经阴道超声检查早期诊断宫颈功能不全的价值

目的：探讨经阴道超声检查早期诊断宫颈功能不全的临床应用价值。方法：采用经阴道超声对25例宫颈功能不全的孕妇于中孕时进行检查诊断,并与经腹超声检查结果进行对比分析,以评价经阴道超声检查在早期诊断宫颈功能不全中的价值。结果：经腹超声检查诊断符合17例,符合率达68%,误诊4例,占16%,漏诊4例,占16%;经阴道超声诊断宫颈功能不全符合23例,符合率可达92%,漏诊1例,占4%,误诊1例,占4%。23例宫颈功能不全孕妇中,13例行选择性环扎术,足月分娩9例,早产2例,流产2例;10例行保守治疗,足月分娩5例,早产3例,流产2例。结论：经阴道超声检查早期诊断宫颈功能不全是目前安全、直观、准确的检查方法,具有重要临床价值。     

超声测量宫颈长度和宫颈内口宽度在早产预测中的应用价值

目的探讨超声测量宫颈长度和宫颈内口宽度在早产预测中的应用价值。方法本研究于2010年3月～2012年3月对因有先兆早产征象的初产妇经阴道超声测量宫颈长度和宫颈内口宽度,并随访其妊娠结局,分析宫颈长度、宫颈内口宽度与早产的关系。结果108例产妇中早产32例,发生率为29．63％,将其列为早产组,其余76例产妇的先兆早产症状消失后出院。早产组产妇的宫颈长度较非早产组明显缩短（t=12．05,P〈0．05）;而早产组产妇的宫颈内口宽度则较非早产组明显延长（t=12．64,P〈0．05）;早产组产妇的宫颈Bishop评分明显高于非早产组（t=4．83,P〈0．05）。将108例初产妇按照其超声检查的宫颈长度分为≥30mm组、20-29mm组、10-19mm组、〈10mm组,并对各组之间早产发生率进行比较发现宫颈长度越短,早产发生率越高（X^2=18．67,P〈0．05）。将108初产妇按照其超声检查的宫颈内口宽度将其分为≥5mm组、〈5mm组,并对各组之间早产发生率进行比较发现宫颈内口宽度越宽,早产发生率越高（X^2=15．21,P〈0．05）。结论经阴道超声检测妊娠期宫颈变化是一种客观、有效、可重复的预测早产的方法。有望成为临床上预测早产的有效指标之一。     

宫颈环扎术治疗宫颈功能不全预防早产临床分析

目的:观察官颈环扎术和卧床休息治疗宫颈功能不全预防早产的临床疗效.方法:回顾性分析1999年8月～2009年8月我科共收治官颈功能不全患者83例,行官颈环扎术55例(A组),卧床休息保守治疗28例(B组).结果:A组预防早产成功率90.90%,B组为21.43%,两组差异有显著性(P＜0.01).结论:官颈环扎术是治疗宫颈功能不全预防早产的有效方法.     

多胎妊娠管理模式的探讨—附290例分析

目的 探讨多胎妊娠管理模式.方法 将290例多胎妊娠产妇分为A、B、C三组,2010年85例分为对照A组,为传统孕期产检;2011年73例分为实验B组,孕晚期B超测量宫颈长度预测早产,2012年132例为实验C组,孕晚期B超测量宫颈长度联合检测胎儿纤维连接蛋白（fFN）预测早产.对比三组平均孕周和平均出生体重.结果C组孕周（36.1±1.1）,较A组（33.8±1.4）、B组（35.6±1.3）延长（P＜0.05）;C组早产率（43.2％）较A组（60.0％）、B组（52.0％）降低（P＜0.05）;C组新生儿平均体重[（2.48±0.04）kg]较A组[（2.24±0.03）kg]、B组[（2.36±0.03）kg]升高（P＜0.01）;C组妊娠并发症较A、B组减少（P＜0.05）.结论 加强多胎妊娠管理,可以有效预测早产,及时采取有效措施,减少母婴并发症.     

胎儿纤维连接蛋白联合宫颈长度检测在早产预测中的临床应用

目的研究胎儿纤维连接蛋白（fetal fibronentin,fFN）及宫颈长度的检测在早产预测中的临床应用。方法用fFN快速测试条对有先兆早产症状的孕妇进行阴道后穹隆分泌物中fFN的检测及经会阴超声检测宫颈长度,结合孕妇的妊娠结局进行分析。结果两种方法联合预测早产的敏感性、特异性、阳性预测值、阴性预测值分别为93.3％、46．7％、63．6％、87．5％。结论先兆早产孕妇阴道分泌物fFN检测是预测早产较为可靠的指标。     

宫颈环扎术治疗妊娠期宫颈机能不全的效果观察

目的评价宫颈环扎术治疗妊娠期宫颈功能不全的疗效。方法选取2007年1月-12月在我院产科住院的36例宫颈功能不全的患者,分为环扎组23人和非环扎组13人,环扎组行宫颈环扎术,非环扎组给予常规宫缩抑制剂治疗,观察两组疗效。结果环扎组流产3例,早产8例,足月分娩12例,而非环扎组流产11例,早产2例,足月分娩0例,比较差异有显著性（P〈0．05）。结论宫颈环扎术是治疗宫颈功能不全的有效方法。     

宫颈环扎术治疗妊娠期宫颈机能不全的效果观察

目的 评价官颈环扎术治疗妊娠期宫颈功能不全的疗效.方法 选取2007年1月-12月在我院产科住院的36例宫颈功能不全的患者,分为环扎组23人和非环扎组13人,环扎组行宫颈环扎术,非环扎组给予常规宫缩抑制剂治疗,观察两组疗效.结果 环扎组流产3例,早产8例,足月分娩12例,而非环扎组流产11例,早产2例,足月分娩0例,比较差异有显著性(P<0.05).结论 宫颈环扎术是治疗宫颈功能不全的有效方法.     

宫颈环扎术治疗妊娠期宫颈机能不全的效果观察

目的 评价官颈环扎术治疗妊娠期宫颈功能不全的疗效.方法 选取2007年1月-12月在我院产科住院的36例宫颈功能不全的患者,分为环扎组23人和非环扎组13人,环扎组行宫颈环扎术,非环扎组给予常规宫缩抑制剂治疗,观察两组疗效.结果 环扎组流产3例,早产8例,足月分娩12例,而非环扎组流产11例,早产2例,足月分娩0例,比较差异有显著性(P<0.05).结论 宫颈环扎术是治疗宫颈功能不全的有效方法.     

宫颈环扎术加卧床休息治疗宫颈机能不全的临床研究

目的：探讨宫颈环扎术加卧床休息治疗宫颈机能不全的效果。方法：回顾性分析34例宫颈机能不全病人,26例行宫颈环扎术＋卧床休息,8例行保守性治疗（卧床休息）,分析两组的未足月胎膜早破率、新生儿存活率。结果：手术治疗组来足月胎膜早破18例（69．2％）,新生儿存活19例（73．8％）;保守治疗组未足月胎膜早破5例（62．5％）,新生儿存活4例（50．0％）,明显低于手术治疗组（P〈0．05）。结论：宫颈环扎术＋卧床休息治疗宫颈机能不全可延长妊娠时间,提高新生儿存活率。     

Impact of mediators present in amniotic fluid on preterm labour

Preterm birth continues to be one of the most important issues in current obstetric medicine, being the single largest cause of perinatal morbidity and mortality. The signals that initiate preterm and term labour remain a mystery. Intrauterine inflammation with the secretion of cytokines is one of the accepted explanations for the mechanism of initiation of preterm labour. This review discusses the current understanding of the molecular mechanisms for the initiation of preterm labour, focusing chiefly on the role of intra-amniotic fluid mediators, whether endogenous or infection-induced, in the regulation of inflammatory response pathways associated with spontaneous preterm labour. Prostaglandins (PGs) are considered to be one of the key mediators of preterm labour, with the concentration of biologically active PGs in the amniotic fluid, particularly PGE(2) and PGF(2α), being significantly higher in women with preterm labour. Cytokines, such as interleukins and tumour necrosis factor alpha, additionally play a dominant role in preterm labour, particularly in association with infection. Elevated amniotic fluid concentrations of extracellular matrix mediators, including metalloproteases, are also implicated in the process of foetal membrane rupture in preterm labour. Allelic variations in the main amniotic fluid mediators may be the key to understanding the disparity in the rates of preterm birth between different ethnic populations. We also discuss the role of other potential mediators such as cell-adhesion molecules, nitric oxide and novel biomarkers found in the amniotic fluid.     

宫颈缝扎术治疗宫颈机能不全临床分析

目的探讨宫颈缝扎术治疗宫颈机能不全的临床疗效。方法分析2000年1月～2011年6月19例因宫颈机能不全行宫颈缝扎术患者的临床资料。结果 19例宫颈机能不全患者中17例获得活婴,2例失败,手术总成功率为89.5%。其中孕20周前行宫颈缝扎术者15例,手术成功14例;孕20周后手术者4例,成功3例;急诊手术2例,均成功。手术方式分别为U型缝合法、Shirodkar法、McDonald法。结论宫颈缝扎术治疗宫颈机能不全疗效肯定,手术时机宜选择在孕20周前。经阴道行宫颈缝扎术方法简单,术式较多,采用术式应根据病情变化进行合理选择。经临床实践,急诊行宫颈缝扎术是可行的,它可以改善宫颈机能不全患者的妊娠结局。     

p38 Mitogen activated protein kinase (MAPK): a new therapeutic target for reducing the risk of adverse pregnancy outcomes

Introduction: Spontaneous preterm birth (PTB) and preterm premature rupture of the membranes (pPROM) remain as a major clinical and therapeutic problem for intervention and management. Current strategies, based on our knowledge of pathways of preterm labor, have only been effective, in part, due to major gaps in our existing knowledge of risks and risk specific pathways.

Areas covered: Recent literature has identified physiologic aging of fetal tissues as a potential mechanistic feature of normal parturition. This process is affected by telomere dependent and p38 mitogen activated protein kinase (MAPK) induced senescence activation. Pregnancy associated risk factors can cause pathologic activation of this pathway that can cause oxidative stress induced p38 MAPK activation leading to senescence and premature aging of fetal tissues. Premature aging is associated with sterile inflammation capable of triggering preterm labor or preterm premature rupture of membranes. Preterm activation of p38MAPK can be considered as a key contributor to adverse pregnancies.

Expert opinion: This review considers p38MAPK activation as a potential target for therapeutic interventions to prevent adverse pregnancy outcomes mediated by stress factors. In this review, we propose multiple strategies to prevent p38MAPK activation.     

Oxytocin antagonists

Preterm delivery is the single largest cause of perinatal mortality and morbidity. At present, there is no effective long-term treatment for uncomplicated preterm labour. Recent basic and clinical research suggests that oxytocin antagonists provide promise for the future. The current review outlines the clinical aspects of preterm labour and the problems with current pharmacological management. The rationale for administration of oxytocin antagonists is outlined, and the chemistry, biology and efficacy in vitro for patented oxytocin antagonists is assessed. The implications of the use of oxytocin antagonists, such as tocolytic agents, are considered and it is suggested that more specific inhibitors may be more efficacious.     

经会阴超声测量宫颈长度及形态对早产预测的临床研究

目的 探讨经会阴超声测量宫颈长度及形态对早产预测的临床研究效果.方法 选取有自发性早产高危因素的孕24~34周孕妇54例,行会阴超声测量宫颈长度及内口宽度,随访妊娠结局,分析妊娠结局与宫颈长度及形态之间的相关性.结果 54例有先兆早产征象的孕妇有16例,其发生率为29.6%,将病人分为两组,先兆早产组16例及非先兆早产组38例;先兆早产组的宫颈长度明显短于非先兆早产组(P<0.05),先兆早产组的宫颈内口宽度明显长于非先兆早产组(P<0.05),不同宫颈长度的先兆早产发生率不同,差异有统计学意义(P<0.05),其中,宫颈长度<10 mm的孕妇先兆早产的发生率显著高于宫颈长度≥10 mm的孕妇(P<0.01).结论 经会阴超声测量宫颈长度及形态的检测是一种客观、有效对早产预测的方法,宫颈长度缩短、宫颈内口宽度增长是早产高风险指标,该方法灵敏度高,有望成为临床早产预测的重要指标.     

胎儿纤维连结蛋白和宫颈长度联合测量预测早产的临床应用

目的探讨胎儿纤维连结蛋白(fFN)和宫颈长度联合测量预测早产的临床应用价值。方法收集我院妇产科2010年10月-2012年6月收治的先兆早产的孕妇124例,根据其结局分为早产组(n=44)和足月组(n=80)。彩色多普勒超声诊断仪测量宫颈长度,双抗体夹心免疫层析法检测fFN的表达。结果早产组和足月组中fFN的阳性率分别为72.7%和22.5%,早产组显著高于足月组(P0.05)。fFN预测早产的敏感性为72.7%(32/44),特异性为77.5%(62/80),漏诊率为27.3%(12/44),误诊率为22.5%(18/80),阳性预测值为64.0%(32/50),阴性预测值为83.8%(62/74)。早产组和足月组中宫颈平均长度分别为(21.34±5.08)mm和(29.59±5.46)mm,早产组显著短于足月组(P0.05)。宫颈长度预测早产的敏感性为68.2%(30/44),特异性为76.2%(61/80),漏诊率为31.8%(14/44),误诊率为23.8%(19/80),阳性预测值为61.2%(30/49),阴性预测值为81.3%(61/75)。fFN联合宫颈长度预测早产的敏感性为90.9%(40/44),特异性为88.8%(71/80),漏诊率为9.1%(4/44),误诊率为11.2%(9/80),阳性预测值为81.6%(40/49),阴性预测值为94.7%(71/75)。联合检测预测早产的敏感性、特异性、漏诊率、误诊率、阳性预测值以及阴性预测值显著优于fFN或宫颈长度的单独预测(P0.05)。结论 fFN联合宫颈长度测量预测早产效果显著,值得临床推广应用。     

Regulation of uterine function: a biochemical conundrum in the regulation of smooth muscle relaxation

Premature birth accounts for the majority of fetal morbidity and mortality in the developed world and is disproportionately represented in some populations, such as African Americans in the United States. The costs associated with prematurity are staggering in both monetary and human terms. Present therapeutic approaches for the treatment of labor leading to preterm delivery are inadequate and our understanding of the regulation of myometrial smooth muscle contraction-relaxation is incomplete. The ability of nitric oxide to relax smooth muscle has led to an interest in employing nitric oxide-donors in the treatment of preterm labor. Fundamental differences exist, however, in the regulation of uterine smooth muscle relaxation and that of other smooth muscles and constitute a conundrum in our understanding. We review the evidence that nitric oxide-mediated relaxation of myometrial smooth muscle, unlike vascular or gastrointestinal smooth muscle, is independent of global elevation of cyclic guanosine 5'-monophosphate. Applying our current understanding of microdomain signaling and taking clues from genomic studies of pregnancy, we offer a framework in which to view the apparent conundrum and suggest testable hypotheses of uterine relaxation signaling that can explain the mechanistic distinctions. We propose that understanding these mechanistic distinctions in myometrium will reveal molecular targets that are unique and thus may be explored as therapeutic targets in the development of new uterine smooth muscle-specific tocolytics.     

抗生素治疗胎膜早破早产合并生殖道感染效果观察

目的：探讨抗生素治疗胎膜早破早产合并生殖道感染的临床疗效。方法：选取2013年12月～2015年11月我院收治的80例胎膜早破早产合并生殖道感染患者作为研究对象,将40例宫颈分泌物培养有菌生长者作为研究组,40例培养结果无菌者为对照组。进行抗生素、宫缩抑制剂以及糖皮质激素治疗,探讨治疗效果。结果：两组患者分娩方式产后出血、产褥感染以及绒毛膜羊膜炎等指标差异无统计学意义（P＞0.05）。两组新生儿体质量、肺炎发生率以及死亡率差异无统计学意义（P＞0.05）。结论：临床治疗过程中我们应该密切监测胎儿宫内状况以及宫内感染指标,明确致病菌,合理采用药物进行预防及控制感染。     

Preterm labor: current pharmacotherapy options for tocolysis

Introduction: In the developed world, preterm birth is in quantity and in severity the most important issue in obstetric care. Adverse neonatal outcome is strongly related to gestational age at delivery. Since the pathophysiological mechanism of preterm birth is not yet completely unraveled, the development of successful preventive strategies is hampered. When preterm labor is actually threatening, current pharmacological therapies focus on inhibition of preterm contractions. This allows for transportation of the mother to a center with a neonatal intensive care unit and administration of corticosteroids to enhance fetal lung maturation. Globally, however, large practice variation exists.

Areas covered: The aim of this review is to provide an overview of current pharmacological therapies for preterm labor.

Expert opinion: For the initial tocolysis, the use of atosiban or nifedipine for 48 h is recommended based on the largest effectiveness and most favorable side effect profile. However, since data that convincingly indicate the beneficial effect of tocolytics on neonatal outcome are lacking, it might well be that tocolytics are ineffective. The role of progesterone in treatment of acute tocolysis is limited, but it might play a role in the prevention of preterm labor or as sensitizer for other tocolytic agents.     

经阴宫颈峡部环扎术在复发性流产中的应用

目的：探讨经阴宫颈峡部环扎术在复发性流产中的应用效果。方法120例晚期复发性流产患者,随机分成观察组和对照组。对照组采用常规方式治疗。观察组在常规方式治疗的基础上,加经阴宫颈峡部环扎术。结果观察组平均分娩孕周、流产率、早产率、围生儿不良结局发生率和胎膜早破发生率明显少于对照组,差异具有统计学意义（P＜0.05）。结论经阴宫颈峡部环扎术治疗复发性流产,可有效改善妊娠结局。     

宫颈病变锥形切除术后妊娠15例临床分析

目的：探讨宫颈锥形切除术（简称宫颈锥切术）对宫颈上皮内瘤变（CIN）患者妊娠结局的影响。方法：对15例因CIN实施宫颈锥切术患者的妊娠间隔时间、锥切范围、血清c反应蛋白（cRP）、妊娠周数、妊娠结局和终止妊娠方式进行回顾性分析。结果：0）15例患者中,锥切术后小于6个月妊娠3例,大于6个月妊娠11例患者中,1例胎膜早破合并早产。（2）9例大锥切患者中宫颈机能不全4例,5例小锥切患者无宫颈机能不全。（3）15例妊娠患者中,1例自然流产。结论：宫颈锥切术后小于6个月妊娠、大锥切与不良妊娠结局有关。