早发型和晚发型重度子痫前期临床分析

重度子痫前期是孕产妇和围产儿死亡的主要原因,特别是早发型重度子痫前期,发病早、进展迅速且症状重,严重威胁母婴健康。本文回顾早发型与晚发型重度子痫前期的临床资料,分析其临床特点与妊娠结局,以寻求最好的方法,改善母婴预后。     

重度子痫前期终止妊娠时机及方式的探讨

目的:探讨重度子痫前期终止妊娠的时机及方式对母婴的影响.方法:回顾性分析在不同孕周与采取不同方法终止妊娠对136例重度子痫前期患者母婴结局影响.结果:136例重度子痫前期患者入院后经系统常规治疗,均选择适当时机及适当方式终止妊娠,无1例孕产妇和围产儿死亡,新生儿的窒息13.2％.结论:适时终止妊娠是治疗重度子痫前期的极重要的手段,应适当放宽剖宫产指征.     

重度子痫前期终止妊娠时机及方式的临床探讨

目的:探讨重度子痫前期终止妊娠时机的选择.方法:回顾分析180例患者的临床资料.结果:本组180例产妇均痊愈出院,无子痫发生;围产儿情况:体质量2000-2500g者128例,2501-3000g者52例;轻度窒息者32例,重度窒息者20例,无一例新生儿死亡.结论:重度子痫前期对孕妇及胎儿有很大的威胁,病情允许的前提下,患者终止妊娠的时间最好在孕34周后,终止妊娠的方式首选剖宫产.     

早发型重度子痫前期期待治疗与预后结局临床分析

目的 探讨早发型重度子痫前期期待治疗与预后结局临床分析.方法 对笔者所在医院2005年2月～2011年3月收治的早发型重度子痫前期患者患者不同孕期发病分为A、B以及C组进行期待治疗.结果 3组患者在相关并发症的发生比较中差异无明显统计学意义（P ＞0.05）;A组患者期待治疗的时间明显高于其他两组（P ＜0.05）;3组患者围生儿死亡率差异有统计学意义（P ＜0.05）,3组患者胎儿生长受限率也存在明显差异.结论 在对早发型重度子痫前期期待治疗时应当严格选择病例,并对其进行短时治疗,可改善患者妊娠结局.     

重度子痫前期并发子痫的预防及护理干预

目的:探讨重度予痫前期患者并发子痫的预防及护理干预.方法:对我院收治的15例重度子痫前期患者的临床护理情况进行回顾性分析.结果:1例并发子痫抽搐,2例产后出血,其余12例未发生产科并发症,均痊愈出院.结论:严密观察、积极治疗、精心护理可减少重度子痫前期患者子痫的发生及预防并发症.     

妊娠高血压子痫前期的护理

目的 探讨妊娠高血压子痫前期的护理.方法 22例患者自然分娩,17例因胎儿宫内窘迫行剖宫产术.结果 39例子痫前期患者,新生儿Apgar评分均9分,无窒息现象发生,产妇也未发生大出血.结论 妊娠高血压子痫前期护理非常重要,应严格遵守护理的操作规程,有效保证临床治疗.     

规范化护理干预改善早发型重度子痫前期患者的期待治疗结局

目的观察对早发型重度子痫前期期待疗法患者实施规范化护理干预的临床效果,探讨规范化护理干预在临床诊疗过程中的积极意义。方法回顾性分析我院就诊的早发型重度子痫前期期待治疗患者94例,其中2009年1月至2010年9月就诊的47例设为对照组,实行规范化护理干预之后的2010年10月至2012年6月的47例设为观察组。对照组按当时的临床处理常规进行诊疗;观察组在常规治疗的基础上严格执行规范化护理干预:强化护理评估、开展针对性心理护理、健康教育、用药护理及密切观察等。结果观察组期待治疗时间[(13.40±4.87)d]长于对照组[(6.12±3.02)d];母体并发症发生率(10.64%)低于对照组(27.66%);观察组新生儿体重[(2.97±0.30)kg]、Apgar评分(7.78±0.56)及生存率(89.36%)均高于对照组[分别为(2.55±0.31)kg、(6.56±0.70)、72.34%];观察组护理满意度(97.87%)高于对照组(85.11%)(P均0.05)。结论规范化护理干预能够显著改善早发型重度子痫前期患者的期待治疗结局。     

早发型重度子痫终止妊娠时期的分析

目的:探讨重度子痫前期(EOSP)期待疗法的临床特点、对母婴的影响、妊娠并发症、妊娠的处理方法及时机.方法:对孕24-27+6周21例(甲组)、28-31+6周34例(乙组)、32-33+6周42例(丙组)EOSP实施期待疗法:基础治疗、促进胎儿成熟、密切监护、适时终止妊娠.结果:三组延长孕周时间有差异,乙组最长;孕妇并发症甲组最高,乙、丙组无差异;新生儿情况甲组况预后最差,乙、丙组比较无差异.结论:早发型重度子痫前期严重影响母婴的预后,在期待治疗过程中要密切监护母胎的情况,选择好终止妊娠的适当时间,剖宫产可作为终止妊娠的首选方法.     

早发型重度子痫前期对母婴结局的影响

目的:探讨平发型量度予痛前期保守治疗时间及终止妊娠时机与母婴的结局.方法:对我院2008年1月～2010年12月收治的早发型量度子痈前期92例患者进行田属性分析,根据发病的孕周分组:A组(孕周<28用),B组(28<孕周<30),C组(30<孕周<34).比较3组间孕产妇终止妊娠和保守治疗时间,并发症发生情况、围生儿存活情况以及分娩方式,结果:3组间终止妊娠时间比较差异有统计学意义(P<0.05),B组保守治疗时间比A、C两组长,A组并发症发生率比B、C两组高,差异有统计学意义(P<0.05)三组孕妇并发症随孕周的延长而下降,但B、C两组差异无统计学意义(P>0.05),3组间围生儿死亡率(胎死宫内及新生儿死亡)比较差异有统计学意义(P<0.05),A组胎儿生长受限和胎儿窘迫发生率与C组比较,B组胎儿生长受限发生率与C组比较差异均有统计学意义(P<0.05):3组均无孕妇死亡.结论:早发型重度子痫前期的母儿结局与发病孕周密切相关,在严密观察病情期待过程中,应尽量延长孕周,选择适时终止妊娠时间是至关重要的.     

硫酸镁联合硝酸甘油治疗重度子痫前期心力衰竭的临床价值

目的探讨硫酸镁联合硝酸甘油治疗重度子痫前期心衰的临床价值。方法选择80例患者,分为两组,各40例,对照组使用硫酸镁,观察组则在对照组的基础上使用硝酸甘油,比较两组患者治疗后不同时间点平均动脉压变化,检测血小板凝集率及24h尿蛋白量变化,并统计两组发生的产科并发症。结果治疗后观察组15min、30min、1h及3h,其平均动脉压均显著低于对照组（P〈0．05）,观察组血小板凝集率显著低于对照组（P〈0．05）,24h尿蛋白量值显著少于对照组（尸〈0．05）,发生宫内窒息、新生儿窒息及产后出血的比率显著低于对照组（P〈0．05）。结论硝酸甘油联合硫酸镁治疗重度子痫前期在预防和治疗心衰方面能有效降低平均动脉压,保护凝血功能和肾功能,减少产科并发症,具有显著疗效。     

2008年北京协和医院收治子痫前期及子痫病例分析

目的探讨子痫前期及子痫患者的特点,以及孕期监测、治疗及减少其严重并发症的措施。方法分析2008年北京协和医院收治的有我院系统产前检查及非我院系统产前检查的妊娠期高血压疾病患者的临床特点。结果 2008年北京协和医院共收治分娩总数1,438例,其中有我院系统产前检查者1,346例。接受我院系统产前检查的孕妇合并子痫前期者28例(A组),无子痫、无孕妇严重并发症;早产12例(43%)、小于胎龄儿2例(7%)、新生儿窒息1例(4%);经阴道分娩6例;平均住院7.1 d,平均住院费用4,524元。非我院系统产前检查的孕妇子痫5例及子痫前期者48例,共53例(B组),早产40例(76%)、新生儿窒息9例(17%)、小于胎龄儿14例(26%)、新生儿围产期死亡5例(9%);合并胎盘早剥3例(6%)、视网膜剥离3例(6%)、颅内病变5例(9%);除1例因胎死宫内经阴道分娩,余均行剖宫产、5例行全麻手术;平均住院6.8 d,平均住院费用9,457元。A组患者均进行规范的产前检查,平均产检次数9.2次。B组患者平均产检次数为2.1,且产检不规范(8例未做任何产检,12例仅行超声检查,20例未进行血压监测和尿常规检查)。所有患者接受的是规范硫酸镁治疗,而B组转院前均未接受硫酸镁静脉推注或肌注。结论加强孕妇的系统产前检查的宣教,规范治疗妊娠期高血压疾病,改善新生儿预后,减少医疗费用。     

Acute Renal Failure During Eclampsia: Incidence Risks Factors and Outcome in Intensive Care Unit

Objective: To assess the incidence, risk factors and the outcome of acute renal failure (ARF) associated with eclampsia in intensive care unit (ICU). Design: Prospective and analytic study. Setting: A surgical ICU in a university hospital. Patients: 178 consecutive women with eclampsia admitted to an intensive care unit during seven years. ARF was defined by a serum creatinine concentration > 140 µmol/L. Results: The incidence of ARF was 25.8%. In univariate analysis the severity of patient illness, the complications associated with eclampsia (disseminated intravascular coagulation, Hellp syndrome, neurologic complications, abruptio placenta, aspiration pneumonia, delivery hemorrhage) were significantly associated with ARF. In a logistic regression model, risk factors for ARF included organ system failure (OSF) odds ratio (OR) = 1.81 confidence interval (CI) [1.08–3.05], bilirubin > 12 µmol/L OR = 4.42 CI [1.54–12.68], uric acid > 5.9 g/dL OR = 16.5 CI [3.09–87.94], abruptio placenta OR = 0.2 7 CI [0.08–0.99], and oliguria OR = 0.10 CI [0.03–0.44]. In contrast, severity of blood pressure or proteinuria on dipstick were not associated with ARF. However, in this series, 15 women required dialysis in the short term and one required long‐term dialysis. ARF associated with eclampsia was significantly associated with mortality (32.6% versus 9.1% p = 0.0001). Conclusion: ARF with eclampsia is a frequent situation that required intensive management when risks factors were present. The need for dialysis was a rare condition.     

Clinical and ultrasonographic assessment of airway indices among non-pregnant,normotensive pregnant and pre-eclamptic patients: a prospective observational study

BackgroundPrediction of a difficult airway is of paramount importance for an anaesthesiologist. Various anatomical and physiological factors contribute to a difficult airway in pregnant females, especially those with pre-eclampsia. The aim of the study was to assess airway indices using both routinely used clinical methods and ultrasound.MethodsFifty-five non-pregnant females, 55 normotensive pregnant females and 55 females with pre-eclampsia were included in this prospective study. Clinical airway assessment was the modified Mallampati score, thyromental distance, hyomental distance, hyomental distance ratio, chest circumference, neck circumference and chest-to-neck circumference ratio. Sonographic assessment included tongue width, tongue volume, anterior neck soft tissue thickness at the level of hyoid, epiglottis and vocal cords, subglottic diameter, ratio of pre-epiglottic space to anterior, posterior and midpoint of anterior and posterior vocal folds.ResultsSeveral significant differences were observed between pregnant and non-pregnant females, with additional changes in pre-eclamptic females. These included clinical parameters such as the modified Mallampati score and sonographic measurements of tongue width, tongue volume, subglottic diameter, anterior neck soft tissue thickness at the level of hyoid, epiglottis and vocal cords, and the ratio of pre-epiglottic space to anterior, posterior and midpoint of anterior and posterior vocal folds.ConclusionRoutinely used clinical methods of airway assessment lack sensitivity and specificity. Ultrasound can visualise anatomical structures in the supraglottic and subglottic views and is encouraging as an airway assessment tool.     

The first micturition times of the newborns whose mothers were treated with magnesium sulfate

Background: The aim of this study was to determine whether magnesium sulfate used for the treatment of severe pre-eclampsia or eclampsia had an effect on the first micturition time of the newborn. Methods: The first group included 20 newborns all of whose mothers had severe pre-eclampsia or eclampsia, and all mothers had been treated with magnesium sulfate according to the Parkland Memorial Hospital eclampsia regimen. The second group included 20 newborns all of whose mothers were normal pregnants, and did not receive any drug that had an effect on the contractility of smooth muscles. The first micturition times of all newborns in two groups were determined following delivery and were compared statistically. Results: All newborns urinated in the first 24 hours. There were no statistically significant differences in the micturition times between the two groups (p > 0.05). There was no residual urine after the first micturition, and none of them had any urinary tract abnormality and neurological pathology. Conclusions: From the results, it was concluded that magnesium sulfate had no effect on the first micturition time of the newborns, when applied according to the Parkland Memorial Hospital eclampsia regimen in severe pre-eclamptic or eclamptic pregnants. This revised version was published online in June 2006 with corrections to the Cover Date.     

剖宫产瘢痕妊娠42例临床分析

目的探讨剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)的病因、临床特征、早期诊断及治疗方法。方法对我院2008年1月～2011年12月收治的42例CSP患者的临床资料进行回顾性分析。结果 CSP占同期异位妊娠的1.81%(42/2 316),所有患者术前行彩色多普勒超声检查,明确诊断33例(78.57%)。42例患者中30例行宫腔镜指引下清宫术,6例行药物治疗+清宫术,3例行双侧子宫动脉栓塞术联合化疗+清宫术,2例行经腹妊娠病灶切除术+子宫瘢痕修补术,1例引产排胎过程中出现DIC切除子宫。结论 CSP近年来呈上升趋势,彩色多普勒超声图像具有特征性,是诊断CSP最为直接、准确、简便的手段。宫腔镜指引下清宫术能明确孕囊着床部位,彻底清除妊娠病灶,减少手术时间及术中出血,避免子宫破裂,是安全有效的治疗方法,可作为CSP治疗的备选方案之一。     

剖宫产术后瘢痕妊娠17例临床分析

目的探讨剖宫产术后瘢痕妊娠（CSP）的临床特点及治疗方法。方法对我院2007年1月～2010年8月收治的17例剖宫产术后瘢痕妊娠患者的临床数据进行回顾性分析。结果 17例患者中12例停经后有不规则阴道流血,6例患者人工流产术中大出血,3例人工流产术后阴道淋漓出血,6例术前明确诊断,均通过彩超诊断瘢痕妊娠,14例予子宫动脉栓塞术联合刮宫术均治疗成功,1例予药流后行清宫术,2例吸宫术发生大出血致休克直接行子宫切除术。结论子宫动脉栓塞术联合刮宫术是治疗剖宫产术后瘢痕妊娠最快捷、最有效的方法。     

双胎胎儿生长不一致妊娠结局及临床预测

目的分析双胎妊娠中胎儿生长不一致的妊娠结局及临床预测。方法回顾性分析2009年1月～2010年12月分娩的双胎妊娠孕妇199例的临床资料。以双胎胎儿体重差〉20%为诊断标准,分为发育不一致组（观察组）和发育一致组（对照组）,比较两组分娩前B超提示两胎儿间腹围和脐动脉血流差值及比较两组在妊娠并发症、合并症、分娩情况和围产儿预后等方面的差异。结果①观察组妊娠期高血压、双胎输血综合征的发生率明显高于对照组,两组比较,差异有统计学意义（P〈0.05）;②观察组小于孕龄儿和围产儿死亡的发生率较对照组高,两组比较差异有统计学意义（P〈0.01）;③观察组新生儿高胆红素血症、新生儿呼吸窘迫综合征、新生儿进入NICU比率均明显高于对照组,差异有统计学意义（P〈0.05或〈0.01）;④两组中胎儿腹围差〉20cm,或脐动脉血流S/D差〉0.4的发生比例有明显差异（P〈0.05）。结论①发育不一致性双胎妊娠并发症及围生儿患病率和死亡率明显高于发育一致性双胎。发育不一致双胎妊娠主要的并发症为妊娠期高血压、双胎输血综合征、分娩小于孕龄儿、围产儿死亡。双胎中体重轻者围产儿死亡率高。②分娩前B超胎儿腹围差及脐动脉血流S/D值在双胎妊娠中对胎儿协调发育和围产儿预后有较好的预测价值,及早发现和处理双胎发育不一致,是改善胎儿和新生儿预后的关键。     

Pregnancy characteristics and outcomes after bariatric surgery: national-level analysis in the United States

BackgroundBariatric surgery is an effective surgical treatment for weight reduction in individuals with obesity. Pregnancy outcomes related to prior bariatric surgery are currently under active investigation.ObjectiveTo assess national-level trends, characteristics, and outcomes of pregnancy after bariatric surgery in the United States.SettingRetrospective cohort study queried the National Inpatient Sample.MethodsThe study population was 14,648,135 patients who had vaginal or cesarean delivery from January 2016 to December 2019. Exposure allocation was based on the history of bariatric surgery. The main outcomes were (1) trends and characteristics related to bariatric surgery, assessed with multivariable binary logistic regression model; and (2) Centers for Disease Control and Prevention–defined severe maternal morbidity, assessed by propensity score matching and generalized estimating equation.ResultsA total of 53,950 (.4%) patients had prior bariatric surgery. The number of patients with prior bariatric surgery increased from .3% to .5%, and this trend remained independent in multivariable analysis (P < .001). Patients who had bariatric surgery were also more likely to be older and have obesity, medical co-morbidities, fetal growth restriction, preterm birth, and cesarean delivery compared with those without bariatric surgery (all, P < .05). In a propensity score matched model, patients who had bariatric surgery were more likely to receive blood product transfusion (2.3% versus 1.6%; odds ratio = 1.45; 95% confidence interval, 1.19–1.77), but severe maternal morbidity other than blood product transfusion was comparable to those without (1.1% versus 1.4%; odds ratio = .80; 95% confidence interval, .63–1.02).ConclusionThere is a gradual increase of pregnancy after bariatric surgery in recent years in the United States.     

126例妊娠期肝内胆汁淤积症治疗临床分析

目的：探讨临床治疗妊娠期肝内胆汁淤积症的疗效。方法：采用回顾性统计分析西安市红十字会医院5年来收治的126例妊娠期肝内胆汁淤积症患者的临床资料,分为研究组（66例）和对照组（60例）,采用不同方法治疗,观察其治疗指标变化,并对分娩后情况进行统计。结果：两组患者治疗后瘙痒评分、血清甘胆酸、谷丙转氨酶、谷草转氨酶、总胆红素与直接胆红素的含量平均较治疗前低（研究组：t值分别为3．61,3．45,3．23,3．46,3．25,3．42,均P〈0．01;对照组：t值分别为3．21,2．45,2．74,2．68,2．80,2．77,均P〈0．01）;研究组治疗前后瘙痒评分、血清甘胆酸、谷丙转氨酶、谷草转氨酶、总胆红素与直接胆红素的含量的差值水平较对照组大（f值分别为2．21,2．09,2．03,2．15,2．05,2．11;均P〈0．05）;治疗后,研究组胎儿窘迫、早产及新生儿窒息的发生率较对照组低（妒值分别为4．25,4．58,4．23;P〈0．05）。结论：思美泰与熊去氧胆酸联合用药能提高妊娠期肝内胆汁淤积症的疗效,尤其对于重症患者有更明显的疗效,可以改善新生儿的预后。     

妊娠合并卵巢肿瘤32例临床分析

回顾性分析1997年1月至2002年1月收治的32例妊娠合并卵巢肿瘤的患，均予以手术治疗，肿瘤标本送病检，并追踪随访母婴。妊娠合并卵巢肿瘤呈上升趋势，绝大部分为良性肿瘤，手术疗效满意。妊娠合并卵巢肿瘤可通过孕早期妇检、B超检查及剖宫产术中对附件探查等早期诊断，予适时手术治疗，预后良好。