高龄妊娠与妊娠期高血压疾病

1958年7月国际妇产科协会建议以35岁作为高龄妊娠的界限，我国及大多数国家均以此为标准。     

高龄孕妇合并妊娠期高血压疾病妊娠结局的临床分析

目的分析高龄孕妇合并妊娠期高血压疾病的临床特征,为改善其妊娠结局提供临床依据。 方法采用回顾性研究方法,收集和分析2018年1月至2018年12月在中山大学孙逸仙纪念医院住院分娩妊娠期高血压疾病71例患者的临床资料,其中年龄≥35周岁24例(高龄组),年龄<35周岁47例(对照组),比较两组患者发病孕周、入院孕周、分娩孕周、妊娠合并症或并发症、分娩孕周、新生儿出生体重、新生儿窒息、新生儿呼吸窘迫综合征发生情况;正态分布资料使用t检验,非正态分布资料,使用Mann-Whitney U法进行统计分析,计数资料采用χ²检验。 结果高龄组与对照组相比较,尿素(5.49±2.44)mmol/L vs (4.40±1.46)mmol/L, t＝－2.342)、入院孕周(34.86周vs 37.14周,t＝－2.095)、分娩孕周(36.07周vs 37.43周,t＝－2.564)、剖宫产率(70.83% vs 42.55%, χ²＝5.092)、顺产率(8.33% vs 46.81%, χ²＝10.510)、引产率(16.67% vs 2.13%, χ²＝5.130),差异有统计学意义(P<0.05)。两组新生儿体重(2 680 g vs 2 960 g, Z＝－1.876)、新生儿窒息率(8.33% vs 8.51%, χ²＝0.001)、新生儿呼吸窘迫综合征率(4.17% vs 14.89%, χ²＝0.913),差异无统计学意义(P>0.05)。 结论高龄患者合并妊娠期高血压疾病,与35岁以下孕妇发生妊娠期高血压疾病相比,临床特征为发病更早、肾脏功能损害更严重,终止妊娠孕周较早,早产率、剖宫产率升高,顺产率降低。对于高龄孕妇,应在妊娠过程中给予比普通孕妇更严密的母胎监测。     

妊娠一过性甲状腺功能亢进与妊娠剧吐相关性研究

目的:通过观察妊娠剧吐患者孕期血清甲状腺功能及血清β-h CG水平,探讨妊娠剧吐合并一过性甲状腺功能亢进与血清β-h CG水平的相关性。方法:选取2008年1月至2013年12月因妊娠剧吐于大连医科大学附属第一医院产科住院治疗的129例孕妇,测定血清甲状腺功能,其中65例患者同时行血清β-h CG检测。分析患者血清甲状腺功能情况与β-h CG水平情况及两者相关性。根据患者孕周,分为A(5~(+1)~9周)、B(9~(+1)~12周)、C(12~(+1)~17~(+5)周)3组,分析各组甲状腺激素水平及β-h CG水平。结果:(1)129例妊娠剧吐患者的血清TSH、FT4、FT3水平中位数分别为0.446μIU/ml、19.17pmol/L、34.99pmol/L。A、B、C组患者血清TSH中位数为0.717μIU/ml、0.293μIU/ml和0.315μIU/ml;A组的血清TSH水平明显大于B、C组(P=0.043),但后两组间差异无统计学意义(P=0.086)。A、B、C组患者的血清β-h CG均数分别为(82465.56±45800.90)IU/L、(109338.00±52879.90)IU/L和(121179.67±43666.69)IU/L,3组间差异无统计学意义。(2)血清β-h CG与TSH两者之间存在显著负相关(r=-0.37,P0.01);β-h CG与FT4之间存在显著正相关(r=0.404,P0.01)。当妊娠剧吐患者血清β-h CG水平小于80000IU/L时,10.3%患者的血清TSH受到抑制;β-h CG为80 000~120 000IU/L时,47.4%血清TSH受到抑制;β-h CG大于120 000IU/L时,76.5%血清TSH受到抑制;差异有统计学意义(P=0.001)。结论:妊娠剧吐患者的血清β-h CG和TSH水平呈显著负相关,血清β-h CG和FT4水平呈显著正相关,当β-h CG水平大于120 000IU/L时,76.5%患者出现TSH水平抑制。     

顽固性妊娠剧吐致代谢紊乱治愈一例

<正>妊娠剧吐(hyperemesis gravidarum,HG)指孕妇严重频繁恶心、呕吐,不能进食,体质量减轻超过5%,排除其他疾病引发的呕吐,并导致体液失衡及新陈代谢障碍,需住院输液治疗。目前,尚无任何单一理论可以解释HG的确切发病机制。临床治疗原则以止吐、补液、纠正电解质紊乱和恢复酸碱平衡为主,绝大多数患者经治疗数天后病情很快好转,极少数患者病情长期反复,需肠外营养支持治疗数月之久。     

不同年龄妊娠期高血压疾病患者的围生期结局

目的比较不同年龄妊娠期高血压疾病（HDCP）患者的围生期结局。方法对173例HDCP患者的临床资料进行回顾性分析,比较不同年龄组患者的妊娠并发症发生情况。结果①≥35岁组HDCP发病率为12.69%（92/725）,占同期HDCP的53.18%（92/173）,20～34岁组HDCP发病率为5.42%（81/1 494）,占同期HDCP的46.82%（81/173）,两组比较,差异有统计学意义（P〈0.05）;②≥35岁组早产率为16.30%（15/92）,胎儿生长受限（FGR）为11.96%（11/92）,产后出血为10.87%（10/92）,新生儿窒息为10.87%（10/92）,胎盘早剥为4.35%（4/92）;20～34岁组分别为6.17%（5/81）、11.11%（9/81）、7.41%（6/81）、6.17%（5/81）和2.47%（2/81）,两组早产发生率比较,差异有统计学意义（P〈0.05）;其他指标比较,差异无统计学意义（P〉0.05）;③≥35岁组和20～34岁组不同程度HDCP发生率比较,差异有统计学意义（P〈0.05）。结论≥35岁高龄患者轻度、重度子痫期及早产所占比例高于20～34岁患者,应加强围生期管理。     

妊娠剧吐44例血气分析

妊娠剧吐４４例血气分析中国医科大学第二临床学院妇产科（１１０００３）王丹波陆景明马晓欣沈阳市红十字会医院妇产科（１１００１３）宾红妊娠剧吐，常继发电解质紊乱，酸碱平衡失调。许多临床医生忽视综合分析酸碱失衡类型，病人不能及时得到满意治疗。本文回顾性总结...     

妊娠期高血压疾病终止妊娠指征

妊娠期高血压疾病惟一治愈方式即终止妊娠。文章从孕周、母体并发症和胎儿情况等方面,讨论妊娠期高血压疾病终止妊娠的指征。在近足月的轻度子痫前期和妊娠期高血压患者,宫颈和胎儿条件允许时,可以通过引产终止妊娠。     

妊娠剧吐并发Wernicke脑病2例

病例1：患者25岁，因停经2个月，食欲不振，恶心20天，于1998年10月6日以“妊娠剧吐”收入院。既往月经规律，末次月经1998年8月2日，停经40天感食欲不振，查尿妊娠试验阳性。近10天恶心、呕吐频繁，不能进食，在家输液治疗5天无效来我院就     

中、美、加、英妊娠期恶心呕吐及妊娠剧吐诊治指南的解读

恶心呕吐是妊娠早期的常见症状,其中妊娠剧吐是最严重的阶段。因担心药物对胚胎的潜在影响,选择治疗方案时常因过于保守,从而给孕妇的生活质量及生命安全等带来一定的影响。此外,由于受认识程度等因素的影响,该病的及时就诊率及用药率较低。本文拟通过对中国、美国、加拿大及英国四国最新妊娠期恶心呕吐及妊娠剧吐诊治指南(共识)的对比,为临床医师们对妊娠期恶心呕吐及妊娠剧吐的规范化诊治提供参考。     

妊娠剧吐并发Wernicke脑病三例报告

妊娠剧吐并发Ｗｅｒｎｉｃｋｅ脑病临床上较为罕见。由于临床医师对本病认识的不足 ,确诊率相对较低[1] ,加之处理不够及时 ,往往致患者预后不良。现将我院收治的 3例妊娠并发Ｗｅｒｎｉｃｋｅ脑病患者的诊治情况报道如下。一、病例介绍例 1　 36岁 ,孕 1产 0 ,末次月经 1985年 2月 2 1日 ,停经40ｄ开始呕吐 ,不能进食 ,尿酮体 ( ) ,于 1985年 4月 17日急诊入院。经补液、镇静治疗仍呕吐频繁 ,尿酮体 ( )。1985年 5月 7日出现烦躁、头痛头晕、谵语等神经精神症状。1985年 5月 15日突然出现高热休克 ,次日发现胎死宫内。给予静脉输注…     

Tuberculous meningitis in pregnancy presenting as hyperemesis gravidarum

Objective. Optimal management of isolated oligohydramnios (IO) remains debatable. We surveyed Society for Maternal–Fetal Medicine (SMFM) members regarding their opinions and practice patterns.

Study Design. Questionnaires were mailed to perinatologists across the US. IO was defined as sonographic low fluid (per the practitioner's definition) in the absence of intrauterine growth restriction, fetal anomaly or significant maternal comorbidity.

Results. The overall response rate was 35% (n = 632). Ninety-two percent of respondents consider IO to be a risk factor for various adverse outcomes. With a favourable cervix, 34% and 82% would consider inducing labour without documented lung maturity prior to 37 and 39 weeks, respectively. When asked whether induction of labour in cases of IO reduces perinatal morbidity, 45% were unsure and 21.4% thought it would not. Only 33% believe induction could decrease adverse outcomes. Newer members of SMFM (<10 years) and those of private practice were more likely to believe that induction is efficacious in decreasing morbidity.

Conclusion. There is significant divergence regarding the management of IO. Despite being unsure of its benefit, most practitioners lean towards intervention. The available literature is insufficient to make firm recommendations supporting intervention for IO.     

Relationship between Helicobacter pylori seropositivity and hyperemesis gravidarum with the use of questionnaire

AIM: The aim of the present study was to investigate the relationship between Helicobacter pylori (HP) infection and Hyperemesis gravidarum (HG) by using a questionnaire. METHODS: Twenty-five pregnant women with HG and 85 asymptomatic pregnant women (aged 14-40) of matching gestational age were enrolled between October 2004 and January 2006. Anti-HP immunoglobin G (IgG) serum antibody was tested to establish seropositivity. In our study we used a multi variable questionnaire (name, age, gravida, number of vomits daily etc.). The results were analyzed using chi squared and Mann-Whitney U- test. RESULTS: The prevalence of HP infection was 56% (14 of 25) among patients with Hyperemesis gravidarum and 48.2% (41 of 85) among control subjects (P>0.05, chi squared test). In the same study the HP seropositivity is not related to age of the woman (50%, 55 of 110 were HP positive, P>0.05 chi squared test) but there was a significantly association between number of deliveries and HP seropositivity (primigravida [+] 34.2% versus 65.8%, multigravida [+] 6.1% versus 38.9%, P<0.05 chi squared test). The history for gastrointestinal problems of the tested women and their husbands is not related to HP seropositivity(38.1% positive for HP and with gastrointestinal disorders she/he or both versus 61.8% positive and without problems both, P>0.05, Mann-Whitney U- test). Finally there was no relativity between the number of vomits daily and the HP seropositivity (48.2% with HP [+] and 0-3 vomits daily versus 56% with HP [+] and 4-8 vomits daily, P>0.05 chi squared). CONCLUSIONS: Our findings do not support any direct correlation between HP seropositivity and Hyperemesis gravidarum, number of vomits daily, age of woman, history for gastrointestinal problems but only with the number of deliveries.     

Posttraumatic stress symptoms following pregnancy complicated by hyperemesis gravidarum

Abstract

Objective.?Hyperemesis gravidarum (HG) can be accompanied by severe physical and emotional distress. Most studies have focused on the physical and psychological stress associated with this condition during the affected pregnancy. This study explores posttraumatic stress symptoms (PTSS) and negative life outcomes following HG pregnancies.

Methods.?A total of 610 women (HG?=?377 and control?=?233) were recruited and completed an online survey. χ-square analyses were used to compare the HG and control groups on various life outcome variables.

Results.?Eighteen percent of women with HG reported full criteria PTSS (n?=?68). Negative life outcomes regarding financial and marital status, career, as well as psychological and physical well-being differed significantly for the HG groups compared to the control group (0.001?<?p?<?0.05).

Conclusions.?PTSS is common following HG pregnancies and is associated with negative life outcomes including inability to breastfeed, marital problems, financial problems, and inability of self care.     

Treatment of hyperemesis gravidarum

Hyperemesis gravidarum, or pernicious vomiting of pregnancy, is a complication of pregnancy that affects various areas of the woman's health, including homeostasis, electrolytes, and kidney function, and may have adverse fetal consequences. Recent research now provides additional guidelines for protection against and relief from hyperemesis gravidarum. Alterations to maternal diet and lifestyle can have protective effects. Medicinal methods of prevention and treatment include nutritional supplements and alternative methods, such as hypnosis and acupuncture, as well as pharmacotherapy.