围生期颅内静脉窦血栓形成的诊治体会

围生期是指从妊娠28周起至产后7天这一特殊时期,此期若孕产妇合并颅内静脉窦血栓,即称为围生期颅内静脉窦血栓形成(CVST).CVST病死率及致残率较高,临床表现多样而无特异性,常易误诊,但随着头颅CT、MRI及数字减影血管造影(DSA)的广泛应用,报道逐渐增多.我院2003年1月至2007年2月共收治CVST患者7例.本文对其发病原因、临床特点、实验室检查及治疗措施进行分析,旨在提高对本病的认识和进行有效防治.     

孕产妇颅内静脉窦血栓形成26例临床分析

目的探讨孕产妇颅内静脉窦血栓形成(CVST)的高危因素、临床特点、诊治及预防。方法回顾性分析1997年1月至2007年12月南方医科大学南方医院26例孕产妇CVST患者的临床资料。结果26例患者危险因素以剖宫产术、长期卧床、子前期为主;孕早期7例占26.9%,孕中期2例占7.7%,孕晚期3例占11.5%,产褥期14例占53.8%,以上矢状窦区病灶多见。主要临床表现为头痛;影像学检查为主要诊断方法;以首选抗凝的综合治疗为原则,其显效率61.5%,病死率11.5%,误诊率高达57.7%。结论CVST临床表现缺乏特异性,高危因素众多,误诊率高,确诊有赖于影像学检查,综合治疗为原则,抗凝治疗安全有效,重在预防。     

孕产妇及胎婴儿预防传染性非典型肺炎的几个问题

传染性非典型肺炎是由冠状病毒亚型变种引起的 ,WHO称之为严重急性呼吸综合征 (severeacuterespiratorysyndrome,SARS)。作为易感人群的孕产妇及其胎婴儿 ,因其生理特点不同于一般人群而具有特殊性。对这组特殊人群 ,除在原有的保健工作基础上 ,还需要有针对SARS的特殊保健措施。此外 ,孕产妇预防SARS的保健措施 ,对于今后围生期预防其他传染性疾病也具有普遍的指导意义和实用价值。1　孕产妇及胎儿的免疫特点1 1　孕产妇的免疫特点　孕期母体处在免疫功能抑制状态 ,抵抗外来病原体的能力下降。另外 ,孕产妇的代谢率增高 ,血容量增加 …     

新型冠状病毒肺炎孕产妇分娩期管理建议

自2019年12月,新型冠状病毒肺炎(COVID-19)在武汉暴发以来,传播迅速。人群普遍对新型冠状病毒易感,而孕产妇作为一类特殊的易感人群,在当前形势下,新型冠状病毒感染的孕产妇数量有增加的趋势,而孕产妇由于其特殊的病理生理特点,临床管理与普通人群不完全相同。尤其是在分娩期存在多种可能增加病毒传播的风险,使得分娩期病毒传播防护更加困难,更需要精细化的管理。在对此方面认识更多的基础上,结合来自武汉前线的经验,本文对疑似或确诊COVID-19孕产妇的分娩期管理进行建议,希望对促进当前的产科临床工作能发挥更大的作用。     

妊娠合并脑血管疾病四例分析

颅内静脉窦血栓形成(cerebral venous sinus thrombo-sis,CVST)是脑血管疾病中的特殊类型,临床表现复杂多样且缺乏特异性,常表现为头痛、呕吐、视物不清、癫痫样发作等颅内压增高.CVST可发生于任何人群,妊娠期、产褥期及长期口服避孕药的女性更多见.妊娠合并颅内出血是指发生在妊娠、分娩期的急性出血性脑血管疾病,临床表现为头痛、呕吐、癫癎发作、昏迷及各种相应神经功能障碍.一旦发病,病情凶险,致残率和病死率较高.现将我院2007年收治的4例妊娠合并脑血管疾病病例总结分析如下.     

妊娠合并脑血管疾病四例分析

颅内静脉窦血栓形成(cerebral venous sinus thrombo-sis,CVST)是脑血管疾病中的特殊类型,临床表现复杂多样且缺乏特异性,常表现为头痛、呕吐、视物不清、癫痫样发作等颅内压增高.CVST可发生于任何人群,妊娠期、产褥期及长期口服避孕药的女性更多见.妊娠合并颅内出血是指发生在妊娠、分娩期的急性出血性脑血管疾病,临床表现为头痛、呕吐、癫癎发作、昏迷及各种相应神经功能障碍.一旦发病,病情凶险,致残率和病死率较高.现将我院2007年收治的4例妊娠合并脑血管疾病病例总结分析如下.     

孕妇新型冠状病毒感染防疫期间互联网“云产检”策略

新型冠状病毒(SARS-CoV-2)感染疫情期间,孕产妇作为特殊易感人群,常规产检落实困难。互联网门诊等新颖就医模式的出现及推广逐渐引起医患双方重视。为使广大孕妇在疫情防控期间获得科学产检指引,现将互联网"云产检"的适应人群及产检策略做一概述。     

近期流产后并发脑静脉窦血栓形成12例临床对比分析

目的:探讨近期流产后(流产后2周内)并发脑静脉窦血栓形成(CVST)的临床特征、治疗效果及短期预后。方法:收集CVST患者22例,根据是否近期流产分为近期流产组(RM-CVST组,12例)和近期无流产组(NM-CVST组,10例),从临床表现、诊断、治疗及短期预后等方面对两组进行比较。结果:1 RM-CVST组患者的病程时间(3.59±6.14天)短于NM-CVST组(14.57±20.49天),而急性起病患者比例(66.7%)高于NM-CVST组(20.0%),差异均有统计学意义(P0.05);RM-CVST组临床表现中癫痫发作、发热、视力障碍的比例高于NM-CVST组,差异均有统计学意义(P0.05)。2两组头部CT平扫检出率仅50.0%,头部低场强磁共振脑静脉窦血管成像(MRV)和影像学检查数字减影血管造影(DSA)检出率达100.0%;RM-CVST组头部MRI平扫检出率(90.0%)高于NM-CVST组(55.6%),差异有统计学意义(P0.05)。3RM-CVST组治疗的有效率和Rankin量表短期预后评分良好的比例与NM-CVST组比较,差异均无统计学意义(P0.05)。结论:近期流产后发生CVST的患者病程短、发病急、病情进展迅速;MRV和DSA检查对CVST患者有较高诊断率,近期有流产的CVST患者MRI检出率更高;经及早诊断、规范化治疗近期有流产CVST患者可获得与近期无流产患者一样的良好结局。     

子痫前期的主要生物标志物预测指标及其评价

<正>子痫前期是妊娠期特有的并发症,在我国孕妇人群中的发病率为3%～8%,其中重度子痫前期的发病率为0.3%～0.5%。在我国西部、北部地区及高原居住人群中,其发病率更高。本病可引起严重的母胎并发症,如重度高血压、肾功能衰竭、弥散性血管内凝血、HELLP综合征、胎儿发育迟缓、胎儿窘迫等,是导致孕产妇和围产儿死亡的主要原因之一。在我国,子痫前期导致的死亡占总孕产妇死亡数的25%之多。本病无特殊的治疗手段,其唯一有效的根治方法是娩出胎盘。     

2009～2010年南宁市妇幼保健院婚前保健人群和孕产妇HIV监测结果分析及干预措施研究

目的:了解南宁市婚前保健人群和孕产妇中人类免疫缺陷病毒(HIV)抗体检测及艾滋病(AIDS)感染情况。方法:我院HIV抗体初筛实验室对2009～2010年11041份血清标本进行HIV抗体初筛检测,并将初筛阳性的标本送往南宁市疾病预防控制中心(CDC)做确认实验。其后,对所有实验结果进行分析。结果:11041份标本中,HIV抗体阳性的标本有4例,阳性率为0.036%;检查类型分布,孕产妇4例,婚检人群未发现;感染者户籍均为暂住和流动人口。结论:做好婚前保健人群和孕产妇女人群中的HIV抗体初筛工作,能控制AIDS在高危人群流行一定时间后,向一般人群扩散蔓延,并有效防止和降低HIV母婴传播的发生率。     

Cerebral Venous Sinus Thrombosis in a Woman Using the Etonogestrel-Ethinyl Estradiol Vaginal Contraceptive Ring: A Case Report

BackgroundThe vaginal contraceptive ring is a hormonal contraceptive that releases etonogestrel and ethinyl estradiol. Cerebral venous sinus thrombosis (CVST) is a rare but serious complication of hormonal contraceptive use.CaseWe present a case of CVST in a 33-year-old nulligravid woman who was using a vaginal contraceptive ring. At the time of presentation, she had been using the ring for 18 months, having previously used oral contraceptives for 13 years. She had no additional risk factors for thrombosis apart from cigarette smoking. Despite vigorous management, the patient died from the effects of the CVST.ConclusionThe serious adverse effects of the vaginal contraceptive ring are not well known, although deep vein thrombosis, pulmonary embolism, and aortic thrombosis in association with use of the ring have been reported to Health Canada. Continuing post-market surveillance of thrombotic risk in users of the vaginal contraceptive ring is critical.     

早、中期妊娠合并颅内静脉窦血栓形成10例临床处理分析

目的:探讨早、中期妊娠合并颅内静脉窦血栓形成患者的治疗及终止妊娠的临床处理.方法:回顾性分析我院2000 ～2011年收治的10例孕早期(8例)和孕中期(2例)妊娠合并颅内静脉窦血栓患者的临床资料.结果:伴意识障碍、脑血管造影明确为静脉窦血栓6例患者(孕早期4例,孕中期2例),行股静脉或颈静脉入路药物局部溶栓及机械联合溶栓和碎栓治疗.其中孕早期2例结合静脉窦成形术,1例孕早期及1例孕中期术后还保留微导管.6例患者中5例术后2～7天神智转清,临床症状明显改善,其中1例孕早期术后1天自然流产;2例孕早期患者病情平稳行负压吸引术;2例孕中期患者,1例行依沙吖啶羊膜腔穿刺引产,1例行剖宫取胎术;仅1例孕早期保留微导管患者溶栓期间出现全身出血倾向,经积极治疗,维持至孕中期行依沙吖啶羊膜腔穿刺引产.3例孕早期神清患者经甘露醇脱水降颅压及低分子肝素积极抗凝治疗,1周后病情平稳行负压吸引术.1例孕早期昏迷患者因弥漫性脑出血、脑疝,经开颅减压治疗无效后死亡.9例患者终止妊娠后均无并发症发生,2例遗留功能缺损,1例合并视物模糊,余6例预后较好.结论:妊娠合并颅内静脉窦血栓形成应积极治疗原发病,先行抗凝、溶栓等治疗,待病情平稳后终止妊娠,妊娠终止方法依据产科特点选择.     

Central Venous Sinus Thrombosis in a Young Woman Taking Norethindrone Acetate for Dysfunctional Uterine Bleeding: Case Report and Review of Literature

BackgroundThe association between the progestin-only pill used for treatment of menstrual disorders and central venous sinus thrombosis (CVST) has rarely been reported in the literature. This report describes a case of central venous sinus thrombosis following intake of norethindrone acetate for dysfunctional uterine bleeding secondary to polycystic ovary syndrome in a young woman with undiagnosed underlying hyperhomocysteinemia.CaseA 23-year-old woman presented with severe headache, followed by hemiparesis, seizures, and altered sensorium. She had been prescribed norethindrone acetate for the management of dysfunctional uterine bleeding secondary to polycystic ovary syndrome. Investigations revealed acquired hyperhomocysteinemia, presumably due to nutritional deficiencies, and evidence of CVST on MRI and magnetic resonance venography. Investigations showed no evidence of inherited thrombophilia. The patient was treated with low molecular weight heparin, followed by warfarin, vitamin B₁₂, vitamin B₆, and folic acid, and recovered successfully.ConclusionAlthough venous thrombosis is usually linked to the ingestion of estrogen, rather than progestogen, this case illustrates that patients who are prescribed progestogen-only pills for gynaecological disorders may develop thrombosis, especially if they have predisposing metabolic disorders.     

Cerebral venous sinus thrombosis in a neonate with homozygous prothrombin G20210A genotype.

We describe a 7-day-old infant who presented with extensive cerebral venous sinus thrombosis (CVST) and was found to be homozygous for the prothrombin G20210A gene mutation. No other known risk factors for thrombosis were identified.     

Psychosomatic obstetrics in the countries of Central and Eastern Europe

Womens' experiences of pregnancy and birth in the countries of Central and Eastern Europe are explored in this paper. Most of these countries are in transition from a totalitarian system of government to that of democracy. The implications of this re-orientation are many. Not least of all are the changes taking place in health care systems in general, as well as in maternal-child health care in particular. This paper reviews the current state of some perinatal care systems in these countries. It is not a research paper: it reflects observations and recommendations arising from humanitarian aid service in these countries and from available literature.     

Embryonal rhabdomyosarcoma (botryoid type) of the cervix: A case report and review

A case report of embryonal rhabdomyosarcoma originating from the cervix in a 3-year-old girl is presented and a brief review of the literature on this topic given. The histopathology of the tumor is discussed and the effectiveness of a less aggressive surgical approach and chemotherapy is demonstrated in this particular case.     

The Advanced Training Skills Module in Paediatric and Adolescent Gynaecology – A trainee's perspective

The Royal College of Obstetricians and Gynaecologists (RCOG) has developed Advanced Training Skills Modules (ATSMs) which trainees have to take up in last two final years of their training. Every trainee is required to make their choices at the end of year five of their specialist training. The decision to choose a particular ATSM depends on the primary interest of the trainee, and also the likelihood of enhancing suitability for a consultant job. Currently there are 20 ATSMs available, of which 14 are in Gynaecology, five in Obstetrics and 1 in Medical Education.Paediatric and Adolescent Gynaecology (PAG) is expanding globally. The RCOG Working party report identifies different needs for minors and implementation of these changes will mean expansion of consultant body trained in Paediatric and Adolescent Gynaecology. Therefore, trainees are encouraged to take up this ATSM and this article intends to give them advice and tips on how to gain the required competencies.     

Perioperative Management of Women Undergoing Risk-reducing Surgery for Hereditary Breast and Ovarian Cancer

Carriers of genetic mutations that predispose to cancer syndromes are often faced with complex decisions. For women with hereditary breast and ovarian cancer in particular, the decision to undergo risk-reducing mastectomy or bilateral salpingo-oophorectomy is burdensome from a physical and psychological perspective. Although risk-reducing surgery is the most effective preventative measure in reducing a genetic mutation carrier's risk of breast or ovarian cancer, the success of these procedures requires a multidisciplinary approach that centers on careful counseling regarding the risks and benefits of risk-reducing surgery. The physical and psychological distress associated with risk-reducing surgery often makes a combined surgical approach attractive to some patients. In this review, we present the evidence surrounding the comprehensive surgical care of women with hereditary breast and ovarian cancer syndromes and evaluate the perioperative factors that influence surgical management.     

Men and women--still far apart on HIV/AIDS

What could be more logical than a gay-feminist alliance to respond to the AIDS epidemic in Latin America? However, drawing on published articles and the author's experience in HIV/AIDS work in Chile, this paper argues that such an alliance is more rhetorical than real. Instead, both groups tend to stick to their respective niches and view the epidemic through the prism of the particular needs and concerns of their target constituencies, rather than learn from and support each other. Feminist rhetoric sometimes suggests that AIDS is a problem only because it affects women. The African paradigm of vulnerable women is inexactly applied, given the predominantly male and homosexual nature of the epidemic in most Latin American countries. Both women and homosexually active men are highly vulnerable to HIV infection, and little is gained by competing for the top slot on the "tragedy honour roll". Latin American gay men's groups, torn between AIDS and gay rights activism, often resist both protagonism by women and women's issues. Although the fight for access to antiretroviral treatment has obscured this conflict, it resurfaces in associations of HIV-positive people and may increase along with heterosexual transmission in the region. Discussion and exchanges should be encouraged to overcome these largely hidden divisions.