产时、产后止血活动的变化

目前认为,止血系统的活化可能在产时,并与产后深部静脉血栓形成发病率增高有关。过去通过血小板计数、纤维蛋白原、凝血因子Ⅷ和纤维蛋白溶酶原减少推测止血系统的活化。目前的技术已使特异性止血系统测定达到分子水平。由此可测出血凝块(血纤维蛋白肽A)、血纤维蛋白溶解作用(血纤维蛋白-血纤维蛋白原降解产物,D-二聚体)和血小板活性(血小板因子4,β-血栓球蛋白)。这些指标增高,反映了体内止血系统的激     

临床多选题

[A型题] 问12:下列哪种现象不属于妊娠期血液系统的生理性变化? A 纤维蛋白原显著增加。 B 血小板增加。 C 凝血因子Ⅶ、Ⅷ、Ⅹ明显增加。 D 血浆纤维蛋白溶酶原增加。 E 纤维蛋白溶解活性增加。问13:下述哪种检查对诊断产科DIC的价值较大? A 出血时间。B 血红蛋白含量。C红细胞数。D 红细胞压积。E 血沉.     

口服Ⅱ号避孕药对血小板功能及血液凝固的影响

为了解口服Ⅱ号避孕药对血小板功能及血液凝固性的影响,本文对65名连续服药妇女进行了研究。她们的年龄为27～45(平均36.5)岁。服药期限1～17(平均6.7)年。测定项目有纤维蛋白原,血小板粘附率,血小板聚集率,Ⅷ因子相关抗原,抗凝血酶活力等。20例未服药妇女作对照。测定结果服药组血小板粘附率、聚集率及纤维蛋白原比对照组明显增高(P<0.001)。Ⅷ因子相关抗原略增高,但无统计学意义。抗凝血酶活力显著降低(P<0.001)。本文就急性心肌梗塞及血栓栓塞的潜在可能性等问题进行了讨论,并对预防此类并发症提出了建议。     

凝血状态、自身抗体及受孕方式与绒毛膜下血肿发生的关系

目的探讨绒毛膜下血肿(SCH)的发生与凝血状态、自身抗体及受孕方式的关系。方法回顾性收集郑州大学第三附属医院2020年6月至2021年12月收治的SCH孕妇100例(SCH组), 选取同时期产前检查的健康孕妇100例作为对照组。统计分析两组孕妇的凝血状态(包括血小板计数、凝血酶原时间、凝血酶时间、活化部分凝血活酶时间、纤维蛋白原、抗凝血酶Ⅲ、纤维蛋白降解产物、D-二聚体、血同型半胱氨酸、蛋白S活性、蛋白C活性)、自身抗体[包括抗磷脂抗体(抗心磷脂抗体和抗β2糖蛋白Ⅰ抗体)、抗核抗体]阳性率及受孕方式的差异。结果两组孕妇血清学检测结果相比较, SCH组血小板计数[(240±45)×109/L、(227±37)×109/L]、纤维蛋白原[(4.0±0.8)、(3.6±0.7)g/L]、D-二聚体[(0.42±0.18)、(0.31±0.15)mg/L]、血同型半胱氨酸[(8.9±4.2)、(6.9±2.3)μmol/L]均高于对照组, 蛋白S活性[(55±14)%、(68±20)%]低于对照组, 分别比较, 差异均有统计学意义(P均<0.05)。SCH组孕妇的自身抗体阳性率[24.0...     

孕产妇感染性休克61例临床分析

目的:探讨孕产妇感染性休克发生的常见临床因素及其预防措施。方法:回顾性分析2012年1月—2017年12月郑州大学第一附属医院产科收治的61例感染性休克的病例资料。根据结局分为生存组(45例)和死亡组(16例),分析2组患者的临床特征。结果:61例感染性休克的患者死亡16例(26.23%),产褥期患者37例(60.66%)。2组患者急性生理功能和慢性健康状态评分系统Ⅱ(APACHEⅡ)评分比较,差异有统计学意义(t=4.170,P=0.001)。2组患者比较,死亡组患者未足月胎膜早破和多器官功能衰竭(MODS)的发生率增高,差异有统计学意义(均P0.05)。确诊感染性休克时,死亡组患者较生存组血小板(PLT)下降、凝血酶原时间(PT)增高、纤维蛋白原(FIB)下降、降钙素原(PCT)增高,差异有统计学意义(均P0.05)。Logistic回归分析提示APACHEⅡ评分高、并存未足月胎膜早破、并发MODS为影响感染性休克孕产妇预后的危险因素。结论:孕产妇发生感染性休克后病死率高;确诊感染性休克后注意监测PLT、PT、FIB、PCT等临床指标变化,加强对其预后的评估;对APACHEⅡ评分高、并存未足月胎膜早破、并发MODS的感染性休克患者,加强临床管理,减少不良预后。     

年轻妇女口服避孕药时的血液粘度变化

服用雌激素避孕药时,有增加静脉血栓、梗塞性动脉病及高血压的危险。这些病人的血液粘度也增加。为此,作者以服用雌激素避孕药的年轻妇女为对象,探讨其服药时血液粘度的变化。作者选择18～29岁的自愿者:男25人,女50人,其中服雌激素避孕药3个月以上的25人,及从未服药者25人。受试者均于早晨空腹静脉采血,妇女在经期中期(13～15天)采血,EDTA(乙二胺四乙酸,1mg/ml)抗凝。血液粘度用百分园盘粘度计测定;血浆粘度用BSM_3毛细血管粘度计测定;枸橼酸血浆中的纤维蛋白原用Clauss法、用Dade纤维蛋白原测定计测定;红细胞压积用Hawksley的微量红细胞压积计测定。     

血栓形成体质和胎儿丢失综合征患者妊娠期间止血系统状态

为研究胎儿丢失综合征和血栓形成体质患者在妊娠期间止血系统状态,将97例患者纳入研究(观察组),其中胎儿丢失综合征和抗磷脂综合征(APS)26例(Ⅰ组),胎儿丢失综合征和遗传型血栓形成体质53例(Ⅱ组),多原型血栓形成体质18例(Ⅲ组),另选健康妊娠妇女30例作为对照组(Ⅳ组),检测复钙活化时间、活化部分凝血活酶时间(APTT)、凝血酶指数、纤维蛋白原浓度、血小板总数及血小板功能活性、血管内血栓形成标志物-纤维蛋白降解产物和可溶性纤维蛋白复合物含量.所得结果经统计学处理.     

大量输血

当前妇产科常用的血制品有五种:全血、浓缩红细胞、血小板、新鲜冻结血浆和冷沉淀物,制作方法不同,特点各异,应用指征亦不同。全血已少用,浓缩红细胞用于恢复血容量,血小板主要用于维持止血,新鲜冻结血浆主要为补充Ⅰ、Ⅴ、Ⅶ、Ⅹ、Ⅺ因子及治疗体液免疫缺陷,冷沉淀物可补充纤维蛋白原。     

口服避孕药对妇女血小板聚集程度、血浆纤维蛋白原及纤溶活性的影响

本文观察了先服短效复方18甲、后改服减量长效复方18甲的已婚育龄妇女的ADP诱导血小板聚集程度、血浆纤维蛋白原、纤溶酶原及血清纤维蛋白原裂解产物(FDP)含量的变化,并以相似年龄的正常志愿者作为对照。结果:服全量长效复方18甲妇女的血小板聚集程度较服药前显著增加,但停药后恢复至正常水平,表明对血小板聚集程度的影响是可逆的。服减量长效复方18甲妇女的血小板聚集程度低于正常水平。无论服短效复方18甲还是服减量长效复方18甲三个月、半年时,纤维蛋白原含量均较对照组高,但服减量长效复方18甲一年后其含量恢复至正常范围。此外,服减量长效复方18甲妇女的纤溶酶原含量较对照组高,但FDP水平均在正常范围内。     

人工流产术后药物干预对子宫内膜影响的临床观察

目的:评价在人工流产术后口服短效避孕药优思明及单纯雌激素补佳乐对减少术后阴道流血时间、促进术后子宫内膜恢复、缩短首次月经恢复时间及减少术后并发症的临床疗效。方法:选择来我院因非意愿妊娠者要求行无痛人工流产者为研究对象,随机分为对照组即未用药组(n=200),优思明组(n=100)和补佳乐组(n=100)。3组均于术后2周及月经转归后1个月、3个月后随诊。观察术后阴道流血时间、术后2周子宫内膜厚度、首次月经恢复时间及术后3个月内并发症的发生情况。结果:①优思明组术后阴道流血时间短于对照组和补佳乐组,差异均有统计学意义(P<0.05);②优思明组术后2周子宫内膜略厚于对照组,但差异无统计学意义(P>0.05),补佳乐组术后2周子宫内膜厚度大于对照组和优思明组,差异有统计学意义(P<0.05)。③优思明组术后首次月经恢复时间短于对照组和补佳乐组,差异有统计学意义(P<0.05)。④用药组(优思明组和补佳乐组)术后并发症发生率均低于对照组,差异有统计学意义(P<0.05);用药组宫腔积液发生率低于对照组,差异有统计学意义(P<0.05)。结论:人工流产术后立即服用单纯雌激素对子宫内膜厚度的恢复优于避孕药,术后并发症的发生率更低。     

The influence of oral contraceptive no. II on platelet function and blood coagulability]

The influence of the No. II oral contraceptive on platelet function and blood coagulability were studied in 65 women who had taken the drug for 1 to 17 (average 6.7) years. 20 women who hadn't taken any contraceptive served as controls. Results showed that platelet aggregation, adhesive rates, and fibrinogen levels were significantly increased than in the control group (P0.001). Factor VIII related antigen was slightly elevated, but not statistically significant. Antithrombin activity was significantly decreased (P0.001). The possibility of acute myocardial infarction and thromboembolic diseases are discussed and measures for prevention suggested.     

Comparison of continuation rates for hormonal contraception among adolescents.

BACKGROUND: Inadequate contraception is common among sexually active female adolescents, resulting in a high incidence of unwanted pregnancy. The authors were interested in comparing continuation rates for the different forms of hormonal contraception in this age group. METHODS: A retrospective chart review. The setting was an urban clinic in a large Midwestern city. Participants were 64% black, 34% white, and the average age was 15.5 years (+/- 1.6 SD), with implant users significantly older than oral contraceptive pill (OCP) users (P < .05). Interventions were self-selection to depo-medroxyprogesterone acetate (Depo-Provera; DMPA), levonorgestrel implants (Norplant), or oral contraceptive pills (OCPs). Previous pregnancy was significantly more prevalent in implant and DMPA users than in OCP users (P < .001). Over 4 years of follow-up, continuation rates were significantly higher for implant users than for the other hormonal groups (P < .001). At 1 year, continuation rates were as follows: 82% implants, 45% DMPA, and 12% OCPs. Combining these rates with those of the subsample who switched without interruption to another hormonal method, "continued protection" rates were much higher after 1 year: 96% implants, 83% DMPA, and 49% OCPs. Calculations of contraceptive "restarts," i.e., hormonal method use in those who discontinued and then restarted after a gap of time, also increased to the prevalence of contraceptive protection. CONCLUSION: Continuation rates for levonorgestrel implants were significantly higher than those for DMPA and OCPs, the latter group having the lowest continuation rates. Factoring in switches and restarts to other hormonal methods further boosted the prevalence rates of contraceptive use in the adolescent population.     

Condom practices of urban teens using Norplant contraceptive implants, oral contraceptives, and condoms for contraception

OBJECTIVES: The availability of long-acting hormonal birth control methods has created new contraceptive options for adolescents. The purpose of this study was to determine whether teens initiating these methods use condoms less frequently than teens using oral contraceptive pills or condoms alone and may therefore be at an increased risk of acquiring sexually transmitted infections. STUDY DESIGN: To investigate ongoing condom behavior in teens using levonorgestrel (Norplant) contraceptive implants, oral contraceptives, and condoms alone, we examined data from a 2-year prospective cohort study of 399 urban teens. The study consisted of 3 clinic-based cohorts of adolescent female contraceptive users: Norplant contraceptive implants (n = 200), oral contraceptives (n = 100), and condoms alone (n = 99). Data were collected at an admission interview and at 1- and 2-year follow-up from method continuers. RESULTS: Norplant contraceptive implant users were less likely than oral contraceptive or condom users to report condom use at last sex or consistent condom use at 1- and 2-year follow-up. The implant group showed a significant decrease in condom use from admission to 2 years after method initiation. The proportion of implant users self-reporting new sexually transmitted infections at 2-year follow-up, however, was not significantly greater than that of oral contraceptive or condom users. CONCLUSIONS: Our findings indicate that teen users of Norplant contraceptive implants are less likely to use condoms than teens who choose oral contraceptives but, probably because of differences in sexual behavior, are no more likely to self-report sexually transmitted infections. Our findings also indicate that teens who choose oral contraceptives and condoms do not use them consistently enough to avoid pregnancies or sexually transmitted infections.     

产后妇女避孕节育干预与效果评价

目的:评价在上海市静安区产后妇女中进行避孕节育干预对提高产后避孕率并降低产后意外妊娠的效果。方法:对居住在静安区的产后1年内已婚妇女进行避孕服务干预,并于干预前和干预后进行问卷调查。结果:干预后0~3个月、4~6个月、7~9个月和9个月以上各时段避孕率均显著高于干预前,尤其是在有性生活的产后妇女中,产后的前6个月累积避孕率从干预前的58.9%提高到干预后的97.6%。产后1年内意外妊娠发生率为1.4%,意外妊娠主要原因为未避孕和避孕套、安全期避孕失败。结论:产后定期避孕干预能有效提高产后1年内妇女的避孕率,降低产后妇女意外妊娠率。     

Impact of increased access to emergency contraceptive pills: a randomized controlled trial

OBJECTIVE: To assess how a strategy to maximize access to emergency contraceptive pills would affect rates of pregnancy and sexually transmitted infections. METHODS: Sexually active women, 14-24 years old, were randomly assigned to two methods of access to emergency contraceptive pills: increased access (two packages of pills dispensed in advance with unlimited resupply at no charge) or standard access (pills dispensed when needed at usual charges). Participants were followed for 1 year to assess incidence of pregnancy, gonorrhea, chlamydia, and trichomonas. RESULTS: The numbers of women enrolled in the increased and standard access groups were 746 and 744, respectively. More than 93% of participants completed a full year of follow-up. The incidence of pregnancy was similar in both groups (increased access group: 9.9/100 woman years, 95% confidence interval [CI] 7.7-12.6; standard access group: 10.5/100 woman years, 95% CI 8.2-13.2). Aggregate rates of gonorrhea, chlamydia, and trichomonas were also similar in the two groups (increased access group: 6.9/100 woman years, 95% CI 5.1-9.1; standard access group: 7.6/100 woman years, 95% CI 5.7-9.9). The increased access group used emergency contraceptive pills substantially more often and sooner after coitus than the standard access group. No other differences were noted between groups in self-reported measures of sexual behavior and contraceptive use. CONCLUSION: This intensive strategy to enhance access to emergency contraceptive pills substantially increased use of the method and had no adverse impact on risk of sexually transmitted infections. However, it did not show benefit in decreasing pregnancy rates. LEVEL OF EVIDENCE: II-1.     

Low-dose oral contraceptive usage and coagulation

A prospective investigation was initiated to assess the effect of a low-dose oral contraceptive containing 35 micrograms of ethinyl estradiol and 0.4 mg of norethindrone on blood coagulation and fibrinolysis. Twenty-four women were studied before, during, and after one year of treatment. Positive results included an accelerated activated partial thromboplastin time and an increase in fibrinolytic and anticoagulation factors as measured by alpha 1-antitrypsin antigen and plasminogen antigen and activity. Antithrombin III antigen was decreased but its activity was unaffected. There was no evidence of ongoing intravascular coagulation. No patient had a detectable thromboembolic event. In short, one year's usage of this low-dose oral contraceptive was not associated with a procoagulant hematologic profile.     

Hemostatic responses to maximal exercise in oral contraceptive users.

OBJECTIVE: This study examined the effect of exercise on markers of fibrinolysis and coagulation in users and nonusers of oral contraceptives. STUDY DESIGN: Fourteen oral contraceptive users and 14 nonusers performed a maximal exercise test on a cycle ergometer. Blood samples were collected before and immediately after the completion of the test. A repeated-measures analysis of variance was used for statistical analysis with values considered significant at P =.05. RESULTS: Acute maximal exercise resulted in significant increases in tissue plasminogen activator activity in both groups. There was a trend toward a smaller increase in tissue plasminogen activator activity in oral contraceptive users, but the difference between groups was not statistically significant. Plasminogen activator inhibitor 1 activity was reduced with exercise in both groups but with a significantly greater decrease observed in the nonusers (P <.0001). Prothrombin fragment 1+2 was significantly higher (P <.0001) in the oral contraceptive group but did not change with exercise. Epinephrine levels before and after exercise were similar between the 2 groups, but postexercise norepinephrine concentrations were significantly lower (P =.026) in the oral contraceptive users. CONCLUSION: These data suggest that oral contraceptive use blunts the fibrinolytic response to exercise. This, together with increased coagulation activation in oral contraceptive users, may alter the hemostatic balance during exercise.