Prospective assessment of reproducibility of three-dimensional ultrasound for fetal biometry

PurposeTo compare fetal ultrasound measurements performed by two observers with different levels of experience and evaluate the potential contribution of the use of three-dimensional (3D) ultrasound on repeatability, reproducibility and agreement of two-dimensional (2D) and 3D-derived measurements.Materials and methodsTwo observers (one senior and one junior) measured head circumference (HC), abdominal circumference (AC) and femur length (FL) in 33 fetuses (20 to 40 weeks of gestation). Each observer performed two series of 2D measurements and two series of 3D measurements (i.e., measurements derived from triplane volume processing). Measurements were converted into Z-scores according to gestational age. Variability between the different series of measurements was studied using Bland–Altmann plots and intra-class correlation coefficients (ICC).ResultsAgreement with the 2D measurements of the senior observer was higher in 3D than in 2D for the junior observer (systematic differences of −0.4, −0.2 and −0.8 Z-score vs. −0.1, −0.1 and −0.6 for HC, AC and FL on 2D and 3D datasets, respectively). The use of 3D ultrasound improved junior observer repeatability (ICC = 0.94, 0.88, 0.90 vs. 0.94, 0.94 and 0.96 for HC, AC and FL in 2D and 3D, respectively). The reproducibility was greater using the junior observer 3D datasets (ICC = 0.75, 0.60 and 0.45 vs. 0.79, 0.89 and 0.63 for HC, AC and FL, respectively).ConclusionThe use of 3D ultrasound improves the consistency of the measurements performed by a junior observer and increases the overall repeatability and reproducibility of measurements performed by observers with different levels of experience.     

Another look at returns to birthweight

We revisit the causal effect of birthweight. Because variation in birthweight in developed countries primarily stems from variation in gestational age rather than intrauterine growth restriction, we depart from the widely-used twin fixed-effects estimator and employ an instrumental variable – the diagnosis of placenta previa, which provides exogenous variation in gestation length. We find protective effects of additional birthweight against infant mortality and health capital loss, such as cerebral palsy, but in contrast to sibling and twin studies, no strong evidence for non-health long-run outcomes, such as test scores. We also find that short-run birthweight effects have diminished significantly over the decades.     

妊娠期休克指数特点及与产后出血结局的相关性研究

目的:测定产妇在不同围产期的休克指数,研究围产期不同时期休克指数的特点,探讨休克指数与产后出血结果的关系。方法:选取2017年1月-2018年12月在恩平市人民医院妊娠足月待产的产妇共129例,根据患者产后是否发生产后大出血(即阴道分娩后24 h累计失血量>500 mL或剖宫产术后累计失血量>1000 mL),将产妇分为出血组(41例)和对照组(88例)。在两组产妇临产时、胎儿娩出后及产后12 h检测产妇的心率和收缩压,计算休克指数(休克指数=心率/收缩压),比较不同阶段两组产妇的休克指数,并分析不同阶段休克指数与产后出血量的相关性。结果:两组产妇在临产时和胎儿娩出后所测得的休克指数比较,差异无统计学意义(P>0.05)。但在产后12 h,出血组产妇的休克指数显著低于对照组,差异有统计学意义(P<0.05)。临产时及胎儿娩出后,产妇的休克指数与产后出血量无显著相关性(P>0.05)。但产后12 h,产妇休克指数与产后出血量呈显著负相关(R=-0.382,P=0.029)。结论:临产时和胎儿娩出后产妇的休克指数与产后出血无关,但产后12 h的休克指数与产妇产后出血有一定关系,可用于预测和发现产后出血。     

米非司酮对胚胎生长及TGF-β和TNF-α水平的影响分析

目的探讨米非司酮对胚胎生长、早孕蜕膜和绒毛中转化生长因子β(TGF-β)以及血清肿瘤坏死因子α(TNF-α)的影响。方法临床纳入自愿进行人工流产的妊娠妇女90例,根据人工流产术前处理方案的不同分为研究组与对照组。研究组人工流产术前给予100 mg米非司酮口服,对照组不给于米非司酮口服。使用反转录-聚合酶链反应(RT-PCR)检测两组早孕蜕膜和绒毛中TGF-β1以及受体TGF-β1R基因的表达情况;使用放射免疫法检测研究组服药前后血清TNF-α的水平。结果研究组蜕膜中TGF-β1以及受体TGF-β1R基因表达明显高于对照组(1.66±0.61 vs.1.00±0.46;1.54±0.50 vs.0.89±0.30),差异均有显著性(P0.05);两组绒毛中TGF-β1以及受体TGF-β1R基因表达未见明显差异(P0.05)。研究组服用米非司酮后血清TNF-α明显高于服药前(0.87±0.14μg/L vs.0.55±0.10μg/L),差异有显著性(P0.05)。结论米非司酮能够明显组阻止胚胎的生长、发育,其能够通过下调蜕膜中TGF-β1以及受体TGF-β1R的转录,提升血清TNF-α的水平,从母-胎界面局部至外周,促使免疫刺激以及抑制失调,造成母体对胚胎排斥而不利于妊娠的维持。     

孕前体重指数和孕中期体重增加对妊娠期糖尿病发病影响的队列研究

目的 探讨孕前BMI和孕中期体重增加对妊娠期糖尿病(GDM)患病的影响。方法 采用以孕妇人群作为基础的队列研究, 在安徽省马鞍山市妇幼保健院围生期门诊选取首次孕期体检、孕周≤14周、马鞍山市常住户口的孕妇, 首次、孕中期和孕晚期体检时分别填写问卷、测量身高和体重, 在24～28周接受75 g口服糖耐量试验(OGTT)进行GDM诊断, 并追踪记录分娩结局。使用t检验、方差分析、χ²检验和logistic回归模型进行分析。结果 孕妇GDM的发生率为14.73%, 孕前BMI与孕中期增重呈负相关(r=-0.085, P<0.01)。GDM孕妇孕中期增重多于正常孕妇。孕妇年龄≥35岁、孕前超重和肥胖及孕早期血糖水平升高是GDM的危险因素, OR值(95%CI)分别为3.06(1.68～5.58)、2.08(1.38～3.13)、3.73(1.84～7.56)和2.17(1.57～3.00)。结论 孕前超重和肥胖以及孕期体重增加是GDM的危险因素.     

围生期下肢静脉血栓栓塞症的临床分析和护理

目的分析围生期下肢静脉血栓栓塞症患者的临床特征、妊娠结局以及护理措施,为减少和预防围生期下肢静脉血栓栓塞症的发生提供依据。方法回顾性分析2007年11月-2014年12月我院分娩的32例发生妊娠期静脉血栓栓塞症的孕产妇临床资料。结果发生下肢静脉血栓栓塞症的孕妇,通过综合治疗和护理后,无一例发生肺栓塞。结论在妇产科护理工作中,应该熟悉围生期下肢静脉血栓栓塞症的各种危险因素及临床表现,对患者进行正确的健康指导,特别是高危因素的患者应积极筛选,及时尽早的干预治疗,改善预后。     

Maternal arsenic exposure and birth outcomes: A comprehensive review of the epidemiologic literature focused on drinking water

Inorganic arsenic (iAs) is a human toxicant to which populations may be exposed through consumption of geogenically contaminated groundwater. A growing body of experimental literature corroborates the reproductive toxicity of iAs; however, the results of human studies are inconsistent. Therefore, we conducted a comprehensive review of epidemiologic studies focused on drinking water iAs exposure and birth outcomes to assess the evidence for causality and to make recommendations for future study. We reviewed 18 English language papers assessing birth weight, gestational age, and birth size. Thirteen of the studies were conducted among populations with frequent exposure to high-level groundwater iAs contamination (>10 μg/L) and five studies were conducted in areas without recognized contamination. Most studies comprised small samples and used cross-sectional designs, often with ecologic exposure assessment strategies, although several large prospective investigations and studies with individual-level measurements were also reported. We conclude that: (1) the epidemiologic evidence for an increased risk of low birth weight (<2500 g) is insufficient, although there exists limited evidence for birth weight decreases; (2) the evidence for increased preterm delivery is insufficient; and, (3) there exists minimal evidence for decreased birth size. In further investigation of birth weight and size, we recommend incorporation of individual susceptibility measures using appropriate biomarkers, with collection timed to windows of vulnerability and speciated arsenic analysis, as well as consideration of populations exposed primarily to drinking water iAs contamination <10 μg/L. Given the large potential public health impact, additional, high quality epidemiologic studies are necessary to more definitively assess the risk.     

药物流产后阴道持续流血的临床观察与治疗探讨

目的：探讨药物流产后阴道持续流血的临床治疗以及治疗方法。方法：选取本院收治药物终止妊娠患者64例,将患者按照随机数字表法分为观察组和对照组,每组32例。对照组前2天服用米非司酮,晨空腹服用50 mg,晚空腹服用25 mg,在服药前后2 h不进食。第3天上午实施阴道后穹隆置入米索前列醇600μg,观察组除以上操作外还进行清宫术。结果：观察组平均出血时间为（13.2±1.5）d,对照组为（19.3±3.8）d;观察组平均出血量为（56.3±4.5）mL,对照组为（96.0±5.7）mL;观察组月经复潮时间为（32.3±5.2）d,对照组为（43.4±10.2）d;两组比较差异均有统计学意义（P〈0.05）。观察组尿hCG转阴时间超过14 d的发生率为21.9%,对照组为53.1%;观察组术后炎性细胞浸润率为28.1%,对照组为71.9%,两组比较差异均有统计学意义（P〈0.05）。结论：药物流产后如果持续流血时间过长需进行清宫术,以利于康复和减少并发症。     

妊娠合并甲状腺功能亢进症110例临床分析

目的分析妊娠合并甲状腺功能亢进的治疗对妊娠结局的影响。方法将妊娠合并甲状腺功能亢进症孕妇105例分为治疗组68例和对照组37例。治疗组为妊娠期经过系统治疗且分娩前甲状腺功能基本正常者,对照组为未经正规系统的治疗或曾进行短暂治疗后自行停药在住院分娩前发现甲状腺功能显著升高者。比较2组孕妇甲状腺功能及妊娠结局。结果治疗组FT3、FT4水平明显低于对照组,TSH明显高于对照组;治疗组低体重儿（LBW）、早产、新生儿窒息、新生儿甲亢、新生儿甲减及新生儿黄疸的发生率均低于对照组,差异均有统计学意义（P〈0．05或P〈0．01）。结论妊娠合并甲亢需引起临床医师重视,加强孕妇甲状腺功能监测,积极治疗可减少孕妇和胎儿不良事件的发生。