巨细胞病毒感染与妊娠

巨细胞病毒感染与妊娠中国医科大学附属二院（１１０００３）王德智巨细胞病毒（ＣＭＶ）是引起新生儿先天性感染的重要病原微生物之一，据徐桂林报道［１］，我国ＣＭＶ的先天性感染率可高达３．５％，若以每年出生２０００万新生儿计算，每年ＣＭＶ先天性感染的新生儿达...     

病原体及巨细胞病毒感染与输卵管妊娠的关系

目的　探讨解脲支原体、沙眼衣原体、巨细胞病毒感染与输卵管妊娠的关系。方法应用PCR技术 ,检测 12 8例输卵管妊娠患者 (观察组 )和 5 0例行附件切除术、无输卵管妊娠史的卵巢囊肿患者 (对照组 )的宫颈分泌物和输卵管组织中解脲支原体、沙眼衣原体、巨细胞病毒DNA。结果(1)观察组 5 6例宫颈分泌物检测出解脲支原体DNA ,阳性率为 4 3 8% ,对照组 10例宫颈分泌物检测出解脲支原体DNA ,阳性率为 2 0 0 % ;观察组 4 8例输卵管组织检测出解脲支原体DNA ,阳性率为37 5 % ,对照组 5例输卵管组织检测出解脲支原体DNA ,阳性率为 10 0 % ;两组比较 ,差异有极显著性 (P <0 0 1) ;(2 )观察组 35例宫颈分泌物检测出沙眼衣原体DNA ,阳性率为 2 7 3% ,对照组 5例宫颈分泌物检测出沙眼衣原体DNA ,阳性率为 10 0 % ;观察组 34例输卵管组织检测出沙眼衣原体DNA ,阳性率为 2 6 6 % ,对照组 3例输卵管组织检测出沙眼衣原体DNA ,阳性率为 6 0 % ;两组比较 ,差异有显著性 (P <0 0 5 ) ;(3)观察组 2 1例宫颈分泌物检测出巨细胞病毒DNA ,阳性率为 16 4 % ,对照组 3例宫颈分泌物检测出巨细胞病毒DNA ,阳性率为 6 0 % ;观察组 2 5例输卵管组织检测出巨细胞病毒DNA ,阳性率为 19 5 % ,对照组 2例输卵管组织检测出巨细胞病     

输卵管妊娠患者生殖道巨细胞病毒和沙眼衣原体的测定

目的：探讨巨细胞病毒和沙眼衣原体感染与输卵管妊娠的关系。方法：应用酶联合免疫吸附试验法检测95例输卵管妊娠患者（异妊娠组）和42例际件切除术,无输卵管妊娠史的卵巢囊肿患者（对照组）血清中抗巨细胞病毒IgM,应用聚合酶链反应技术测定生殖道组织中巨细胞病毒gH基因和沙眼衣原体热休克蛋白基因。结果：异位妊娠组抗巨细胞病毒IgM阳性14例,阳性率为15％,对照组阳性1例,巨细胞病毒gH基因阳性18例,阳性率为19％,对照组则2例阳性,两组比较差异有差异性（P＜0．05）。异位妊娠组沙眼衣原体热休克蛋白基因阳性25例,阳性率为26例,对照组则阳性2例,两组比较,差异有显著性（P＜0．05）。结论：巨细胞病毒和沙眼衣原体感染可能与输卵管妊娠的发生有关。     

人巨细胞病毒感染与异位妊娠

目的探讨人巨细胞病毒(HCMV)感染与异位妊娠的相关性.方法采用酶联免疫吸附(ELISA)方法检测72例输卵管妊娠患者(病例组)血清中的抗HCMV抗体;聚合酶链反应(PCR)技术检测其中49例患者的输卵管、宫颈及宫腔标本中HCMV DNA;同时选择38例正常足月妊娠行剖宫产妇女作为对照2结果病例组血清抗HCMV IgG抗体检出率为31.9%,明显高于对照组(15.8%)(P＜0.05);IgM抗体检出率高于对照组,在统计学上无明显差异(P＞0.05).病例组宫颈、宫腔及输卵管标本中均检出HCMV DNA,且宫颈检出率为14.3%,明显高于对照组(P＜0.05).结论异位妊娠与HCMV感染存在相关性.     

妊娠早期巨细胞病毒感染和产前诊断案例分析

目的 分析妊娠早期动态定量检测巨细胞病毒（cytomegalovirus,CMV）抗体水平的意义,为临床医师对妊娠期CMV筛查和诊断提供参考依据。 方法 随机抽取2021年1—12月在惠州市中心人民医院妇产科门诊进行常规妊娠期检查的孕妇810例为研究对象。所有孕妇均在妊娠12周内采用电化学发光法定量检测CMV的IgG和IgM,间隔1~2周复查1次。结合2次抗体定量结果判断孕妇是否感染和感染类型。对诊断为CMV感染并引产的胎儿做病理分析。 结果 810例样本中CMV感染者为801例,其中既往感染者为783例（96.7%）,CMV原发感染和复发感染各1例,原发感染率和复发感染率均约为0.1%,IgM持续阳性共16例（2.0%）;CMV未感染者9例（1.1%）。1例引产胎儿病理诊断为播散性先天性CMV感染。结论 妊娠早期动态定量检测CMV抗体可反映孕妇感染情况和感染类型,有效排除临床诊治中的干扰,避免过度医疗干预。科学规范的妊娠期CMV检测是出生缺陷防控的核心所在。     

妊娠妇女及围产儿巨细胞病毒感染的研究

应用酶联免疫法（ＥＬＩＳＡ），对不同孕周孕妇２５６例及其中８４例巨细胞病毒ＩｇＭ抗体（ＨＣＭＶ－ＩｇＭ）阳性的妊娠晚期孕妇所分娩新生儿的脐血，进行ＨＣＭＶ－ＩｇＭ检测。结果：妊娠早期、中期妇女的４２份血清标本中，ＨＣＭＶ－ＩｇＭ阳性１７例，感染率为４０．４８％。妊娠晚期２１４份标本中，ＨＣＭＶ－ＩｇＭ阳性８４例，感染率为３９．２５％。ＨＣＭＶ－ＩｇＭ阳性者围产儿死亡率、新生儿窒息抢救率、胎儿畸形及有异常妊娠病史的妊娠妇女的比例均增加（Ｐ＜０．０１）。提示：ＨＣＭＶ－ＩｇＭ阳性表明妊娠妇女近期有巨细胞病毒（ＨＣＭＶ）感染，或既往有隐性的ＨＣＭＶ感染，在妊娠期复发（活动性感染）。     

妊娠期巨细胞病毒感染

巨细胞病毒(cytomegalovirus,CMV)是引起人类病毒性感染的常见原因,也是人类最常见的先天性感染病毒。巨细胞病毒可以通过胎盘、产道以及母乳垂直传播,妊娠早期感染可能引起胚胎发育异常,导致流产;妊娠中晚期感染可导致早产、胎儿生长受限、出生缺陷及迟发性中枢神经系统障碍等不良结局。本文对妊娠期巨细胞病毒感染的发病情况、产前诊断及防治进行简要综述。     

Ectopic tubal pregnancy after hysterectomy and tubal ligation

Posthysterectomy ectopic pregnancy is an unusual condition that may present soon after hysterectomy or several years later. Similarly, although tubal ligation is a widespread method of contraception, tubal pregnancy after tubal ligation is not common either. If any of these conditions are rare, having an ectopic pregnancy after hysterectomy and tubal ligation is even more infrequent and only one of such cases was found in our review of the literature. We describe the case of a 35-year-old patient, with history of bilateral tubal ligation and vaginal hysterectomy that looked for medical attention due to abdominal pain. A pregnancy test was positive and a transvaginal ultrasound demonstrated the presence of a gestational sac at the vaginal cuff, adjacent to the ovary. An exploratory laparotomy showed a ruptured ectopic pregnancy located in the distal portion of the left fallopian tube. The occurrence of an ectopic pregnancy several years following tubal ligation and vaginal hysterectomy is a rare phenomenon that appears to be secondary to a fistulous connection into the peritoneal cavity.     

Falloposcopy after prostaglandin treatment of tubal pregnancy

We report on a tubal pregnancy treated with prostaglandin F₂ locally. Falloposcopy two years afterwards showed multiple, non obstructive adhesions of the tubal epithelium.     

甲氨蝶呤和米非司酮联合治疗非破裂型输卵管妊娠

目的探讨甲氨蝶呤(MTX)和米非司酮联合治疗非破裂型输卵管妊娠的效果。方法米非司酮300mg一次顿服,MTX20mg静注×5d。单用MTX的病人设为对照组。结果MTX和米非司酮联合治疗的成功率为87.5％,明显高于对照组。观察治疗期间病情变化,发现疗效与血β-hCG高低及有无心管搏动有关。结论MTX和米非司酮联合治疗非破裂型输卵管妊娠安全有效,适用于生命体征平稳、无剧烈腹痛、无心管搏动及血β-hCG＜30μg/L的非破裂型输卵管妊娠。     

Ectopic pregnancy following tubal sterilization

Over a 5 year period 232 ectopic pregnancies were recorded at Ullevaal Hospital in Oslo, Norway. There had been 10,294 births during this July 1976 to June 1981 period. In 3 cases tubal sterilization had been performed prior to the development of the extrauterine pregnancy. A total of 1047 female tubal sterilizations were performed during these 5 years. Almost all the sterilizations were done by laparoscopy. Different methods of sterilization were used: unipolar diathermy; spring clips according to Hulka; silicone rings; and endotherm coagulation. Each case of the 3 ectopic pregnancies, observed following tubal sterilization, is reviewed. A 36 year old patient became pregnant 3 years after diathermy sterilization. The right tube was found normal, and the pregnancy located in the lateral part of the divided left tube. 14 months following silicone ring sterilization a 26 year old patient had an ectopic pregnancy in the lateral right tube. The silicone ring was in perfect position on the left side. The medial right tube showed fibrous scarring after the ring application, but the ring was located in the mesosalpinx. A 37 year old patient was admitted to the hospital after a tubal pregnancy 10 months after diathermy sterilization. The pregnancy was in the lateral part of the tube. Both tubes had been transected, and there was a diastase of about 2 centimeters. The etiology of ectopic pregnancies is complex. It is only recently that previous sterilization has been recognized as a factor in this condition. Luteal phase pregnancies are because of a failure in the timing of the procedure and are unrelated to the procedure itself. Pregnancies resulting from operative failure range from 0-2.4/1000 sterilizations in different series. Technical failure may be caused by recanalization, fistula formation, and product failure. An important cause of ectopic pregnancy after laparoscopic sterilization is probably fistula formation that allows sperm to pass out of the uterus. Such fistulas have frequently been documented. Thus, if it is considered necessary to confirm tubal occlusion by salpingogram, this should be delayed for at least 12 weeks. As fistula formation probably is a major cause in this entity, division of the tube at the time of sterilization is neither necessary nor desirable. It is important to damage the tube in the isthmic segment and to minimize the involvement of the parametrium in the destructive process.     

A case of tubal endometriosis mimicking the appearances of tubal pregnancy at laparoscopy

Tubal pregnancy is a common gynaecological emergency. Due to the accuracy of transvaginal ultrasonography and serum human chorionic gonadotrophin (hCG) analysis is being managed more frequently by laparoscopy in asymptomatic patients. A case of presumed tubal pregnancy is presented in which the evidence generated by ultrasonography, hCG levels and laparoscopy all suggested tubal pregnancy. However, histological examination showed a tubal endometrioma. This case highlights the importance of histological analysis of all surgical specimens and provides a rare differential diagnosis of tubal mass.     

Rupture of tubal pregnancy in the Vilnius population

OBJECTIVES: To evaluate the determinants of tubal rupture in women who suffered from ectopic pregnancy in relation to their demographic profile and medical history. STUDY DESIGN: This retrospective observational clinical study was conducted in five general hospitals in Vilnius, Lithuania. The population was composed of 879 women with surgically proven ectopic pregnancy. Tubal rupture was diagnosed at the time of surgery. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for tubal rupture. RESULTS: The occurrence of tubal rupture was 29.5% (259/879). It was encountered significantly more often in women with age of > or =35 years (odds ratio 1.9 [1.3-2.8]). Patients whose EP was located in the isthmus were at higher risk of having tubal rupture (odds ratio 3.2 [2.2-4.5]) while known risk factors for EP were not associated with an elevated risk. CONCLUSIONS: Our data suggest that age of > or =35 years and implantation in the straightest segment of the tube could be associated with increased rate of tubal rupture. Of particular interest is the overall tubal rupture prevalence (29.5%) observed since these women were managed in an environment where transvaginal ultrasound equipment and quantitative assessment of beta-human chorionic gonadotrophin were not routinely available.     

Unsuccessful treatment of tubal pregnancy by shock wave lithotripsy

A tubal pregnancy was unsuccessfully treated by means of a lithotrypter.     

氨甲喋呤单次肌肉注射治疗输卵管妊娠疗效分析

目的 探讨氨甲喋呤（ＭＴＸ）单次肌肉注射治疗输卵管妊娠的疗效,并观察失败的相关因素及其数量与失败可能性的关系。方法 对４１例治疗成功和１１例治疗失败病例的临床资料、包块面积改变以及血清β－ｈＣＧ值的变化进行对比分析。结果 失败组平均停经时间６３．４天、血β－ｈＣＧ平均１５７７６．５ＩＵ／Ｌ、治疗３日后β－ｈＣＧ平均下降１８．３％、治疗后包块平均面积增加６４．２％。成功组平均停经时间５６．４天、血β     

Ectopic pregnancy in a distal tubal remnant

Ectopic pregnancy is a well-recognized complication of tubal reanastomosis (Young PE, Egan JE, Barlow JJ: Reconstructive surgery for infertility at the Boston Hospital for Women. Am J Obstet Gynecol 108: 1092, 1970 and Hodari AA, Vibhasiri A, Isaac AY: Reconstructive tubal surgery for midtubal obstruction. Fertil Steril 28: 620, 1977). We describe here, however, a case of tubal pregnancy occurring in a tubal remnant on the opposite side to a successful tubocornual reanastomosis.