16例染色体异常核型分析

目的与方法本文对189例自然流产、闭经、发育不全患者进行细胞遗传学检查,结果发现异常核型16例,异常核型涉及1、3、4、5、6、7、8、9、10、 15、X、Y染色体.其中平衡易位10例,性染色体异常3例,大Y染色体3例.结论染色体异常是导致流产、闭经、性发育异常的重要遗传因素,应引起临床医师的高度重视.     

Cell-Mediated Immunity in Infertility

ABSTRACT: A role of cell-mediated immunity in immunologic infertility is indicated by a number of animal immunization studies and by reported clinical associations between cellular immune responses and infertility. Furthermore, recent technical advances in the field of cellular immunology have enabled advanced studies on the cellular and soluble mediators of cell-mediated immune responses and their interactions with reproductive processes. In this article we review some of the recent technical and conceptual advances in cellular immunology, the classic literature on cellular immune responses in infertility, and recent evidence that certain products of activated lymphocytes and macrophages significantly affect reproductive functions.     

长效可逆避孕措施在人工流产后即刻实施的效果评价

目的探究长效可逆避孕措施在人工流产后即刻实施的效果。方法从2017年7月-2018年7月,抽选在广州市增城区妇幼保健院行人工流产女性1200例,按照随机数字表法分为常规组(612例)和强化干预组(588例)。常规组给予常规流产后关爱(PAC)服务,强化干预组在常规PAC服务的基础上采用长效可逆避孕措施。对比两组长效可逆避孕措施使用情况、重复人工流产率以及避孕措施的持续时间情况。结果强化干预组的高效避孕措施使用率比常规组更高,同时重复人工流产率比常规组低,差异有统计学意义(P<0.05);强化干预组长效可逆避孕措施LARC(IUS/IUD)避孕术后6个月、1年使用率明显高于常规组,差异有统计学意义(P<0.05);复方口服避孕药优思悦(COC)避孕术后3个月、6个月、1年的使用率比常规组高,差异有统计学意义(P<0.05)。结论人工流产后即刻实施长效可逆避孕措施,可提升高效避孕措施的使用率,减少意外妊娠及再次人工流产的几率,值得推广。     

《2020 ACOG实践简报:孕龄≤70 d药物流产(No.225)》解读

药物流产(MA)是早孕期避孕失败的补救措施,主要药物为米非司酮和米索前列醇,二者联合使用,可使早孕期孕妇完全终止妊娠率达到90%。但是,MA导致的患者阴道流血时间长、量多,甚至阴道大流血,而需采取急诊刮宫术治疗等,尚未被彻底解决。如何安全、有效终止早孕期妊娠,保护女性生殖健康是目前国内外该领域的研究重点。美国妇产科医师学学会(ACOG)发布的《2020 ACOG实践简报:孕龄≤70 d药物流产(No.225)》对早孕期孕妇终止妊娠,具有重要指导作用。笔者拟就该简报对MA用于孕龄≤70 d孕妇的临床效果评估,MA用药方案、禁忌证、适应证,MA前咨询和检查,MA疼痛管理,MA后观察、预防性抗菌药物使用、随访管理、避孕措施9个方面基于循证医学推荐进行解读。     

低出生体重儿危险因素病例对照研究

目的 探索低出生体重儿发生的相关危险因素。方法 对沈阳市妇婴等15家医院分娩的部分产妇进行低出出生重儿的病例对照研究。结果 在控制孕妇患慢性疾病,生殖器官畸形,严重妊妊反应,化程度和巨细胞病毒等感染以及主动吸烟等混杂因素后,产妇受孕期受被动吸烟,自然流产、人工流产史,家族低出生体重史,孕前体重指数（BMI）,职业接触有机物以及丈夫饮酒史诸因素影响,分娩低出生体重儿的危险性为对照组的2．95,2．17,2．25,2．04,2．98和1．75倍。结论 上述因素均可能是低出生体重儿的危险因素。     

人工流产术前宫颈及子宫内膜麻醉的镇痛效果探讨

目的　探讨宫颈与子宫内膜两部位联合麻醉、普鲁卡因与利多卡因两药物配合应用在人工流产术中的镇痛效果。方法　人工流产术前对麻醉组 10 6例行普鲁卡因宫颈浸润麻醉和利多卡因子宫内膜表面麻醉。术中记录受术者腹痛程度、无阻力插入宫颈内口的扩张器号、出血量、人流综合征例数等指标。按照世界卫生组织规定疼痛标准及人工流产综合征反应进行评价 ,同期选择按传统机械扩宫法 10 4例做对照。结果　麻醉组镇痛有效率95 3% ,宫口松驰有效率 95 3% ,人流综合征无 1例发生。两组比较P均 <0 0 0 1。两组出血量比较无差异 ,无利多卡因毒性反应发生。结论　人工流产术前普鲁卡因宫颈浸润麻醉和利多卡因子宫内膜表面麻醉镇痛效果显著 ,可大大降低人流综合征的发生 ,避免利多卡因的毒性反应     

药物流产不全延迟处理54例临床分析

目的　探讨药物流产不全的原因及诊治方法。方法　收集药物流产后阴道出血达 1月以上而未行治疗者 ,根据B超等协助诊断 ,予以清宫后治愈。结果　 5 4例全部行清宫术 ,刮出物病检均为机化变性绒毛组织 ,部分伴炎性反应。清宫后阴道出血停止。结论　对于药物流产后阴道出血时间过长者 ,应及早明确诊断 ,及时行清宫术。     

Mechanical dilation to remove incarcerated laminaria during a second trimester abortion

Cervical preparation with laminaria reduces complications with 2nd trimester dilation and evacuation. During a surgical abortion at 22 weeks, we could not remove laminaria manually or with ring forceps due to laminaria “dumbbelling” [1]. Without pushing laminaria into the uterus, we mechanically dilated the cervix and removed the incarcerated laminaria.     

History of pandemic H1N1-containing influenza vaccination and risk for spontaneous abortion and birth defects

BackgroundOne recent study suggested an association between receipt of pandemic H1N1 (pH1N1)-containing vaccines in consecutive influenza seasons and spontaneous abortion, but corroborating scientific evidence is limited. In the present study, we leveraged a population of vaccine-compliant pregnant military women to examine history of pH1N1-containing influenza vaccination and adverse pregnancy outcomes. Because seasonal influenza vaccination is compulsory for military service, safety concerns regarding repeat vaccination are particularly relevant in this population.MethodsPregnancies and live births from Department of Defense Birth and Infant Health Research program data were linked with military personnel immunization records to identify women vaccinated with a pH1N1-containing vaccine in pregnancy prior to 21 6/7 weeks’ gestation, October 2009–April 2015. Cox and modified Poisson regression models estimated associations between vaccination with pH1N1- versus non–pH1N1-containing influenza vaccine in the season prior to the index pregnancy, and spontaneous abortion and birth defects, respectively. Cox models were calculated for two periods of follow-up: through (1) 21 6/7 weeks’ gestation and (2) 28 days postvaccination.ResultsOf 26,264 pregnancies, 21,736 (82.8%) were among women who received a dose of pH1N1-containing vaccine in the prior influenza season and 4,528 (17.2%) were among women who received non–pH1N1-containing vaccine in the prior influenza season. Among 23,121 infants, 19,365 (83.8%) and 3,756 (16.2%) had mothers exposed and unexposed to pH1N1-containing vaccine in the prior influenza season, respectively. The adjusted hazard ratio (aHR) for spontaneous abortion approximated 1.0 across the complete follow-up period (95% confidence interval [CI]: 0.89–1.13) and was slightly elevated when censored at 28 days postvaccination, though the CI was imprecise (aHR: 1.19; 95% CI: 0.97–1.46). No associations with birth defects were observed.ConclusionThis work lends additional safety evidence and support for vaccination against pH1N1 in pregnancy, regardless of the vaccine received in the prior influenza season.