宫颈机能不全孕妇行宫颈环扎术的时间对妊娠结局的影响

目的:探讨不同妊娠周数时行宫颈环扎术对治疗宫颈机能不全的疗效。方法:回顾性分析宫颈机能不全而行U字型宫颈环扎术的29例患者的妊娠结局,分析母儿预后与手术时间的关系。以妊娠18周为界,分成两组:A组,妊娠12～18周时手术,16例;B组,大于妊娠18周手术,13例。比较两组间早产、胎膜早破及宫腔感染率的差异。结果:A组的早产、胎膜早破及宫腔感染率分别为6.25%、12.50%和0%;B组分别为23.08%、30.77%和15.38%;两组相比差异显著(P<0.05)。结论:宫颈机能不全病人,妊娠18周前行U字型宫颈环扎术是较理想的手术时机。     

Maternal serum level of the DDT metabolite DDE in relation to fetal loss in previous pregnancies

Use of 1,1,1-trichloro-2,2-bis(p-chlorophenyl)ethane (DDT) continues in about 25 countries. This use has been justified partly by the belief that it has no adverse consequences on human health. Evidence has been increasing, however, for adverse reproductive effects of DDT, but additional data are needed. Pregnant women who enrolled in the Collaborative Perinatal Project (United States, 1959-1965) were asked about their previous pregnancy history; blood samples were drawn and the serum frozen. In 1997-1999, the sera of 1717 of these women who had previous pregnancies were analyzed for 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (DDE), the major breakdown product of DDT. The odds of previous fetal loss was examined in relation to DDE level in logistic regression models. Compared with women whose DDE level was <15 microg/L, the adjusted odds ratios of fetal loss according to category of DDE were as follows: 15-29 microg/L, 1.1; 30-44 microg/L, 1.4; 45-59 microg/L, 1.6; and 60+ microg/L, 1.2. The adjusted odds ratio per 60 microg/L increase was 1.4 (95% confidence interval 1.1-1.6). The results were consistent with an adverse effect of DDE on fetal loss, but were inconclusive owing to the possibility that previous pregnancies ending in fetal loss decreased serum DDE levels less than did those carried to term.     

Reproductive health history of lesbians: implications for care

OBJECTIVE: Parity and hormonal contraceptives modify the risk of reproductive cancers and cardiovascular disease. However, clinicians may not obtain reproductive histories from patients who self-identify as lesbian. We report lifetime pregnancy-related outcomes and hormonal contraception for 392 women who reported sexual activity with another woman in the preceding year. STUDY DESIGN: Among self-referred volunteers, previous pregnancy, pregnancy outcome, contraceptive use, and sexual identity were assessed with self-administered questionnaire. RESULTS: One in 4 subjects had been pregnant, and more than 50% of the women had used oral contraceptives (mean duration, 40 months). Sixteen percent of all subjects and 63% of those who had been pregnant previously reported having 1 or more induced abortions. The most common pregnancy outcome for women younger than 25 years was induced abortion (59% of pregnancies). Identifying as "lesbian" or "bisexual" predicted neither the duration of oral contraceptive use nor a report of induced abortion. CONCLUSION: Previous pregnancy, induced abortion, and hormonal contraceptive use are common among women who report sex with women, regardless of self-identification as lesbian.     

原因不明复发性流产患者血中亚甲基四氢叶酸还原酶基因C677T和A1298C位点突变的研究

目的　探讨 5 ,10 亚甲基四氢叶酸还原酶基因C6 77T和A12 98C位点突变与原因不明复发性流产 (unexplainedrecurrentspontaneousabortion ,URSA)易感因素的相关性。 方法　采用PCR-限制性片段长度多态性方法 ,检测 14 7例原因不明复发性流产患者 (URSA组 )和 82例有正常妊娠史的妇女 (对照组 )血中亚甲基四氢叶酸还原酶基因C6 77T和A12 98C位点突变。结果　 ( 1)C6 77T的 3种基因型在URSA组和对照组总体分布存在显著性差异 (P =0 0 12 ) ,其中URSA组 :基因型CC占 33 3% ,CT占 5 3 1% ,TT占 13 6 % ,对照组 :基因型CC占 5 2 4 % ,CT占 5 1 5 % ,TT占 6 1%。两组 6 77CC基因表达差异有显著性 (P =0 0 0 5 ) ,URSA组C和T等位基因分别为 4 0 1%、5 9 9% ,两组基因分布情况比较 ,差异有显著性 (P <0 0 0 5 ) ;( 2 )A12 98C的 3种基因型在URSA组和对照组中总体分布情况比较 ,差异无显著性 ,12 98AA/AC/CC基因型和A/C等位基因频率比较 ,差异无显著性 (P >0 0 0 5 ) ;( 3)C6 77T/A12 98C连锁基因分析显示 ,8种连锁基因型中 ,URSA组 6 77CC/ 12 98AA表达频率显著降低 ,而 6 77(CT TT) / 12 98CC仅在URSA组中表达。结论　URSA与亚甲基四氢叶酸还原酶基因C6 77T和A12 98C位点突变有关。     

妊娠早期阻断协同刺激分子诱导自然流产模型孕鼠脾脏细胞母-胎免疫耐受的研究

目的　探讨阻断协同刺激分子———CD80 和CD86对自然流产模型孕鼠妊娠结局及孕鼠脾脏免疫细胞对父系抗原免疫耐受状态的影响。方法　将雌性小鼠 (CBA/J)分别与BALB/c及DBA/2两种雄性小鼠合笼交配 ,分别建立正常妊娠模型CBA/J×BALB/c( 2 0只 ,对照组 )和自然流产模型CBA/J×DBA/2 ( 2 0只 ,研究组 )。CBA/J小鼠于妊娠第 4天 (着床期 )腹腔分别注射大鼠同型IgG 0 2mg( 10只 ) ,或大鼠抗小鼠CD80 和CD86单克隆抗体 ( 10只 )。妊娠第 9天 ,采用单向混合淋巴细胞反应 ,分析孕鼠脾脏免疫细胞对父系抗原的增殖能力 ,并测定细胞培养上清液中白细胞介素 2(IL 2 )水平 ,以研究脾脏细胞母 胎免疫耐受状态 ;妊娠第 14天观察两组的胚胎吸收率。结果　 ( 1)研究组中 ,腹腔注射大鼠IgG的孕鼠胚胎吸收率为 2 4 3% ,而注射大鼠抗小鼠CD80 和CD86单克隆抗体的孕鼠胚胎吸收率为 9 8% ,两者比较 ,差异有显著性 (P <0 0 5 )。 ( 2 )应用大鼠抗小鼠CD80 和CD86单克隆抗体 ,使妊娠 9d的孕鼠脾脏免疫细胞对父系抗原的增殖能力及IL 2水平显著下降(P <0 0 5 )。结论　孕早期阻断协同刺激分子 ,可诱导产生孕鼠脾脏免疫细胞对父系抗原的免疫耐受 ,从而使自然流产模型孕鼠的妊娠结局达到正常妊娠水平。     

Comprehending the role of LPS in Gram-negative bacterial vaginosis: ogling into the causes of unfulfilled child-wish

Introduction Intrauterine infection is frequently associated with pregnancy loss in pregnant women.Discussion This article reviews the role of Gram-negative bacterial infection in various complications related to early pregnancy and subsequent pregnancy loss. Here we discus the pathways of ascending intrauterine infection, microbiology and the pathophysiology of such infections. The clinical impact, therapy, consequences, prevention and implications of Gram-negative bacterial infections in women during their reproductive life span is also discussed. This article also makes an attempt to discuss our studies and findings, related to the effect of the LPS component of the Gram-negative bacterial endotoxin on preimplantation stage embryonic development and implantation. This early phase of pregnancy remains mostly unnoticed by the mother as well as the health care provider, and therefore holds more threat to the life of the fetus and the mother. The molecular mechanisms of LPS-induced pregnancy losses through abnormal embryonic development, implantation failure, and preterm labor and birth with specific references to the role of proinflammatory cytokines like IL-1 and TNF are discussed.Conclusion Once these inflammatory mediators have increased in the feto-maternal tissues, it may be too late or harmful to try and prevent the adverse outcomes of pregnancy.     

Regarding Abortion: Informed Consent or Selective Disclosure?

Nursing is multidimensional, interactive, interdisciplinary, and complex. Almost anything that can be said about nursing can be said another way. Some things worth being said and heard will not follow the norms of journal presentation. A forum accommodates the emerging voice, the new format, the innovative approach. Nursing Forum, in an effort to honor the independent voice in nursing, presents here the voice who elects to enter the dialogue, but who does so "in another way."     

Effect of nurses' attitudes on hospital-based abortion procedures in Massachusetts

Our study explored a largely unacknowledged obstacle to abortion access in Massachusetts: the unwillingness of nurses to staff abortion procedures. Evidence suggests that nurses tend to be more likely to oppose abortion than other medical professionals. However, the attitudes and practices of hospital-based nurses regarding abortion have not been thoroughly investigated. We collected qualitative information from physicians and nurse managers to understand how nurses' attitudes affect hospital-based abortion services in Massachusetts. We surveyed key respondents at all hospitals in Massachusetts where abortion services are available to any woman who requests them. Of the 20 individuals who responded (87%), 17 were physicians and 3 were nurse managers. We found that over half of physician respondents believed that the unavailability or unwillingness of nurses to staff abortions is a slight or moderate problem, and nearly a quarter of physician respondents characterized it as a large or very large problem. Thus, nurses' attitudes towards abortion and their unwillingness to assist with procedures may hinder patient access to abortion services.     

主动免疫治疗对不明原因习惯性流产患者辅助T细胞因子水平的影响

目的　探讨主动免疫治疗对不明原因习惯性流产 (UHA)患者辅助T细胞 (Th) 1 /Th2型细胞因子水平的影响。方法　采用酶联免疫吸附法 ,检测 30例半年内接受过淋巴细胞主动免疫治疗的UHA患者 (治疗组 ) ,及 2 5例未经治疗的UHA患者 (未治疗组 ) ,外周血单个核细胞 (PBMC)经滋养细胞抗原刺激产生的Th1型细胞因子白细胞介素 (IL) 2、γ干扰素 (IFN γ)及Th2型细胞因子产生IL 4、IL 1 0水平。并选取 1 5例正常非妊娠妇女作为对照 (对照组 )。结果　 (1 )在最佳诱导时间内 ,治疗组IL 2、IFN γ的水平分别为 (1 0 8± 37)ng/L、(1 1 0± 52 )ng/L ,明显低于未治疗组的 (2 2 3± 85)ng/L、(32 6±92 )ng/L(P值均 <0 .0 5) ;IL 4、IL 1 0水平分别为 (50± 1 1 )ng/L、(1 4 0± 37)ng/L ,明显高于未治疗组的(2 3± 1 1 )ng/L、(52± 2 8)ng/L(P值均 <0 .0 5)。未治疗组IL 2、IFN γ水平明显高于对照组的 (92± 32 )ng/L、(1 0 2± 35)ng/L(P值均 <0 .0 5) ;IL 4、IL 1 0水平低于对照组的 (62± 2 1 )ng/L、(1 50± 42 )ng/L(P值均 <0 .0 5)。治疗组与对照组各细胞因子水平比较 ,差异均无显著性 (P值均 >0 .0 5)。 (2 )治疗组30例患者治疗后半年内妊娠 2 6例 ,其中 8例自然流产 ,IL 2、IFN γ水平明显高于 1 8例妊娠     

妥塞敏用于人工流产术止血的初步观察

目的　探讨妥塞敏用于早孕妇女行人工流产负压吸引术的止血效果。方法　 12 0例早孕妇女分为妥塞敏组和对照组。每组 6 0例 ,对两组妇女按妇科检查及B超测定判断孕周大小进行配对。两组妇女年龄、停经天数、孕次、宫腔大小、血红蛋白及血小板计数比较 ,差异无显著性 (P>0 0 5 ) ,具有可比性。妥塞敏组妇女在负压吸引术前 30min静脉推注妥塞敏 1g +5 %葡萄糖 2 0ml,5min推注完毕。对照组妇女在负压吸引术前 30min静脉推注 5 %葡萄糖 2 0ml,5min推注完毕。观察两组妇女的术中、术后 30min出血量及副反应。结果　 (1)妥塞敏组出血量 (5 1 6± 17 2 )ml,对照组出血量 (6 3 3± 17 1)ml,两组比较 ,差异有显著性 (P <0 0 5 )。 (2 )妥塞敏组妇女在用药过程中有 18例 (30 0 % )出现轻度恶心 ,8例 (13 0 % )轻度头晕。对照组仅 1例有轻度恶心 ,余无副反应 ,两组妇女均未做任何处理自行好转。结论　妥塞敏用于早孕妇女负压吸引术 ,有较好的止血效果 ,术中及术后出血量均明显减少 ,无严重不良副反应 ,有利于患者的恢复