不同类型重度子痫前期血流动力学改变及与妊娠结局的关系

目的探讨重度子痫前期血流动力学改变与期待疗法妊娠结局的关系。方法选取2005年1月-2006年6月住院分娩的重度子痫前期孕妇共217例,按入院孕周分为两组：I组（早发型）发病孕周≤33．6周111例,Ⅱ组（晚发型）为发病孕周≥34周106例。两组入院时均行MP妊娠高血压监测系统测定心输出量、心脏指数、外周阻力、血液粘度及血管顺应性;同时对进行期待疗法的101例早发型重度子痫前期,比较结局良好组（64例）与结局不良组（37例）上述指标的差异。结果I组与Ⅱ组的心输出量、心脏指数、外周阻力、血液粘度及血管顺应性均无统计学差异,I组期待疗法结局良好组和结局不良组心输出量、心脏指数、外周阻力、血液粘度及血管顺应性均无统计学差异。结论不同类型的重度子痫前期存在着相同的血流动力学变化;且血流动力学对预测早发型重度子痫前期期待疗法的妊娠结局意义尚不能肯定。     

妊娠合并系统性红斑狼疮孕妇的妊娠时机及对妊娠结局的影响（附25例临床资料分析）

目的：探讨影响妊娠合并系统性红斑狼疮（SLE）妊娠结局的相关因素,提出SLE患者最佳受孕时机和孕期的治疗监护,预防妊娠合并SLE的恶化及SLE对妊娠的不良影响,以提高围产质量。方法回顾性分析25例妊娠合并SLE的临床资料。结果25例妊娠合并SLE患者,14例病情处于缓解期或控制期的患者,仅1例双胎妊娠发生早产,新生儿窒息0例,1例孕妇狼疮性肾炎加重,子痫前期0例;11例病情未控制或有SLE活动者,发生早产4例,新生儿窒息2例,孕期发生狼疮性肾炎3例,血小板减少3例,子痫前期2例。结论SLE患者应首先控制疾病的活动,在产科医师及风湿免疫科医师的指导下受孕,妊娠期加强胎儿监护及SLE疾病的监测、治疗。泼尼松是目前安全可靠的妊娠期治疗及预防SLE恶化、控制SLE活动的首选药物。SLE孕妇应加强孕期的监护,争取良好的妊娠结局。     

子痫前期的病因学新进展

子痫前期／子痫属于妊娠期高血压疾病，为妊娠期特有的疾病，是自古以来导致孕产妇和围产儿发病率及死亡率增高的主要原因。它发生于妊娠中晚期、分娩期及产后早期，表现为高血压、蛋白尿及其他全身系统性的紊乱，以全身抽搐为特征的子痫是疾病的终期阶段。子痫前期不能预防。临床上以筛查无症状的孕妇、监测已诊断的孕妇及胎儿、必要时终止妊娠为主要处理措施，这也是治疗性早产最主要的原因。     

不同类型的妊娠期高血压疾病对于产妇妊娠结局的影响分析

目的探讨和研究不同类型妊娠期高血压疾病对于产妇妊娠结局的影响。方法选取2006年1月～2012年1月我院收治的140例妊娠期高血压病患者为观察组,选取同期我院分娩的健康产妇140例为对照,分析两组孕妇妊娠结局。结果观察组患者中包括73.6%(103例)的妊娠期高血压和26.4%(37例)的子痫前期患者,子痫前期患者胎儿窘迫、产后出血、新生儿窒息、围生儿死亡、剖宫产及早产儿事件发生率明显高于高血压疾病患者,对比差异显著(P<0.05)。结论妊娠期高血压疾病对于产妇和新生儿的影响极大,应当通过有效的预防和治疗减少妊娠期高血压疾病的发生,同时更应当警惕子痫的发生,以提高生育质量和保证患者健康。     

在妊娠期高血压中使用低分子肝素可以提高子宫动脉阻力指数预测子痫前期和胎儿生长受限

目的探讨在高危孕妇中短疗程的皮下注射低分子肝素是否能提高子宫动脉阻力指数预测子痫前期和胎儿生长受限。方法挑选24至26周妊娠期高血压患者96名和正常孕妇30名,治疗前和治疗2周后超声多普勒测量子宫动脉阻力指数,58例妊娠期高血压为治疗组,38例妊娠期高血压和30正常孕妇为对照组。结果低分子肝素治疗组子宫动脉阻力指数明显下降,而对照组无明显改变。然而低分子肝素引起的子宫动脉阻力指数减少只局限有正常妊娠结局的产妇,从0.64±0.01降至0.52±0.01（P〈0.05）。结论低分子肝素可以提高子宫动脉阻力指数预测子痫前期和胎儿生长受限。     

孕11～13~(+6)周子宫动脉超声多普勒血流参数与子痫间前期相关性的研究

目的 :探讨孕11~13+6周时,采用超声多普勒监测孕妇子宫动脉血流以评估超声检测对预测子痫间前期的可行性。方法:选择1 500例在我院行正规产前检查的单胎妊娠孕妇,于孕11~13+6周时采用超声多普勒检测双侧子宫动脉血流,并记录双侧子宫动脉血流搏动指数(pulsatility index,PI)、阻力指数(resistance index,RI)、有无舒张早期切迹等。随访所有研究对象的妊娠过程及母胎结局等情况。结果:11 500例孕妇中11例于中孕期终止妊娠,72例发生妊娠期高血压疾病,214例发生其他不良妊娠结局,另1 203例正常妊娠(正常组)。2将72例发生妊娠期高血压疾病的孕妇分为早发型子痫间前期(16例)、迟发型子痫间前期(26例)、妊娠期高血压(30例)3组,各组的子宫动脉血流PI和RI值均高于正常组(P     

妊娠期高血压疾病子痫前期对胎儿的影响

目的研究妊娠期高血压疾病子痫前期对胎儿的影响。方法 2007年至2009年安阳市妇幼保健院共有90例妊娠高血压综合征子痫前期患者,轻度妊娠期高血压疾病子痫前期（A组）45例,重度妊娠期高血压疾病子痫前期（B组）45例,妊娠期无各类疾病包括高血压病的患者50例（C组）。三组之间的年龄、病程比较差异无统计学意义（P〉0.05）。观察妊娠期高血压子痫前期的轻度、重度以及无高血压病孕妇生产胎儿的结果,观察期为1.5年。结果轻度妊娠期高血压疾病子痫前期（A组）、重度妊娠期高血压疾病子痫前期（B组）以及妊娠期无各类疾病包括高血压病的孕妇（C组）间比较差异有统计学意义（P〈0.05）。妊娠期高血压对胎儿有一定的影响,会影响新生儿的体质量,增加早产率和死亡率。结论在我们的临床工作中要对妊娠期高血压疾病的危害有认识并且时刻警惕,及时进行有效地救治。     

早发型重度子痫前期胎儿不良围产结局及其影响因素分析

目的探讨早发型重度子痫前期胎儿不良围产结局及其危险因素。方法对89例单胎妊娠、接受期待治疗的早发型(发病孕龄24～34周)重度子痫前期患者的住院病例进行回顾性分析。结果不同发病孕龄的产妇其胎儿不良结局的发生率比较差异具有统计学意义(P<0.01);发病孕龄和入住房间床位数是胎儿围产结局的影响因素。结论入住房间床位数是胎儿发生不良围产结局的危险因素,发病孕龄是胎儿发生不良围产结局的重要保护因素,医务工作者应积极努力查找早发型重度子痫前期的发病原因,做好孕期保健,预防疾病的发生。     

妊娠高血压疾病对孕妇心电图和胎儿心电图的影响

目的了解妊娠高血压疾病对孕妇心电图和胎儿心电图的影响。方法选择在浙江大学医学院附属妇产科医院住院分娩的患妊娠高血压疾病的孕妇294例及对应的胎儿心电图82例,分析孕妇妊娠高血压疾病病情、孕妇心电图及胎儿心电图。结果妊娠高血压疾病的孕妇其心电图发生病理性改变的概率于妊娠高血压疾病的严重程度有关,妊娠高血压疾病病情越严重心电图发生病理性改变的概率越高。如果患者出现典型的脑血管病变型的T波改变,特别是出现高耸宽大的T波,表明病情已非常严重,应特别引起关注并及时进行抢救,防止孕妇死亡的发生。结论异常胎儿心电图的发生与妊娠高血压疾病的严重程度无明显关系,但是对于妊娠高血压疾病患者,特别是子痫前期和子痫患者在整个孕期反复检查胎儿心电图仍是非常必要的。     

超声检测妊娠期高血压疾病患者胎儿主动脉峡部收缩指数的意义

目的通过检测及分析胎儿主动脉峡部收缩指数,结合围产儿预后,探讨胎儿主动脉峡部收缩指数对妊晚期妊娠高血压疾病患者胎儿窘迫的诊断意义。方法应用彩色多普勒超声技术,对80例妊娠期高血压疾病孕妇和80例相同孕周无年龄差别的正常孕妇行对照研究,妊娠期高血压疾病孕妇分为妊娠期高血压组、轻度子痫前期组和重度子痫前期组,测定胎儿主动脉峡部收缩期峰值流速(PSV)、收缩末期最低点流速(NS),并计算主动脉峡部收缩指数(ISI=NS/PSV);病例组围产儿分为预后不良组和预后良好组,采用方差分析或t检验比较ISI值在各组中的变化。结果妊娠晚期随着孕周的增加,PSV逐渐增加,NS、ISI逐渐减低。ISI值在轻度子痫前期组和重度子痫前期组均减小(P0.01);预后不良组与预后良好组比较ISI值减小,差异有统计学意义(P0.01)。结论妊娠期高血压疾病子痫前期患者胎儿主动脉峡部收缩指数发生明显变化,这种变化与围产儿预后有关。     

Maternal cardiac function in fetal growth-restricted and non-growth-restricted small-for-gestational age pregnancies.

OBJECTIVE: To compare maternal cardiac function in women with intrauterine growth restriction (IUGR) to those with small-for-gestational age (SGA) pregnancies (non-IUGR). METHODS: This was a cross-sectional study involving maternal echocardiography and uterine, umbilical and fetal middle cerebral artery Doppler assessment in 52 normotensive women at 20-36 weeks' gestation with SGA fetuses (26 IUGR and 26 non-IUGR). RESULTS: In the IUGR (compared to the non-IUGR) group, maternal cardiac output (CO) was lower (4.7 vs. 6.1 L/min, P<0.001) and total vascular resistance (TVR) was higher (1444 vs. 1088 dynes/s/cm5, P<0.001). The lower CO was due to a lower preload, demonstrated by a reduced stroke volume (59.9 vs. 73.6 mL, P<0.01) and smaller left atrial diameter (LAD) (31.5 vs. 34.1 mm, P=0.01). Mean arterial pressure and diastolic function were similar between the groups. Logistic regression and receiver-operating characteristics curve analysis for detection of IUGR demonstrated that a model using TVR, LAD, fetal middle cerebral artery pulsatility index and gestational age, had a sensitivity of 96.2% and a specificity of 84.6%. CONCLUSIONS: Maternal echocardiography can provide a very sensitive tool for identifying IUGR pregnancies.     

Short- and long-term strategies for the management of hypertensive disorders of pregnancy

The hypertensive disorders of pregnancy include gestational hypertension and preeclampsia, both de novo and superimposed on chronic hypertension. These disorders occur frequently among pregnant woman and are important contributors to maternal and perinatal mortality and morbidity worldwide. In this review, we will focus on recent developments in the prediction and pathogenesis of these disorders, prevention of preeclampsia and current strategies for the treatment of hypertension in pregnancy. We also explore the evidence relating adverse pregnancy outcome to an increased future risk of cardiovascular disease and potential strategies to minimize this risk.     

基于IKAP模式的家庭跟进式护理干预对妊娠合并高血压性心脏病患者遵医行为及心肺功能的影响

目的探讨基于信息-知识-信念-行为(IKAP)模式的家庭跟进式护理干预对妊娠合并高血压性心脏病患者遵医行为及心肺功能的影响。方法将82例妊娠合并高血压性心脏病患者根据随机数字表法分为对照组与观察组,各41例。对照组给予常规护理,观察组在对照组基础上给予基于IKAP模式的家庭跟进式护理干预。比较两组的护理效果。结果干预后,观察组的按时体征监测、出入量计算、饮食管理、GSES评分均高于对照组,SPBS评分低于对照组,LVEF、E/A、SaO₂、PaO₂均优于对照组(P<0.05)。结论基于IKAP模式的家庭跟进式护理干预可提高妊娠合并高血压性心脏病患者的遵医行为,也能改善其自我感受负担、自我效能状态及心肺功能。     

Chronic hypertension in pregnancy.

Pregnancies in women with chronic hypertension are at increased risk of superimposed pre-eclampsia, abruptio placentae, fetal growth retardation and prematurity. The frequencies of these complications are increased in those women who have high-risk chronic hypertension, ie severe hypertension or pre-existing cardiovascular or renal diseases, as well as in those with target organ damage. Such women should receive antihypertensive therapy and close management to improve maternal and fetal outcome. In women with low-risk chronic hypertension, antihypertensive treatments do not improve pregnancy outcome. Prophylactic low-dose acetylsalicylic acid treatment does not reduce the frequency of superimposed pre-eclampsia nor does it improve perinatal outcome in these pregnancies.     

Chronic hypertension in pregnancy

Pregnancies in women with chronic hypertension are at increased risk of superimposed pre-eclampsia, abruptio placentae, fetal growth retardation and prematurity. The frequencies of these complications are increased in those women who have high-risk chronic hypertension, ie severe hypertension or pre-existing cardiovascular or renal diseases, as well as in those with target organ damage. Such women should receive antihypertensive therapy and close management to improve maternal and fetal outcome. In women with low-risk chronic hypertension, antihypertensive treatments do not improve pregnancy outcome. Prophylactic low-dose acetylsalicylic acid treatment does not reduce the frequency of superimposed pre-eclampsia nor does it improve perinatal outcome in these pregnancies.     

Renal complications during pregnancy: In the hypertension spectrum

In pregnancy, there are numerous changes which occur to accommodate the needs of both the fetus and placenta. These changes present us with a unique set of clinical challenges particularly in the setting of any disease processes occurring during pregnancy. It is essential to understand that the systems profoundly affected are the cardiovascular and renal systems. The most predominant disease process occurring in pregnancy affecting both the cardiovascular and renal system is the spectrum of hypertensive disorders specifically pre-eclampsia. Due to its high incidence worldwide, it is considered as the most common cause of infant and maternal morbidity and mortality. While the international definition, classification scheme and diagnostic criteria for Hypertensive Disorders of Pregnancy still must be agreed upon, hypertension has been the mandatory feature for all established guidelines. Pre-eclampsia particularly the severe form which is recognized as HELLP (Hemolysis, Elevated Liver enzymes and Low Platelet count) syndrome is the primary cause of acute kidney injury in pregnancy. In this review, we would primarily discuss the hemodynamic and vascular changes, anatomical and physiologic renal adaptations occurring during normal pregnancy and the complications which arise in the setting of hypertensive diseases. Mainly focusing on the pre-eclampsia spectrum, since knowledge of these is of clinical importance not only in understanding its role in the disease process but more so its implications for prevention, screening, diagnosis, and management.     

264例妊娠期高血压疾病母婴结局分析

目的通过对264例妊娠期高血压疾病病例分析,了解妊娠期高血压疾病对母婴结局的影响。方法选取2007年1月至2009年12月在本院住院治疗并分娩的妊娠期高血压疾病病例264例,按威廉姆斯产科学分类标准分组：妊娠高血压组（A组）30例,轻度子痫前期组（B组）120例,重度子痫前期组（C组）114例。比较三组间母婴并发症发生情况：早产、胎盘早剥、低蛋白血症、产后出血、胎儿生长受限（FGR）、剖宫产率、胎儿窘迫、新生儿窒息、新生儿发病率及死亡率。结果孕产妇、低蛋白血症、早产、产后出血、剖宫产率、围产儿发病率及死亡率A组低于B组,B组低于C组,组间比较差异均有统计学意义（P〈0．05）;胎儿窘迫、新生儿窒息、FGR、胎盘早剥发生率各组比较,差异无统计学意义（P〉0．05）。结论重度子痫前期明显增加母婴不良妊娠结局,通过加强定期产前保健,早期发现、早期诊断、早期治疗,以改善妊娠高血压疾病患者母婴结局。     

Assessment and evaluation of the woman with cardiac disease during pregnancy

Maternal heart disease complicates 0.2 to 3% of pregnancies and is responsible for 10% to 25% of maternal deaths. Many healthy women manifest subtle signs of cardiac failure during uncomplicated pregnancy and birth. Classic symptoms of heart disease mimic common symptoms of late pregnancy, such as palpitations, shortness of breath with exertion, and occasional chest pain. A complete cardiovascular examination assists the healthcare team to fully assess and evaluate the pregnant woman with known heart disease. Detailed assessment of the woman throughout pregnancy may lead to initial discovery of heart disease. Compilation of these objective data with subjective functional capacities allows for risk stratification and assignment to a New York Heart Association functional classification.     

Association between Bell's palsy in pregnancy and pre-eclampsia

BACKGROUND: Previous published case series have suggested an association between the onset of Bell's palsy in pregnancy and the risk of pre-eclampsia and gestational hypertension. Aim: To evaluate the period of onset of Bell's palsy in pregnancy and the associated risk of adverse maternal and perinatal events, including the hypertensive disorders of pregnancy. Study design: Case series study of consecutive female patients. METHODS: Women presenting with Bell's palsy during pregnancy or the puerperium were identified by a hospital record review at five Canadian centres over 11 years. Information was abstracted about each woman's medical and obstetrical history, period of onset of Bell's palsy, and associated maternal complications, including pre-eclampsia and gestational hypertension as well as preterm delivery and low infant birth weight (<2500 g). These rates were compared to those previously described for the province of Ontario or for Canada. RESULTS: Forty-one patients were identified. Mean onset of Bell's palsy was 35.4 weeks gestation (SD 3.9). Nine (22.0%, 95%CI 10.8-35.7) were also diagnosed with pre-eclampsia and three (7.3%, 95%CI 1.4-17.1) with gestational hypertension, together (29.3%, 95%CI 16.5-43.9) representing nearly a five-fold increase over the expected provincial/national average. There were three twin births. The observed rates of Caesarean (43.6%) and preterm (25.6%) delivery, as well as low infant birth weight (22.7%), were also higher than expected, although the rate of congenital anomalies (4.5%) was not. CONCLUSIONS: The onset of Bell's palsy during pregnancy or the puerperium is probably associated with the development of the hypertensive disorders of pregnancy. Pregnant women who develop Bell's palsy should be closely monitored for hypertension or pre-eclampsia, and managed accordingly.     

妊娠合并心脏病不同心功能状态对围生儿预后的影响

目的探讨妊娠合并心脏病的类型,以及不同心功能状态对围生儿预后的影响及产前检查的重要性。方法对2002年2月～2011年2月期间在新疆医科大学第一附属医院住院分娩的102例妊娠合并心脏病孕产妇的临床资料进行回顾性分析。其中,心功能Ⅰ～Ⅱ级组61例、心功能Ⅲ～Ⅳ级组41例。结果本组102例妊娠合并心脏病患者包括先天性心脏病38例(占37.25%)、心律失常22例(占21.57%)、风湿性心脏病17例(占16.67%)、围生期心肌病15例(占14.71%)、妊娠期高血压心脏病7例及其他类型心脏病3例。心功能Ⅲ～Ⅳ级组的平均分娩孕周和新生儿平均体重均低于心功能Ⅰ～Ⅱ级组,两组差异有统计学意义(P<0.05);心功能Ⅲ～Ⅳ级组早产、足月低体重儿、新生儿窒息和围生儿死亡的发生率均高于心功能Ⅰ～Ⅱ级组,两组差异也均有统计学意义(P<0.05);心功能Ⅰ～Ⅱ级组的正规产检率显著高于心功能Ⅲ～Ⅳ级组,两组差异有统计学意义(P=0.008);正规产检组与未正规产检组患者早产及足月低体重儿发生率差异有统计学意义(P<0.05);新生儿窒息与围生儿死亡的发生率差异均无统计学意义(P>0.05)。结论妊娠合并心脏病孕产妇的心脏病类型以先天性心脏病最为常见,母亲的心功能状态直接影响围生儿的预后,而正规的产前检查和及时的诊断、治疗则可改善母子预后。