妊娠期高血压30例临床分析

目的：分析妊娠期高血压对母婴结局的影响,从而积极预防降低围产期新生儿的死亡率,防止并发症的发生,进一步指导临床。方法选取我院2010年9月～2013年9月收治入院治疗的妊娠期高血压疾病孕妇30例作为观察组,与同期入院分娩的非妊娠期高血压疾病孕妇30作为对照组,对两组患者进行回顾性的分析,观察两组患者的并发症和对母婴结局的影响。结果观察组妊娠期高血压疾病合并症发生率为80％,而对照组合并症发生率为6.67％,差异显著,具有统计学意义（ P＜0.05）,观察组早产、胎儿窘迫、胎盘早剥、产后出血等情况也明显高于对照组,有明显差异,具有统计学意义（ P＜0.05）。结论妊娠期高血压疾病对母婴结局可以造成不良的后果,要积极预防并发症的发生。     

钙剂联合Mp监测系统对妊娠期高血压疾病的预防作用

妊娠期高血压疾病是妊娠期特有疾病,是孕产妇和围产儿死亡的重要原因,发病率为5％～12％[1]。且呈逐渐上升趋势,其发病原因尚未完全阐明。流行病学调查证实低钙饮食人群妊娠期高血压疾病的发生率明显高于高钙饮食人群：通过缺钙饲料和去钙离子水喂养孕羊,其导致血压升高、血管阻力增加、子宫胎盘血流减少和蛋白尿嘲;柴新燕等[3]研究发现妊娠期高血压疾病患者血清中钙离子浓度低于正常妊娠的孕妇,且随着妊娠期高血压疾病病情的加重血清钙离子浓度降低更为明显。     

妊娠期糖尿病及糖耐量受损对母婴的影响

目的探讨妊娠期糖尿病及糖耐量受损对母婴的影响。方法2007年1月～2008年6月在我院进行定期产前检查孕妇1835例,其中确诊妊娠期糖耐量受损（GIGT）82例,妊娠期糖尿病（GDM）56例。比较妊娠期糖耐量受损,妊娠期糖尿病及正常孕妇的母婴结局。结果妊娠期糖耐量受损孕妇羊水过多、巨大儿、胎儿窘迫,新生儿低血糖、早产及剖宫产率均高于正常组。妊娠期糖尿病（未治疗组）孕妇妊娠高血压疾病、胎膜早破、羊水过多、胎儿窘迫、巨大儿、早产、胎儿畸形发生率及剖腹产率高于正常组（P〈0．05）,差异有显著性意义。结论GDM与GIGT均是影响孕妇及围生儿结局,导致母婴近期远期严重并发症的重要因素,临床医师应重视孕期糖代谢异常的筛查、诊断和治疗。同时加强产后随访,降低2型糖尿病的发生。     

妊娠期高血压疾病严重程度与胎儿发育及结局的相关性研究

目的分析不同严重程度妊娠期高血压疾病(HDCP)患者子宫动脉血流参数与胎儿发育及结局的相关性,探讨彩色多普勒超声检测子宫动脉血流在预测胎儿结局的临床应用价值。方法将我院2015年1月～2017年6月确诊的145例HDCP孕妇根据血压和并发症情况分为妊娠高血压组55例、轻度子痫前期组48例、重度子痫前期组42例,并以同期入院的健康孕妇60例作为对照组。彩色多普勒超声检测所有孕妇子宫动脉血流阻力指数(RI)、搏动指数(PI)、收缩期与舒张期流速比(S/D),测定胎儿左右心室Tei指数,随访并记录胎儿生长受限、宫内窘迫、早产、新生儿窒息的发生情况。比较四组孕妇子宫动脉血流参数和胎儿左右心室Tei指数的差异,并分析两者之间的相关性,比较四组胎儿不良结局发生率的差异。结果妊娠高血压组、轻度子痫前期组、重度子痫前期组孕妇的子宫动脉血流参数RI、PI、S/D和胎儿左右心室Tei指数明显高于对照组(P0.05),轻度子痫前期组、重度子痫前期组明显高于妊娠高血压组(P0.05),重度子痫前期组又明显高于轻度子痫前期组(P0.05);孕妇子宫动脉血流RI、PI、S/D与胎儿左右心室Tei指数均呈正相关(P0.01);四组胎儿生长受限、宫内窘迫、早产、新生儿窒息的不良结局的发生率具有明显统计学差异(P0.01)。结论随着HDCP严重程度的增加,孕妇子宫动脉血流RI、PI、S/D与胎儿左右心室Tei指数也随之增加,且两者具有明显相关关系,胎儿不良结局的发生率也明显升高。彩色多普勒检测高血压疾病患者子宫动脉血流参数可为预测胎儿发育及不良结局的发生提供数据依据。     

妊娠期高血压疾病孕妇与其胎儿左室Tei指数的相关性研究

目前,Tei指数已广泛应用于胎儿心脏功能的估测[1-3],但是,有关妊娠期高血压疾病（hypertensive disorderscomplicating pregnancy,HDP）孕妇与其胎儿左室Tei指数之间的关系文献报道较少。本文旨在探讨HDP孕妇与胎儿左心室Tei指数之间的关系,为Tei指数在评价胎儿左心室功能的应用与推广提供科学的临床依据。     

妊娠高血压疾病的治疗

妊娠高血压疾病是当代病理产科一大难题，发病率达5％～10％，是孕产妇死亡的主要原因之一。同时，早产、胎儿宫内窘迫、发育迟缓是围产儿死亡的重要原因，因此对本病处理的正确与否，直接关系着母婴的健康甚至生命。现将妊娠期高血压疾病药物治疗加以概述。     

妊娠期高血压疾病与胎儿血流动力学的关系

目的 :探讨孕晚期胎儿大脑中动脉和脐动脉阻力指标及比值与妊娠期高血压疾病的关系。方法 :运用彩色多普勒超声检测80例胎龄34~40周的正常胎儿和88例母体患妊娠期高血压疾病胎儿的大脑中动脉和脐动脉的搏动指数(PI)、RI、收缩期峰值流速与舒张末期流速比值(S/D)。88例妊娠期高血压组又分为轻度组与重度组。对正常组、轻度组、重度组的阻力指标与比值结果行统计学分析。结果:正常组与妊娠期高血压疾病轻度组阻力指标及比值比较,差异均无统计学意义(均P0.05);正常组与妊娠期高血压疾病重度组比较,差异均有统计学意义(均P0.01);妊娠期高血压疾病轻度组与重度组比较,差异均有统计学意义(均P0.05)。结论:晚期妊娠胎儿大脑中动脉和脐动脉各项阻力指标比值与妊娠期高血压疾病严重程度有一定的相关性。随着妊娠期高血压疾病的加重,胎儿脐动脉3个阻力指标升高,胎儿大脑中动脉3个阻力指标及与脐动脉阻力指标比值降低。     

妊娠期高血压性心脏病20例临床分析

妊娠期高血压性心脏病是妊娠期高血压疾病中较严重的并发症,发病率虽低,但病情危重,严重威胁着母婴安全。为探讨其临床特点和有效治疗措施,本研究就我院近10年来收治的20例妊娠期高血压性心脏病患者的临床资料进行分析,现将结果报告如下。     

孕妇妊娠期高血压疾病发生危险因素及疾病严重程度对妊娠结局影响

目的 探讨孕妇妊娠期高血压疾病发生的危险因素及疾病严重程度对妊娠结局的影响。方法 将2019年1月至2021年11月运城市妇幼保健院收治的187例妊娠期高血压疾病患者纳入妊娠期高血压疾病组,另择同期195例健康孕妇纳入健康组。根据疾病进展将187例妊娠期高血压疾病患者分为妊娠期高血压组(n=71)、轻度子痫前期组(n=65)、重度子痫前期组(n=51),比较不同疾病严重程度妊娠期高血压疾病孕妇的妊娠结局;通过单因素分析、多因素Logistic回归分析法分析孕妇妊娠期高血压疾病发生的危险因素。结果 重度子痫前期组的孕产妇早产发生率高于妊娠期高血压组、轻度子痫前期组,且轻度子痫前期组高于妊娠期高血压组,差异均有统计学意义(P<0.05)。多因素Logistic分析结果显示,年龄≥35岁、初产、孕前体质量指数(BMI)≥24 kg/m²、有高血压家族史、非单胎、未规律孕期检查为孕妇妊娠期高血压疾病发生的危险因素(比值比分别为2.430、2.221、1.833、2.252、2.052、1.874,P<0.05)。结论 随着妊娠期高血压疾病严重程度的增加,妊娠不...     

妊娠期肝内胆汁淤积症53例护理干预效果分析

目的探讨妊娠期肝内胆汁淤积症的有效护理措施。方法对53例妊娠期肝内胆汁淤积症孕妇在孕期、产时及产后分时段采用相应的护理措施,确保母婴平安。结果 53例产妇均痊愈出院。55例新生儿中,早产11例,占21%,胎儿宫内窘迫8例,占15%;围生儿死亡3例,占5%;52例痊愈出院,占95%。结论在孕期、产时及产后给予恰当的护理是降低妊娠期肝内胆汁淤积症孕妇母婴死亡率和并发症发生率的有效护理措施。     

Myomectomy during early pregnancy

Abdominal pain during early pregnancy may be caused by leiomyoma of the uterus. Inconsistency of uterine size and gestational dates in a pregnant patient with acute abdominal pain may be the first sign of leiomyoma. This 31-year-old primigravida presented with progressively worsening lower abdominal pain at 12 weeks gestational age. Ultrasonography and magnetic resonance imaging demonstrated a large fundal heterogeneous mass and an intrauterine gestation compatible with her menstrual dates. Exploratory surgery and myomectomy confirmed a large leiomyoma showing benign degenerative changes. The operative procedure was successful, and the pregnancy progressed normally. An elective cesarean section was performed at 37 weeks gestation after confirming fetal maturity by amniocentesis and serial ultrasonography. Abdominal pain in a pregnant patient with leiomyoma uteri may be attributable to degenerative changes in the myoma. Surgical intervention during pregnancy is occasionally necessary in uncommon cases of intractable pain.     

孕期注射乙肝免疫球蛋白与新生儿HBV宫内感染关系的研究

 目的 探讨孕期注射乙肝免疫球蛋白(hepatitis B immunoglobulin, HBIG)对乙型肝炎病毒(hepatitis B virus, HBV)宫内感染的保护作用.方法 以315例乙型肝炎表面抗原阳性、孕期注射过HBIG的孕妇及其新生儿为干预组;以402例乙型肝炎表面抗原阳性、孕期未注射过HBIG的孕妇及其新生儿为对照组,通过比较两组HBV宫内传播发生率,探讨HBIG的保护作用;同时通过分析HBIG对干预组HBsAg滴度、HBVDNA载量的影响,探讨其预防机制.结果 干预组有15例新生儿发生宫内感染,对照组有15例发生宫内感染,两组无统计学差异.相关分析显示孕期HBIG注射剂量与HBVDNA拷贝数、HBsAg滴度无关(P＞0.05).结论 本研究未发现孕期注射HBIG对HBV宫内传播具有保护作用,也未发现孕期注射HBIG能降低孕妇病毒载量.     

宫角妊娠36例临床分析

目的 探讨宫角妊娠的临床特点、诊断和治疗方法.方法 对1990年1月～2006年8月北京协和医院收治的36例宫角妊娠进行回顾性分析.结果 在1 717例异位妊娠中,宫角妊娠共36例,占2%,临床表现为停经(100%)、不规则阴道出血(44%)和腹痛(39%).宫角妊娠术前诊断困难,误诊率达50%,易被误诊为输卵管间质部妊娠、绒癌.36例患者中1例(3%)观察治疗,9例(25%)在B超或腹腔镜监测下行清宫术,5例(14%)行全子宫切除术,16例(44%)行开腹或腹腔镜下宫角和/不和同侧输卵管切除术,5例(14%)行开腹或腹腔镜宫角妊娠物清除术.36例患者均预后良好,随访有3例宫内妊娠.结论 宫角妊娠的诊断主要依据B超,治疗以手术为主,治疗方案应个体化.     

孕期血糖逆向增高与妊娠结局的关系研究

目的 探讨孕期75g葡萄糖耐量试验(OGTT)结果逆向增高与妊娠结局的关系.方法 采用回顾性分析的研究方法,收集2014年南方医科大学珠江医院常规产检及分娩的孕产妇资料,选取服糖后2h血糖高于1h血糖者226例为观察组,随机抽取同期分娩的无妊娠期糖尿病(GDM)及糖尿病者235例为对照组.结果 观察组OGTT结果空腹血糖、服糖后1h血糖均低于对照组,而服糖后2h血糖高于对照组,差异均有统计学意义(P<0.01).观察组羊水过多、羊水过少、胎儿生长受限(FGR)、早产、妊娠合并高血压疾病、胎膜早破、胎死宫内、非疤痕子宫剖宫产的发生率以及新生儿发育异常率、窒息率均高于对照组,但差异无统计学意义(P>0.05).对照组新生儿转科率低于观察组,差异有统计学意义(P<0.01).结论 孕期OGTT结果逆向增高者存在血糖代谢延迟,可能影响新生儿的远期预后,临床上应加强对该部分孕妇的孕期管理.     

Analysis of ultrasonographic criteria in the evaluation for ectopic pregnancy.

To assess the usefulness of ultrasound in diagnosing ectopic pregnancy, the ultrasonographic findings, pregnancy test results, and proven diagnoses in 148 patients referred for evaluation for ectopic pregnancy were reviewed. Of these patients, 33 were subsequently proven to have ectopic gestations. The ultrasonograms were coded for uterine size, intrauterine gestation sac, adnexal mass, adnexal ring, cul-de-sac fluid, or normal findings. With a positive pregnancy test, the presence of an intrauterine gestation sac excludes the diagnosis of ectopic pregnancy. Of those patients with positive pregnancy tests and no intrauterine gestation sac, 73% had ectopic pregnancy. All patients with normal ultrasonograms had other diagnoses. With a negative pregnancy test, the intrauterine findings are not helpful, and evaluation of the adnexa is more important. An adnexal ring is a significant, though not absolute, indicator of ectopic pregnancy. A normal scan excludes this diagnosis. Other criteria were not significant. A clinical approach to the evaluation for ectopic pregnancy, based on the data accumulated in this study, is suggested.     

Quadruplet heterotopic pregnancy; ectopic managed successfully with laparotomy with subsequent viable intrauterine pregnancy: A case report

Heterotopic pregnancy is characterized by a concurrent intrauterine and ectopic pregnancy. It can occur after natural conception, however, it is more common with assisted reproductive techniques , when over one embryo is transferred. Quadruplet heterotopic pregnancy is an exceedingly rare subset. Our case describes a woman who presented to the emergency room with amenorrhea for 9 weeks and lower abdominal pain for 3 days. Transvaginal ultrasound revealed three alive intrauterine fetuses and one left tubal ectopic pregnancy (Quadruplet heterotopic pregnancy). Patient benefited from emergent laparotomy with favorable outcome both in the short term and in the long term. In a patient with a history of assisted reproductive techniques, a high index of suspicion is warranted towards extra-uterine pregnancy. Sonologists should precisely look for adnexal mass. The presence of peritoneal free-fluid requires further investigation. The prognosis of intrauterine fetuses is good, provided the ectopic pregnancy is managed timely and in an effective manner.     

妊娠期合并外科急腹症的误诊分析及外科处理策略探讨

目的探讨妊娠合并急腹症患者的临床表现、误诊原因及确诊经验分析,为临床妊娠并发急腹症诊治提供可借鉴依据。方法收集我院2006年6月～2011年6月132例妊娠期并发急腹症患者的资料,分析各疾病误诊率及各疾病在妊娠早、中、晚期误诊率,分析其误诊原因并探讨其确诊经验。结果常见误诊疾病包括卵巢囊肿蒂扭转（10.61%）,异位妊娠（10.61%）,酮症酸中毒（7.58%）,急性胰腺炎（7.58%）,急性阑尾炎（6.82%）,浆膜下子宫肌瘤扭转（6.82%）等。妊娠各期误诊疾病分布各有特点,以酮症酸中毒、急性阑尾炎、泌尿系结石及异位妊娠、卵巢囊肿蒂扭转等疾病多见。结论妊娠期合并急腹症有较高误诊率,妊娠各期误诊疾病分布各有特点,常可因妊娠期腹内变化导致急腹症诊断困难而延误治疗,提高对罕见疾病的警惕性,积极慎重处理,可及早确诊及降低流产、早产及母孕死亡的相关风险。     

Suspected ectopic pregnancy: endovaginal and transvesical US

Until the advent of endovaginal ultrasonography (US), transvesical US was the only US technique availab le for evaluation of patients with suspected ectopic gestation. A study was undertaken to assess the predictive ability of transvesical and endovaginal US and determine whether endovaginal US could be used alone. Fifty-three patients who had a positive pregnancy test finding and who were at risk for ectopic pregnancy were examined with both endovaginal and transvesical US. Twenty-nine were examined retrospectively and 24 were examined prospectively. Standard sonographic criteria were used to differentiate between intrauterine pregnancy and ectopic gestation. The clinical or pathologic diagnosis was ectopic pregnancy in 18 patients (34%), normal intrauterine pregnancy in 19 (36%), and abnormal intrauterine pregnancy in 16 (30%). Endovaginal US increased the sensitivity of detecting a live ectopic pregnancy (from 6% to 17%). Endovaginal US, by allowing early diagnosis of intrauterine pregnancy, significantly increased the diagnostic accuracy for ectopic pregnancy (from 60% to 83%). Endovaginal US provided significant additional information in women referred for sonography with a suspected ectopic gestation. On the basis of these findings it is concluded that endovaginal US can be used alone in the majority of women with suspected ectopic gestation.     

Ectopic pregnancy

The differential diagnosis in a pregnant patient who presents with pain and bleeding in the first trimester includes normal early pregnancy, spontaneous abortion, molar pregnancy, and ectopic pregnancy. Knowledge of the sonographic appearance of these entities is helpful at arriving at the correct diagnosis. When no intrauterine pregnancy is visualized, careful attention to the adnexa is crucial for finding an extraovarian mass, since the fallopian tube is the most common location for ectopic pregnancy. This review describes and illustrates the sonographic findings of ectopic pregnancy.     

孕期低强度游泳运动对哺乳期过度喂养子代肥胖大鼠生长发育和糖脂代谢的影响

目的:探究孕期低强度游泳运动对哺乳期过度喂养子代大鼠(OF大鼠)生长发育和糖脂代谢的影响,为孕期体力活动指导提供理论依据。方法:80只SD雌性大鼠妊娠后第3天,随机选取22只母鼠孕期游泳运动(10min/day,6 days/week)至分娩结束,其余58只安静至分娩。全部母鼠分娩后第2天随机调整每窝子鼠喂养数目为4只或10只,最终获得子代大鼠实验分组为孕期安静+哺乳期正常喂养模型对照组(CNC,n=16窝,10只/窝),孕期安静+哺乳期过度喂养对照组(CSC,n=15窝,4只/窝)和孕期游泳运动+哺乳期过度喂养组(ESC,n=22窝,4只/窝)。生理发育指标检查出生后第7天(d7)张耳、d11出牙、d12开眼;神经行为发育指标检查d7断崖回避反射,d14平面翻正反射、d14负向地性反射、d14嗅觉定向和d21避暗试验、d21自主活动;血糖和血脂采用酶化学法,血胰岛素采用放射免疫法。结果:ESC组出生后d14负向地性反射、d21记忆行为和d21自主活动次数显著高于CSC组;ESC组和CSC组的摄乳量、体重、Lee指数、内脏脂肪垫体重比、血清胰岛素、瘦素和TC均显著高于CNC组,但ESC组和CSC组组间比较无显著差异;三组母鼠的血清和乳汁中瘦素、胰岛素水平均无显著差异。结论:哺乳期过度喂养可致OF大鼠具有肥胖表型;以增加母鼠孕期体力活动水平为目的的低强度游泳运动对子代OF大鼠的神经反射、记忆行为和自主活动水平下降有一定的预防效果,但对过度喂养所致子代大鼠肥胖表型和糖脂代谢异常无显著的预防效果。