不同妊娠期经阴道子宫颈环扎术后妊娠结局分析

Objective?To investigate the differences in pregnancy outcomes between the different transvaginal cervical cerclage. Methods?This retrospective study included pregnant women with cervical insufficiency admitted to Peking University People’s Hospital between January 2013 and September 2021. There were 37 patients in the study group underwent Shirodkar’s cerclage, and 32 patients in the control group underwent McDonald’s cerclage. The pregnancy outcomes were compared. Results?Compared with the control group, the study group showed more weight gain during pregnancy[(12.66±6.00) kg/m2, (9.21±5.79) kg/m2; P=0.022], long operation time [45 min(40-51.3 min) vs. 20.5 min (17.3-25.0), P<0.001] and later cerclage removal [36.71(36.14-37) vs. 34.43(24.32-36.75), P=0.003]. Gestational weeks at delivery in the Shirodkar group were more advanced than in the McDonald group[38.9 (36.3-39.8) vs.35.0 (30.1-39.0), P=0.005]. Compared with the McDonald group, the Shirodkar group had higher incidences of deliveries≥28 gestational weeks (91.9% vs. 68.8%, P=0.027), deliveries≥34 gestational weeks (81.1% vs. 59.4%, P=0.037), deliveries≥37 gestational weeks (67.6% vs. 37.5%, P<0.001), induced labor (43.2% vs. 12.5%, P=0.006), and fewer fetal loss (8.1% vs. 31.3%, P=0.017). Multivariate regression analysis of preterm birth factors showed that Shirodkar cervical cerclage was a protective factor to reduce the incidence of preterm birth(OR=0.063, 95%CI: 0.008, 0.492, P=0.008). Conclusion?Shirodkar cerclage appears to have advantages over McDonald cerclage in preventing fetal loss and a fewer frequency of preterm deliveries.     

妊娠合并极重度血小板减少26例临床分析

Objective To investigate the etiology and perinatal outcome of pregnancies complicated with extremely severe thrombocytopenia [ at least two times of platelets count (PLT) < 10 × 109/L during pregnancy]. Methods Clinical data, including basic information, etiology, management and outcomes of pregnant women with extremely severe thrombocytopenia, admitted to Peking University People's Hospital from January 2004 to March 2009, were retrospectively collected. The management of these cases varied according to different etiology and the symptoms: (1) PLT were maitained > 20 × 109/L and hemoglobulin> 70 g/L in those women without spontaneous bleeding; (2) PLT transfusion would be required when PLT< 10 × 109/L or bleeding occur and RBC would be supplied when hematocrit <25% and hemoglobulin <70g/L; (3) Hemoglobulin should be > 70 g/L and PLT >30 × 109/L before cesarean section or delivery;(4) Predinisone and/or intravenous immunoglobulin G (IVIG) would be given in women complicated with idiopathic thrombocytopenic purpura (ITP) when PLT < (20-30) × 109/L or bleeding. PLT would be given if all the above management were failed, or PLT < 10 × 109/L, or bleeding. Women without bleeding would be closely monitored and delivery would be planned. Results (1) Twenty-six cases were identified among 9302 deliveries during the study period (0.28%), with an average of maternal age of 29. Seventeen were diagnosed before conception and 9 during pregnancy. Among the 26 women, half received regular prenatal check in our hospital and the average gestations at diagnosis was 24 weeks and the other half without regular prenatal visits and the average gestations at diagnosis was 32 weeks. Etiology was identified in 24 out of the 26 women, including 14(54%) ITP, 5 myelodysplastic syndrome (MDS), 4 chronic aplastic anaemia(CAA) and 1 systemic lupus erythematosus (SLE). (2) Management: All of the 26 women received blood products. Among the 14 ITP cases, 6 received predinisone and IVIG and 8 only took predinisone. Nine of the 26 patients (35%) had pregnant complications, among which 6 (6/9) were preeclampsia. The overall average gestation at delivery was 36 weeks. Only 2 delivered vaginally with the average blood loss of 83 ml and 23 cesarean sections were performed with the average blood loss of 410 ml. (3) Perinatal outcomes:There were 26 perinatal babies, among which 1 died intrauterine and 25 were born alive (12 preterm infants). The average birth weight was 2877 g. Neonatal severe thrombocytopenia presented in 2 newborns whose mother complicated with ITP. Conclusions The main cause of extremely severe thrombocytopenia during pregnancy is ITP, managed mainly by predinisone and IVIG, followed by CAA and MDS, which may require supportive treatment. Pregnancy complicated with extremely severe thrombocytopenia is not an indication of termination. Better maternal and fetal outcomes can be achieved through proper treatment based on the etiology, intensive care in prevention and management of complications and cesarean section.     

46,XX,t（4;6）携带者3次流产一例

病例：女，30岁，汉族。结婚两年流产3次。3胎均在70天左右，无诱因流产。夫妇非近亲婚配，孕期无患病及有毒、有害接触史。家族中无类似病史。     

胎儿先天性心脏病多个相关基因SNP位点突变的初步研究

目的研究多个先天性心脏病相关基因SNP位点与胎儿复杂先天性心脏病发生的关系。方法选取2011年6月至2013年3月于北京大学人民医院妊娠中期或晚期超声胎儿系统筛查诊断为先天性心血管畸形并行脐静脉穿刺者为先心组共30例,终止妊娠前行脐静脉穿刺留取胎儿脐血3～5ml,同时留取胎儿父母静脉血3～5ml。按1：2随机选取同时期正常分娩病例60例作为对照,分娩时留取脐静脉血3～5ml。所有留取静脉血均提取基因组DNA,检测所选择60个基因位点突变情况。结果本研究发现突变位点主要集中在TBX20、GATA4、GATA6、GL11、CRELD15个基因中,它们可能是北京附近人群的高突变基因。GL11基因2101G〉A的杂合突变结果具有统计学意义,且与父母遗传相关性小,提示该基因位点的突变可能与先心病的发病密切相关。结论北京附近人群的高突变基因为TBX20、GATA4、GATA6、GL11、CRELD1,GL11基因2101G〉A的杂合突变可能与先心病的发病相关度较高。多突变位点联合作用是否增加先心病发病风险还需扩大样本进一步研究。     

IL-10及TGF-β1在妊娠期免疫性血小板减少性紫癜及妊娠期血小板减少症发病中的初步研究

目的探讨IL-10以及TGF-β1在妊娠期免疫性血小板减少性紫癜（ITP）及妊娠期血小板减少症（GT）发病中的作用。方法研究组选取2011年7月至2012年3月于北京大学人民医院产科住院择期剖宫产分娩的妊娠期免疫性血小板减少性紫癜（ITP）患者9例以及妊娠期血小板减少症（GT）患者11例,对照组取同期在北京大学人民医院择期剖宫产分娩的健康孕妇16例。采用ELISA方法分别检测三组母血、脐血中IL-10、TGF-β1的浓度,对比妊娠期ITP组、GT组母血及脐血中IL-10、TGF-β1的浓度,并对母血、脐血中IL-10、TGF-β1的浓度与母血血小板、新生儿血小板计数进行相关性分析。结果妊娠期ITP组、GT组母血中IL-10、TGF-β1浓度与对照组母血对比差异无统计学意义（P〉0.05）,三组脐血中IL-10浓度差异无统计学意义（P〉0.05）,妊娠期ITP组脐血中TGF-β1浓度与GT组及对照组脐血对比差异无统计学意义（P〉0.05）,GT组脐血TGF-β1浓度较对照组升高。在妊娠期ITP组及GT组中,母血、脐血中IL-10、TGF-β1浓度与母体及新生儿血小板水平无明显相关性。结论 IL-10、TGF-β1在妊娠期ITP及GT发病中的作用可能与非妊娠期ITP不同,IL-10、TGF-β1在母血及脐血中的浓度与血小板水平无相关性。     

剖宫产术后再孕大面积胎盘穿透性植入一例

一、病例摘要 患者33岁,孕2产1,主因“停经31^＋2托周,B超提示胎儿左肾多囊肾、完全性前置胎盘1个月余,要求终止妊娠”,于2009年3月4日收住北京大学人民医院。末次月经2008年7月28日,预产期2009年05月05日。孕期在外院定期产检。1个月前B超提示“胎儿左侧多囊。肾”,后于多家医院复查B超提示：胎儿左肾多囊,     

腹腔镜子宫肌瘤剔除术后妊娠的孕期保健

随着腹腔镜技术的发展,腹腔镜下行子宫肌瘤剔除术的可行性、安全性及优势已得到公认,其术后妊娠的问题及结局也逐渐受到关注.本期报道了几例腹腔镜子宫肌瘤剔除术后妊娠期发生自发子宫破裂的病例,结合目前已有的文献报道,虽然其发生率不足1%,但其对母儿造成的严重危害仍应引起临床医生的高度重视[1-2].为加强对腹腔镜子宫肌瘤剔除术后妊娠期的高危管理和提高对发生子宫破裂危险因素的认识,及时发现异常征兆,及时诊断和积极处理,应重视以下几方面的管理.     

妊娠合并混合性结缔组织病临床分析

目的探讨妊娠合并混合性结缔组织病(MCTD)的孕产期处理和妊娠结局。方法回顾性分析北京大学人民医院2006年1月至2016年1月间收治及分娩的合并MCTD患者的临床资料,并电话随访母儿情况。结果共有4例孕妇5次分娩纳入分析,子痫前期发生率20%(1/5),血小板减少40%(2/5),肺动脉高压40%(2/5),其中1例剖宫产后死亡。活产儿5个,平均分娩孕周35.9周,平均体重2 556 g,剖宫产率80%(4/5)。早产率60%(3/5),胎儿生长受限20%(1/5),新生儿狼疮40%(2/5)。4例MCTD患者,1例死亡,其余3例随访1~5年疾病未发生转化。1例新生儿失访,其余4例目前无免疫相关疾病。结论 MCTD患者的母儿预后与孕前病情程度、孕期是否坚持治疗以及综合保健水平密切相关。     

巨大胎盘绒毛膜血管瘤致胎儿水肿一例并文献复习

一、病例摘要患者26岁,主因＂停经32周,B超发现胎盘绒毛膜血管瘤1个月,胎儿水肿1周＂于2010年9月1日收住院。患者末次月经2010年1月20日,预产期2010年10月27日。孕1产0。孕18周首次行B超检查,胎盘无异常,孕27周当地医院B超提示胎盘下缘可见7.7cm×5.7cm的低回声,考虑胎盘绒毛膜血管瘤,     

北京地区52例女性不孕不育患者染色体核型及临床分析

目的对809例女性不孕不育患者进行染色体核型及临床分析,探讨染色体畸变与表型的效应关系,分析女性不孕不育患者染色体异常检出率及异常类型和频率分布。方法外周血淋巴细胞培养,常规染色体G显带400带分析。结果809例女性不孕不育患者中52例存在染色体核型异常,其中常染色体结构异常35例,占67．31％;性染色体数目异常12例,占23．07％;性染色体结构或功能异常5例,占9．62％。52例患者反复自然流产、多次胎停育29例,占55．77％,畸形儿分娩史6例,占11．54％,女性生殖器发育不全17例,占32．69％。其染色体异常涉及3、4、6、7、8、9、10、13、14、15、21、22和X、Y等。结论染色体畸变是不育的重要因素,久治不愈的不孕不育患者应检查染色体以排除染色体畸变的可能。