补肾活血法孕前治疗LPD复发性流产患者的临床疗效

目的探讨补肾活血法孕前治疗黄体功能不全(luteal phase defect,LPD)复发性流产患者,观察其对妊娠结局的改善情况。方法按照诊断标准纳入57例LPD复发性流产患者,并随机分为治疗组和对照组,治疗组予补肾活血法治疗3个月,妊娠后再予益肾安胎法保胎治疗,对照组于妊娠后予益肾安胎治疗。采用化学发光法检测血清激素指标(E_2、P、β-HCG),同时采用ELISA法检测血清Kisspeptin水平,并电话随访妊娠结局;比较治疗前后中医症状评分、血清激素及Kisspeptin指标、妊娠结局情况、安全性。结果两组患者治疗后中医症状积分、妊娠激素水平(E_2、P、β-HCG)、Kisspeptin水平、妊娠结局比较,差异有统计学意义(P0.05),两组患者均无严重不良反应。结论补肾活血法孕前治疗LPD复发性流产能显著改善其临床症状,调节妊娠激素及Kisspeptin水平,健全黄体功能,从而有效改善妊娠结局。     

雌二醇、孕酮及β-人绒毛膜促性腺激素水平变化对早期先兆性流产的预测价值分析

目的:研究雌二醇(E_2)、孕酮(P)及β-人绒毛膜促性腺激素(β-HCG)水平变化对早期先兆性流产的预测价值。方法:选择2014年12月至2015年10月在我院就诊的早期妊娠女性130例,按照临床检查情况分为A组及B组,A组均为早期先兆性流产妊娠女性,B组均为早期输卵管妊娠女性;再选择正常早孕孕妇65例纳入C组,三组一般资料比较无统计学意义(P0.05)。三组均于入院后次日及第8d行E_2、P、β-HCG检测,比较三组检测结果及诊断符合率。结果:C组E_2、P、β-HCG检测值均显著高于A组、B组(P均0.05);A组E_2、P、β-HCG检测值均显著高于B组(P均0.05);入院8d后A组E_2检测值较入院次日显著降低(P0.05),P检测值降低幅度较小(P0.05),β-HCG检测值较入院次日显著升高(P0.05);8d后B组E_2、P、β-HCG检测值均较入院次日无显著变化(P均0.05);8d后C组E_2、P、β-HCG检测值均较入院次日显著升高(P均0.05)。联合诊断符合率(95.00%)远高于E_2(83.33%)、P(81.67%)、β-HCG(78.33%),P均0.05;结论:E_2、P、β-HCG联合检测对先兆流产较E_2、P、β-HCG单独检测具有更高的应用价值。     

CATHOLICISM AND EVERYDAY MORALITY: Filipino women’s narratives on reproductive health

This study examines the relationship between state policies, religion, reproductive politics, and competing understandings of embodied sexual and reproductive morality. Using ethnographic and life history interviews, this study looks at the lives of Filipino urban poor women and how they interpret, follow and resist Catholic Church doctrines and practices as these relate to sexuality and reproduction. Taking everyday morality as embedded in social practice, this paper argues that women’s subjective reinterpretations of Catholic teachings regarding contraception and abortion render religion pliant in a way that restores moral equilibrium in women’s lives. It is in this process of adjusting and re-adjusting this moral order that women are able to construct their moral worlds. Further, this article investigates how social class, gender and religion work in tension with one another in women’s everyday decisions and how the constraints and opportunities that poor women encounter in their everyday lives are enabled by the state and its institutions.     

微信平台在门诊人工流产妇女延续护理中的应用效果

目的 调查基于微信公众平台在门诊人工流产妇女延续护理中的应用效果。 方法 选取234例门诊人工流产妇女,根据患者的入院顺序奇偶数进行编号分为微信组和普通组,每组117例,普通组采用传统门诊宣教,微信组在此基础上应用微信公众平台进行网络健康教育、多层次的医患沟通、门诊预约就诊等延续护理,比较2组避孕措施的掌握情况、避孕措施的运用情况。 结果 干预1个月后微信组避孕措施掌握情况明显好于普通组(t=3.923,P<0.001);干预4个月后,微信组未使用避孕措施的患者少于普通组(χ²=4.294,P=0.038)。 结论 微信延续护理可提高对人工流产妇女的关爱,降低重复流产率。     

Maternal and procedural factors associated with estimated blood loss in second trimester surgical uterine evacuation: a retrospective cohort analysis

BackgroundPrior studies examining bleeding with uterine evacuation have focused on high-volume centers performing over 1100 procedures annually. The aim of this study was to examine associations between blood loss and patient and procedural characteristics in a center performing fewer than 50 procedures annually.MethodsThis retrospective cohort study, with institutional review board approval, utilized procedural codes to identify patients undergoing uterine evacuation procedures between 14 weeks’ and 24 weeks’ gestational age across a 50-month period. The primary outcome was estimated blood loss; secondary outcomes were hemorrhage, transfusion and hospital re-admission. Associations between blood loss and other variables were examined using linear regression models.ResultsCharts of 161 women met inclusion criteria. Median estimated blood loss was 400 mL (IQR 300 mL) with 37% of patients having blood loss of ≥500 mL. In univariate analyses, increased blood loss was associated with later gestational age (P <0.001) and pregnancy termination (P <0.001). In a multiple linear regression model, both remained significant. Each one-week increase in gestational age was associated with a 7.1% mean increase in estimated blood loss (95% CI 2.47% to 11.9%; P=0.003). Patients whose uterine evacuation was indicated for pregnancy termination had an 80.6% increase in blood loss compared with those with pre-operative fetal demise (95% CI 37.5% to 137.2%; P <0.001). Rates of peri-operative transfusion and re-admission for bleeding were <4%.ConclusionWhile blood loss may be greater in low volume centers, our transfusion and re-admission rates were low following second trimester uterine evacuation.     

Twelve years after abortion decriminalization in Mexico City: Can we still remain an island of liberties?

Latin America hosts the most restrictive abortion legislation globally. In 2007, Mexico, the second largest Catholic country in the world, decriminalized elective abortion within the first twelve weeks of pregnancy in the capital: Mexico City (also known as Federal District of Mexico). Following the reform, the Mexico City Ministry of Health (MX-MOH) implemented safe and legal services. Free services are provided to Mexico City residents and a sliding fee of up to $100 is applied to women from other Mexican states. Conscientious objection (CO) was addressed and included in service provision guidelines. Since 2007, 18 of 32 states amended their penal codes to restrict abortion. The road toward increasing access to abortion services at the MX-MOH included a shift from dilation and curettage (D&C) to medical abortion (MA), first with the misoprostol-alone regimen, followed by the combined mifepristone-misoprostol regimen. Manual vacuum aspiration is offered to out-of-state-women or to those beyond the gestational age where MA is less effective. Contraceptive uptake among abortion seekers is high (up to 95% of them prefer a free method of their choice). The Legal Interruption of Pregnancy program at the MX-MOH continues to provide effective, safe, reliable, and free services. However, women from indigenous groups residing in rural areas, those with low schooling, and adolescents with an unintended pregnancy who live in rural, urban, peri-urban districts, and at the state level are underserved despite being legally eligible to receive abortion services. Therefore, information and services for the disadvantaged groups need to be strengthened.     

浅谈“百病皆在调气血”在哈氏妇科的应用

气血理论是中医重要理论，妇科疾病应首调其气血，哈氏妇科是全国中医妇科十大流派之一，诊治疾病独具特色，哈孝廉教授宗古人"百病皆在调气血"思想，治疗崩漏、产后身痛、滑胎等妇科常见疾病，疗效显著，值得深入学习与探讨。     

The Legal Challenge of Abortion Stigma—and Government Restrictions on the Practice of Medicine

During the 2016 election, Donald Trump won conservative support by promising that he would, if elected, nominate “pro-life” justices to the U.S. Supreme Court. Whether President Trump makes good on his campaign promise to restrict abortion rights may come down to competing impulses of the chief justice, John Roberts. These dueling dispositions—from the man whom many see as the new “swing justice”—hold the key to a blockbuster new case that legal historians call “the most unpredictable the Supreme Court has been on abortion in decades.” The case, June Medical Services v. Russo, turns on arduous new requirements that Louisiana has imposed on facilities and clinicians that provide abortion. But the case is not just about abortion access. The Court will have to decide whether a clinic has a right to challenge the law in the first place.     

地屈孕酮对不明原因复发性自然流产患者外周血辅助T细胞的影响

目的探讨地屈孕酮补充治疗对不明原因复发性自然流产(URSA)患者外周血辅助性T细胞(Th)亚群Th1/Th2的影响。方法选取30例不明原因复发性自然流产患者为URSA组,另选取30例正常育龄妇女作为对照组,URSA组予以地屈孕酮治疗,对照组不采取任何治疗措施。两组均进行γ干扰素(IFN-γ)(Th1细胞因子)、白细胞介素-4(IL-4)(Th2细胞因子)的检测,观察URSA组妊娠情况,比较两组Th细胞因子变化情况、妊娠后不同时期Th1/Th2的变化,分析地屈孕酮对不同流产次数患者再次妊娠成功后Th细胞因子的影响。结果30例URSA患者妊娠28例,其中2例生化妊娠,3例妊娠40+d胚胎停育清宫,23例妊娠成功已转入产科定期产前检查。URSA组外周血Th1型细胞因子IFN-γ(26.37±3.13)pg/ml高于对照组的(17.01±3.22)pg/ml,差异有统计学意义(P<0.05)。两组Th2型细胞因子IL-4比较差异无统计学意义(P>0.05)。流产2次患者与流产>2次患者之间,IFN-γ活性出现升高趋势,Th1/Th2比值明显向Th1偏移。妊娠40 d及妊娠3个月,外周血Th1型细胞因子IFN-γ活性低于妊娠前,差异有统计学意义(P<0.05);与对照组比较差异无统计学意义(P>0.05);Th2型细胞因子IL-4活性高于妊娠前,差异有统计学意义(P<0.05)。Th1/Th2模式向后者偏移,Th1/Th2比值为4.37 vs 2.37。至孕3个月,偏移越趋于明显,5例妊娠失败患者外周血中,Th1型细胞因子IFN-γ及Th2型细胞因子IL-4与妊娠前比较,差异无统计学意义(P>0.05)。经地屈孕酮治疗后,流产2次的URSA患者Th1型细胞因子IFN-γ(16.03±5.11)pg/ml低于流产>2次的(21.48±1.83)pg/ml,差异有统计学意义(P<0.05);流产>2次的URSA患者呈现出更为明显的Th2偏移现象。结论地屈孕酮治疗可以使Th1/Th2平衡向Th2偏移,对免疫调节起重要作用,有利于妊娠成功。