胎盘早剥85例分析

目的：探讨发生胎盘早剥的病因及经验教训和对母婴的影响。方法：回顾性分析本院2004年4月至2010年8月85例胎盘早剥的病因并对母婴预后进行分析。结果：严重妊娠期高血压疾病是导致胎盘早剥的主要原因,本组无孕产妇死亡,但严重妊娠期高血压疾病合并胎盘早剥患者术后可并发各种严重并发症。结论：胎盘早剥对母婴危害极大,应早诊断,早处理,以防孕产妇死亡和尽量降低围产儿死亡率。     

妊高征并发溶血、肝酶升高、血小板减少综合征三例报告

<正>溶血、肝酶升高、血小板减少综合征(HELLP综合征)是重度妊高征的严重并发症,如处理不及时会对母婴造成危害,我院近年诊治了3例HELLP综合征,报     

妊娠高血压综合征的临床护理体会

妊娠高血压综合征（以下简称妊高征）是妊娠特有疾病。本病发生于妊娠20周以后，临床表现为高血压、蛋白尿、水肿，严重的可有抽搐、昏迷甚至母婴死亡。目前是孕产妇和新生儿发病率及死亡率高的主要原因。因此，提高此类患者护理质量，不仅可减少母婴的并发症，同时也可降低母婴死亡率。现将笔者对本病的护理体会总结如下。     

妊娠期高血压疾病对母婴的影响分析

目的：探究降低妊娠期高血压疾病患者母婴并发症的预防措施。方法：对我院2008年1月至2012年12月收治的妊娠期高血压疾病患者进行回顾性分析。结果：妊娠期高血压疾病母婴并发症呈现高于正常妊娠的发生率。结论：在妊娠中期即开展妊娠期高血压疾病的预测性诊断,有助于预防妊娠期高血压疾病的发生。加强围产期保健,开展产前诊断,酌情及时终止妊娠,可有效降低妊娠期高血压疾病患者母婴并发症发生。     

子前期并发大量蛋白尿的围生期结局分析

目的探讨大量蛋白尿是否增加子前期母婴严重并发症的发生率。方法对北京大学第四临床医院1990-01-2005-03收治的资料完整的56例子前期患者临床资料进行回顾性分析,按照尿蛋白定量分为24h尿蛋白<5g和24h尿蛋白≥5g组,分析统计严重母婴并发症的发生率,并进行统计学分析。结果两组母婴严重并发症,包括子、胎盘早剥、HELLP综合征、胎死宫内等发生率差异无统计学意义(P>0.05)。结论合并大量蛋白尿不增加子前期患者母婴严重并发症的发生率。单纯依据大量蛋白尿不应作为判断子前期患者预后或选择结束妊娠的主要指标。     

子痫前期并发大量蛋白尿的围生期结局分析

目的 探讨大量蛋白尿是否增加子痫前期母婴严重并发症的发生率.方法 对北京大学第四临床医院1990-01-2005-03收治的资料完整的56例子痫前期患者临床资料进行回顾性分析,按照尿蛋白定量分为24h尿蛋白＜5g和24h尿蛋白≥5g组,分析统计严重母婴并发症的发生率,并进行统计学分析.结果 两组母婴严重并发症,包括子痫、胎盘早剥、HELLP综合征、胎死宫内等发生率差异无统计学意义（P＞0.05）.结论 合并大量蛋白尿不增加子痫前期患者母婴严重并发症的发生率.单纯依据大量蛋白尿不应作为判断子痫前期患者预后或选择结束妊娠的主要指标.     

子(癎)前期并发大量蛋白尿的围生期结局分析

目的 探讨大量蛋白尿是否增加子(癎)前期母婴严重并发症的发生率.方法 对北京大学第四临床医院1990-01-2005-03收治的资料完整的56例子(癎)前期患者临床资料进行回顾性分析,按照尿蛋白定量分为24h尿蛋白＜5g和24h尿蛋白≥5g组,分析统计严重母婴并发症的发生率,并进行统计学分析.结果 两组母婴严重并发症,包括子(癎)、胎盘早剥、HELLP综合征、胎死宫内等发生率差异无统计学意义(P＞0.05).结论 合并大量蛋白尿不增加子(癎)前期患者母婴严重并发症的发生率.单纯依据大量蛋白尿不应作为判断子(癎)前期患者预后或选择结束妊娠的主要指标.     

2 486例妊娠期高血压疾病患者的临床分析

目的了解近年来南方医科大学附属深圳妇幼保健院收治的妊娠期高血压疾病患者的发病趋势、并发症情况及对妊娠结局的影响。 方法回顾性分析2009年1月至2013年12月在南方医科大学附属深圳妇幼保健院就诊并分娩的2 486例妊娠期高血压疾病患者的临床资料,包括发病率、孕妇年龄、住院天数、分娩方式、流动人口比例及母婴并发症等。 结果5年间我院重度子痫前期发生率呈现下降趋势,从2009年的1.74%降至2013年的1.34%(χ²＝12.321,P<0.05);流动人口所占比例较高(46.46%);分娩方式仍然以剖宫产为主(74.09%),高于阴道分娩(21.44%),(χ²＝736.084,P<0.001)。妊娠期高血压疾病孕妇严重并发症的构成依次是：产后出血、胎盘早剥、HELLP综合征、心功能不全、弥散性血管内凝血、急性肾衰竭、脑血管意外;其围产儿严重并发症的构成依次为：早产、胎儿生长受限、新生儿窒息、死胎、流产。 结论妊娠期高血压疾病仍是威胁孕产妇以及围产儿健康的严重疾病,必须加强产前保健,早发现、早诊断和早治疗,以改善母婴妊娠结局。     

子

目的 探讨大量蛋白尿是否增加子(癎)前期母婴严重并发症的发生率.方法 对北京大学第四临床医院1990-01-2005-03收治的资料完整的56例子(癎)前期患者临床资料进行回顾性分析,按照尿蛋白定量分为24h尿蛋白＜5g和24h尿蛋白≥5g组,分析统计严重母婴并发症的发生率,并进行统计学分析.结果 两组母婴严重并发症,包括子(癎)、胎盘早剥、HELLP综合征、胎死宫内等发生率差异无统计学意义(P＞0.05).结论 合并大量蛋白尿不增加子(癎)前期患者母婴严重并发症的发生率.单纯依据大量蛋白尿不应作为判断子(癎)前期患者预后或选择结束妊娠的主要指标.     

艾滋病、梅毒和淋病母婴传播的防治

正妊娠合并梅毒、淋病和艾滋病均可导致母婴严重并发症和后遗症。迄今为止,艾滋病仍无理想治疗方法,先天梅毒可导致婴儿严重残疾。基于妊娠合并梅毒和艾滋病感染后果严重,我国正在全国范围开展妊娠合并艾滋病、梅毒和乙型肝炎母婴传播阻断项目,以期降低这些感染的母婴传播率,提高围产期保健水     

Chronic hypertension in pregnancy

Hypertension is the most common medical disorder during pregnancy. Chronic hypertension is a serious medical complication in pregnancy with increased maternal and perinatal morbidity and mortality. Those who develop uncontrolled severe hypertension, those with target organ damage, and those who are poorly compliant with prenatal visits are at high risk for poor perinatal outcome. Maternal complications include abruptio placenta, stroke, and superimposed pre-eclampsia. Fetal complications include prematurity, low birth weight, and perinatal death. Careful antepartum, intrapartum and postpartum management of women with high-risk chronic hypertension in pregnancies may reduce morbidity and mortality.     

Uterine rupture of placenta accreta

The uterine rupture during pregnancy is one of the most serious complications, increase morbidity and maternal and fetal mortality. The uterine rupture by percrete placenta is rare. We present the case of a 39 years-old patient, pregnancy of 16.3 weeks by ultrasound, which enters by abdominal pain 48 hours of evolution, of predominance in the hypogastric region, that during its evolution presented hemodynamic compromise and increase of abdominal pain. By ultrasound: free liquid in abdominal cavity is observed. With laparothomy we found perforated uterus with placenta free and product in abdominal cavity, obstetrical hysterectomy was performed, we confirmed the diagnosis of uterine rupture by percrete placenta.     

Antenatal management of a large placental chorioangioma. A case report

Chorioangiomas of the placenta are found in approximately 1% of all pregnancies. In most cases the lesion is identified only on histologic examination of the placenta after delivery. Prenatal diagnosis of large lesions is possible with ultrasound. The occurrence of a large chorioangioma during pregnancy may lead to serious maternal and fetal complications. A case of a large chorioangioma was associated with polyhydramnios and diagnosed antenatally with ultrasound. Fetal compromise from pressure necrosis of the tumor on the normal placental tissue necessitated preterm delivery.     

Conservative management of placenta accreta and unruptured interstitial cornual pregnancy using methotrexate

We describe two cases which demonstrate methotrexate (mtx) to be an effective alternative to surgery in two serious complications of early pregnancy, namely placenta accreta diagnosed at attempted evacuation of retained products of conception and interstitial cornual pregnancy diagnosed at laparoscopy.     

无严重并发症重度子痫前期终止妊娠指征影响因素分析

目的 分析无严重并发症重度子痫前期（severe preeclampsia,sPE）的终止妊娠影响因素和现状。方法   分析2009年1月至2012年12月北京大学第三医院单个教学医院4年间入院即诊断为重度子痫前期但不伴有严重并发症的330例临床观察资料的终止妊娠指征,按终止妊娠孕周分组。结果   330例入院诊断为sPE且不伴有严重并发症病例占同期出院诊断为sPE的83.3%。终止妊娠的指征在＜26周终止者以孕周为考虑因素者占3/5。26~＜28周组中社会因素是独立影响因素(P<0.001)。在28~＜30周组的主要影响因素有单纯尿蛋白因素（>10g/24h）、发生严重并发症 ;独立影响因素顺位为社会因素、母体因素、胎儿因素、胎盘因素 (P<0.05)。在30~＜32周组影响终止妊娠的主要因素为出现严重并发症;独立影响因素顺位为母体因素、单纯尿蛋白因素、胎盘因素、胎儿因素(P<0.05)。32~＜34周组影响终止妊娠的主要因素为尿蛋白因素、难以控制的高血压及胎心监护异常;独立影响因素顺位为母体因素以及尿蛋白因素、胎儿因素、胎盘因素。34~＜36周组以孕周为考虑因素占44.3%;独立影响因素顺位为孕周因素、难以控制的高血压、脐血流值异常、胎心监护异常(P<0.05)。≥36周后终止妊娠指征以孕周为考虑因素占68.3%。结论   影响入院时无严重并发症sPE终止妊娠的指征性因素较多,但存在着单纯以尿蛋白定量或单纯孕周因素为终止指征者。单纯以尿蛋白定量或单纯孕周因素为终止妊娠指征是否适宜有待更深入研究。     

Comparative biology of the IGF system in endometrium, decidua, and placenta, and clinical implications for foetal growth and implantation disorders

The insulin like growth factors and their binding proteins appear to play a central role during implantation and establishment of pregnancy in all species studied. Although there are similarities among species in the cell types that express IGFs and IGFBPs and their regulation during implantation and pregnancy, there are also significant differences. Understanding of the role of the IGF system in placental function in the human is of immense clinical importance, because serious complications of pregnancy such as intrauterine growth restriction and pre-eclampsia are thought to be associated with alterations in IGF system during early pregnancy and later in gestation. Research in laboratory and domestic animals, including transgenic and gene targeting studies in mice, has significantly improved our understanding of the role of IGF system in placental and foetal development. This paper reviews the diversity in the expression and regulation of IGF system in the decidua and placenta at the foetal-maternal interface in the human and different animal species, which may benefit in directing future studies in understanding of various complications of human pregnancy.     

穿透入膀胱的凶险型前置胎盘处理决策

随着孕妇妊娠年龄的增加,以及剖宫产后再次妊娠数量的增加,凶险型前置胎盘合并胎盘植入已经成为相对常见的严重并发症之一。其中临床处理最困难的情况往往是前置胎盘合并胎盘植入并穿透子宫浆膜层侵及膀胱后壁,一般称为“穿透入膀胱的凶险型前置胎盘”。文章基于近期相关病例报道和综述性文献的收集,就穿透入膀胱的凶险型前置胎盘的孕期处理、术前诊断、围手术期的准备以及不同手术方式的介绍、保守性治疗方案等关键问题进行了阐述,提出目前该种病例的诊治尚没有统一的临床指南或规范,往往强调个体化的诊治思路。即以保证孕妇生命安全和生活质量为底线,兼顾胎儿生存,减少术中出血,最大可能保护再生育能力为原则。诊治工作重在预防和早期识别,充分的产前评估及术前准备以及正确的手术策略选择是诊治成功与否的关键。     

Epigenetic features of the mouse trophoblast

Trophoblast cells are required for the growth and survival of the fetus during pregnancy, and failure to maintain appropriate trophoblast regulation is associated with placental insufficiencies and intrauterine growth restriction. Development of the trophoblast lineage is mediated by interactions between genetic and epigenetic factors. This review will focus on new insights that have been gained from analysis of mouse models into the epigenetic mechanisms that are required for the early establishment of the trophoblast lineage and for the development of specialized cell types of the fetal placenta. In particular, the importance of DNA methylation, 5-hydroxymethylcytosine and histone modifications in orchestrating trophoblast gene expression and functional outcome will be discussed. These insights are beginning to be extended towards human studies and initial results suggest that the causes and consequences of a variety of placental pathologies are related to epigenetic processes. Furthermore, the epigenetic landscape that regulates trophoblast cells seems to be particularly vulnerable to perturbation during development. This has major implications for diet and other environmental factors during pregnancy.The placenta is required for the growth and survival of the fetus during pregnancy. Placental insufficiencies, including pre-eclampsia and intrauterine growth restriction, occur in ～10% of pregnancies and are associated with serious complications for mother and baby. Better understanding of how the placenta is formed is critical for the development of early diagnoses and therapies for treatment. Studies of animal models have revealed several critical pathways that are required for the proper development and function of the placenta. In particular, epigenetic processes, which determine how genes are switched on and off, are necessary for the early establishment of the placental lineage and also for the development of specialized cell types within the mature placenta. These crucial and recent insights form the basis for this review. Importantly, much of our understanding gleaned from animal models are now beginning to be extended towards human studies. Initial results suggest that the causes and consequences of a variety of placental pathologies are related to epigenetic pathways. As epigenetic processes can be susceptible to alterations by environmental factors, these studies have major implications for diet and other external influences during pregnancy.     

剖宫产后子宫瘢痕憩室形成因素的研究进展

剖宫产后子宫瘢痕憩室(cesarean scar diverticula,CSD)是继发于剖宫产的一种妇科疾病,指剖宫产术后子宫切口肌层愈合不良,在子宫峡部出现突向浆膜层,并与宫腔相通的一个囊状缺陷,导致异常子宫出血、慢性盆腔痛、瘢痕妊娠、胎盘植入,甚至再次妊娠子宫破裂等严重并发症.目前CSD形成因素尚未完全阐明,可能...     

Primary hyperparathyroidism in pregnancy: a case series and literature review

Primary Hyperparathyroidism (PHP) in pregnancy constitutes a serious danger to mother and fetus. The diagnosis of PHP in pregnancy presents a challenge, and PHP commonly goes unidentified and untreated in pregnancy. We present four case reports about patients having PHP, which is very rare condition in pregnancy and their treatment modalities. Three patients, not to be controlled biochemically, denied the parathyroidectomy operation although they are informed about the details of their disease. They are followed up with medical therapy. The first one had no maternal or fetal complications, the second one acquired nephrolithiasis crisis in the last trimester and the third one gave birth to a premature baby who succumbed to tetany. The fourth patient who underwent parathyroidectomy operation in the second trimester had no maternal or fetal complications. PHP in pregnancy is a preventable cause of fetal and maternal mortality and morbidity. Thus, suspecting from PHP during the pregnancy and early diagnosis is critically important in terms of maternal and fetal wellness.