宫腔粘连的危害及影响因素

宫腔粘连指因宫腔操作以及感染等因素影响,造成子宫内膜基底层受损,内膜修复过程中形成的宫腔内和(或)宫颈处粘连、闭塞等。患者可出现月经量少、痛经、不孕及反复妊娠丢失等临床症状,孕期有流产、早产、胎盘植入等风险。本文就发生宫腔粘连的影响因素,该疾病对于患者生理、心理和妊娠的影响,以及相关治疗效果的影响因素三方面加以综述。旨在引起同行对宫腔粘连的重视,加强宫腔粘连的预防。     

Impact of training level on postplacental levonorgestrel 52 mg intrauterine device expulsion

Objective

To determine the association between provider training level and postplacental intrauterine device (IUD) outcomes following insertion instruction by email only.

A pilot study of levonorgestrel concentrations and bleeding patterns in women with epilepsy using a levonorgestrel IUD and treated with antiepileptic drugs

Objectives

We explored levonorgestrel (LNG) concentrations, bleeding patterns and endometrial thickness in women with epilepsy (WWE) initiating an LNG-intrauterine device (IUD) co-administered with antiepileptic drugs (AEDs).

Re-engineering the interpretation of electronic fetal monitoring to identify reversible risk for cerebral palsy: a case control series

Background: Even key opinion leaders now concede that electronic fetal monitoring (EFM) cannot reliably identify fetal acidemia which many vouch as the only labor mediated pathophysiologic precursor for cerebral palsy (CP). We have developed the “Fetal Reserve Index” – an algorithm combining five dynamic components of EFM (1. Rate, 2. Variability, 3. Accelerations, 4. Decelerations, and 5. Excessive uterine activity) considered individually that are combined with the presence of: 6. maternal, 7. obstetrical, and 8. fetal risk factors.

Objective: Here, we compare this 8-point fetal reserve index (FRI) against the performance of ACOG monograph criteria and ACOG Category systems for predicting risk for both CP and the need for emergency operative delivery (EOD). We then studied how varied management for screen positives (Red zone-defined below) impacts the outcome of such cases.

Study design: Four hundred twenty term patients were studied: all entered labor with normal EFMs and no apparent cause of harm except events of labor and delivery. Sixty subsequently developed CP, and 360 were apparently normal controls. An FRI, normal on all eight parameters scored 100%, 4 of the 8 was 50%, etc. We divided cases into Green zone >50%, Yellow 50–26%, and Red ≤25%. An FRI in the Red zone was considered a positive screen. We then compared performance metrics for the three evaluation schemes and differences between controls that reached Red against those controls whose worst scores were Green/Yellow.

Results: For detection of injury during labor, the FRI performed much better than the ACOG Category criteria (sensitivity 28%), and Category III (45%) (p?Conclusions: FRI shows better discrimination for adverse fetal outcome and EOD than traditional EFM interpretation. The Category system is a very poor, subjective screening method as the vast majority of CP babies never reach the “action point” result of Category III. While reaching the Red zone does not ordain a bad outcome, how it is managed, does. Compared to CP cases, Red controls were delivered faster, had higher FRIs, and often had prompt management including IR maneuvers, which improved the FRI and lowered the risk of EODs even for cases with normal outcomes. With further study and validation, the quantitative FRI approach may replace the current, very subjective interpretation with a quantitative “lab test” approach.     

子宫腔整复手术后再粘连的防治

宫腔粘连是子宫内膜基底层损伤所引起的疾病，严重影响女性生理健康和生育功能。宫腔镜下宫腔粘连分离术作为子宫腔整复手术的首选治疗方法，以恢复子宫正常解剖结构及功能为目的，但术后复发仍是妇科医生面临的巨大挑战。目前防治术后再粘连的方法主要有屏障治疗、激素治疗和羊膜疗法等，其他的治疗选择，如干细胞疗法、阿司匹林、富血小板血浆、西地那非等治疗尚处于研究当中。目前尚无防治术后再粘连的最佳治疗方案，如何达到最佳治疗效果仍需进一步研究。     

33 例非免疫性胎儿水肿临床特征及转归

目的探讨非免疫性胎儿水肿(NIHF)临床特征及转归。方法回顾分析2014年1月—2016年12月收治的33例NIHF新生儿的临床资料,将其分为死亡组和治愈组,进行两组间各因素的比较分析。结果 33例患儿中,男16例、女17例,中位胎龄33.4周(31.2～35.1周),出生体质量(2 714±712)g,死亡20例。死亡组出生体质量、1分钟及5分钟Apgar评分低于治愈组,差异均有统计学意义(P0.05)。新生儿产时复苏插管组和未插管组的母亲孕期合并症发生率及宫内干预率的差异有统计学意义(P0.05)。宫内干预是导致新生儿需产时复苏的独立危险因素(OR=15.30,95%CI:2.46～95.19);1分钟Apgar评分是NIHF疾病转归的独立危险因素(OR=1.75,95%CI:1.20～2.53),评分越低、死亡率越高。结论宫内干预与产时需要复苏有关,而1分钟Apgar评分是影响NIHF结局的重要因素。     

Incidence of anticardiolipin antibodies and lupus anticoagulant factor among women experiencing unexplained recurrent abortion and intrauterine fetal death

The aim of this research study was to estimate anticardiolipin (IgG & IgM) antibodies (aCL) and lupus anticoagulant (LA) factor in patients of recurrent unexplained pregnancy loss and intrauterine fetal deaths (IUFD). 82 women were selected for this study by virtue of having more than two consecutive unexplained pregnancy losses in their first trimester and were referred by the department of Obstetrics and Gynecology, King Saud Medical City Hospital, Riyadh, KSA. All patients had gone through a standardized investigation sequence. Lupus anticoagulants and Anticardiolipin antibodies (IgM and IgG) were detected in the serum by the enzyme linked immunosorbent assay method. To check the significance of aCL and LA, two-tailed t-test was done. Non parametric data was calculated either by Chi-Square test or Fischer exact test when relevant. Total 82 females grouped as 52 cases of recurrent (≥ 2) mainly first and second trimester miscarriage and 30 cases of recurrent (≥ 2) late intrauterine fetal death. Lupus anticoagulants was observed in twenty one (21) cases (25.6%) while anticardiolipin antibodies IgM and or IgG positive cases were estimated in forty four (44) cases (53.65%). The prevalence of APS in both studied group was thirty five (35) cases (42.68%). Antiphospholipid antibodies are calculated as the most important reason for recurrent abortion. The patients with unexplained recurrent pregnancy loss must be advised to go for a screening test for all this aPL antibodies.