瘢痕子宫孕妇孕中晚期引产的方法探讨

目的 探讨瘢痕子宫孕妇孕中晚期引产的适宜方法.方法 选择2002年9月-2009年6月在首都医科大学附属北京妇产医院因医疗指征于孕中晚期引产的瘢痕子宫孕妇共90例,引产指征为胎儿畸形、严重妊娠并发症、胎死宫内.其中,孕中期72例,孕晚期18例;距离前次子宫手术的间隔时间<2年20例,≥2年70例.肝功能正常者服用米非司酮,并行利凡诺过敏试验,阴性者首选利凡诺羊膜腔注射引产法;试验阳性、羊水过少、孕周过小、利凡诺羊膜腔注射困难或注射失败者采用卡前列甲酯(卡孕栓)引产法.共有54例孕妇采用利凡诺引产(利凡诺组),36例孕妇采用卡孕栓引产(卡孕栓组).(1)记录两组孕妇入院时情况,包括年龄、孕周、孕次、产次;(2)前次导致子宫瘢痕的手术种类、手术方法、有无并发症、前次手术间隔时间;(3)此次妊娠的引产方法,并记录孕妇用药至宫缩发动的时间,用药至胎儿娩出的时间;(4)产后出血量,胎盘滞留率,引产成功率,有无子宫破裂及行全子宫切除术等情况.结果 (1)利凡诺组与卡孕栓组孕妇的年龄、孕次、产次、距前次子宫手术间隔时间比较,差异均无统计学意义(P>0.05).但两组孕妇的引产孕周比较,差异有统计学意义(P<0.01).(2)两组孕妇引产的成功率及产后出血量比较,差异无统计学意义(P>0.05),但卡孕栓组孕妇引产用药后宫缩发动的时间及分娩时间明显短于利凡诺组,两组比较,差异有统计学意义(P<0.01);卡孕栓组孕妇24 h内分娩率达到94%(34/36),明显高于利凡诺组的13%(7/54),两组分别比较,差异均有统计学意义(P<0.01).(3)卡孕栓组孕妇胎盘滞留率(31%,11/35)明显高于利凡诺组(10%,5/52);而利凡诺组胎盘胎膜残留率(54%,28/52)明显高于卡孕栓组(34%,12/35),两组分别比较,差异均有统计学意义(P<0.01).但两组孕妇总的产时并发症发生率比较,差异无统计学意义(P>0.05).不良事件发生与前次子宫手术间隔时间的关系分析显示,<2年的孕妇在胎盘滞留、胎盘胎膜残留、胎盘早剥、子宫破裂、产后出血的发生率分别与≥2年的孕妇比较,差异均无统计学意义(P>0.05).(4)卡孕栓组孕妇中有1例发生子宫破裂,利凡诺组孕妇中有1例宫缩发动1 h后发生胎盘早剥.结论 对瘢痕子宫孕妇于孕中晚期应用利凡诺羊膜腔注射引产和卡孕栓阴道用药引产均是可行的,但需在充分的术前准备及严密监护下进行,以警惕子宫破裂的发生.     

Intrauterine hematomas in the second and third trimesters associated with adverse pregnancy outcomes: a retrospective study

Objective: To carry out a retrospective study of the clinical features of patients with intrauterine hematoma in the second and third trimesters, and discuss the risk factors for poor pregnancy outcomes.

Methods: A total of 398 patients who underwent routine examination in our hospital from January 2011 to December 2015 were classified into normal pregnancy (NP) group (N?=?265) and adverse pregnancy (AP) group (N?=?133), according to their pregnancy outcomes. Maternal clinical demographics, gestational age, location of hematoma, volume of hematoma, and accompanying contraction and vaginal bleeding were recorded.

Results: The average age of pregnant women in the NP and AP groups was 28.25?±?4.06 and 29.5?±?5.06 years, respectively (p?=?0.007). Gestational age at first detection of hematoma was 15.11?±?5.13 weeks in the NP group compared with 21.22?±?8.25 weeks in the AP group (p?p?Conclusion: Intrauterine hematoma in the second and third trimesters is a sign of pathological pregnancy, resulting in adverse outcomes. Maternal age, gestational age at first diagnosis, location of hematoma and accompanying contraction are risk factors for poor pregnancy outcomes.     

4D ultrasound study of fetal facial expressions in the third trimester of pregnancy

Objective: To evaluate the frequencies of fetal facial expressions in the third trimester of pregnancy, when fetal brain maturation and development are progressing in normal healthy fetuses.

Methods: Four-dimensional (4?D) ultrasound was used to examine the facial expressions of 111 healthy fetuses between 30 and 40?weeks of gestation. The frequencies of seven facial expressions (mouthing, yawning, smiling, tongue expulsion, scowling, sucking, and blinking) during 15-minute recordings were assessed. The fetuses were further divided into three gestational age groups (25 fetuses at 30–31?weeks, 43 at 32–35?weeks, and 43 at ≥36?weeks). Comparison of facial expressions among the three gestational age groups was performed to determine their changes with advancing gestation.

Results: Mouthing was the most frequent facial expression at 30–40?weeks of gestation, followed by blinking. Both facial expressions were significantly more frequent than the other expressions (p?p?=?.031). Other facial expressions did not change between 30 and 40?weeks. The frequency of yawning at 30–31?weeks was significantly higher than that at 36–40?weeks (p?Conclusions: Our results suggest that 4D ultrasound assessment of fetal facial expressions may be a useful modality for evaluating fetal brain maturation and development. The decreasing frequency of fetal yawning after 30?weeks of gestation may explain the emergence of distinct states of arousal.     

Three-dimensional versus two-dimensional ultrasound for fetal nasal bone evaluation in the second trimester

Objectives: To compare two-dimensional with three-dimensional ultrasound evaluation of the fetal nasal bone in the second trimester.

Methods: A prospective, non-interventional study was conducted, in 55 singleton fetuses, between 18 and 24 weeks’ gestation. Fetal nasal bone length was measured in the midsagittal plane by two-dimensional imaging and in the midsagittal and coronal plane with three-dimensional ultrasound. All three measurements were compared with one another using one-way repeated samples-measures ANOVA and paired samples t-test.

Results: The average fetal nasal bone length (mean?±?SD) as determined by the three methods was 7.01?±?0.94?mm for the two-dimensional midsagittal, 6.96?±?1.34?mm for the three-dimensional midsagittal, and 6.98?±?1.32?mm for the three-dimensional coronal plane; comparisons between one another were not statistically significant. Unilateral hypoplasia and bifid shape of the fetal nasal bone were detected in 8.2% and 20.4% of cases, respectively, by three-dimensional ultrasound, whereas all cases evaded detection with two-dimensional ultrasound (p?<?0.001 and p?=?0.001, respectively).

Conclusions: Fetal nasal bone length measured with two-dimensional ultrasound does not differ significantly from three-dimensional measurements. However, three-dimensional ultrasound is superior in detecting unilateral nasal bone hypoplasia or absence and in assessing fetal nasal bone shape. Hence, fetal nasal bone examination in the second trimester should include three-dimensional ultrasound evaluation.     

Effect of second trimester and third trimester weight gain on immediate outcomes in neonates born to mothers with gestational diabetes: a retrospective observational study from India

Abstract

Aim: To evaluate the effect of second trimester and third trimester rate of weight gain on immediate outcomes in neonates born to mothers with Gestational Diabetes Mellitus (GDM).

Method and material: This retrospective observational study enrolled 593 eligible mothers. The records of all pregnant women booked before 24?weeks and screened for diabetes were eligible if they were diagnosed with Gestational Diabetes Mellitus (GDM) anytime during pregnancy. All the necessary maternal and neonatal details were collected from hospital database. The rate of weight gain was calculated at 18–24?weeks, 28–30?weeks, and that before delivery. The enrolled women were categorized into: poor weight gain, normal weight gain, and increased weight.

Results and discussion: The mean birth weight, length, and head circumference of neonates were significantly lower in women who had poor rate of weight gain in comparison with normal weight gain group. The mean prepregnancy BMI was significantly high in women with increased rate of weight gain when compared to normal weight gain women in second and third trimester. Regression analysis done to evaluate the independent effect of weight gain on C section and neonatal complications, showed that the independent predictors for cesarean section were previous cesarean section or 12.5 (95% CI 6.7–23) and conception by assisted reproductive technologies or 1.75 (95% CI 1.01–4.3), and the neonatal complications were influenced by birth weight or 1.5 (95% CI 1.1–2.2) and weight gain during second trimester or 1.26 (95% CI 1–1.6).

Conclusion: In women with GDM, reduced weight gain during pregnancy is associated with small for gestational age neonates. Caesarean section is predicted by previous C-section, and mode of conception whereas neonatal complications were predicted by birth weight and maternal weight gain during second trimester.     

妊娠晚期HPV潜伏感染对妊娠结局的影响

目的:探讨妊娠晚期HPV潜伏感染是否改变了阴道内酸性环境及阴道菌群,进而对妊娠结局产生不良影响;了解妊娠晚期HPV潜伏感染的高危因素。方法:选取我院产检的孕妇312例,孕28～30周。进行问卷调查,取阴道分泌物及宫颈分泌物检测滴虫、念珠菌性阴道炎、细菌性阴道病及HPV;检测阴道pH值,按照HPV DNA是否阳性分研究组与对照组,追踪孕妇不良妊娠结局的发生情况。结果:妊娠晚期HPV DNA阳性发生率45.51%(142/312),感染高危型23.08%(72/312),低危型16.67%(52/312),高危型与低危型混合感染18例,发生率5.77%(18/312);妊娠合并念珠菌性阴道炎患病率15.06%(47/312);妊娠合并滴虫性阴道炎患病率1.28%(4/312);妊娠合并细菌性阴道病患病率29.81%(93/312)。研究组孕妇阴道pH值明显高于对照组,差异有显著性(P<0.05);研究组与对照组细菌性阴道病发生率有显著差异(P<0.05);而两组间念珠菌性阴道炎、滴虫性阴道炎的发生率无显著差异(P>0.05);妊娠晚期HPV潜伏感染与低文化水平、吸烟因素及首次性生活年龄小有关(P<0.05);研究组与对照组间分娩方式相似。结论:妊娠晚期HPV潜伏感染与阴道内酸性环境改变相关,增加了妊娠合并细菌性阴道病的发生率且可增加胎膜早破发生。对围生期妇女行生殖道感染筛查,尤其是HPV、BV检测很有必要。     

中晚期妊娠胎盘植入患者的临床分析

目的 探讨中晚期妊娠发生胎盘植入的高危因素、诊断和治疗方法.方法 对北京协和医院1997年5月至2007年5月收治的中晚期妊娠发生胎盘植入的47例患者的临床资料进行回顾性分析.结果 (1)发生率:北京协和医院1997年5月至2007年5月的10年间,胎盘植入的总发生率为0.262%(47/17 918).(2)高危因素:有子宫手术史者占81%(38/47),本次妊娠合并前置胎盘者占30%(14/47),合并子宫肌瘤者占11%(5/47),有产后出血史者占11%(5/47).(3)诊断:47例胎盘植入患者中,发生在中孕期17例,其中产后B超确诊胎盘植入12例,临床确诊5例;发生在晚孕期30例,其中病理确诊8例,产后B超确诊2例,临床确诊20例.(4)治疗:中孕期患者刮宫术治疗有效率为43%(6/14),子宫动脉栓塞术治疗有效率为100%(11/11);晚孕期患者刮宫术治疗有效率为21%(6/29),宫腔纱布填塞术治疗有效率为87%(13/15),子宫动脉栓塞术治疗有效率为4/4.结论 胎盘植入发生的高危因素主要有子宫手术史,其次是前置胎盘、合并子宫肌瘤及产后出血史;胎盘植入的诊断以临床诊断为主,B超对产后诊断有重要价值;子宫动脉栓塞术是治疗胎盘植入的一种行之有效的方法.     

Psychosocial correlates of depression symptoms during the third trimester of pregnancy

OBJECTIVE: To explore the psychosocial correlates of depression symptoms during the third trimester of pregnancy. DESIGN: Cross-sectional design guided by Selye's theory of stress. SETTING: Prenatal care provider offices or mutually agreeable locations in the Pacific Northwest. PARTICIPANTS: One hundred thirty-nine women in their third trimester of pregnancy. The majority was Caucasian and married. Fifty-two of the participants (38%) had scores greater than or equal to 16 on the Centers for Epidemiologic Studies Depressed Mood Scale. MAIN OUTCOME MEASURE: The Centers for Epidemiologic Studies Depressed Mood Scale. RESULTS: Stepwise linear regression indicated that 46% of the variance of third-trimester depressive symptoms was due to brief and intermittent negative mood states that occurred primarily during the first trimester, a lack of marital satisfaction and social support, and gravida. Lifetime abuse did not contribute significantly to third-trimester depression symptoms. CONCLUSIONS: One third of the sample reported subclinical levels of depression symptoms. Prenatal care providers may want to consider these minor and brief mood changes as predictive of depression symptoms later in pregnancy, particularly when experienced during the first trimester.     

Effects of a prolonged, 72 hours,interval between mifepristone and gemeprost in second trimester termination of pregnancy: a retrospective analysis

Objective: To evaluate if the 72 hours interval between mifepristone and gemeprost has a similar efficacy compared to the 48 hours interval for second trimester termination of pregnancy

Study Design: Two-hundred and fifteen consecutive pregnant women, admitted to our hospital, for second trimester TOP, were included in this retrospective analysis. Standard protocol was followed for all patients. On the first day of the procedure oral mifepristone 200?mg was administered. After 72 (group A, n?=?78) or 48 hours (group B, n?=?113) women were admitted for administration of gemeprost 1?mg pessary as per protocol. The induction to abortion time was defined as the interval between the insertion of the first gemeprost pessary and the expulsion of the fetus.

Results: There are no significant differences in the number of pessaries in the two groups. The induction to abortion interval was longer in group A than in group B. Twenty-one women required surgical evacuation of the uterus for retained placenta or incomplete abortion without difference between groups.

Conclusion: A 48-hours interval between mifepristone and gemeprost leads to better results than a 72-hours interval, with a shorter abortion length and represents the elective method for second trimester TOP.     

The predictive nature of uterocervical angles in the termination of second trimester pregnancy

Aim: To establish how useful and the predictive capacity of uterocervical angles (UCA) in the termination of second trimester pregnancies.

Material and methods: This prospective cohort study was conducted at a tertiary center with a total of 120 singleton pregnancies delivered between 14 and 24 gestational weeks. Before the beginning of misoprostol induction, patients were screened for both cervical length (CL) and uterocervical angles (UCA). The UCA is defined as an angle constructed by the measurement of the cervical canal and lower uterine segment. The study population was subdivided into four groups; successful and failed terminations at the end of 24?hours of induction and successful and failed terminations at the end of 48?hours of induction. We decided to further evaluate our study population based on their UCAs, and placed them into four categories; UCA ≥95°, UCA <95°, UCA ≥105°, and UCA <105°.

Results: In the 24-hour time frame group, the mean UCA was 105.50?±?15.38 degrees in the successful termination group and was 100.22?±?11.12 degrees in the failed group (p?=?.001). In the 48-hour time frame group, the mean UCA was 104.19?±?13.51° in the successful termination group and was 93.52?±?7.84° in the failed group (p?=?.007). The mean hour of induction was shortest in the UCA ≥105° group.

Conclusions: Regardless of the time frames, patients who had successful terminations had a broader angle, less amount of misoprostol use and shorter duration of induction as compared to the failed termination groups. What do the results of this study add? The uterocervical angle has never been measured in second trimester pregnancies to predict the timing of termination. Our study demonstrated the useful application of this ultrasonographic finding in the prediction of successful second trimester terminations.

Trial registration: ClinicalTrials.gov identifier: NCT03220607.     

多胎妊娠妇女孕中期选择性减胎术的临床应用

目的 通过对多胎妊娠妇女于孕中期行选择性减胎术,研究其手术指症、时机、安全性、目标胎儿的选择标准和减灭胎儿数,探讨选择性减胎术在改善多胎妊娠结局中的作用.方法 对37例孕12周+1～25周多胎妊娠孕妇(6例双胎、21例三胎、8例四胎、2例五胎,共117个胎儿)在超声引导下经腹行选择性减胎术,按产科医疗指征,在拟被减的46个胎儿心脏内注射10%氯化钾2～5 ml,见胎心逐渐减慢至停跳视为减胎术成功.术后定期产前检查和监测凝血功能,记录妊娠期并发症及妊娠结局.结果 (1)成功率:共减去胎儿46个,减胎成功率为100%(46/46个胎儿),已有27例孕妇分娩,获24个健康新生儿,妊娠成功率为88.9%(24/27).(2)分娩孕周:＞36周分娩者15例;32～36周7例;28～32周3例;＜28周流产者2例;正在妊娠中10例.平均分娩孕周(34.9±4.1)周,孕28周后分娩率为92.6%(25/27).(3)新生儿平均出生体重:单胎妊娠新生儿平均出生体重为(3014±640)g,双胎妊娠为(2557±573)g,三胎妊娠中除1例两个胎儿存活(出生体重分别为1400及1500 g)外,其余均死亡.(4)安全性:除2例单羊膜囊双胎在减灭1个胎儿后,另1个胎儿随即死亡外,其余多胎妊娠妇女的保留胎儿均未发生胎死宫内.(5)并发症:37例多胎妊娠妇女中仅3例发生子痫前期,减胎术后均无凝血功能障碍发生.(6)阴道流血:有13例孕妇减胎术前发生阴道流血,其中1例在妊娠13周强烈要求减胎,减胎术后于孕22周流产;另12例均在阴道流血停止1周以上后施行减胎.结论 (1)孕中期选择性多胎妊娠减胎术,可以有效减少多胎妊娠胎儿数目、避免异常胎儿出生,降低孕产妇并发症,提高新生儿出生体重.(2)胎儿保留数目以达双胎为好.(3)减胎术前有阴道流血者,避免在流血期间减胎,应选择在流血停止1周以上进行.(4)孕中期多胎妊娠减胎术不会造成孕妇的凝血功能障碍,也不会造成保留胎儿的宫内死亡,安全性好;减胎术后子痫前期的发病率明显下降.     

Mifepristone and misoprostol versus Dilapan and sulprostone for second trimester termination of pregnancy

Objective. To compare two methods for second trimester termination of pregnancy: mifepristone and misoprostol versus Dilapan® and sulprostone.

Methods. This was a randomized study involving 16 patients with a singleton live fetus with congenital malformations or genetic disorders. Eight patients were treated with 200 mg mifepristone orally followed by 200 μg misoprostol vaginally 3 hourly and eight patients received a sulprostone infusion after cervical dilatation with Dilapan.

Results. Mifepristone and misoprostol had a mean induction interval of 17.8 hours and sulprostone and Dilapan 20.9 hours. The mean induction interval did not differ significantly. Mean hospital stay was shorter in the patients treated with misoprostol: 2.1 vs. 3.3 days (p = 0.02) with a 95% confidence interval of ?2.1 to 0.3.

Conclusion. Mifepristone and misoprostol did not reduce the induction interval significantly compared to the sulprostone and Dilapan treatment for second trimester pregnancy termination. Hospital admission was significantly shorter in patients treated with mifepristone and misoprostol.     

孕晚期羊水细胞的荧光原位杂交

目的前瞻性研究孕28周以后羊水细胞的荧光原位杂交。方法采用盲法，对孕28周后需进行产前诊断的32例孕妇在取脐带血的同时抽吸5ml羊水进行荧光原位杂交。结果32例孕妇发现染色体数目异常6例（18三体3例，21三体2例，47XYY1例）。且羊水细胞荧光原位杂交结果与脐带血染色体核型分析的结果一致，符合率达100％。结论孕28周后羊水细胞荧光原位杂交，对常见的染色体数目异常诊断准确性高，有一定的临床推广价值。     

孕晚期介入性产前诊断的指征和妊娠结局

目的:探讨孕晚期介入性产前诊断的指征及妊娠结局。方法:回顾性分析2016年1月至2020年12月于解放军总医院第一医学中心行孕晚期介入性产前诊断的共121例病例的临床资料。根据产前诊断指征的不同采用不同遗传学诊断方法。对孕晚期介入性产前诊断的指征、结果、术后2周内并发症发生情况、妊娠结局以及新生儿随访情况进行描述性统计...     

妊娠晚期妇女性现状研究

目的　了解妊娠晚期妇女性行为现状并分析其影响因素。　方法　2003 年 6 月至 8月期间对在北京大学第一医院产科分娩的338例产妇,运用自行设计的《妊娠期妇女性现状调查表》,于产后2~4 d在专人指导下进行回顾性调查。　结果　28.4%的产妇在晚孕期有性行为,性行为次数的增加与缺乏妊娠期性知识(Waldχ2 = 12 10, P< 0. 01)、配偶文化程度(Waldχ2 = 9 68,P<0.01)呈正相关,与产妇本人文化程度(Waldχ2 =11 77,P<0.01)、既往妊娠次数(Waldχ2 =6 05,P<0.05)、主观认为妊娠期不可以性交(Waldχ2 =9 59,P<0.05)及性欲下降(Waldχ2 =5 50,P<0.05)呈负相关。分娩孕周与晚孕期性行为呈正相关(P<0.05)。　结论　妊娠晚期妇女仍有性要求,性行为不增加早产的发生。     

Detailed fetal anatomy assessment in the first trimester at 11, 12 and 13 weeks of gestation

Objective: The aim of the present observational study was to evaluate the feasibility of a morphological scan and determine the detection rate of fetal organs, structures and systems in the first trimester of pregnancy. Methods: 977 single pregnant women attending our Fetal Medicine Section to undergo first trimester screening for aneuploidies were enrolled and divided into three groups depending on gestational age and crown-rump-length measurement. Scans targeted on a total of 26 fetal anatomical structures were performed by a single operator. Results: The overall detection rate was 96% at 11 weeks and reached 100% at 12 and 13 weeks, with a significant statistical difference between 11 and 12/13 weeks for the majority of the investigated fetal anatomical structures. Conclusions: Evaluation of most part of the fetal anatomical structures is feasible with high accuracy in the first trimester. Visualization of the majority of the targeted fetal organs improves from 11 to 13 weeks.     

Mifepristone and second trimester pregnancy termination for fetal abnormality in Western Australia: Worth the effort

Objective:  To determine the impact on the process of second trimester medical termination for fetal abnormality following the introduction of adjunctive mifepristone in an Australian tertiary hospital.
Methods:  All second trimester medical terminations for fetal abnormality between July 2006 and June 2009 were prospectively identified. Two temporal therapeutic cohorts were created: the first (1 July 2006 to 31 December 2007) using vaginal misoprostol alone and the second (1 January 2008 to 30 June 2009) using mifepristone priming prior to the administration of misoprostol. The primary outcome was to evaluate the impact of mifepristone priming upon the duration of pregnancy termination.
Results:  During the study period, 388 women with prenatally recognised fetal anomalies between 14 and 24 weeks gestation underwent medical termination: 189 with misoprostol alone and 199 with mifepristone priming followed by misoprostol. There was no difference between the groups for maternal age, parity or prior caesarean delivery. The median abortion duration was 15.5 h (interquartile ranges (IQR) 11.2–22.7) in the misoprostol group and 8.6 h (IQR 5.6–13.8) in the mifepristone primed group ( P  < 0.001). In both the groups, nulliparity and advancing gestation were associated with a significant prolongation of the abortion interval. Duration of hospitalisation was significantly longer in the misoprostol alone group (31.5 h (27–48.9) vs 27.2 h (22–31.5), misoprostol vs mifepristone priming, respectively, P  < 0.001).
Conclusions:  The introduction of mifepristone priming prior to second trimester medical termination with misoprostol has resulted in a significant reduction in the duration of the termination procedure and length of inpatient stay. These observed benefits of mifepristone provide objective support for the decision to permit use of this medication in Australia.     

妊娠晚期超声检查异常再次行葡萄糖耐量试验结果分析

目的分析妊娠晚期因超声检查异常行75g葡萄糖耐量试验(OGTT)的结果及影响妊娠期糖尿病(GDM)诊断的因素。方法选择2010年9月至2011年1月间北京大学人民医院产科门诊,妊娠中期常规GDM筛查和诊断试验阴性,晚期因超声提示羊水过多和(或)胎儿大再次行75gOGTT的孕妇116例为研究对象,分为GDM组和非GDM组,对可能影响GDM诊断的因素进行统计学分析。结果诊断GDM19例(16.4%)。单因素分析提示年龄>30岁及常规筛查或诊断试验孕周<24周的孕妇GDM诊断阳性率高于年龄≤30岁和常规筛查或诊断试验孕周≥24周的孕妇(P<0.05)。多因素分析提示相对于年龄≤30岁的孕妇,>30岁的孕妇患GDM的OR>30(P<0.05);相对于超声检查时体质指数(BMI)较孕前增幅<4的孕妇,增幅>6的孕妇患GDM的OR=0.08(P<0.05),但增幅>6的孕妇超声检查孕周晚于增幅<4的孕妇(P<0.01)。结论对于妊娠中期常规筛查或诊断试验阴性的孕妇来说,妊娠晚期超声检查提示羊水过多和(或)胎儿大时,年龄>30岁的孕妇患GDM的可能性增加,超声检查时BMI较孕前增幅>6的孕妇可能性减少,但须考虑孕周的影响。     

Comparison of intravaginal misoprostol and intracervical Foley catheter alone or in combination for termination of second trimester pregnancy

Objectives: To examine the effectiveness, safety and acceptability of intravaginal misoprostol and intracervical Foley catheter alone or in combination for termination of second trimester pregnancy.

Methods: This clinical study was conducted on 90 pregnant patients intended for termination of pregnancy between 13 and 24 gestational weeks for any indication. Enrolled women are equally allocated into three groups:

??Group I (Misoprostol group): a standard regimen of moistened misoprostol (400?μg) 4 hourly inserted vaginally.

??Group II (Catheter group): intracervical Foley catheter inserted, inflated and placed on traction.

??Group III (Combined group): intracervical Foley catheter inserted with a standard regimen of moistened misoprostol (400?μg) 4 hourly intravaginally was used.

Procedure efficacy (defined as complete abortion performed on site), safety and acceptability were assessed.

Results: The induction to abortion interval was 7.5?±?1.25?h in the combined group, compared to 11.76?±?1.63?h in the misoprostol group and 19.76?±?1.52?h in the catheter group (p value?Conclusions: The present results confirmed the high success rate with the shortest induction to abortion interval with a combined use of intracervical Foley catheter and misoprostol for termination of second trimester pregnancy.