羊水过少对围产儿结局的影响

为探讨羊水过少的相关因素及其对围产儿的影响,我们对近年来在我院分娩的126例羊水过少病例的临床资料回顾性分析如下。     

羊水过少与妊娠并发症的关系及对围产儿的影响

目的探讨羊水过少发生的原因及对围产儿的影响以及与妊娠并发症的关系。方法对我院2005年1月-2008年12月收治的78例羊水过少患者与同期羊水量正常的78例患者进行对比分析。结果羊水过少组妊娠并发症发生率较对照组高。胎儿宫内窘迫,羊水粪染,新生儿窒息发生率明显高于对照组。结论羊水过少提示胎儿宫内情况不良,且与妊娠并发症关系密切。     

妊娠晚期羊水过少198例分析

目的探讨妊娠晚期羊水过少对围生儿及分娩方式的影响,寻找正确的处理方法。方法对妊娠晚期诊断为羊水过少的198例产妇临床资料进行分析。结果羊水过少的发生率为3．33％（198／5827）。羊水量越少,羊水粪染程度越严重,剖宫产率越高,胎儿窘迫及新生儿窒息发生率越高。羊水过少妊娠并发症发生率为28．28％（56／198）。结论羊水过少确诊后应严密监护,适时终止妊娠,确保母婴安全。     

妊娠晚期并发羊水过少对分娩的影响

目的探讨妊娠晚期并发羊水过少的临床特点及预后。方法选取2010-12～2011-12在该院住院分娩的羊水过少孕产妇45例(羊水过少组)和同期住院分娩的羊水正常孕产妇45例(羊水正常组),分别对两组的分娩方式和对围生儿影响情况进行对比分析。结果羊水过少组急诊剖宫产率为73.33%(33/45),羊水正常组为20.00%(9/45),羊水过少组高于羊水正常组(P<0.01);羊水过少组羊水Ⅲ度污染及胎儿窘迫的发生率均高于羊水正常组(P均<0.01)。结论妊娠晚期并发羊水过少对母体和胎儿均造成一定的影响,一经确诊,应积极采取措施结束分娩。     

羊水过少对胎膜早破产妇妊娠结局和新生儿的影响

目的探讨羊水过少对胎膜早破产妇妊娠结局和新生儿的影响。方法比较100例羊水过少胎膜早破产妇和100例羊水正常胎膜早破产妇妊娠结局和新生儿情况。结果观察组组胎儿宫内窘迫34例、羊水污染37例,对照组分别为10、13例,两组胎儿宫内窘迫和羊水污染发生率相比,P均〈0.05。观察组82例行剖宫产、1例行阴道助产、17例正常分娩,对照组分别为46、2、51例,两组剖宫产率相比,P〈0.01。观察组新生儿体质量（3.4±0.9）kg,出生后1 min Apgar评分（9.7±1.2）分,出生后5 min Apgar评分（9.9±0.9）分;对照组分别为（3.3±0.6）kg、（9.4±0.9）分、（9.7±0.7）分,两组相比P均〉0.05。结论羊水过少对胎膜早破产妇剖宫产率有影响,对新生儿无明显影响。     

羊膜腔输液及羊水置换治疗妊娠晚期羊水过少临床研究

将126例妊娠晚期羊水过少患者随机分为两组,治疗组经腹羊膜腔穿刺输液或经宫颈羊膜腔输液(AI),并记录输液量及输液后羊膜腔容积与胎儿情况.对照组给予吸氧、输液等一般宫内复苏方法.结果显示,治疗组在B超引导下行AI,其中8例羊水粘稠者行羊水置换,症状改善97.06%;对照组症状改善仅10.34%,两组差异有显著性(P＜0.01).治疗组剖宫产率13.24%,新生儿窒息率14.71%;对照组分别为51.72%、46.55%,明显高于治疗组(P均＜0.01).对照组新生儿胎粪吸入6例,新生儿死亡2例,畸形儿4例,而治疗组无1例发生.两组产褥病率比较无显著性(P＞0.05).认为对妊娠末期羊水过少患者进行AI或羊水置换,降低了新生儿病率及剖宫产率,是减少围产期母婴病率的有效方法.     

羊水过少140例分析

羊水过少是产科并发症之一，它可以严重地影响围产儿的预后，因此，及时地发现和处理羊水过少对提高围产期质量有很重要的意义。现对140例羊水过少病例进行分析，总结报道如下。     

羊水过少105例临床分析

目的探讨羊水过少对围产儿的影响,寻找正确的处理方法,降低围产儿病死率。方法对105例羊水过少病例进行回顾性分析,并与105名正常孕妇进行比较。结果羊水过少多发生于孕40周后,观察组中羊水粪染、胎儿窘迫、新生儿窒息、剖宫产率均明显高于对照组。结论羊水过少是胎儿窘迫的敏感指标,应加强产前监护,适时剖宫产终止妊娠,改善围产儿预后。     

羊水过少对于妊娠晚期孕妇分娩方式的影响分析

目的探讨晚期妊娠羊水过少对分娩的影响,降低新生儿病死率。方法选取2009年2月—2011年1月晚期妊娠者应用超声测定羊水指数(AFI),对估测羊水量≤8cm及分娩时羊水总量<300ml的119例与随机抽取同期分娩的羊水量正常孕妇119例作为对照组,对其临床资料进行分析。两组病例就分娩方式、妊娠并发症、围生儿情况进行比较。结果两组羊水过少发生率比较,差异有统计学意义(P<0.05)。两组胎儿窘迫、羊水粪染、新生儿窒息发生率比较,差异均有统计学意义(P<0.05)。剖宫产114例,占95.7%,阴道分娩5例,占4.2%,其中B超提示羊水过少作为剖宫产指征45例,剖宫产20例未临产,其他在试产过程中因产科原因阴道检查测羊水均<5ml,行剖宫产术,经阴道分娩5例中3例羊水Ⅱ～Ⅲ度。结论诊断羊水过少孕妇,应根据综合检查结果及妊娠是否存在高危因素选择最佳分娩方式及时终止妊娠,可以明显改善围生儿预后。     

低分子肝素治疗妊娠晚期羊水过少的效果及安全性

目的：观察低分子肝素治疗妊娠晚期羊水过少的效果及安全性。方法选取妊娠晚期羊水过少孕妇100例,随机分为观察组、对照组各50例。对照组接受饮水和静脉输液法治疗,观察组在对照组基础上加用低分子肝素5000 U,皮下注射,1次/d,连用7 d。分别观察两组治疗前后羊水[羊水指数（ AFI）、最大羊水池深度（AFD）]、脐血流[脐动脉收缩期最大血流速度/舒张期末血流速度（S/D）]、凝血功能[血浆凝血酶原时间（PT）、纤维蛋白原含量（FIB）、活化部分凝血活酶（APTT）、凝血酶时间（TT）]及妊娠结局,并记录治疗期间主要不良反应。结果两组治疗后AFI和AFD均较治疗前明显升高、S/D明显降低（ P均＜0．05）,且观察组治疗后改善明显优于对照组治疗后（ P均＜0．05）;观察组剖宫产率、早产率、新生儿Apgar评分≤7分发生率明显低于对照组（ P均＜0．05）,新生儿体质量明显高于对照组（P＜0．05）。两组均未发生明显不良反应,且治疗前后凝血功能无明显变化。结论低分子肝素能显著增加妊娠晚期羊水量,降低脐血流阻力,改善妊娠结局,并且对凝血功能无明显影响,安全可靠,值得临床推广应用。     

羊水过少对分娩方式及围生儿的影响

目的探讨羊水过少对分娩方式和产妇及围生儿的影响。方法选择100例足月妊娠羊水过少的产妇作为实验组,另选择同期100名健康产妇作为对照组,两组均根据具体情况,选择合适的分娩方式。结果 (1)实验组行剖宫产87例,剖宫率(87.0%)显著高于对照组57例(57.0%)(P<0.05);(2)实验组行剖宫产产妇手术相关指标,如术中出血、肛门排气、住院时间等指标虽高于对照组,但差异无统计学意义(P>0.05);(3)实验组阴道分娩17例(17.0%),产妇的手术相关指标也高于对照组43例(43.0%),但差异无统计学意义(P>0.05)。(4)实验组围生儿羊水污染≥Ⅱ度、新生儿窒息、缺氧、胎儿窘迫等方面显著高于对照组(P<0.05),胎儿病死率差异无统计学意义(P>0.05)。(5)实验组组内不同分娩方式比较,剖宫产围生儿并发症发生率差异无统计学意义(P>0.05)。结论分娩方式和分娩结局主要受羊水过少影响,而分娩方式对分娩结局并无明显影响。羊水过少孕妇如能早期诊断,及时处理,预后良好。     

妊娠晚期孕妇尿道压力分布及临床意义

目的 探讨妊娠晚期孕妇尿道压力分布情况及功能变化的临床意义。方法 按照国际尿控协会推荐的检查标准对15例志愿孕妇（产前组）于产前行静态及排尿期持续定点尿道压力测定。将结果与14例上尿路疾病（下尿路功能正常）的已婚未育妇女（对照组）比较。结果 产前组静态尿道压力测定时最大尿道压力、最大尿道闭合压力和功能性尿道长度均显著高于对照组（P均〈0．05）。两组排尿期持续定点尿道压力相关指标均无统计学意义,均无膀胱出口梗阻。结论 妊娠晚期孕妇静态尿道阻力增加,孕妇控尿能力增加;排尿期括约肌多代偿性松弛,膀胱排空能力未受到明显影响。     

妊娠晚期生殖道感染检测分析及对妊娠结局的影响

目的分析妊娠晚期生殖道微生物感染状况及其对妊娠结局的影响,为临床防治提供理论依据。方法选取2015年3月—2019年3月我院收治的286例妊娠晚期妇女为研究对象,入组孕妇均进行生殖道病原微生物感染的检测,分析生殖道微生物感染状况,并观察妊娠晚期生殖道感染对妊娠结局的影响。结果入组286例妊娠晚期妇女,52例(18.18%)出现生殖道病原微生物感染,其中2.10%(6/286)为滴虫感染,11.89%(34/286)为解脲支原体感染,1.40%(4/286)为沙眼衣原体感染,6.64%(19/286)为假丝酵母菌感染,共11例合并有2种或2种以上微生物感染,占3.85%;此外,妊娠晚期生殖道存在微生物感染者早产、胎膜早破、产褥期感染、胎儿窘迫、新生儿窒息和新生儿感染等不良妊娠结局发生率均明显高于无微生物感染者(P均<0.05);多重微生物感染者早产发生率明显高于单一微生物感染者(P<0.05);治愈组不良妊娠结局发生率明显低于无效组(P<0.05)。结论妊娠晚期生殖道微生物感染以解脲支原体、假丝酵母菌较为常见,且妊娠晚期生殖道微生物感染会增加孕妇不良妊娠结局发生风险,多重微生物感染会增加妊娠妇女的早产发生率,临床上可据此为妊娠期妇女制定合理的防治方案,对确保母婴良好结局有重要临床意义。     

产前抗生素暴露对晚期早产儿肠道菌群的影响

目的 分析产前抗生素暴露对晚期早产儿肠道菌群的影响。方法 选择2020年3月至2021年5月在广西医科大学第二附属医院住院治疗的晚期早产儿13例,胎龄34^0/7～36^6/7周。其中5例早产儿母亲于产前使用过抗生素(观察组),余8例早产儿母亲产前未使用过抗生素(对照组)。收集早产儿出生后第3(D3)、7(D7)、14(D14)天的粪便标本,应用16SrRNA高通量测序技术对细菌V3-V4区进行测序,比较两组肠道微生物的组成结构及多样性。结果 两组Shannon指数随婴儿日龄的增长而上升,观察组Shannon指数始终低于对照组,但仅在D3时观察组Shannon指数与对照组比较差异有统计学意义(Z=-2.717,P=0.007)。随着日龄的增长,对照组变形菌门占比降低而观察组占比升高;对照组厚壁菌门占比升高,而观察组占比降低。观察组副拟杆菌属水平呈先增高再降低趋势,而对照组几乎检测不到副拟杆菌属。在D3时,与对照组相比,观察组双歧杆菌属定植减少,厌氧芽胞杆菌属、肠杆菌属及克吕沃尔氏菌属定植延迟。结论 产前抗生素暴露会影响晚期早产儿肠道菌群定植,降低...     

Effect of the antiprogestin RU486 on uterine sensitivity to oxytocin in ewes in late pregnancy.

The effect of RU486, a synthetic progesterone receptor antagonist, on basal uterine prostaglandin (PG) release and release in response to oxytocin injection has been investigated in late-pregnant sheep (days 135-140 of gestation). Fifteen hours after i.m. injection of RU486 (50 mg; n = 5) or vehicle alone (n = 4), bolus injections of oxytocin (50, 500 and 5000 mU) were administered via a uterine artery ipsilateral to the pregnant uterine horn at 2-hourly intervals. Utero-ovarian vein concentrations of 13,14-dihydro-15-keto PGF2 alpha (PGFM) and PGE2 were determined before and during oxytocin stimulation. Basal concentrations of both PGFM and PGE2 were significantly (P < 0.001) increased in ewes 15 h after RU486 administration compared with ewes receiving vehicle alone. Concentrations of PGFM, but not PGE2, increased significantly (P < 0.001) following injection of each dose of oxytocin in both treated and untreated animals. The response to oxytocin, measured both as the area under the curve and as the peak height of PGFM release, was significantly (P < 0.05) greater in RU486-treated ewes. There was no significant effect of oxytocin on the area or peak height of PGE2 response in either RU486-treated or control animals. These results demonstrate that treatment of late-pregnant ewes with RU486 results in an increase in basal uterine PGFM and PGE2 as well as oxytocin-stimulated PGFM release.     

Effect of maternal hyperthyroidism during late pregnancy on the risk of neonatal low birth weight

OBJECTIVE: Hyperthyroidism in pregnancy occurs with a prevalence of 0.05--0.2% and has been shown to affect neonatal outcomes. Fetal weight increases markedly during the third trimester of pregnancy. This retrospective study was performed to examine the effect of maternal hyperthyroidism during late pregnancy on neonatal birth weight (NBW). DESIGN: Medical and obstetric records of 293 pregnant women with present and past history of hyperthyroidism were retrospectively reviewed. PATIENTS: There were 188 records of 181 patients with adequate data for inclusion in the analysis. The patients were divided into two groups according to the maternal thyroid function during the third trimester of pregnancy: hyperthyroidism (HT; 35 cases) and euthyroidism (ET; 153 cases). MEASUREMENTS: Maternal thyroid function tests were periodically evaluated before and during the third trimester of pregnancy. Neonatal thyroid function tests and birth weight of the newborn infants were also assessed. RESULTS: There was no significant difference of maternal age between HT and ET groups mean +/- SD (27.6 +/- 5.5 vs. 29.2 +/- 5.4 years). The NBW of the HT group was not significantly different from that of the ET group (2880 +/- 590 vs. 3019 +/- 426 g). However, the prevalence of infants with low birth weight (LBW) defined as NBW of lower than 2500 g in HT group was 22.9% which was significantly higher than the 9.8% in the ET group (P = 0.039, OR = 2.7, 95%CI = 1.1--7.1) and 9.7% of infants born to healthy mothers at Siriraj Hospital (control group) between 1991 and 1995 (P = 0.01, OR = 2.7, 95%CI = 1.3--6.1). The 90% CI for the true difference between the prevalence of LBW infants born to ET and HT mothers was 0.7--25.4. There was no significant difference in the prevalence of LBW infants in ET and control groups. Multiple logistic regression analyses showed that maternal hyperthyroidism during the third trimester of pregnancy was an independent factor associated with increased prevalence of LBW infants (P = 0.037, OR = 4.1, 95%CI = 1.1--15.0). CONCLUSIONS: Maternal hyperthyroidism during the third trimester of pregnancy independently increases the risk of low birth weight by 4.1-fold. Appropriate management of hyperthyroidism throughout pregnancy is essential in the prevention of this undesirable neonatal outcome.     

孕晚期B族链球菌感染情况对妊娠结局的影响

目的　研究孕晚期妇女B族链球菌（group B Streptococcus, GBS）感染情况对妊娠结局的影响。方法　采集2016年6月—2018年8月在北京积水潭医院产科进行产前检查的孕35～37周160例待产孕妇的阴道与肛周分泌物,常规用荧光定量PCR法和细菌培养法进行筛查,按照检测结果分为GBS阳性组和GBS阴性组,分析GBS感染情况对孕妇妊娠结局的影响。结果　160例孕晚期妇女GBS阳性者82例,阳性率51.25%（82/160）。2组在年龄、孕周、产次方面进行对比,差异均无统计学意义（P均＞0.05）。GBS阳性组产后出血率（40.24%）、胎膜早破率（20.73%）、宫内感染率（24.39%）均高于GBS阴性组,差异有统计学意义（P均＜0.05）。分离的82株GBS对青霉素G、头孢曲松、氨苄青霉素、利奈唑胺敏感率均为100%;对四环素、克拉霉素、万古霉素、左氧氟沙星、红霉素、克林霉素敏感率分别为7.31%、8.54%、82.93%、68.29%、71.95%、68.29%。结论　孕妇在孕晚期感染GBS将会增加产后出血,宫内感染,胎膜早破的发生率,对妊娠结局产生不良影响。孕妇在孕晚期进行GBS筛查是非常有必要的。     

围产期因素对极低出生体重儿暂时性低甲状腺素血症的影响

调查早产极低出生体重儿生后早期甲状腺激素水平的动态变化及其发生暂时性低甲状腺素血症的围产期危险因素.7日龄时TT4值为(61.03±24.19)nmol/L,暂时性低甲状腺素血症的发生率为12.05%(n=10);肺表面活性物质应用(OR=14.25,95%CI 2.61～70.07)、机械通气(OR:13.76,95%CI2.55～68.05)、多巴胺应用(OR=9.45,95%CI2.26～39.5)以及胎龄≤30周(OR=5.78,95%CI1.36～24.49)是早产极低出生体重儿发生暂时性低甲状腺素血症的危险因素.