Conclusions Repeat cesarean section is associated with more complicated surgery technique and increased frequency of maternal morbidity. However, the incidence of neonatal morbidity is similar to primary cesarean section.     

Epidemiology of respiratory distress and the illness severity in late preterm or term infants: a prospective multi-center study

Background The severity of respiratory distress was associated with neonatal prognosis. This study aimed to explore the clinical characteristics, therapeutic interventions and short-term outcomes of late preterm or term infants who required respiratory support, and compare the usage of different illness severity assessment tools.Methods Seven neonatal intensive care units in tertiary hospitals were recruited. From November 2008 to October 2009, neonates born at ≥34 weeks＇ gestational age, admitted at 〈72 hours of age, requiring continuous positive airway pressure （CPAP） or mechanical ventilation for respiratory support were enrolled. Clinical data including demographic variables, underlying disease, complications, therapeutic interventions and short-term outcomes were collected. All infants were divided into three groups by Acute care of at-risk newborns （ACoRN） Respiratory Score 〈5, 5-8, and 〉8.Results During the study period, 503 newborn late preterm or term infants required respiratory support. The mean gestational age was （36.8±2.2） weeks, mean birth weight was （2734.5±603.5） g. The majority of the neonates were male （69.4%）, late preterm （63.3%）, delivered by cesarean section （74.8%）, admitted in the first day of life （89.3%） and outborn （born at other hospitals, 76.9%）. Of the cesarean section, 51.1% were performed electively. Infants in the severe group were more mature, had the highest rate of elective cesarean section, Apgar score 〈7 at 5 minutes and resuscitated with intubation, the in-hospital mortality increased significantly. In total, 58.1% of the patients were supported with mechanical ventilation and 17.3% received high frequency oscillation. Adjunctive therapies were commonly needed.Higher rate of infants in severe group needed mechanical ventilation or high frequency oscillation, volume expansion,bicarbonate infusion or vasopressors therapy （P 〈0.05）. The incidence of complications was also increased significantly in severe group （P 〈0.05）. The in-hospital mortality in the severe group was significantly higher than other two groups （P〈0.05）. ACoRN Respiratory Score was correlated with Score for Neonatal Acute Physiology-Version Ⅱ （SNAP-Ⅱ） （P〈0.01）. High gestational age, high SNAP-Ⅱ score and oxygenation index （OI）, and Apgar score at 5 minutes 〈5 were independent risks for death.Conclusions Neonatal respiratory distress is still a common cause of hospitalization in China. Illness severity assessment is important for the management. ACoRN Respiratory Score which correlated with SNAP-Ⅱ score is easy to use and may be helpful in facilitating the caregivers in local hospital to identify the early signs and make the transfer decision promptly.     

Prevention of intrauterine infection by hepatitis B virus with hepatitis B immune globulin: efficacy and mechanism

Objective　To evaluate the efficacy of hepatitis B immune globulin (HBIG) in preventing intrauterine infection by hepatitis B virus (HBV) and to investigate its mechanism. Methods　Forty-eight pregnant women positive for hepatitis B surface antigen (HBsAg) were randomly divided into 2 groups. The 34 women in the study group were injected with HBIG during pregnancy; the other 14 women were controls. Maternal blood samples were taken before HBIG injection and at delivery. Neonatal blood samples were taken within 24 hours after birth before HBIG and hepatitis B vaccine were given. HBsAg and antibody to HBsAg (anti-HBs) were tested by radioimmunoassay. Results　None of the 35 newborns (including 2 twins) in the study group was positive for HBsAg, but 3 (21%) in the control group were positive (P=0.02). The HBsAg titers in the women in the study group decreased after HBIG injection. Of the 35 newborns in the study group, 32 (91%) were positive for anti-HBs. Conclusion　Systematic injections of HBIG during pregnancy may prevent intrauterine HBV infection, the mechanism of which may be reduction of maternal HBV viremia and production of fetal passive immunity.     

Mechanism of peripheral blood mononuclear cell invasion by HBV on artificial immunization in newborns

Objective To study the effect and mechanism of the peripheral blood mononuclear cell (PBMC) invasion by HBV on artificial immunization in newborns.Methods Fifty- two newborns of HBsAg positive mothers were immunized with HBIG (hepatitis B immunoglobulin) and HBVac (hepatitis B vaccine) and were followed up for 7 months. The newborns’ HBV- DNA in serum and in the PBMCs was detected with nested- PCR; anti- HBs was tested with solid phase radioimmunoassay (SP- RIA). PBMCs isolated from newborn peripheral blood were incubated in the presence of PHA or purified HBsAg. Interleukin- 2 (IL- 2) level in culture supernatants of activated cells was detected by ELISA.Results The failure rate of immunization was higher in infants with positive HBV- DNA in PBMCs than those with negative HBV- DNA (P<0.05); IL- 2 level in PBMC culture supernatants was lower in former than in the latter and in normal controls (P<0.05). The level of IL- 2 in the immunization failure newborns was lower than that in the successfully immunized newborns and in normal controls (P<0.05).Conclusions Intrauterine invasion of PBMCs by HBV is one of the important reasons for immunization failure in newborns. IL- 2 production is closely related to the invasion of PBMCs by HBV, which may contribute to the failure of artificial immunization in newborns.     

DIAGNOSIS AND TREATMENT OF CESAREAN SCAR PREGNANCY

Objective To investigate the early diagnosis and treatment of cesarean scar pregnancy （CSP）. Methods Clinical data of 28 patients with CSP in Peking Union Medical College Hospital from January 1994 to April 2007, including age, interval from the last cesarean delivery to diagnosis, clinical presentation, location of the lesion, process of diagnosis and treatment, outcome, and follow-up, were retrospectively analyzed. Re, salts CSP constituted 1.05 % of all ectopic pregnancies, and the ratio of CSP to pregnancy was 1 ： 1 221. The mean age of the group was 31.4 years. Twenty-six women had only one prior cesarean delivery. The interval from the last cesarean delivery to diagnosis ranged from 4 months to 15 years. The most common presenting symptoms of CSP were amenorrhoea and vaginal bleeding. Seventeen cases were misdiagnosed as early intrauterine pregnancies and 2 were misdiagnosed as gestational trophoblastic tumor. The other 9 were diagnosed definitely before treatment. The diagnosis was made based on cesarean delivery history, gynecologic examination, ultrasound, and magnetic resonance imaging （MRI）. The treatment of CSP included systemic or local methotrexate administration, conservative surgery, and hysterectomy. The conservative treatment was successful in 24 cases. All of the 28 women were cured through individual therapies. Conclusions CSP is rare and usually misdiagnosed as other diseases. Ultrasound is valuable for diagnosing CSP, and MRI can be used as an adjunct to ultrasound scan. Early diagnosis offers the options of conservative treatment and greatly improves the outcome of patients. Individual therapy is strongly recommended.     

Complication of cesarean section: pregnancy on the cicatrix of a previous cesarean section

Objective To probe into the clinical manifestation, diagnosis, as well as treatment of pregnancy on the cicatrix of a previous cesarean section at the uterine isthmus in the first trimester.Methods Analysis of 14 patients with pregnancy on the cicatrix of a previous cesarean section at the uterine isthmus in the first trimester was made after conservative treatment by drugs from January 1996 to December 1999.Results The 14 patients with a pregnancy on the cicatrix of a previous cesarean section at the uterine isthmus in the first trimester were painless, had slight vaginal bleeding, and concurrently had increased serum β-subunit human chorionic gonadotropin (β-HCG). Doppler ultrasonic examination revealed an obvious enlargement of the previous cesarean section cicatrix in the uterine isthmus, and found a gestational sac or mixed mass attached to the cicatrice, with a very thin myometrium between the gestational sac and bladder walls. Among the 14 patients, 12 patients had crystalline trichosanthes injected into the cervix, mifepristone taken orally, or methotrexate in the form of intramuscular injection. Following this procedure, their serum β-HCG dropped to normal. The other 2 patients had a total hysterectomy.Conclusions Pregnancy on the cicatrix of a previous cesarean section at the uterine isthmus in the first trimester is a complication of cesarean section. Early diagnosis and effective conservative treatment by drugs are instrumental in decreasing the potential occurrence of uterine rupture, which is also conducive to preserving the patient’s future fertility.     

Clinical analysis of 322 cases of placenta previa

In recent years, the incidence of placenta previa has been increasing. According to the literature, it is mainly related to induced labor, artificial abortion, cesarean section, high aging pregnancy, multipara or smoking. The placenta previa is the chief cause of bleeding in late pregnancy and threatens the lives of mother and infant, resulting in a high risk problem in obstetrics. This article studies 322 cases of placenta previa from my hospital and Dalian Obstetrics and Gynecological Hospital from January, 2002 to July, 2009, on the basis of clinicretrospective analysis, in order to deepen our understanding and art of treating placenta previa. The study revealed that： 1. With 322 cases of placenta previa, the incidence was 0.73%. It was higher than the incidence 0.3% reported abroad and lower than the incidence 0.94% reported in our country. The data were from sampling survey and did not prove relations between placenta previa and ages, different from the result obtained abroad in which placenta previa had relation with pregnancy ages. The outcome needs further study. But artificial abortion, induced labor, cesarean section and multipara clearly influence the incidence. The study did not analyze the relation between smoking and placenta previa, but there was external data proving that smoking was related to placenta previa; 2. Ultrasound-B is a better method for examination at present; 3. In cases of vaginal childbirth there was a higher incidence of lateral placenta previa and partial placenta previa. The conservative temporization and timely cesarean section can greatly decrease the mortality of mother and infant.     

Role of different childbirth strategies on pelvic organ prolapse and stress urinary incontinence: a prospective study

Background Traumatic damage to fascial and muscular support structures during childbirth may be a major factor of the development of stress urinary incontinence （SUI） and pelvic organ prolapse （POP）. The aim of this study was to prospectively investigate the role of different childbirth strategies on POP and SUI.
Methods A total of 120 selected pregnant women were recruited and divided into two groups： vaginal delivery group （n=72） and selective cesarean delivery group （n=48）. The women were questioned with SUI sheet and estimated with POP quantification （POP-Q） within 6-8 weeks after delivery. The correlations of SUI and results of POP-Q with the strategies of delivery were analyzed, ttest, X2 test, and the Mann-Witney test were used for statistical analysis.
Results Among the 120 women, SUI was developed during 29-30 gestational weeks in 20 patients （16.6%）, of whom 14 （70%） had symptoms of SUI till 6 weeks postpartum. Totally 20 （16.6%） women had SUI symptoms after delivery. The prevalence of postpartum SUI was positively correlated with the occurrence of SUI during 29-30 gestational weeks （P〈0.001）. In the vaginal delivery group, 100% of the women suffered form urinary prolapse 6 weeks postpartum, while 87.5% of those in the selective cesarean delivery group developed POP （P〈0.01）. The percentages of the first- and second-degree urinary prolapse in the vaginal delivery group were 20.8% and 79.2% respectively, which were significantly different from those in the selective cesarean delivery group （64.6% and 22.9%; both P=0.000）.
Conclusions Pregnancy and delivery play an etiologic role in the development of SUI and POP. The onset of SUI during late pregnancy implies a significant risk of postpartum SUI symptoms. The prevalence of POP is significantly higher after vaginal delivery than after cesarean delivery.     

乙肝免疫球蛋白阻断病毒母婴传播的效果观察

目的 :探讨高效价乙肝免疫球蛋白 (HBIG)阻断乙型肝炎病毒 (HBV)母婴传播的作用机理。方法 :将5 0例HBsAg阳性的孕妇随机分成两组 ,实验组 30例 ,分别自孕 2 8周、32周、及 36周肌肉注射HBIG2 0 0IU ,分娩后 2 4h内再注射HBIG 2 0 0IU 1次 ;对照组 2 0例 ,不用HBIG。两组孕妇所生婴儿均于出生后 2 4h内肌肉注射HBIG 10 0IU 1次 ,注射乙肝疫苗的时间和剂量均按正常婴儿的操作方案进行。母儿血清HBsAg ,HBeAg和抗 HBs用固相放免法检测 ,HBV DNA用荧光定量PCR检测。结果 :实验组婴儿血清HBsAg和HBV DNA检出率明显低于对照组 (P <0 .0 5 ) ;实验组婴儿抗 HBs阳性率显著高于对照组 (P <0 .0 5 )。结论 :孕妇于孕期多次注射HBIG进行被动免疫 ,可有效地阻断乙型肝炎病毒母婴传播 ,减少婴儿HBV感染率。     

HBsAg阳性母亲的新生儿乙型肝炎疫苗免疫长期效果研究

目的： 探讨血源性乙型肝炎疫苗对乙型肝炎表面抗原（ ＨＢｓＡｇ） 阳性母亲的新生儿免疫持久性。方法：应用反向间接血凝反应（ ＲＰＨＡ） 法从１５００ 名孕妇中筛查出８２ 名ＨＢｓＡｇ ≥１∶６４ 的滴度阳性携带者的新生儿,分为疫苗组和对照组（ 人数比例为３∶１） 。疫苗组在新生儿出生２４ ｈ 内注射第１ 针,１ 月、６ 月龄分别注射第２ 针、３ 针乙肝疫苗,对照组按同样程序注射安慰剂。结果： 在第１３ 年时疫苗组抗 ＨＢｓ 阳性率仍高达５９３２ ％ （３５／５９） ;对照组１３ 年中有２３５３ ％ （４／１７） 受到自然感染后变为抗 ＨＢｓ 阳性,两组有显著性差异（ Ｐ＜ ００５） 。疫苗组的抗 ＨＢｓ阳性者中,抗 ＨＢｓＧＭＴ 峰值也在第１２ 个月,Ｓ／Ｎ 值为６８８４ ,到１３ 年时已下降到１７８２ ,相当于高峰的１／４ ,但仍明显高于对照组。除了出生时疫苗组与对照组ＨＢｓＡｇ 阳性率无明显差异外,疫苗组ＨＢｓＡｇ 阳性率一直明显低于对照组,在第１３ 年时疫苗组和对照组的ＨＢｓＡｇ 阳性率分别为６７７ ％ 、４７０６ ％ ,有显著性差异（ Ｐ＜ ００５） 。结论：ＨＢｓＡｇ 阳性母亲的新生儿进行乙型肝炎疫苗免疫１３ 年时,大部分仍有较好的?     

分娩方式对乙型肝炎病毒母婴垂直传播的影响

目的探讨不同分娩方式对乙型肝炎病毒(HBV)母婴垂直传播的影响,为控制HBV母婴垂直传播提供参考。方法选取2012年1⁶月松滋市计划生育服务站收治的HBsAg阳性孕妇150例及其分娩的活产新生儿152例为研究对象,按照分娩方式不同分为阴道分娩组(64例)及剖宫产分娩组(86例),检测孕妇血清HBV标志物及HBV DNA水平,新生儿出生后肌内注射乙型肝炎免疫球蛋白、重组酵母乙型肝炎疫苗,比较两组婴儿主被动免疫阻断效果。结果两组婴儿出生24h之内、3个月、6个月的HBsAg及HBsAb阳性率比较差异均无统计学意义(P>0.05),产妇HBV DNA≤1011copies/mL时分娩的新生儿HBV阻断失败率两组比较差异无统计学意义(P>0.05),HBV DNA>1011copies/mL阻断失败率比较差异具有统计学意义(χ2=4.87,P<0.05)。结论 HBsAg阳性孕妇HBV DNA≤1011copies/mL时,分娩方式对HBV垂直传播影响不大,但HBV DNA>1011copies/mL时建议选择剖宫产。     

乙肝疫苗对HBsAg阳性母亲的新生儿免疫效果长期研究

目的 :探讨血源性乙型肝炎疫苗 ,对HBsAg(乙型肝炎表面抗原 )阳性母亲所生新生儿的免疫持久性。方法 :应用RPHA法从 15 0 0名孕妇中筛查出 82名HBsAg≥ 1∶64的滴度阳性携带者的新生儿 ,按随机、双盲、设安慰剂的原则将研究对象分为疫苗组和对照组 (人数比例为 3 :1)。疫苗组在新生儿出生 2 4小时内注射第 1针 ,1月、6月龄分别注射第 2针、3针乙肝疫苗 ,对照组按同样程序注射安慰剂。结果 :在第 13年时疫苗组抗 -HBs阳性率仍高达 5 9.3 2 % (3 5 /5 9) ;对照组 13年中有 2 3 .5 3 % (4 /17)受到自然感染后变为HBsAb(乙型肝炎表面抗体 )阳性 ,疫苗组与对照组有显著性差异 (P <0 .0 5 )。疫苗组的HBsAb阳性者中 ,HBsAbGMT峰值也在第 12个月 ,S/N值为68.84,到 13年时已下降到 17.82 ,相当于高峰的 1/4 ,但仍明显高于对照组。除了出生时疫苗组与对照组HBsAg阳性率无明显差异外 ,疫苗组HBsAg阳性率一直明显低于对照组 ,在第 13年时疫苗组和对照组的HBsAg阳性率分别为 6.77%、47.0 6% ,有显著性差异 (P <0 .0 5 )。结论 :HBsAg阳性母亲的新生儿进行乙型肝炎疫苗免疫 13年时 ,大部分仍有较好的保护效果 ,发生HBsAg阳转者多发生于当初免疫失败和HBsAb滴度较低者中 ,对这一部分高危人群在适当时间应筛查HBsAb ,对     

HBV 宫内感染预测指标的探讨

 【目的】 探讨HBsAg阳性孕妇的新生儿乙肝联合免疫前的HBV-M和HBV DNA预测HBV宫内感染的实用价值&;#65377; 【方法】 对我院2006年6月至2008年2月间分娩的HBsAg阳性孕妇的420例婴儿,其中新生儿HBsAg或HBV DNA阳性为33例,HBsAg和HBV DNA双阳性共6例,对其满6月龄时进行随访,复查HBV-M以确诊HBV宫内感染&;#65377;【结果】 HBV宫内感染率为0.95%(4/420),新生儿HBsAg或HBV DNA阳性诊断HBV宫内感染的阳性似然比为14.3,而HBsAg和HBV DNA双阳性时诊断宫内感染的阳性似然比为208.3&;#65377; 【结论】 HBsAg阳性孕妇的新生儿乙肝联合免疫前的HBsAg和HBV DNA双阳性对HBV宫内感染具有较准确的预测作用,可以作为HBV宫内感染的初步临床诊断&;#65377;     

孕妇的HBV-DNA含量与分娩方式对其新生儿2h HBV感染的分析

目的探讨孕妇的HBV-DNA含量与分娩方式对其新生儿出生后2hHBV感染的关系。方法以PCR荧光定量法检测孕妇及新生儿血清HBV—DNA定量,采用电化学免疫发光法检测新生儿血HBsAg定量。结果 1075例HBsAg阳性的孕妇中610例HBV-DNA阳性的孕妇,剖宫产组501例,阴道分娩组109例,其新生儿生后2h内静脉血HBsAg和（或）HBV-DNA阳性率分别为7.19%（36/501）,11.01%（12/109）,组间阳性率差异有统计学意义。另465例HBV-DNA阴性的孕妇,剖宫产组368例,阴道分娩组97例,其新生儿生后2h内静脉血HBsAg和（或）HBV—DNA阳性率分别为2.17%（8/368）,4.12%（4/97）,组间阳性率差异无统计学意义。结论孕妇所产新生儿生后2h内HBV感染与孕妇的HBV-DNA含量及分娩方式有关,孕妇HBV-DNA阳性其阴道分娩较剖宫产的感染率高;孕妇HBV-DNA阴性其阴道分娩与剖宫产无明显差异。     

血清HBsAg与抗—HBs双阳性的HBVDNA测定

目的：探讨HBsAg与抗-HBs双阳性血清乙型肝炎病毒DNA复制情况，以及更好地向临床医生解释两对半结果。方法：将50例HBsAg与抗-HBs双阳性标本按血清HBV抗原-抗体标志物出现模式不同分为三组(第1组 HBsAg、抗-HBs、抗-HBc阳性组，n＝23；第2组HBsAg、抗-HBs、抗-HBe、抗-HBc阳性组，n＝11；第3组HBsAg、抗-HBs、HBeAg、抗-HBc阳性组，n＝16)，应用地高辛斑点杂交法测定HBVDNA。三组病人总检出阳性为22例，阳性率为44％。第1组血清标本HBVDNA检出阳性5例；第2组HBVDNA检出阳性2例，第3组HBVDNA检出阳性15例。结论：当临床检验测定HBV抗原-抗体标志物出现HBsAg与抗-HBs双阳性时，在不同的两对半模式时都存在HBVDNA的复制；HBsAg与抗-HBs双阳性时并不能认为此时抗-HBs抗体有中和保护作用。必要时一定要进行HBVDNA的检测。     

不同分娩方式与乙肝病毒母婴垂直传播

目的探讨不同分娩方式对阻断乙型肝炎病毒母婴垂直传播的影响。方法选择207例HBsAg阳性孕妇及其分娩的209例新生儿,采用酶联免疫吸附试验(ELISA)方法检测新生儿出生时脐血/1月龄时外周血HBV-M。209例新生儿根据分娩方式的不同分为阴道产组、剖宫产组,以1月龄时HBsAg阳性作为垂直感染的指标,比较两组新生儿感染率。结果123例阴道产组婴儿有9例发生了垂直传播,感染率为7.3%;86例剖宫产组婴儿有2例发生了垂直传播,感染率为2.3%,两组婴儿感染率差别具有统计学意义(p<0.05)。结论婴儿垂直感染HBV与分娩方式有关,与阴道产相比剖宫产可以降低HBV的母婴垂直传播。     

37例子痫临床诊治分析

探讨子痫的预防、治疗、终止妊娠的时机及分娩方式,提高子痫的防治水平,降低孕产妇和围生儿的死亡率。方法对37例子痫患者均采用硫酸镁,甘露醇,安定、吗啡或冬眠合剂,血压控制不理想者加用酚妥拉明或柳胺苄心啶降压治疗。比较子痫患者终止妊娠的时机及分娩方式对母婴的影响。结果 22例产前子痫患者终止妊娠时间<2、≥6h时围生儿1min Apgar评分为0～3分所占比例均明显高于≥2～<6h(均P<0.05),终止妊娠时间<2h时围生儿1min Apgar评分为4～7分所占比例均明显高于≥2～<6、≥6h(均P<0.05),终止妊娠时间<2、≥6h时围生儿1min Apgar评分为8～10分所占比例均明显低于≥2～<6h(均P<0.05);终止妊娠时间<2、≥2～<6、≥6h时围生儿死亡率比较差异均无统计学意义(均P>0.05)。产后子痫患者阴道分娩时围生儿1min Apgar评分为0～3分所占比例明显高于剖宫产术(P<0.05),子痫患者阴道分娩时围生儿1min Apgar评分为4～7分所占比例与剖宫产术比较差异无统计学意义(P>0.05),子痫患者阴道分娩时围生儿1min Apgar评分为8～10分所占比例明显低于剖宫产术(P<0.05)。有产前检查7例,无产前检查30例。有并发症25例次。结论产前及产时子痫中抽搐控制后2～6h行剖宫产术终止妊娠,则新生儿发生窒息率低。做好产前监测,尽早发现妊娠期高血压疾病并积极、正确的处理及子痫抽搐控制后及时终止妊娠可改善子痫患者母婴的预后。