妊娠期高浓度血红蛋白对妊娠结局的影响

妊娠期母体血液系统发生一系列生理变化以适应胎儿生长发育,血液总容量增加并有一定程度的血液稀释。如果妊娠期血液不能有效稀释,血红蛋白浓度过高,会引起血液黏度增加,全身血液循环不能适应子宫-胎盘血流的需要。其结果可能导致子宫-胎盘血流量减少、减慢,而引起子宫胎盘缺血缺氧、血管痉挛、血压升高等,而发生妊娠期高血压疾病、小于胎龄儿、早产、低出生体质量、妊娠期糖尿病、死产等。综述妊娠期高浓度血红蛋白对不良妊娠结局的影响, 以引起对妊娠期高浓度血红蛋白的重视。     

缺血性胎盘起源母体远期疾病——综述与思考：妊娠期高血压疾病与母体远期疾病研究结果

妊娠期高血压疾病（hypertensive disorders complicating pregnancy）、（胎盘相关性）胎儿生长受限（fetal growth restriction,FGR）是常见的因胎盘缺血缺氧、胎盘血液循环灌注异常引起的疾病,其中绒毛膜外滋养细胞侵入异常、子宫螺旋动脉重塑异常、子宫-胎盘血液循环异常是引起血管阻力增加、胎盘血液灌注不足的常见原因,是一组常见的以胎盘缺血缺氧为特征的缺血性胎盘疾病,是导致母儿近、远期并发症的重要因素［1-3］。 浏览更多请关注本刊微信公众号及当期杂志。     

妊娠期母体高浓度血红蛋白对妊娠结局的影响及其与补铁的关系

母体血红蛋白（hemoglobin，Hb）浓度是妊娠期产前检查的重要指标。近来，越来越多的研究注意到妊娠期高浓度Hb或血浆容量的减少和血液稀释的不足对妊娠结局有潜在的不利影响，包括低出生体重（low birth weight，LBW）、早产、小于胎龄儿（small for gestational age，SGA）、死产以及妊娠期糖尿病（gestational diabetes mellitus，GDM）等。然而，由于高浓度Hb常常被错误的认为处于良好的血铁状况而没有得到足够的注意。     

妊娠合并缺铁性贫血

贫血是妊娠期最常见的合并症。贫血是指循环血液的红细胞数或血红蛋白值低于正常。成年女性的贫血标准是红细胞计数 <3.5× 10 12 /L或血红蛋白值 <110g/L。由于妊娠期血容量增加的特点是血浆增加多于红细胞增加 ,出现血液稀释 ,故我国孕妇贫血的诊断标准是红细胞计数 <3.5× 10 12 /L、血红蛋白值 <10 0g/L ,血细胞比容 (HCT) <0 .30。按此标准推算 ,我国有 6 0 %～ 70 %孕妇患各种原因引起的贫血。妊娠期间由于胎儿生长发育需要铁 ,孕妇血容量增加致使红细胞数增多需要铁 ,而孕妇对铁的摄入量又不能大幅度增加 ,故临床上孕妇以缺铁性贫…     

胎盘胆汁酸转运体及核受体与妊娠期肝内胆汁酸淤积症

妊娠期肝内胆汁酸淤积症(ICP)可由多种因素引起,如雌激素过高、遗传、免疫、环境等因素,但最终结果均是胆汁酸在胎儿体循环增加了,而造成这一结果的原因可能是胎儿自身产生的胆汁酸不能有效通过胎盘转运体转运至母体代谢,也有可能是母体过多的胆汁酸经胎盘胆汁酸转运体转运至胎儿体循环,对胎儿造成不利影响。不管是哪种方式,胎盘胆汁酸转运体及其调控因子核受体在其中均起着关键作用。本文就胎盘胆汁酸转运体及其相关核受体与妊娠期肝内胆汁酸淤积的关系作一综述。     

胎盘生长因子、转化生长因子-β与妊娠期高血压疾病

胎盘生长因子促进妊娠早期时滋养细胞的增殖和分化,在正常妊娠胎盘形成和发育中起重要作用。转化生长因子-β可促进子宫内膜的蜕膜化过程,抑制滋养细胞的增生、迁移、浸润,参与胎盘结构的形成及功能调节,在胎盘和胚胎的生长发育中起重要作用。这两种因子表达异常可能与妊娠期高血压疾病滋养细胞功能低下、血管内皮损伤有关,可能参与妊娠期高血压疾病的发生和发展过程。     

易栓症与不良妊娠结局的病理改变

妊娠期血液处于高凝状态是生理性的血栓前状态,遗传性和获得性易栓症增加了孕妇血栓形成的几率。虽然易栓症与胎盘介导的妊娠期并发症相关,但是否为直接原因仍未证实。妊娠期易栓症不具备特征性的胎盘病变,故易栓症及妊娠不良结局与胎盘异常病理之间的关系值得进一步研究。     

妊娠期吸烟与胎儿的血液粘稠度增高的关系

妊娠期吸烟是胎儿在子宫内生长迟缓的一个重要原因。这是由于烟碱有血管收缩作用,可使胎盘血流量减少,从而引起慢性缺氧;和因胎儿及母血中的碳氧血红蛋白量增加而使氧的可用性降低。在非妊娠的成人中,吸烟与血液粘稠度增高及动脉的供血不足有关,从而影响到很多器官。本文研究了母亲吸烟对胎儿血液粘稠度的影响,并观察子宫内生长迟缓是否与吸烟及胎儿的血液粘稠度增加有关。患者,方法及结果:从在整个妊娠期每天吸烟>20支的母亲所生育的40个婴儿的脐静脉中采血,对照组为40例配对的不吸烟母亲所生育的婴儿。用     

妊娠期铁的补充

妊娠期缺铁性贫血的诊断是一个难题。孕期血容量增加约50％,红细胞增加20％,血液稀释将引起血红蛋白浓度下降,常误认为贫血。故应评价给所有孕妇补充铁是否必要和对需要补铁孕妇制定标准。     

胎盘生长因子、转化生长因子-β与妊娠期高血压疾病

胎盘生长因子促进妊娠早期时滋养细胞的增殖和分化,在正常妊娠胎盘形成和发育中起重要作用.转化生长因子-β可促进子宫内膜的蜕膜化过程,抑制滋养细胞的增生、迁移、浸润,参与胎盘结构的形成及功能调节,在胎盘和胚胎的生长发育中起重要作用.这两种因子表达异常可能与妊娠期高血压疾病滋养细胞功能低下、血管内皮损伤有关,可能参与妊娠期高血压疾病的发生和发展过程.     

Prognostic value of absolute versus relative rise of blood pressure in pregnancy

This study evaluated the prognostic value of absolute versus relative rise in blood pressure during pregnancy at the Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria from 17th December 1997 to 31st March 1999. The study sample consisted of 515 consecutive healthy antenatal subjects of the hospital who satisfied the inclusion criteria. The study involved a longitudinal measurement of variables such as blood pressure and anthropometric data of the subjects as well as the maternal mortality rate, caesarean section rate, incidence of eclampsia and proteinuria, perinatal mortality rate, incidence of severe asphyxia and low birth weight, mean birth weight, birth length, ponderal index and gestational age at delivery. Differences in these indices between different groups of the subjects were compared using the chi-square test for categorical variables and one way ANOVA for continuous variables. Grouping was based on the absolute systolic/diastolic blood pressure (SBP/DBP) and relative rise in SBP/DBP from mind-pregnancy until delivery at term. The absolute blood pressure of 140/90 mmHg was a better predictor of feto-maternal outcome than a relative rise in the systolic/diastolic blood pressure from mid pregnancy, which did not reach this absolute level. We conclude that in the Nigerian obstetric population, the practice of diagnosing pregnancy hypertension on the basis of a relative blood pressure rise of 30/15 mmHg alone without reference to the absolute blood pressure level needs to be reviewed.     

ABO血型、ABO血型抗体与IVF/ICSI-ET妊娠结局的关系

目的:探讨ABO血型、ABO血型抗体对IVF/ICSI-ET妊娠结局的影响.方法:回顾性分析2015年1月至2018年1月于山东大学附属生殖医院接受IVF/ICSI-ET的5370例不孕症患者的临床资料.根据女性血型分为O组、A组、B组、AB组,比较各组的妊娠结局,并进一步将O型血女性按血型抗体分组,比较其妊娠结局.结...     

Cancer of the stomach, pregnancy and labor]

The authors describe a case of gastric carcinoma coupled with pregnancy, the only such case they encountered in 80,064 deliveries over a period of 30 years. The pregnancy was complicated by pronounced anemia and general weakness. By administering roborants, antianemic therapy, and blood transfusion to improve the patient's general condition, the pregnancy was completed by the birth of a clinically healthy at-term live child, weighing 3150 g. The patient lived only 6 months after delivery.     

A study of blood coagulation and fibrinolysis in a small-for- gestational-age infant birth group

In order to approach from the aspect of blood coagulation and fibrinolysis the reason for the birth of SGA (small for gestational age) infants, we studied the blood coagulation and fibrinolysis capacity of maternal venous blood in the 36th and 37th weeks after conception employing 54 cases in which were no abnormality was seen during pregnancy up to delivery, and we also studied the relationship of the body weight at delivery and arrived at the following conclusions. In the SGA infant birth group there was a tendency toward acceleration of blood coagulation, acceleration of blood platelet aggregation and inhibition of fibrinolysis when compared with two other groups i.e. AGA (appropriate for gestational age) and LGA (large for gestational age) infant birth groups. In the SGA infant birth group in particular there was seen a statistically significant reduction in prothrombin time (p less than 0.002) when compared with the other two groups. A correlation was noted between prothrombin time for maternal blood and the infant's body weight at birth (r = 0.38446, p less than 0.01), and the shorter the prothrombin time for maternal blood in the late stage of pregnancy, the lower the infant's body weight tended to be at birth. The results indicate that these changes in blood coagulation and fibrinolysis may influence the decrease in the blood output of the uterine placenta, and it may be assumed that this causes the birth of SGA infants. Furthermore, the prothrombin time values become one of the parameters used in forecasting an SGA infant's birth, and this should to be considered as a new fibrinolytic therapy for SGA infants.     

The effects of maternal exercise on fetal oxygenation and feto-placental growth

Sustained bouts of maternal exercise during pregnancy cause an acute reduction in oxygen and nutrient delivery to the placental site. The decreased flow also initiates a slight fall in intervillous and fetal pO2 which initiates a fetal sympathetic response. This, coupled with hemoconcentration and improved placental perfusion balance, maintains fetal tissue perfusion and oxygen uptake. Exercise training during pregnancy (regular bouts of sustained exercise) increases resting maternal (and perhaps fetal) plasma volume, intervillous space blood volume, cardiac output and placental function. These changes buffer the acute reductions in oxygen and nutrient delivery during exercise and probably increase 24 h nutrient delivery to the placental site. Thus, the effect of any given exercise regimen on fetal growth and size at birth is dependent on the type, frequency, intensity and duration of the exercise as well as the time point in the pregnancy when the exercise is performed. Maternal carbohydrate intake is yet another modifying factor. Beginning a moderate exercise regimen increases both anatomic markers of placental function and size at birth while maintaining a rigorous exercise regimen throughout pregnancy selectively reduces growth of the fetal fat organ and size at birth. Likewise, decreasing exercise performance in late-pregnancy increases size at birth while increasing exercise performance decreases it. Finally, the infants born of exercising women who eat carbohydrates which elevate 24 h blood glucose levels are large at birth irrespective of exercise performance.     

早产的流行病学

早产是引起新生儿发病和死亡的重要原因,感染、多胎妊娠、胎膜早破、母体严重并发症和合并症是早产的常见病因。全球各地区的早产发生率具有明显差异,中国不同地区的早产发生率也存在差异,且医源性早产的发生率高于发达国家。控制妊娠高血压疾病、双胎妊娠和感染等疾病是降低早产发生率的重要措施。     

Magnesium and potassium aspartate during the third pregnancy trimester

Following a critical review of published reports on the use of magnesium during the third quarter of pregnancy, the paper examines the value of blood magnesium tests during pregnancy as well as the validity of administrating kalium aspartate and magnesium aspartate to treat the risk of premature birth.     

人乳头瘤病毒感染对妊娠的影响及处理

本文概述了妊娠期人乳头瘤病毒(HPV)感染的发生率及相关因素、HPV感染对妊娠的影响、母婴传播途径及处理。孕期HPV感染的母婴传播,不但可经产道直接接触传播,还可经血液、羊水及胎盘发生宫内传播,其宫内传播率的高低主要与母血的HPV感染相关。妊娠期HPV感染可能与胎儿窘迫、新生儿高胆红素血症、胎儿畸形有关。新生儿脐血的HPV感染主要与母血的HPV感染相关,而产时新生儿咽部的HPV感染主要与宫颈分泌物HPV感染相关。     

Pathophysiology of preterm birth: emerging concepts of maternal infection

Preterm birth remains a significant health concern. Maternal reproductive infections such as bacterial vaginosis pose increased risk for preterm birth, although treatment of bacterial vaginosis has not proven to be universally effective in preterm birth prevention. Maternal oral infection such as clinical periodontal disease has also been identified as a risk factor for preterm birth, and pilot data suggest that oral treatment interventions undertaken during pregnancy may reduce preterm birth risk.