Gestational Trophoblastic Disease Diagnosis and Treatment： An Analysis of 56 Cases

Objective To investigate the diagnosis and treatment of gestational trophoblastic disease （GTD）. Methods A retrospective review was conducted on 56 patients with GTD who under- went treatment in Ruijin hospital from January 2007 to December 2012. Their infor- mation of diagnosis, treatments, follow-up and efficacy were collected and analyzed Results Misdiagnosis rate was 41.1% （23/56）for the first time. Of 56 patients, 31 had direct curettage, 19 had curettage after trichosanthis （TCS） treatment, 3 had curettage after intervention treatment and 3 did not have curettage. Twenty patients with gesta- tional trophoblastic neoplasia （GTN） took fluorouracil＋vincristine＋dactinomycin （VCR ＋KSM＋5-FU） chemotherapy, but 2 of them changed to etoposide＋methotrexate＋acti- nomycetes streptozotocin-D＋cyclophosphamide＋vincristine （EMA-CO） chemo- therapy due to drug resistance. Three patients＂ with GTN took EMA-CO chemotherapy. Two patients with placental site trophoblastic tumor （PSTT） required surgeries, one took hysterectomy, another got mass and adnexectomy. Apart from 1 case who gave up treatment and was dead, all the other women went into remission from their diseases. Conclusion The diagnosis of trophoblastic disease rely on a comprehensive analysis. A reasonable choice of TCS or intervention can be effective and safe in treating GTD. Most patients with GTN could get complete remission by selecting the appropriate chemotherapy and surgery.     

妊娠合并先天性子宫畸形对母婴结局的影响

目的探讨先天性子宫畸形妊娠对于母婴结局的影响。方法回顾性分析2008年1月至2011年6月进入围生期的子宫畸形合并妊娠患者54例（畸形组）和同期正常子宫妊娠者60例（对照组）的临床资料,比较2组的母婴结局。结果畸形组胎位异常发生率（46.3%）、胎膜早破发生率（27.8%）、剖宫产率（77.8%）、早产率（25.9%）及足月低体重儿发生率（11.1%）均显著高于对照组;平均孕周（37.1周）、新生儿平均出生体重（2728g）显著低于对照组;而胎儿宫内窘迫、新生儿窒息发生率2组差异无统计学意义（11.1%vs 8.3%,7.4%vs6.7%）。结论子宫畸形合并妊娠可对母婴结局产生不良影响,应引起临床医生足够重视,加强育龄妇女孕前检查及孕期保健。     

甲氨蝶呤单疗程治疗低危无转移妊娠滋养细胞肿瘤的疗效分析

目的: 观察甲氨蝶呤单疗程治疗低危无转移妊娠滋养细胞肿瘤的疗效。方法: 将105例低危无转移妊娠滋养细胞肿瘤病例按患者自愿原则分为两组,其中60例自愿采用甲氨蝶呤单药单疗程治疗（试验组）,45例自愿采用甲氨蝶呤单药多疗程治疗（常规组）,比较两组治疗后的完全缓解率、耐药率、复发率、从开始治疗到完全缓解的平均时间、平均疗程数及不良反应发生率。结果： 两组完全缓解率、耐药率、复发率及从开始治疗到完全缓解的平均时间均无明显差异（均P＞0.05）;试验组平均化疗疗程数为（1.90±1.48）次,显著少于常规组的（4.93±2.46）次（P＜0.05）。试验组白细胞减少症（2例,3.33%）、恶心呕吐（6例,10%）及黏膜炎（7例,11.67%）发生率也明显低于常规组[分别为13例（28.89%）,15例（33.33%）和13例（28.89%）,均P＜0.05]。 结论： 甲氨蝶呤单药单疗程化疗疗程短,不良反应发生率低,可作为低危无转移妊娠滋养细胞肿瘤治疗的首选化疗方案。     

Effect of Pathoanatomic Diagnosis on the Quality of Birth Defects Surveillance in China1

Objective To provide evidence for more accurate diagnosis of birth defects based on the pathoanatomy of congenital malformations. Methods Data used in this study were obtained from Luliang City Hospital and three county hospitals of Shanxi province between February 2004 and March 2006. Autopsy and pathological examination of 160 dead fetuses and stillbirths were performed. Photos of dead fetuses and stillbirths were taken, tissues were cut into sections for pathological examination under microscope, all pathological information was recorded, and percentage of birth defects was calculated.Results The proportion of dead fetuses and stillbirths with or without congenital malformations was 84.4% (135/160) and 15.6% (25/160), respectively. There were 16 categories of major external and internal birth defects in 135 cases of such defects.Congenital heart defects, anencephaly and spina bifida had a higher prevalence rate in the study period. The prevalence rate of non-malformation death and birth defects < 28 gestational weeks and internal anomalies≥ 28 gestational weeks was 14.61% (61/4175) and 17.25% (72/4175), respectively. A total of 413 in situ anomalies were found in 135 cases of autopsy. Spina bifida,anencephaly, congenital heart defects, aplasia or accessory lobe of lung, renal agenesis and dysplasis and congenital hydrocephaly were more closely associated with severe malformations than with mitis malformations. The cases of dead fetuses and stillbirths with multiple malformations (≥ 2 in situ anomalies) had a higher proportion (74.1%), whereas those with isolated malformations had a lower proportion (25.93%). Conclusion The occurrence of congenital malformations in different embryonic developmental stages affects multiple organs. Postmortem examination of internal and multiple malformations of fetal deaths and stillbirths can provide more accurate diagnostic information for birth defects.     

Studies on congenital abnormalities and related risk factors

Congenital malformations were studied prospectively covering 11680 consecutive deliveries. The overall incidence of malformations was 2.3%. Musculoskeletal system was the most commonly involved system. The incidence of malformation was higher in still borns, premature, low birth weight babies and those with positive heredo-familial history. It was also higher in babies, born to mothers who were more than 35 years of age and gravida four and above. Consanguinity of marriage, drugs and hormone ingestion during pregnancy, antenatal complication like hydramnios, pre eclamtic toxemia, gestational diabetes was associated with high incidence of congenital malformations.     

氨甲喋呤+更生霉素短程疗法对恶性滋养细胞瘤的治疗

本文报道1982～1987年20例恶性滋养细胞瘤患者,单纯应用氨甲喋呤+更生霉素短程化疗(5d)的近期疗效及随访结果,20例患者均获得完全缓解。随访19例,3年治愈率达100％,除6例采取避孕措施外,余13例化疗后均有正常孕产史,所产16个婴儿未见畸形,发育和智力均正常。此方案药源充分、方法简单、疗效好,化疗毒性反应韵发生率及程度均低于常规疗法。     

1274例体外受精-胚胎移植治疗分娩新生儿结局分析

目的 探讨经体外受精-胚胎移植(IVF-ET)治疗分娩的新生儿的情况,以分析IVF-ET技术对新生儿先天畸形的影响.方法 对我中心经IVF-ET治疗分娩的1274个新生儿结局进行回顾性分析,探讨新生儿出生孕周、体质量、受精方式、母亲年龄、胎数与先天畸形的关系.结果 分娩930例,其中足月产706例(75.91%),早产224例(24.09%).获新生儿1274个,其中低体质量儿363例(28.49%),新生儿畸形13例(1.02%),围产期死亡15例(1.18%).结论 IVF-ET治疗增加了多胎妊娠、早产、低体质量儿等发生率,但未增加新生儿畸形发生率和围产期死亡率,卵母细胞内单精子注射术新生儿畸形率较IVF高,母亲年龄和胎数与先天畸形无明显关系,IVF-ET是治疗不孕症的安全手段.     

重症监护病房新生儿死亡病例分析

目的探讨新生儿重症监护病房（NICU）新生儿死亡的危险因素及变迁。方法回顾性分析我院NICU 2004年1月—2009年12月期间死亡的129例患儿的病历资料,筛选死亡危险因素。结果体重〈1.5 kg新生儿年均病死率9.2%;胎龄≤32周早产儿年均病死率为9.4%;死亡新生儿中出生48 h内病死率达34.9%.2004年—2009年新生儿直接死亡原因排序依次为感染性疾病、窒息及其并发症、先天性畸形、其他疾病。结论胎龄小、出生体重低及母亲高龄始终是新生儿死亡的高危因素,死亡高危时段在出生后48 h内。感染性疾病、窒息及其并发症是最主要的直接死因,先天性畸形致死率增高,疾病谱有扩大趋势。     

Maternal diabetes and perinatal outcomes in West Virginia Medicaid enrollees

Diabetes Mellitus (DM) is a serious problem in West Virginia. Diabetes during pregnancy has been associated with several negative outcomes. This study tested the hypotheses that women who had DM during pregnancy would have more negative perinatal outcomes than those who did not and women with pre-gestational DM would have more negative perinatal outcomes than women with gestational DM. The population included 14,583 mothers enrolled in WV Medicaid in 2001 and 2002. The population was divided according to the presence of DM in the mother, and then sub-divided into pregestational and gestational DM groups. Results showed significant associations between maternal diabetes and occurrence of macrosomia, pre-term delivery and less than optimal one-minute Apgar scores. The pre-gestational DM group had significantly more occurrences of macrosomia, pre-term birth, less than optimal Apgar scores, occurrence of complications of labor and/or delivery and occurrence of congenital anomalies than the gestational DM group.     

辅助生殖技术与自然妊娠子代出生缺陷研究

目的　分析辅助生殖技术（ART）、自然妊娠（SP）子代出生缺陷情况,探讨ART出生缺陷的影响因素。方法　选取2008年1月—2017年12月于天津市中心妇产科医院行ART的孕妇12 935例,其子代为ART出生缺陷儿的有139例（ART组）。同期选取于天津市中心妇产科医院产科分娩的SP出生缺陷儿453例为SP组。收集所有出生儿基本资料,包括出生儿性别、胎龄、出生方式、出生体质量及其母亲年龄、胎数、妊娠期并发症情况,ART方法,出生缺陷儿的畸形部位。结果　ART组胎龄、剖宫产率、出生体质量、母亲妊娠期并发症发生率小于SP组,早产、低出生体量、母亲多胎妊娠发生率大于SP组（P<0.05）。ART组畸形部位构成比前3位是心血管循环系统（33.1%）,眼、耳、面、颈部（13.5%）,其他畸形（10.1%）。ART方法：体外受精新鲜胚胎移植（IVF-ET）40例,卵细胞浆内单精子注射新鲜胚胎移植（ICSI-ET）20例,解冻复苏胚胎移植（FET）79例。IVF-ET、ICSI-ET、FET出生儿畸形部位构成比第1位均是心血管循环系统,第2位分别是其他畸形,唇腭裂,眼、耳、面、颈部。ART组不同性别、母亲年龄出生儿畸形部位比较,差异无统计学意义（P>0.05）;ART组不同胎龄、母亲胎数出生儿畸形部位分布比较,差异有统计学意义（P<0.05）。SP组畸形部位构成比前3位是心血管循环系统（62.9%）,消化系统（11.1%）,唇腭裂（7.0%）。SP组不同性别、母亲胎数出生儿畸形部位比较,差异无统计学意义（P>0.05）;SP组不同胎龄、母亲年龄出生儿畸形部位比较,差异有统计学意义（P<0.05）。多因素Logistic回归分析结果显示,出生儿胎龄、母亲胎数、母亲妊娠期并发症情况是ART出生缺陷的影响因素（P<0.05）。结论　ART、SP出生缺陷儿畸形部位分布存在一定差异,但其最常见的畸形部位均为心血管循环系统;出生儿胎龄、母亲胎数、母亲妊娠期并发症情况均为ART出生缺陷的影响因素。     

The outcome of pregnancy in women suffering from migraine.

The reproductive histories of 777 women suffering from migraine were compared with 182 non-migrainous women. The incidence of miscarriage, stillbirth and toxaemia of pregnancy was very similar in both groups and there was no increase in the number of congenital malformations in the children born to women who suffered from migraine compared with the control group or with the national average. It was concluded that women suffering from migraine did not have an increased risk of giving birth to children with deformity and it was unlikely that drugs most commonly used in the treatment of migraine were teratogenic.     

超声在诊断中孕胎儿疾病中的应用价值

目的探讨超声技术在产前诊断中孕胎儿疾病的临床价值。方法应用实时彩色多普勒超声仪进行多个切面对孕20～28周的胎儿进行常规超声检查。结果在5473例中孕妇女中,检出胎儿畸形153例,畸形胎儿发生率约2.79%。超声检查漏诊24例,漏诊病例主要表现为较小畸形及心血管畸形。结论妊娠中期进行常规超声检查是围产期检查中的重要手段,可以产前诊断胎儿明显的形态结构异常,对提高胎儿畸形的检出率,减少畸形儿的出生,降低婴幼儿和围产儿死亡率,提高出生人口质量都有十分重要的意义。     

Blood transfusion reactions in Malaysian newborn infants

A prospective observational study was carried out over a seven month period in the neonatal intensive care unit (NICU) of a large Malaysian maternity hospital to determine the rate of blood transfusion and the incidence of transfusion reactions in newborn infants. During the study period, the rates of blood transfusion was 6.1% (n = 117) of NICU admission or 8.2 per 1,000 live births. The median birth weight of the infants who had received blood transfusion was 1,740 grams (range: 725-4,350), and their mean gestational age was 33.6 weeks (sd = 5.1, range = 24-41 weeks). The median age of infants when they first received blood transfusion was 4.0 days (range: 1-27 days). When compared with infants of birth weight between 3,000 and 3,499 grams, infants of birth weight less than 1,500 grams received significantly higher median number of transfusions per infant, (p < 0.001). The incidence of transfusion reaction was 2.7% (3/110) of all transfused infants or 1.3% (3/223) of all blood transfusions. Febrile nonhemolytic reaction was the only type of transfusion reaction detected during the study period. This study showed that transfusion reactions in newborn infants were not common.     

48例恶性滋养细胞肿瘤的疗效分析

目的探讨恶性滋养细胞肿瘤病例的治疗方法及效果。方法对本院1995~2007年恶性滋养细胞肿瘤住院患者的治疗过程及结果进行回顾性分析。结果共48例恶性滋养细胞肿瘤病例,平均年龄为29.5岁;37例患者行单纯化疗,11例患者行化疗加手术治疗;15例绒毛膜上皮癌的治愈率是80%。31例侵蚀性葡萄胎的治愈率是93.5%。结论化学药物对恶性滋养细胞肿瘤有较好的疗效,必要时应辅以手术治疗。     

Psychological reactions and coping strategies of Sri Lankan women carrying fetuses with lethal congenital malformations

INTRODUCTION: Termination of pregnancy is a popular option for pregnancies complicated by lethal congenital malformations (LCMs). In Sri Lanka, where abortion laws are restrictive, this is not available. We studied the psychological responses and coping strategies of women who had to continue their pregnancies knowing the baby had a LCM. SETTING: A teaching hospital in Sri Lanka. STUDY DESIGN: Qualitative inquiry. METHOD: We conducted a semi-structured interview of 10 women whose fetuses were diagnosed to have a LCM. RESULTS: All women showed a grief reaction on hearing the news and were distressed about having to carry a futile pregnancy. Eight women were grateful they knew of the abnormality because it prepared them for the birth better, while the other two wished they had not known. They all found having to share facilities with 'normal' women to be painful. Seven women who received 'routine' antenatal care felt that the doctors were ill-equipped to deal with their situation. All felt that abortion should be legalised for LCMs. All engaged in religious rites believed to have miraculous powers, hoping that these will result in a normal baby. Two required specialised counselling. CONCLUSIONS: The diagnosis of a LCM causes severe distress and psychological reactions, which the staff dealing with these women should be aware of. Ideally, they should be provided care with minimum contact with other women, taking into account the futility of the pregnancy. Engagement in religious rites, even though with unreal expectations, may possibly help them in the long term bereavement process.     

超声在产前诊断胎儿畸形中的临床价值

目的:探讨超声在产前诊断胎儿畸形的临床价值。方法:对4718例13~40周的孕妇采用实时彩色多普勒超声仪进行系统检查,对胎儿畸形进行筛查的诊断,追踪随访至产后1周。结果:在4718例孕妇中,超声诊断胎儿畸形156例,与产后诊断符合率为100%。超声检查漏诊22例,漏诊病例主要表现为较小畸形。结论:妊娠中晚期进行系统超声检查可以产前诊断胎儿形态结构的明显畸形,对于降低出生畸形发生率,提高人口素质有重要意义。     

Comparison of maternal and fetal outcomes, in epileptic and non-epileptic women

OBJECTIVE: To assess maternal and fetal outcomes, in epileptic and non-epileptic pregnant women. METHODS: A retrospective case-control study was conducted from January 2005 - December 2006 at Riyadh Military Hospital, Riyadh, Kingdom of Saudi Arabia. A total of 16508 live birth charts were reviewed. Maternal, obstetrical, and fetal outcomes were compared between women with epilepsy Group 1 (n = 53) and women who did not have epilepsy (controls) Group 2 (n = 60). RESULTS: There were no significant differences between either group in total length of labor, labor induction and oxytocin augmentation, need for labor analgesia, total blood loss and the need for blood transfusion, mode of delivery, and the length of hospital stay. There were no significant differences in all maternal complications between either group (p=0.8, 95% CI: 0.3-2.1). There was an increase in the mean dose of the antiepileptic medications needed during pregnancy. However, 4 women (7.5%) in the epileptic group had major seizures during pregnancy. All of these women needed addition of a second antiepileptic medication. Major congenital malformations occurred in 2 newborns (3.8%) of epileptic women, and none occurred in the control group. Both newborns were from women who received polytherapy. CONCLUSION: Women with epilepsy are not at increased risk for obstetric and neonatal complications, provided there is a combined team management approach by a neurologist and an obstetrician.     

1996～2006年全国5岁以下儿童先天异常死亡流行病学分析

目的 了解1996～2006年全国5岁以下儿童先天异常死亡的变化趋势和模式.方法 采用全国5岁以下儿童死亡监测网收集的1996～2006年以人群为基础的监测资料,计算不同地区5岁以下儿童先天异常死亡率及其在5岁以下儿童死亡中的比例、死因别死亡率及构成比,同时探讨5岁以下儿童先天异常死亡的年龄分布情况.结果 全国5岁以下儿童先天异常死亡率由1996年的412.0/10~5下降至2006年的342.2/10~5,下降了16.9%.除农村和边远地区外,城市、沿海、内地地区的5岁以下儿童先天异常死亡率亦呈下降趋势,2003～2006年这种下降趋势更为明显.5岁以下儿童先天异常死亡率农村高于城市,边远地区高于沿海和内地地区.全国5岁以下儿童先天性心脏病死亡率未见明显下降,神经管畸形死亡率由1996年的94.2/10~5下降到11.3/10~5,降幅达70.0%,其他异常死亡率未见下降.5岁以下儿童死亡中先天异常所占比例则由1996年的9.2%上升至2006年的14.4%(上升了5.2个百分点),城市、农村亦有上升.结论 先天异常占5岁以下儿童死亡的比例逐年上升,已成为5岁以下儿童死亡的主要死因.我们应继续加强出生缺陷的三级预防,进一步减少5岁以下儿童先天异常死亡.     

北京市严重先天性肾脏畸形二级预防效果分析

目的：回顾分析北京市2008-2013年先天性肾脏畸形监测资料,了解北京市先天性肾脏畸形的发生与产前诊断情况,为先天性肾脏畸形的防控提供相关信息及依据。方法采用描述性统计学分析方法回顾性分析近6年北京市出生缺陷监测及超声诊断资料。结果近6年北京市先天性肾脏畸形发病率为1.17‰,产前诊断率为87.50%;其中,严重肾脏畸形（婴儿型多囊肾、双侧肾缺如、双侧多囊肾、双侧肾发育不良）在肾脏畸形构成比为7.79%,发病率为0.09‰,产前诊断率为97.17%;肾脏畸形合并染色体异常构成比为1.32%、发病率为0.02‰、产前诊断率为100%,染色体异常以三体型为主（构成比为66.67%）。肾脏畸形超声检出孕周以孕20~24周最多（构成比为70.21%）,其次为孕28~34周（构成比为12.87%）。严重肾脏畸形中92.23%于孕28周前被检出。结论北京市产前超声诊断对肾脏畸形、尤其严重肾脏畸形的二级预防效果显著,应加强对先天性肾脏畸形患儿的遗传学诊断。     

Predictors of mortality in very low birth weight neonates in India

INTRODUCTION: Very low birth weight (VLBW) neonates constitute approximately 4-7 percent of all live births and their mortality is very high. The objective of the present study was to determine the predictors of mortality in VLBW neonates. METHODS: A retrospective cohort of VLBW neonates admitted over three years was studied. Exclusion criteria were: (1) neonates weighing less than 500 g and with gestational age less than 26 weeks; (2) presence of lethal congenital malformations; and (3) death in the delivery room or within 12 hours of life. The outcome measure was in-hospital death. Medical records were reviewed and data was analysed. Univariate analysis and logistic regression analysis were done to determine the predictors of mortality. RESULTS: A total of 260 cases were enrolled, of which a total of 96 (36.9 percent) babies died. The survival rate was found to increase with the increase in birth weight and gestational age. Univariate analysis showed maternal per vaginal bleeding, failure to administer steroid antenatally, Apgar score less than or equal to 5 at one minute, apnoea, gestational age, neonatal septicaemia and shock are the factors directly responsible for neonatal mortality. Logistic regression equation showed maternal bleed (1.326), apnoea (3.159), birth weight (0.037), gestational age (0.063), hypothermia (1.132) and shock (3.49) predicted 65 percent of mortality in VLBW babies. CONCLUSION: Common antenatal and perinatal predictors of mortality in VLBW infants in India include maternal bleed, failure to administer antenatal steroids, low Apgar score, apnoea, extreme prematurity, neonatal septicaemia and shock.