CINⅢ患者冷刀锥切术后妊娠结局的探讨

目的:探讨宫颈冷刀锥切术对患者妊娠结局的影响。方法:选取病理切片诊断为(宫颈上皮内瘤变III级)CINⅢ、有生育要求因而进行宫颈冷刀锥切术治疗的80例患者(锥切组),同时随机抽取我院门诊就诊的75例正常妇女为对照组。对两组妇女妊娠结局进行回顾性分析(随访时间24个月)。结果:①锥切组术后6个月内的妊娠率为35%,7²4个月内的妊娠率为69.2%,差异显著具有统计学意义(P<0.01)。24个月内锥切组与对照组受孕率相比,差异无统计学意义(P>0.05)。②锥切组流产率高于对照组流产率,差异有统计学意义(23.8%vs9.8%,P<0.05)。③锥切组早产率与对照组差异有统计学意义(19.7%vs5.8%,P<0.05)。④锥切组及对照组新生儿体重对比差异无显著性(P>0.05)。结论:宫颈冷刀锥切术对妊娠结局有一定影响,流产率及早产率有一定程度的提高。术后妊娠间隔最好大于6个月。     

HIV transmission through breastfeeding: a study in Malawi.

CONTEXT: Understanding the risk of human immunodeficiency virus (HIV) transmission through breastfeeding is essential for advising HIV-infected mothers and formulating public health policy recommendations. OBJECTIVE: To measure the frequency, timing, and risk factors of HIV transmission through breast milk. DESIGN: Prospective cohort study conducted between 1994 and 1997, with follow-up of infants through 24 months of age. SETTING: Postnatal clinic of tertiary care hospital, Blantyre, Malawi. PARTICIPANTS: A total of 672 infants (HIV-negative at birth) born to HIV-infected women who had not received antiretroviral drugs during or after pregnancy. MAIN OUTCOME MEASURE: Incidence of HIV in breastfed infants by age and maternal and infant risk factors for HIV transmission, using proportional hazard models to derive risk ratios (RRs) and 95% confidence intervals (CIs). RESULTS: Forty-seven children became HIV-infected while breastfeeding but none after breastfeeding had stopped. The cumulative infection rate while breastfeeding, from month 1 to the end of months 5, 11,17, and 23, was 3.5%, 7.0%, 8.9%, and 10.3%, respectively. Incidence per month was 0.7% during age 1 to 5 months, 0.6% during age 6 to 11 months, and 0.3% during age 12 to 17 months (P = .01 for trend). The only factors significantly associated with low risk of postnatal HIV transmission in a multivariate model were high maternal parity (RR, 0.23; 95% CI, 0.09-0.56) and older maternal age (RR, 0.44; 95% CI, 0.23-0.84). CONCLUSIONS: Our data suggest that the risk of HIV infection is highest in the early months of breastfeeding, which should be considered in formulating breastfeeding policy recommendations.     

Ovarian neoplasms, functional ovarian cysts, and oral contraceptives

The incidence of ovarian neoplasms and functional ovarian cysts diagnosed at laparotomy or laparoscopy among the 17,000 women taking part in the Oxford Family Planning Association contraceptive study was investigated. Epithelial cancer of the ovary was only 25% as common among those who had ever taken oral contraceptives as those who had never done so (95% confidence interval 8% to 67%). There was little evidence of any important association between use of oral contraceptives and benign teratoma or cystadenoma. Functional cysts of the ovary occurred much less commonly in women who had recently (in the six months preceding diagnosis) taken combined oral contraceptives (but not in those who had taken progestogen only oral contraceptives) than in those who had never taken oral contraceptives or had taken them in the past. This protective effect was more pronounced for corpus luteum cysts (78% reduction; 95% confidence interval 47% to 93%) than for follicular cysts (49% reduction; 95% confidence interval 20% to 70%). It is estimated that about 28 (95% confidence interval 16 to 35) operations for functional ovarian cysts are avoided among every 100,000 women who take oral contraceptives each year.     

Vitamin A,pregnancy, and oral contraceptives

It has been shown that women receiving oral contraceptives have increased levels of serum vitamin A. High vitamin A levels may constitute a teratogenic hazard. Women who conceive soon after discontinuing oral contraceptive therapy may be especially at risk to this hazard. An increase in vitamin A levels in women taking oral contraceptives has been confirmed. During early pregnancy there is no significant difference in vitamin A levels between women who have recently been taking oral contraceptives and those who have not. The authors were not able to demonstrate that either taking oral contraceptives shortly before pregnancy or a high vitamin A level during the first trimester of pregnancy, comparable to that of a woman taking oral contraceptives, has any detrimental effect on the outcome of pregnancy. It seems unlikely that women conceiving soon after discontinuing oral contraceptive, has any detrimental effect on the outcome of pregnancy. It seems unlikely that women conceiving soon after discontinuing oral contraceptive therapy run any teratogenic risk from increased vitamin A levels.     

流产后关爱服务对流产后妇女口服避孕药使用状况的影响

目的：调查流产后关爱服务（PAC）对流产后妇女口服避孕药使用情况的影响,探讨如何促进流产后计划生育服务、降低重复流产率。方法调查2012年10月至2013年10月在我院计划生育科入院终止妊娠的妇女,流产后立即服用口服避孕药2个月。分别于出院1个月、3个月及半年后随访,了解其服药情况、后续避孕方法的选择以及有无重复流产,共随访850名妇女。结果服用2个周期者731例,占86.0%。随访妇女2个周期后避孕方法的使用情况,继续使用口服避孕药者115例（13.5%）,使用其他方法者631例（74.2%）;未采取任何避孕方式者104例（12.2%）。49.8%的妇女因为担心不良反应而不愿意选择口服避孕药为后续避孕方式。服药期间出现不良反应者15例（1.8%）,为恶心或头晕不适。6个月内意外妊娠者34例（4.0%）,再次行人工流产26例,重复流产率为3.1%。结论口服避孕药作为一种高效、安全的避孕方法,尽管非常适合绝大多数的妇女在流产后立即开始使用,但是由于对其不良反应的担心使得目前坚持使用口服避孕药的妇女比例较低。对于流产后妇女,关于避孕方法的选择和使用的咨询内容还需要细化,需要更有针对性,同时咨询要有长期性,才有利于增加妇女长期采用口服避孕药避孕的信心。     

Oral contraceptives and breast cancer: a national study

In a population based case-control study 433 New Zealand women aged 25-54 with newly diagnosed breast cancer were compared with 897 women selected at random from the electoral rolls. The relative risk of breast cancer in women who had ever used oral contraceptives was 0.94 (95% confidence interval 0.70 to 1.25). The relative risk in women aged 25-34 at diagnosis was estimated to be 2.2 (95% confidence interval 0.47 to 9.9) and in older women less than 1. Analyses of risk by duration of use of oral contraceptives, age at first use, and time since first use showed no adverse effect of the pill. In particular, there was no increased risk in women who had used oral contraceptives before the age of 25 or before their first pregnancy, even for prolonged periods. Given the high prevalence of use in New Zealand, this study provides strong evidence against the hypothesis that use of oral contraceptives at young ages increases the risk of breast cancer.     

北京市未婚青年避孕行为的调查研究(英文)

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Contraceptive use behavior among never married young women who are seeking pre gnancy termination in Beijing

Objective To identify contraceptive use behavior and its determinants among never married young women with an unwanted pregnancy and seeking pregnancy termination in Beijing.Methods A cross-sectional study, adopting the Lawrence’ PRECEDE-PROCEED model was conducted in 1999 in Beijing, China. A total of 306 unmarried young women, aged 18 to 24 years and requesting pregnancy termination, were face to face interviewed.Results Only 13% of the young women insisted on contraceptive use, and almost an equal proportion occasionally or never used contraceptives (26% and 27%, respectively). Among 224 women who had contraceptive use during the past 12 months, the methods used most often were condom (49%), withdrawal (28%) and the rhythm method (16%). One of the most important reasons cited by 73 percent of women who had never used contraceptives was that they did not realize the risk of getting pregnant. The results of logistic regression analysis revealed that knowledge on contraception, boyfriend’s approval of contraceptive use, perceived risk of getting pregnant, perceived availability of contraceptive services and discussion of contraception with boyfriend were important indicators of a young woman’s contraceptive use behavior.Conclusion These results indicate an urgent need to develop sex education on conception and contraception among young women and men. It is equally important to enhance young women’s perception about the risk of unwanted pregnancy and the complications of induced abortion. Promoting men’s cooperation and participation in contraceptive use as well as strengthening communication on contraception between young women and their partners is essential.     

Considerations for smoking advice in pregnancy

Cigarette smoking in pregnancy was the single most important preventable factor identified when determinants of birth weight were studied in 375 pregnancies. Current professional intervention was not effective in reducing cigarette consumption in pregnancy in these mothers in Londonderry, of whom only 19 (5%) became ex-smokers. Present health education, which emphasises impaired fetal growth and wellbeing, had its greatest effect amongst primigravid smokers of whom 32% made some reduction in cigarette consumption. Maternal expectation of birth weight differed significantly between non-smokers, light to moderate, and heavy smokers (8.2 lb, 7.9 lb, 7.3 lb respectively). 54% of multiparous smokers expected the birth weight to be similar to the birth weight in previous pregnancies. Of the women who reduced smoking, 57% did so for the baby, 23% because they found the habit less pleasurable during pregnancy and 13% because of professional advice. Maternal expectation of birth weight is one factor which negates the slant of current health education advice in pregnancy. An anti-smoking programme aimed at protecting the fetus from the harmful effects of cigarettes may produce optimal results when targeted at primary school-aged children in whom the smoking habit is less firmly established.     

Malignant hypertension in women of childbearing age and its relation to the contraceptive pill

Eleven of 34 women aged 15-44 with malignant phase hypertension were taking oral contraceptives at presentation. All had had normal blood pressure before starting to take the pill. In four the interval between the start of oral contraception and the diagnosis of malignant hypertension was less than four months, and in eight no other cause for the hypertension was found. Underlying renal disease and renal failure were less common among pill users than among non-users with malignant hypertension who were of similar age. No pill user became normotensive after withdrawal of the pill, but blood pressure was well controlled (diastolic less than 90 mm Hg) in three patients taking only one drug. By contrast, all 23 non-users needed two or more antihypertensive drugs to control blood pressure. Ten year survival was 90% among pill users and 50% among non-users. These results suggest that oral contraceptives may be a common cause of malignant hypertension in women of child-bearing age. If the pill is stopped and underlying renal disease excluded the long term prognosis for such patients is excellent.     

Pregnancy after cytotoxic chemotherapy for gestational trophoblastic tumours

To examine the possibility that cytotoxic drugs may cause sterility or congenital malformations in the offspring of women of childbearing age who are cured of cancer a study was conducted of the obstetric histories of 445 long term survivors treated in this unit with chemotherapy for gestational trophoblastic tumours between 1958 and 1978. After completing treatment 97% of those who wished for a pregnancy (49% of all women studied) conceived and 86% had at least one live birth. All these women had received methotrexate. Of the 47 women who wished to conceive and whose combination therapy included cyclophosphamide, 37 (79%) had a live birth. Women who received three or more drugs were less likely to have a live birth than those who received methotrexate alone or with only one other drug (p less than 0.001). There was no statistically significant excess of congenital malformations. These results are strong evidence that the cytotoxic drug regimens used in this unit for treating gestational trophoblastic tumours are compatible with the preservation of fertility in most women and not associated with any increase in congenital abnormalities.     

The effect of breastfeeding on weight gain in infants: results of a birth cohort study

The objective of this study was to examine whether duration of exclusive breastfeeding is associated with elevated weight gain in infants during the first two years of life. In this prospective cohort study 2624 healthy term neonates were followed from birth to age 2 years in 4 German study centres. Data on breastfeeding and potential confounders were gathered by questionnaires. Data on anthropometric measures at birth and age 2 years were obtained from routine standardised medical check up documentation. Odds ratios for the association between breastfeeding and weight gain until age 2 years (> or = 90th sex-specific percentile of the cohort) were calculated by logistic regression, adjusting for age at introduction and composition of solid food, maternal BMI, maternal smoking during pregnancy, socioeconomic status, study centre, birth order and, in unstratified analysis, sex. Children exclusively breastfed for less than 6 months had a greater risk of elevated weight gain at the age of 2 years than children breastfed for 6 months and more (OR (95% CI): 1.65 (1.17, 2.30)). Duration of exclusive breastfeeding was inversely associated with the risk of elevated weight gain in a strongly duration-dependent way. Those infants who were exclusively breastfed 1 month at the most had twice as often elevated weight gain (OR (95% CI): 1.99 (1.34, 2.97)) compared to infants breastfed at least 6 months. Our data show that exclusive breastfeeding protects against elevated weight gain during infancy which may be the first step on the pathway of obesity development.     

Delayed childbearing and risk of adverse perinatal outcome. A population-based study.

OBJECTIVE--To investigate the effect of advancing maternal age on pregnancy outcome among healthy nulliparous women, after adjustment for demographic characteristics, smoking, history of infertility, and other medical conditions. DESIGN--A population-based cohort study was conducted with prospectively collected data from the Swedish Medical Birth Register. PATIENTS--Nulliparous Nordic women (N = 173,715), aged 20 years and above, who delivered single births at Swedish hospitals from 1983 through 1987. OUTCOME MEASURES--Late fetal and early neonatal death rates; rates of very low birth weight (VLBW, less than 1500 g), moderately low birth weight (MLBW, 1500 through 2499 g), very preterm delivery (less than or equal to 32 weeks), moderately preterm delivery (33 through 36 weeks), and small-for-gestational-age (SGA) infants (less than -2 SDs). RESULTS--Compared with women aged 20 to 24 years, women aged 30 to 34 years had significantly higher adjusted odds ratios (ORs) of late fetal deaths (OR = 1.4); VLBW (OR = 1.2); MLBW (OR = 1.4); very preterm birth (OR = 1.2); and SGA infants (OR = 1.4). Among women aged 35 to 39 years, the adjusted OR was significantly higher for VLBW (OR = 1.9); MLBW (OR = 1.7); very preterm birth (OR = 1.7); moderately preterm birth (OR = 1.2); and SGA infants (OR = 1.7). Among women 40 years old and older, the adjusted OR was significantly higher for VLBW (OR = 1.8); MLBW (OR = 2.0); very preterm birth (OR = 1.9); moderately preterm birth (OR = 1.5); and SGA infants (OR = 1.4). CONCLUSIONS--Delayed childbearing is associated with an increased risk of poor pregnancy outcomes after adjustment for maternal complications and other risk factors.     

1 638例人工流产青少年现状分析及实施流产后关爱的随访研究

目的 分析青少年女性非意愿妊娠现状,探讨实施流产后关爱服务项目对青少年女性流产后避孕的应用效果。 方法 收集2015年8月—2016年7月在宁波市妇女儿童医院计划生育门诊因非意愿妊娠自愿在门诊接受人工流产术的青少年女性,在流产前进行流产后关爱服务,分析青少年患者流产前的一般情况、人工流产次数及高危因素、流产前后的避孕方式、避孕方法立即落实率、高效避孕率及术后1、3个月避孕方法持续使用率等。 结果 青少年患者共1 638例,平均年龄为(21.83±3.67)岁,15岁3例(0.18%),16~19岁的有183例(11.17%),20~24岁的有1 452例(88.65%),青少年意外妊娠原因归结为未避孕和避孕失败,所有接受人工流产后关爱(PAC)的青少年患者流产后避孕立即落实率为100.00%,高效避孕率由流产前1.70%增加到67.33%,高效避孕方法主要为复方短效口服避孕药及宫内节育器。随访第1、3个月高效避孕方法使用率呈下降趋势,其中口服避孕药使用率下降明显。随访期间失访461例,坚持随访人员1 177例中有10例(0.85%)再次妊娠。 结论 青少年意外妊娠原因归结为未避孕和避孕失败。科学系统的优质人工流产后关爱(post abortion care,PAC)能有效指导青少年落实合适的避孕方法,保证避孕效率,防范青少年重复流产的发生,保障青少年女性的生殖健康。      

Oral contraceptives, pregnancy, and endogenous oestrogen in gall stone disease--a case-control study

A case-control study of gall stone disease in women in relation to use of contraceptives, reproductive history, and concentrations of endogenous hormones was undertaken. The study population comprised 200 hospital patients with newly diagnosed gall stone disease, 182 individually matched controls selected from the community, and 234 controls who were patients in hospital. Use of oral contraceptives was associated with an increased risk of developing gall stones among young subjects but a decreased risk among older subjects. The risk of developing gall stone disease increased in association with increasing parity, particularly among younger women. The risk fell with increasing age at first pregnancy, independent of parity. Mean urinary excretion over 24 hours of oestrone, but not of pregnanediol, was significantly (p less than 0.05) greater for postmenopausal patients than controls. The age dependence of the relative risk associated with exposure to oral contraceptives and pregnancy suggests that there are subpopulations of women susceptible to early formation of gall stones after exposure to either oral contraceptives or pregnancy.     

Outcome of infants of very low birth weight: a geographically based study.

The outcome of 143 live-born infants of very low birth weight (defined as less than 1500 g) who were born in 1980-81 to women resident in Newfoundland and Labrador is described. Sixty-one infants (43%) died during the first year of life. Of the 82 surviving infants 79 were followed for 18 months to 3 years. Eight (10%) were found to have evidence of severe neurodevelopmental abnormality, and nine (11%) were found to have various minor problems, including seizures, developmental delay and behavioural disorders. There was an inverse association between birth weight and mortality. Neonatal pneumothorax, seizures and clinical evidence of intraventricular hemorrhage were more commonly seen among infants who died; these factors also seemed to be predictive of an adverse long-term outcome. Continuous monitoring of the rates of death and disability among infants of very low birth weight born within a defined region should provide the basis for rational planning and delivery of neonatal intensive care.     

Barrier contraceptive methods and preeclampsia

Recent investigations have suggested that women who use barrier methods of contraception may be at increased risk for preeclampsia. We used data from two prospective pregnancy studies to examine the relationship between contraceptive use before conception and preeclampsia. The preeclampsia rates among women using barrier contraceptives were not significantly higher than the rates in women using nonbarrier contraceptives or the rates in women using no contraceptives in either study. The odds ratios for preeclampsia in barrier contraceptive users in the two studies were 0.89 (95% confidence interval [Cl], 0.71 to 1.12) and 0.85 (95% Cl, 0.49 to 1.45) compared with nonbarrier contraceptive users and 0.91 (95% Cl, 0.71 to 1.16) and 0.81 (95% Cl, 0.48 to 1.35) compared with women using no contraceptives. After adjusting for other risk factors, we found no association between preeclampsia and barrier contraceptive use. Additional studies are needed to resolve this issue; however, we would recommend that women not be advised to avoid barrier contraceptives unless more data linking their use to preeclampsia appear.     

郑州市人工流产女青年避孕知识、态度、行为及其影响因素分析

目的:调查郑州市人工流产女青年人工流产的原因和对避孕的知识、态度、行为,并分析其影响因素.方法:采用整群抽样的方法,选取2005年8月至2005年10月在郑州市所辖医院要求人工流产的女青年共1 100人进行横断面调查.结果:被调查者首次性行为始于16.4～25.0岁,中位数22.5岁.65.1%的女青年是第1次做人工流产.未采取避孕措施(67.9%)和避孕失败(32.1%)是导致非意愿妊娠的主要原因.在622名曾经使用过避孕方法的女青年中,最常用的避孕方法依次是安全套、紧急避孕、安全期.单因素分析结果显示:年龄、出生地、文化程度是影响避孕知识得分的主要因素(P＜0.05或0.01).Logistic回归分析结果显示:流产女青年在过去3个月中的避孕行为与男方是否关心避孕问题、流产次数、避孕知识水平有关(P＜0.05或0.01).结论:亟需对未婚青年开展有关避孕知识的教育,提高对意外妊娠风险的认识,促进男性积极参与避孕.     

妊娠晚期孕妇生殖道B族溶血性链球菌感染及对妊娠结局的影响

目的：探究妊娠晚期孕妇生殖道B族溶血性链球菌(GBS)感染对妊娠结局的影响。方法随机选取该院2015年1-7月收治的妊娠晚期孕妇100例作为该次研究对象,其中50例为GBS阳性孕妇作为实验组,50例为GBS阴性孕妇作为对照组,对比2组妊娠晚期孕妇妊娠结局的差异性。结果实验组GBS阳性孕妇剖宫产的发生率(36.00%)、胎膜早破、宫内感染、早产、羊水污染的总发生率(46.00%)以及胎儿宫内窘迫、新生儿感染的总发生率(70.00%)明显高于对照组GBS阴性孕妇剖宫产的发生率(56.00%)、胎膜早破、宫内感染、早产、羊水污染的总发生率(26.00%)以及胎儿宫内窘迫、新生儿感染的总发生率(40.00%),P<0.05,差异具有统计学意义。结论 GBS是危害母婴健康的一种致病菌,其会对妊娠结局造成不良的影响,加强围产期GBS的筛查,给予孕妇相应的预防措施,对改善孕妇的妊娠结局十分有益。     

宫腔镜诊治子宫纵隔的临床观察

目的评估宫腔镜检查及宫腔镜下子宫纵隔切除术(TCRS)对于子宫纵隔的临床诊疗意义。方法对65例临床确诊的子宫纵隔患者进行TCRS治疗,分析术后妊娠率及流产率,了解影响妊娠结局的相关因素。结果宫腔镜结合B超或子宫输卵管碘油造影术(HSG)诊断子宫纵隔准确率达到100%。子宫纵隔患者TCRS术后妊娠率为75%(36/48),足月分娩率为63.89%(23/36),流产率为16.67%(6/36)。根据术前自然流产次数将病例分为A、B、C、D 4组,C组的妊娠率(78.95%)高于A组(46.67%)和D组(50%)(P=0.037);不同纵隔深度的患者术后妊娠率和流产率无统计学意义。术后<12个月妊娠者占75%(27/36),12～24个月妊娠者占22.22%(8/36),>24个月妊娠者占2.78%(1/36)。结论 B超或HSG联合宫腔镜检查是确诊子宫纵隔的有效方法,TCRS是治疗子宫纵隔的有效手段。