妊娠合并肾脏疾病28例的产科处理

目的探讨妊娠合并肾脏疾病的产科处理。方法对妊娠合并肾脏疾病28例病例的产科处理做回顾性分析。结果28例妊娠合并肾脏疾病中合并肾炎的发病率最高(20/28),妊娠并发症中妊娠期高血压疾病发生率最高(10/28)。24例肾功能代偿期孕妇均定期接受产科检查,除1例孕13周时行人工流产术外,其余23例均足月正常分娩,母儿预后良好;3例合并妊娠期高血压疾病子痫前期(重度)、肾功能不全(氮质血症期),除1例早产外,另2例剖宫产终止妊娠,母儿预后良好;另有1例孕期未进行产前检查,孕24周合并妊娠期高血压疾病子痫前期(重度),胎儿宫内发育迟缓,肾功能不全(尿毒症期),以剖宫产终止妊娠,胎儿死亡。结论妊娠结局与妊娠合并肾脏疾病中肾功能的分期和有无妊娠并发症密切相关;孕期检查和适时、适当的产科处理对于围生儿、孕妇的预后至关重要。     

妊娠合并艾森曼格综合征的治疗对策

目的 探讨对妊娠合并艾森曼格综合征患者的治疗时策,以期降低此类孕、产妇的病死率.方法 回顾性分析北京大学第一医院2002年1月至2006年12月期间收治的4例妊娠合并艾森曼格综合征患者.结果 4例患者年龄22～34岁,孕周34～35周.2例患者未定期孕期检查,外院急诊转入,1例临产急诊入院后1h余阴道分娩.分娩后突然死亡;另外1例行剖宫产术.其余2例为定期产前保健者,孕晚期入院监护治疗,给予吸氧、卧床体息、严密监测生命体征、血液动力学、血气的变化及胎儿发育情况,择期行剖宫产术.3例行剖宫产者产科与心内科、麻醉科医师密切合作,评估患者的心功能并动态观察,产后恢复良好.结论 妊娠合并艾森曼格综合征母儿预后很差,不宜妊娠,一旦妊娠应尽早行人流术终止妊娠.如果患者坚决要求继续妊娠,应加强产前保健尽早住院监护,加强与心内科、麻醉科、新生儿科合作,全面、正确、有效的处理有助于使患者平稳渡过围生期,改善母儿的预后.     

妊娠合并慢性粒细胞性白血病患者的临床处理特点及妊娠结局分析

目的 探讨妊娠合并慢性粒细胞性白血病(CML)患者的临床处理特点及妊娠结局.方法 1980年6月至2010年2月北京大学人民医院产科共收治妊娠合并CML 16例,采用回顾性分析的方法对妊娠合并CML患者的孕期特点、临床处理及妊娠结局进行分析.结果 (1)孕期临床处理及妊娠结局:16例妊娠合并CML患者中,9例经应用羟基脲或甲磺酸伊马替尼控制病情后,在孕早、中期终止妊娠;该9例患者就诊时平均孕周为7周(5～13周),终止妊娠前、后对症输入红细胞纠正严重贫血,应用抗生素预防感染,未发生相关并发症.另7例妊娠至孕晚期分娩患者中,3例为孕前诊断CML,4例为孕期诊断CML.7例分娩患者就诊时平均孕周为36周(27～40周+2),孕期3例患者服用羟基脲,其中1例在用药过程中受孕,孕期仍继续用药.1例患者在孕40周入院后行白细胞单采术2次.1例行血小板单采术1次.3例未行任何治疗.孕期并发重度子痫前期3例(3/7),其中2例口服羟基脲治疗.7例患者平均分娩孕周为38周(33周+4～41周),其中早产2例.分娩方式为剖宫产2例,阴道顺产3例,产钳助娩2例.有2例阴道顺产者发生产后出血,产后24 h出血量达1500～1800 ml,并引起继发性DIC.7例患者共分娩新生儿7例,新生儿平均出生体质量2469 g(1820～2810 g).早产儿2例,低出生体质量儿2例,1例存在先天畸形,2例血常规检查异常.(2)产后治疗及预后随访:9例孕早、中期终止妊娠的患者中,失访4例;死亡1例,其病程3年;余4例随访5～72个月均存活,其中1例行骨髓移植术后治愈,2例坚持服用甲磺酸伊马替尼,1例服用羟基脲治疗.7例分娩的患者中,2例失访;2例死亡;3例存活.7例新生儿中2例失访,余5例随访4个月～9年,均生长发育正常.结论 妊娠合并CML并非为终止妊娠的绝对指征.孕期在严密监测病情变化的同时,选用相应的药物和(或)白细胞单采术治疗,监测妊娠并发症的发生,可以获得较好的妊娠结局.CML本身和孕期治疗会对母儿产生一定的影响,因此,需要在有条件的综合医院进行治疗和管理.     

286例妊娠合并卵巢肿瘤的临床分析

目的:探讨妊娠合并卵巢肿瘤的临床病程特点,以及相应的诊断和处理对母儿结局的影响。方法:回顾分析2003年3月至2010年12月在上海市第一妇婴保健院住院分娩的286例妊娠合并卵巢肿瘤患者的临床资料,分析比较诊断时孕周,妊娠期间卵巢肿瘤的特点、对妊娠结局影响、分娩方式,病理特点等,并对上述因素进行相关分析。结果:妊娠合并卵巢肿瘤的孕妇阴道分娩54例,剖宫产232例,剖宫产率81.12%;剖宫产获得的232例病理结果中,良性肿瘤227例,交界性肿瘤5例。良性肿瘤行卵巢肿瘤剥除术或患侧附件切除术,交界性肿瘤行患侧附件切除术或肿瘤减灭术;妊娠合并卵巢交界性肿瘤组新生儿体重及分娩孕周均明显低于妊娠合并卵巢良性肿瘤组(P<0.05)。结论:妊娠合并卵巢肿瘤以良性肿瘤最常见。因早期妊娠时缺乏典型的临床症状而不易早期诊断,故应加强孕前及早孕期间的检查;妊娠早期应行B超检查提高卵巢肿瘤检出率;剖宫产术中应仔细探查双侧附件,及时发现卵巢肿瘤;妊娠合并交界性肿瘤,由于终止妊娠时期早,故围产期母儿并发症较高,其处理原则需根据患者年龄、生育情况、组织类型、肿瘤期别、妊娠期限、胎儿成熟度评价等而异。     

妊娠合并急性主动脉夹层4例临床资料分析

目的:探讨妊娠合并急性主动脉夹层(AAD)的预防、诊断、治疗及预后。方法:回顾分析上海长海医院妇产科收治的4例妊娠合并主动脉夹层患者的临床资料。结果:4例患者均主诉胸背痛就诊,孕前及孕期均未发现心脏疾病。3例A型主动脉夹层(TAAD),1例B型主动脉夹层(TBAD)(Stanford分型标准)。1例TAAD患者先行心外科手术,术后11天行剖宫产术;2例TAAD患者行剖宫产术+次全子宫切除+心外科手术;1例TBAD患者药物保守治疗失败后行剖宫产术,术后10天行胸主动脉夹层腔内隔绝术。1例TBAD患者新生儿死亡,母亲存活,其余3例母儿均存活。结论:妊娠期建议常规行心脏超声筛查,预防主动脉夹层应以控制血压为主。一旦发病,诊治需多学科综合治疗,综合考虑孕周、母体心功能等情况,选择适宜治疗方案。若为有生机儿,推荐先行剖宫产再行心外科手术。     

孕产妇合并甲型H1N1流感对母儿结局的影响

目的 探讨孕产妇合并甲型H1N1流感(简称甲流)对母儿结局的影响及产科处理.方法 收集2009年11月7日至2009年12月15日中国医科大学附属盛京医院收治的19例合并甲流的孕产妇资料,回顾性分析甲流对母儿的影响. 结果 19例患者中,产褥期妇女3例,占15.8%,均为轻症,愈后良好.孕期患者16例,占84.2%,其中早期妊娠2例(12.5%),中期妊娠7例(43.8%),晚期妊娠7例(43.8%).16例孕期患者按病情严重程度分,轻症6例(37.5%),重症2例(12.5%),危重症8例(50.0%).2例早期妊娠患者均为轻症,甲流治愈后选择人工流产;中期妊娠的4例轻症患者甲流治愈后足月分娩,3例重症及危重症患者中1例甲流治愈后足月分娩,1例孕27周胎死宫内和1例孕23周因孕妇发生严重并发症,均行剖宫取胎术,后者胎儿娩出后死亡;妊娠晚期的7例均为重症及危重症患者,均行急诊剖宫产术终止妊娠,2例胎儿孕晚期胎死宫内,余5例存活,包括4例早产儿和1例足月儿.行急诊剖宫产手术的全部9例(56.3%,9/16)重症及危重症孕妇中,活产新生儿6例,存活的5例均未感染甲流;2例孕产妇术后死亡(10.5%,2/19). 结论妊娠晚期孕妇感染甲流极易发展为重症及危重症,及时终止妊娠是挽救母儿生命又使新生儿避免甲流病毒感染的有效方法之一.     

妊娠合并系统性红斑狼疮患者孕期并发症及妊娠结局的临床分析

目的分析并探讨系统性红斑狼疮(SLE)患者的孕期并发症情况及妊娠结局。方法回顾性分析2000年1月至2010年3月北京大学人民医院收治的19例妊娠合并SLE患者的临床资料,对影响SLE合并妊娠并发症的相关因素和SLE不同妊娠时机的妊娠结局进行分析。结果 19例患者中11例(11/19,57.9%)出现了母儿并发症,4例重度子痫前期,1例流产,2例死胎,2例足月低出生体重,4例早产。无并发症组8例,两组患者的孕产次及孕前病程、分娩方式无明显差异,但无并发症组患者的年龄小于并发症组,分娩孕周明显延长,新生儿体重明显增加,两组差异有统计学意义(P=0.006);孕前病情的稳定程度对孕期母儿并发症的影响差异无统计学意义(P=0.633);但妊娠前病情稳定大于6个月的患者出现并发症的比例较低(6/12,50.0%vs5/7,71.4%)。3例妊娠期间诊断SLE的患者均在孕期或产后出现了严重的并发症,1例(1/3,33.3%)新生儿诊断为SLE;与孕前病情控制平稳6个月的患者相比,分娩孕周较小,新生儿体重较低(P0.05)。结论 SLE患者即使孕前病情控制平稳,妊娠后仍有可能出现严重的母儿并发症。在病情控制平稳后妊娠,孕期在产科和风湿科医师的共同严密监测下,坚持治疗,适时终止妊娠是改善母婴结局的关键。同时应注意提高对妊娠期SLE的诊断。     

腹腔镜下宫颈环扎术治疗宫颈机能不全16例临床分析

目的探讨腹腔镜下宫颈环扎术治疗宫颈机能不全的效果和安全性。方法对2008年8月至2011年12月中山大学附属第一医院妇科16例经阴道宫颈环扎手术失败和无法行经阴道宫颈环扎术的宫颈机能不全患者,在非孕期行腹腔镜下宫颈环扎术,观察术后妊娠情况。结果 16例患者手术过程均顺利,无一例中转开腹。有10例患者妊娠,其中8例孕足月剖宫产,1例孕31周剖宫产分娩,1例妊娠20周时因胎膜早破导致难免流产,开腹手术剪断环扎带后经阴道娩出胎儿。行剖宫产患者平均分娩孕周为37.9周,较术前平均流产孕周平均延长17.9周。另6例患者中5例现术后1～3个月,尚未计划妊娠,1例术后1+年,未避孕未孕。结论腹腔镜下宫颈环扎术安全有效,可明显延长妊娠时间,增加活产率,可作为宫颈机能不全的治疗方法之一。     

妊娠合并垂体催乳素腺瘤6例临床特点分析

目的:分析6例妊娠合并催乳素腺瘤(大腺瘤1例,微腺瘤5例)患者的临床特点.方法:回顾分析2017年12月1日至2021年5月1日河南大学人民医院收治的6例妊娠合并垂体催乳素腺瘤患者的孕前、孕期、影像学资料、妊娠结局及母儿预后情况.结果:6例妊娠合并催乳素腺瘤患者中,成功妊娠者4例,孕期肿瘤体积增大引起压迫症状者1例,合...     

单角子宫妊娠合并宫颈机能不全一例并文献复习

单角子宫的生殖预后一般较差,可引起不孕、流产、宫颈机能不全和早产。现报告1例3次妊娠,分别于10^+周、26^+周和22^+周自然流产,经联合宫腔镜和腹腔镜诊断单角子宫并残角子宫合并宫颈机能不全,行左侧残角子宫离断+子宫整形修复术后,成功自然妊娠2次,2次均在孕12周行预防性经阴道宫颈环扎术,术后分别在孕35^+5周和36^+4周剖宫产分娩近足月活婴的临床处置经过,并将近年国内外单角子宫合并妊娠的诊治进展相关文献进行回顾总结。     

Preimplantation genetic diagnosis for polycystic kidney disease

OBJECTIVE: To use preimplantation genetic diagnosis for achieving a polycystic kidney disease (PKD)-free pregnancy for a couple in which the female partner was affected by PKD but whose PKD1 or PKD2 carrier status was not established. DESIGN: Case report. SETTING: The IVF program of Reproductive Genetics Institute, Chicago, Illinois. PATIENT(S): An at-risk couple with the female partner affected by PKD, whose PKD1 or PKD2 carrier status was not established. INTERVENTION(S): Removal of PB1 and PB2 and testing for three closely linked markers to PKD1 (Kg8, D16S664, and SM7) and four closely linked markers to PKD2 (D4S2922, D4S2458, D4S423, and D4S1557) after standard IVF. MAIN OUTCOME MEASURE(S): Deoxyribonucleic acid analysis of PB1 and PB2 indicating whether corresponding oocytes were PKD1 or PKD2 allele free, for the purpose of transferring only embryos resulting from mutation-free oocytes. RESULT(S): Of 11 oocytes tested by PB1 and PB2 DNA analysis, 7 were predicted to contain PKD1 or PKD2, with the remaining 4 free of both mutations. Three embryos resulting from these oocytes were transferred, yielding a twin pregnancy and the birth of two unaffected children. CONCLUSION(S): This is the first preimplantation genetic diagnosis for PKD, which resulted in the birth of healthy twins confirmed to be free of PKD1 and PKD2. Preimplantation genetic diagnosis based on linked marker analysis provides an alternative for avoiding the pregnancy and birth of children with PKD, even in at-risk couples without exact PKD1 or PKD2 carrier information.     

Acute Renal Insufficiency in Pregnancy: A Review of Thirty Cases

A review of women with acute changes in renal function during pregnancy including cases with only mild or moderate azotemia was performed to determine the etiology, associated disorders and frequency of this problem in an inner-city population. A retrospective review of the clinical and laboratory data of all patients admitted to the Tulane Obstetric Service at Charity Hospital of New Orleans from 1985-1989 that contained a final diagnosis of hypertension, pre-eclampsia/eclampsia or renal disease was performed to determine if acute renal insufficiency or renal failure occurred during that admission. Renal disease was defined as a serum creatinine level of greater than or equal to 1.2 mg/dl with either a rising or falling level during the hospitalization. Thirty cases of either acute renal insufficiency or renal failure during pregnancy were identified with an incidence of one in 450 deliveries. Seventeen women had either pre-eclampsia or eclampsia. Their clinical and biochemical characteristics were reviewed and found to be similar to those of the 13 women who had other causes of acute renal dysfunction complicating their pregnancies. The mean serum creatinine for all patients in this series was 3.4 mg/dl (range: 1.2-16). Four patients required dialysis, two of whom never regained function. There were no cases of cortical necrosis. Most patients still had abnormal renal function at the time of discharge. There were 21 live births and 9 fetal deaths. Fetal death was more likely to occur with shorter gestation, higher serum creatinine, and lower platelet count. Even in cases with mild acute renal insufficiency complicating pregnancy, there was significant maternal morbidity and fetal mortality. Pre-eclampsia/eclampsia was the most common disorder associated with this problem in pregnancy. In an inner-city population, acute renal insufficiency and renal failure in pregnancy occur more frequently than previously reported; recognition of this problem is necessary to provide appropriate follow-up.     

Pregnancy in women with renal disease. Part II: specific underlying renal conditions

The obstetric outcome in women with kidney disease has improved in recent years due to continuous progress in obstetrics and neonatology, as well as better medical management of hypertension and renal disease. However, every pregnancy in these women remains a high-risk pregnancy. When considering the interaction between renal disease and pregnancy, maternal outcomes are related to the initial level of renal dysfunction more than to the specific underlying disease. With regards to fetal outcomes, though, a distinction may exist between renal dysfunction resulting from primary renal disease and that in which renal involvement is part of a systemic disease. In part II of this review, some specific causes of renal failure affecting pregnancy are considered.     

Renal biopsy in pregnancies complicated by undetermined renal disease

BACKGROUND: The aim of this retrospective study was to verify the role of renal biopsy in pregnancies complicated by renal dysfunction. METHODS: A series of 15 percutaneous renal biopsies performed in 15 pregnant women with renal disease presenting during pregnancy over the past 10 years (1990-1999) were reviewed. RESULTS: All the patients underwent renal biopsy before 30 weeks of gestation. The indications for renal biopsy were renal dysfunction of unknown cause or symptomatic nephrotic syndrome (NS). Patients with toxemia were excluded. Eight women had lupus nephritis, including five with diffuse crescenteric changes and three with a mesangial proliferative pattern. Three had chronic glomerulonephritis (CGN), two had mesangial proliferative glomerulonephritis and one each had diabetic nephrosclerosis and endocapillary proliferative glomerulonephritis. There were no significant complications except in one patient who experienced gross hematuria. Early induction of labor was recommended for the four patients with diabetic nephrosclerosis or CGM. The other 11 patients received intravenous pulse methylprednisolone or high dose oral prednisolone therapy. The responses to steroid therapy in these 11 patients were as follows: five achieved complete remission of NS, three achieved incomplete remission, and three achieved partial remission. After 2 years' follow-up, seven mothers achieved complete remission, three had died, three developed chronic renal failure (CRF), and two progressed to end stage renal failure (ESRF) requiring chronic hemodialysis. Fourteen of the 15 pregnancies resulted in live births and the other child was stillborn. CONCLUSIONS: Renal biopsy performed during pregnancy is not contraindicated. The results of histopathological studies are extremely useful in counseling regarding continuation or termination of pregnancy, potential maternal and fetal outcome, and recommending specific therapeutic modalities.     

Type identification of autosomal dominant polycystic kidney disease by analysis of fluorescent short tandem repeat markers.

Autosomal dominant polycystic kidney disease (ADPKD), is an inherited disorder with genetic heterogeneity. The presence of renal cysts is an important clinical marker for ADPKD diagnosis, but in the early stage, renal cysts do not emerge in individuals who carry the defective gene. Therefore, it is necessary to establish a genetic method of diagnosis. Two ADPKD-related genes have been isolated: PKD1, located on chromosome 16p13.3, and PKD2, located on 4q21-22. In this study, we used fluorescent short tandem repeat (STR) markers to perform linkage analysis in six unrelated ADPKD families. Six markers were included in the PKD1 and five in the PKD2 analysis. Among these six ADPKD families, four showed linkage to PKD1 and two showed linkage to PKD2. Ultrasonography or computerized tomography revealed that PKD1 patients developed cysts only in kidneys, but PKD2 patients developed cysts in kidneys, liver and pancreas. Our results indicate that fluorescent STR linkage analysis is well suited for type identification of ADPKD and presymptomatic diagnosis in ADPKD families.     

Pyloric stenosis in a newborn baby with polycystic kidneys.

Patients with infantile hypertrophic pyloric stenosis (IHPS) have an increased incidence of renal anomalies. Association of IHPS and polycystic kidney disease (PKD) has been reported in three case histories. It is uncertain whether the association of PKD and IHPS is due to genetics, a pathophysiological link or a chance phenomenon. One hypothesis linking the two conditions is nitric oxide synthetase (NOS) deficiency. NOS deficiency leads to lack of locally available nitric oxide causing a failure of smooth muscle relaxation. It is therefore plausible that NOS deficiency plays a part in the pathogenesis of pyloric stenosis, hypertension and cyst development in autosomal-dominant PKD.     

Pregnancy in a woman with chronic renal failure--the case of two successfully completed pregnancies and the review of the literature

Together with the prolongation and improving the quality of life of young women with chronic renal failure (CRF), procreation becomes an important issue. Pregnancies in women on renal replacement therapy are associated with an increased risk of health complications, both for mothers and for fetuses. Medical management of pregnant women with CRF is a great challenge and requires a close co-operation of nephrologists, transplantologists, gynecologists and neonatologists. The complexity of problems in these particular pregnancies has urged us to describe the case of a woman with CRF who successfully delivered two babies. We also review the current state of knowledge on the topic. The first pregnancy five years after renal transplantation, was completed with the delivery of term newborn with Tetralogy of Fallot. Also the second pregnancy on hemodialysis therapy was finished by the birth of a healthy neonate at term. The described case indicates that the gynecologists should be prepared for the challenge of the care for pregnancies in women suffering from chronic renal failure on renal replacement therapy.     

妊高征并发急性肾功能衰竭11例分析

目的 :了解妊高征并发急性肾功能衰竭 (ARF)的发病特点、探讨其发生规律及防治措施。方法 :对 30 5 2 0例产妇进行回顾性分析。结果 :30 5 2 0例产妇中 ,妊高征患者 5 14例 ,急性肾功能衰竭患者 11例 (占分娩总数的 0 .0 4 % ,占妊高征总数的 2 .1% )。诱因 :感染 (2 7.2 % )、心力衰竭 (18.2 % )、原有肾炎 (占 18.2 % )、妊娠肾病综合征、药物、胎盘早剥、DIC(各占 9.1% )。结论 :妊高征并急性肾功能衰竭的发病率为 2 .1% ,与原有肾损害、产时合并感染、心功能衰竭、DIC、胎盘早剥等有关。及时终止妊娠 ,控制高血压和各种诱因是关键 ,内科保守治疗加透析疗法 ,可减少母婴死亡 ,提高 ARF抢救成功率     

Pathogenesis of acute renal failure associated with the HELLP syndrome: a case report and review of the literature

Acute renal failure is a rare but serious complication of pregnancy. We describe a 31-year-old woman with haemolytic anemia, elevated liver enzymes, low platelets (HELLP syndrome) who developed acute peripartum renal failure. Renal biopsy performed 2 weeks later because of persistent oliguria revealed thrombotic microangiopathy and acute tubular necrosis. This case highlights the probable pathogenesis of acute renal failure in HELLP patients and explains why it resolves in the majority of cases. A review of the literature that describes renal histology in HELLP patients is presented.