宫腔镜联合超声检查诊治妊娠终止后不完全流产疗效分析

目的探讨宫腔镜联合超声检查对妊娠终止后不完全流产的诊断和临床治疗效果。方法随机选取2011年3月至2012年6月单纯B超检查及宫腔镜联合B超检查辅助治疗不完全流产患者50例,分别设为对照组和联合组各25例,评估术前诊断率、术中出血和手术时间及术后并发症发生情况。结果联合组患者手术时间[（16.3±6.7）min]、术中出血量[（12.3±15.6）mL]和术后感染率[4.0%（1/25）]均明显少于对照组[（23.3±9.5）min、（51.3±22.7）mL、20.0%（5/25）];同时,联合组术前诊断率[100.0%（25/25）]明显高于对照组[72.0%（18/25）],术后并发症发生率[8.0%（2/25）]明显低于对照组[48.0%（12/25）],差异均有统计学意义（P〈0.05）。结论宫腔镜联合超声检查能显著提高不完全流产的诊断准确率和手术安全性,值得临床进一步推广。     

米非司酮联合米索前列醇用于高危妊娠引产的疗效观察

目的 观察米非司酮联合米索前列醇用于高危妊娠引产的效果.方法 将90例高危妊娠引产的孕妇随机分为观察组和对照组各45例.观察组使用米非司酮联合米索前列醇治疗;对照组应用乳酸依沙吖啶治疗,比较2组临床疗效和引产后出血情况.结果 观察组有效率为82.2%高于对照组的51.1%,差异有统计学意义（P＜0.01）.观察组引产后出血率低于对照组,差异有统计学意义（P＜0.05）.结论 米非司酮联合米索前列醇是一种有效的高危妊娠引产治疗方案,具有疗效好、风险少等优点,有较高的临床价值,值得推广使用.     

不同方法终止瘢痕子宫14～20周妊娠引产的疗效分析

目的 比较分析米非司酮＋依沙吖啶与单纯依沙吖啶两种不同方法终止瘢痕子宫14～20周妊娠引产的疗效.方法 选取本院2011年1月～2014年1月自愿接受引产的100例孕妇为研究对象,均为瘢痕子宫且妊娠均在14～20周,随机将其分为对照组和观察组各50例,对照组孕妇行单纯依沙吖啶羊膜腔内注射引产,观察组孕产给予米非司酮口服联合依沙吖啶羊膜腔内注射引产,比较两组的引产结果及并发症情况.结果 观察组孕妇引产时间、宫缩发动时间明显短于对照组,差异有统计学意义（P＜0.05）.观察组孕妇流产总有效率高达100％,对照组流产总有效率为84％,两组比较差异有统计学意义（P＜0.05）.结论 米非司酮联合乳酸依沙吖啶具有完全引产率高、并发症少、引产时间短等特点,可作为瘢痕子宫14～20周妊娠引产的重要手段.     

Evaluation of CD3+ T Cell Percentage,Function and its Relationship with Serum Vitamin D Levels in Women with Recurrent Spontaneous Abortion and Recurrent Implantation Failure

Background: Women afflicted with recurrent spontaneous abortion (RSA) and repeated implantation failure (RIF) may have immune abnormalities. The role of vitamin D has been demonstrated in the function of the immune system. Objective: To assess the percentage and function of CD3+ T cells and their relationship with the level of the serum vitamin D or 1,25-dihydroxy vitamin D3 (the active form of the vitamin) in women with RSA and RIF. Methods: In this case-control study, peripheral blood was obtained from the patient and the healthy control groups. The ratio of CD3+T cell and activated CD3+ CD69+T cell was investigated using flow cytometry. The serum levels of Interferon-γ (IFN-γ) and vitamin D were measured by ELISA. Results: The mean proportion of CD3+T cells in women with RSA increased significantly compared with the healthy control group (p<0.04). However, no significant difference was observed in RIF women compared with the control group. There was no significant difference in the ratio of activated CD3+CD69+T cells between the patient and the healthy control groups. Serum IFN-γ levels in women with RSA showed a significant increase compared to the control group (p<0.031); however, no significant difference was observed between women with RIF and the control group. Serum levels of vitamin D showed a significant reduction in both RSA (p<0.01) and RIF (p<0.04) groups in comparison with the control. Conclusion: An increase in the percentage and inflammatory function of T cells was associated with RSA. Decreased vitamin D levels may contribute to immune dysfunction and pregnancy loss.     

Caring for women undergoing second-trimester medical termination of pregnancy

Objective

The objective was to explore the experiences and perceptions of nurses/midwives caring for women undergoing second-trimester medical termination of pregnancy (MTOP).

Study design

The study had a qualitative design using semistructured interviews. It took place in three wards at one gynecological clinic in a general hospital in Stockholm. Twenty-one nurses/midwives with experience in second-trimester abortion care were interviewed following a semistructured interview guide. The interviews were recorded, transcribed verbatim and then analyzed using qualitative content analysis to identify common themes.

Results

The analysis revealed two themes: “The professional self,” with six subthemes describing the experiences and perceptions described in terms of professional behavior, and “The personal self,” with four subthemes containing the experiences and perceptions described in terms of personal values.

Conclusions

Taking care of women undergoing second-trimester MTOP is a task that requires professional knowledge, empathy and the ability to reflect on ethical attitudes and considerations. Difficult situations that arise during the process are easier to handle with increased knowledge and experience. The feeling of supporting women's rights bridges the difficulties nurses/midwives face in caring for women undergoing second-trimester MTOP. The findings of this study support the need for training, mentoring and support by experienced colleagues to help nurses/midwives feel secure in their professional role in difficult situations and feel confident in their personal life situation.

Implications statement

Taking care of women undergoing second-trimester MTOP is a task that requires professional knowledge and empathy. Difficult situations that arise during the process are easier to handle with increased knowledge and experience. Mentorship from experienced colleagues and structured opportunities for reflection on ethical issues enable the nurses/midwives to develop security in their professional roles and also feel confident in their personal life situation. The feeling of doing something good for women's rights bridges the difficulties nurses/midwives face in caring for women undergoing second-trimester MTOP.     

Acceptability and clinical outcomes of first- and second-trimester surgical abortion by suction aspiration in Colombia

Objective(s)

Since partial decriminalization of abortion in Colombia, Oriéntame has provided legal abortion services through 15 weeks gestation in an outpatient primary care setting. We sought to document the safety and acceptability of the second trimester compared to the first-trimester surgical abortion in this setting.

Study Design

This was a prospective cohort study using a consecutive sample of 100 women undergoing surgical first-trimester abortion (11 weeks 6 days gestational age or less) and 200 women undergoing second-trimester abortion (12 weeks 0 days–15 weeks 0 days) over a 5-month period in 2012. After obtaining informed consent, a trained interviewer collected demographic and clinical information from direct observation and the patient's clinical chart. The interviewer asked questions after the procedure regarding satisfaction with the procedure, physical pain and emotional discomfort. Fifteen days later, the interviewer assessed satisfaction with the procedure and any delayed complications.

Results

There were no major complications and seven minor complications. Average measured blood loss was 37.87 mL in the first trimester and 109 mL in the second trimester (p<.001). Following the procedure, more second-trimester patients reported being very satisfied (81% vs. 94%, p=.006). Satisfaction was similar between groups at follow-up. There were no differences in reported emotional discomfort after the procedure or at follow-up, with the majority reporting no emotional discomfort. The majority of women (99%) stated that they would recommend the clinic to a friend or family member.

Conclusions

Second-trimester surgical abortion in an outpatient primary care setting in Colombia can be provided safely, and satisfaction with these services is high.

Implications

This is one of the first studies from Latin America, a region with a high proportion of maternal mortality due to unsafe abortion, which documents the safety and acceptability of surgical abortion in an outpatient primary care setting. Findings could support increased access to safe abortion services, particularly in the second trimester.     

Sex selective feticide in India

Regarding sex selective abortion in India, all are aware of exclusive female disadvantage. And yet few study reported sizeable selective male feticide as such. This exercise reveals that: (1) the age-old son-preference has slightly declined on the end of the twentieth century, and (2) a substantial selective male feticide are also being committed annually, of course, along with larger selective female feticide.     

表观遗传学在复发性流产中的研究进展

复发性流产(recurrent spontaneous abortion,RSA)是一种常见的病理性妊娠,其发病机制复杂,常涉及遗传、内分泌、免疫系统、生殖结构异常和环境等多方面因素,人群发病率约为2％～5％.目前仍有约50％患者的发病机制尚不明确,因此,探索新的RSA的生理病理机制迫在眉睫.研究表明表观遗传学通过激活...     

The Irish Journey: Removing the shackles of abortion restrictions in Ireland

In May 2018, the Irish electorate voted to remove from the Constitution one of the most restrictive abortion bans in the world. This referendum followed 35 years of legal cases, human rights advocacy, feminist activism and governmental and parliamentary processes. The reframing of abortion as an issue of women's health rather than foetal rights was crucial to the success of law reform efforts. The new law, enacted in 2018, provides for access to abortion on a woman's request up to 12 weeks of pregnancy and in situations of risk to the life or of serious harm to the health of the pregnant woman and fatal foetal anomaly thereafter. Abortion is now broadly accessible in Ireland; however, continued advocacy is needed to ensure that the state meets international human rights standards and that access to abortion care and abortion rights is fully secured within the law.     

141例人工流产妇女意外妊娠现状调查分析

目的了解深圳市人工流产妇女意外妊娠的现状,探讨其影响因素及预防对策。方法对深圳市人民医院2012年1月至2012年6月收治的141例人工流产妇女进行调查问卷,对其婚姻状况、人工流产原因、避孕措施等资料进行分析。结果患者人工流产原因主要为未采取避孕措施（50．35％）和避孕失败（45．39％）。对其两者之间进行组间比较,并用Logistic多因素分析后结果提示年龄、婚姻状况、文化程度和职业这四个指标差异显著（P〈0．05）,是人工流产的影响因素。结论我国育龄妇女,尤其是青少年,不仅有较高的流产率,而且重复流产、高危流产的发生率也较高。