剖宫产子宫切口撕裂原因及防治临床分析

目的避免或减少剖宫产切口撕裂。方法回顾性分析115例剖宫产子宫切口撕裂产妇,从子宫切口撕裂与先露下降程度、胎方位、宫口扩张程度、子宫切口位置、扩大子宫切口方式、胎儿大小及胎位、剖宫产前产程的关系进行分析。结果胎头深固时子宫切口撕裂率明显高于高浮及衔接(P<0.01);胎方位以枕后拉撕裂率最高,宫口扩张8~10cm子宫切口撕裂率高。切口距膀胱腹膜反折>3cm切口撕裂率显著增高。子宫切口撕裂与胎儿体重有关,术前产程越长,子宫切口越容易撕裂。结论子宫切口撕裂与胎先露高低、胎方位、宫口扩张程度、子宫切口位置、扩大子宫切口方式、胎儿大小、剖宫产前产程有关。     

B超测量胎儿眼距的临床意义

为了探讨超声显像测量胎儿眼距的临床意义,本文对我所300例胎龄3～10个月的产妇进行B超测量胎儿双顶径(BPD)、眼距(FOD),并计算FOD与BPD及FOD与孕月(M)的关系,报告如下。     

超声测量胎儿眼距对估测胎龄的意义

本文对不同孕周的胎儿眼距进行测量,目的是通过眼距测值来判断胎龄,并可通过测值来预测胎儿眼距是否在正常范围,现将检查结果报告如下。     

胎儿胃泡平面及胃泡在产前超声检查中的意义

目的探讨产前超声检查胎儿胃泡平面及胃泡对胎儿异常的诊断价值。方法应用超声对16000例孕中晚期孕妇进行常规超声检查,仔细观察胎儿胃泡平面及胃泡形态。结果发现十二指肠闭锁7例,先天性膈疝3例,内脏反位合并镜像右位心2例,单发左位心1例,单发右位心1例,食管闭锁1例。结论胎儿胃泡平面对于判断胎儿心脏位置,主动脉、下腔静脉位置关系有重要意义;而胃泡的形态学改变对于食管闭锁、胃十二指肠闭锁、膈疝等有重要意义。     

头位分娩脐带位置异常致胎儿死亡3例报告

脐带位置异常对胎儿威胁甚大,若处理不及时极易引起胎儿窘迫、死亡。脐带位置异常按照脐带所处的位置及胎膜是否破裂分：①脐带先露：胎膜未破时,脐带已经到先露前方。②隐性脐带脱垂：不管胎膜破裂与否,脐带位于先露一侧,夹在先露与子宫下段之间。③脐带脱垂：发生于胎膜破裂后,脐带在先露之前脱出宫颈外口。脐带位置异常以横位及臀位及发生率较高,头位则较少。     

超声定位胎儿脊髓圆锥对脊柱区病变的诊断价值

目的通过观察胎儿脊髓圆锥末端位置,确定其与脊柱区病变的相关性。方法回顾性分析本院产前超声诊断胎儿显性脊柱裂10例,隐性脊柱裂3例,骶尾部畸胎瘤3例,腰骶管内囊肿1例及1013例正常胎儿的超声资料,均定位脊髓圆锥末端位置,并与产后超声对照。结果显性脊柱裂及腰骶管内囊肿均表现脊髓圆锥低位,隐性脊柱裂脊髓圆锥可以正常也可以低位,骶尾部畸胎瘤及正常对照组脊髓圆锥位置均正常。结论超声定位脊髓圆锥末端位置对诊断脊柱区病变能提供有价值的信息,具有重要临床价值。     

超声中孕期筛查胎盘脐带入口位置异常的临床价值

目的通过产前超声检查及时发现胎盘脐带入口位置异常的胎儿,特别是帆状胎盘合并血管前置胎儿,便于产中及时采取有效措施,避免因误诊治、漏诊增加围生儿的危险性,降低病死率。方法对我院1876例中孕期孕妇作常规胎儿检查后,重点观察脐带根部与胎盘连接的位置关系、脐血管走行及分支方向、数目,所有受检孕妇常规观察宫颈内口及其附近有无血管走行并用彩色多普勒检测,观察频谱特点。结果 1876例中检查出脐带入口异常99例(5.2%)。边缘性胎盘脐带入口95例(5.1%)。帆状胎盘4例(0.2%),其中1例帆状胎盘合并中央型前置胎盘;2例帆状胎盘合并血管前置;另1例双胎之一帆状胎盘。4例帆状胎盘中3例妊娠至晚期行剖宫产,婴儿存活,1例经阴道分娩一死婴。除5例流失外,所有病例均经产后确诊。结论中孕期是超声检查胎儿脐带根部与胎盘位置关系最佳时期,可提高胎儿脐带入口异常的检出率,特别是帆状盘合并血管前置,可以指导临床及时采取有效措施,避免不良妊娠结局,降低围生儿病死率。     

超声检测中晚期妊娠胎儿动脉导管在先天性心脏畸形筛查中的意义

目的:研究超声对中晚期妊娠胎儿动脉导管在先天性心脏畸形的诊断价值。方法:选取200例正常的胎儿和200例先天心脏畸形的胎儿为研究对象,按照胎儿心脏是否健康分为健康组与异常组,比较两组胎儿动脉导管结构内径及血流方向的差异。结果:异常组发生动脉导管内径增宽、狭窄的情况显著多于健康组(P0.05),差异有统计学意义;而在血流方向比较上无显著差异(P0.05)。结论:对中晚期妊娠具有先天性心脏畸形胎儿的动导管进行检查,提高胎儿先天性心脏病的产前检出率,使先心病的诊断、救治时间提前,从而降低了我国新生儿出生缺陷。     

325例初产妇头位分娩评分法的临床分析

头位分娩评分法是将分娩三大因素(产道、胎儿、产力)结合起来进行评分,用于头位难产的估计。根据骨盆大小、胎儿大小、胎头位置及产力强弱四项分别定分,并     

彩超在筛查胎儿心脏大血管畸形中的价值

目的 探讨彩超在筛查胎儿心脏大血管畸形中的价值.方法 回顾性分析2009年10月至2013年5月在我院进行胎儿心脏彩超筛查的13 056例孕妇的临床资料,胎儿是否存在心脏大血管畸形采用三血管气管切面超声进行检查,观察大动脉的位置、血流方向和分布.结果 13 056例胎儿中有51例彩超显示心脏畸形,行脐带血或羊水染色体检查的有21例,染色体异常4例.本院引产36例,尸检15例,尸检结果与产前诊断相符.结论 胎儿心脏大血管畸形采用彩超进行检查,能获得很高的检出率,彩超在该类疾病的诊断中具有很好的实用性.     

头位难产行手法转正胎头190例回顾性临床分析

目的分析手法转正胎头减少头位难产发生的临床应用。方法回顾性分析手法转正胎头减少头位难产的临床特点、剖宫产率及对母儿影响。结果头位难产经手法转正后自然生产率为90．0％,转正失败剖宫产率为5．79％,两者之间有显著差异性（P〈0．01）。结论手法转正胎头可缩短产程,减轻产妇痛苦,大大降低剖宫产率。     

Sensitization of rotation behavior in rats with unilateral 6-hydroxydopamine or kainic acid-induced striatal lesions

Following unilateral 6-hydroxydopamine (6-OHDA) lesions of the substantia nigra or unilateral kainic acid (KA) lesions of the striatum rats displayed rotation behavior in response to apomorphine (0.25 mg/kg SC or 1 mg/kg SC for the 6-OHDA- and KA-lesioned rats respectively). Three to five days following the initial apomorphine challenge rats were challenged under identical conditions with the same dose of apomorphine received previously. Both 6-OHDA- and KA-lesioned rats demonstrated a significant increase in the total number of rotations. Following a subsequent challenge with apomorphine, rats showed further increases in the total number of rotations. With the second and the subsequent apomorphine challenges there were significant increases in the maximal number of rotations, a significant decrease in the time of onset of rotation behavior and in some cases an increase in the duration of the rotation behavior. These increases in rotation behavior following repeated challenges with apomorphine indicate a supersensitivity to dopamine receptor agonists distinct from that elicited by lesions and chronic antagonist treatments. Furthermore, the utility of the rotation behavior model for testing the efficacy of dopaminergic agonists might be compromised if repeated challenges in individual animals are employed.     

Biological matrices for the evaluation of in utero exposure to drugs of abuse

In recent years, the evaluation of in utero exposure to drugs of abuse has been achieved by testing biological matrices coming from the fetus or newborn (eg, meconium, fetal hair, cord blood, neonatal urine), the pregnant or nursing mother (eg, hair, blood, oral fluid, sweat, urine, breast milk), or from both the fetus and the mother (placenta, amniotic fluid). Overall, these matrices have the advantage of noninvasive collection (with the exception of amniotic fluid) and early detection of exposure from different gestational periods. Matrices such as amniotic fluid, meconium, fetal hair, and maternal hair provide a long historical record of prenatal exposure to certain drugs and can account for different periods of gestation: amniotic fluid from the early pregnancy, meconium for the second and third trimester of gestation, fetal hair for the third, and finally maternal hair (when long enough) for the whole pregnancy. Placenta may reveal the passage of a substance from the mother to the fetus. Cord blood and neonatal urine are useful for determining acute exposure to drugs of abuse in the period immediately previous to delivery. Drug detection in maternal blood, oral fluid, and sweat accounts only for acute consumption that occurred in the hours previous to collection and gives poor information concerning fetal exposure. Different immunoassays were used as screening methods for drug testing in the above-reported matrices or as unique analytical investigation tools when chromatographic techniques coupled to mass spectrometry were not commonly available. However, in the last decade, both liquid and gas chromatography-mass spectrometric methodologies have been routinely applied after appropriate extraction of drugs and their metabolites from these biological matrices.     

Cocaine detection in maternal and neonatal hair: implications to fetal toxicology

Cocaine use during pregnancy is difficult to ascertain, and maternal reports are likely to be inaccurate. Presently, the dose-response characteristics between maternal cocaine use and fetal exposure and adverse effects are unknown. Clinically, some babies are harmed, whereas others are not adversely affected. Taking advantage of the fact that cocaine and its metabolite benzoylecgonine (BE) accumulate and can be detected months after exposure in maternal and neonatal hair, an analytical test for cocaine and BE was developed by the authors. The aim of this study was to describe the characteristics of maternal and neonatal hair cocaine as biomarkers of fetal exposure. Of nearly 10,000 cases, all mother-child pairs in whom at least one had cocaine and/or BE detected in hair were identified. The relationship between maternal and neonatal levels was studied. When available, these data were also compared with meconium levels of cocaine. Median cocaine concentration was 10-fold higher in hair of the mothers compared with the neonates (3.56 ng/mg vs 0.31 ng/mg of hair). Infants' cocaine in hair was positively correlated with maternal cocaine and BE in hair (r2 = 0.41 and r2 = 0.22, respectively, P < 0.001 for both correlations). Infants' BE was also correlated with maternal cocaine and BE concentrations in hair (r2 = 0.50 and r2 = 0.27, P < 0.001 for both correlations). Thirty-nine (40%) babies had negative cocaine and BE results despite their mothers being positive. Mothers whose infants were cocaine-positive had a median hair cocaine concentration of 7.34 ng/mg, significantly higher than those whose infants were negative (1.25 ng/mg). Maternal cocaine levels below 0.24 ng/mg may serve as a relative threshold for detectable fetal exposure during the third trimester of pregnancy. Fetal hair grows in the last trimester. Hence, a positive neonatal hair indicates maternal use after pregnancy became known, a strong indicator of maternal addiction. Transplacental exposure to cocaine of babies of addicted mothers is highly variable. The dose-response relationship of both cocaine and BE between maternal and neonatal hair suggests that the placenta protects some fetuses but not others. More research is needed to understand the mechanisms leading to placental defense against cocaine.     

连续给予阿扑吗啡引起单侧黑质毁损大鼠的快速耐受1

The purpose of the present study was to observe the effects of drug treatment intervals and doses on the development of tolerance to dopamine agonist. Apomorphine was administered at different doses and intervals to rats which were lesioned by unilaterally injection of 6-hydroxydopamine into substantia nigra, and the rotational behavior was monitored. In the intermittent treatment group, three equal doses of apomorphine were injected ip at 1.5 h intervals, the rotations were significantly reduced after repeated treatments of higher doses of apomorphine (0.9 and 2.7mg^.kg^-1), but were not reduced after the repeated administration of lower doses of apomorphine (0.1 and 0.3mg^.kg^-1). A 3 h constant treatment of apomorphine (0.3mg^.kg^-1 ip, once every 15 min) caused a significant reduction of the rotations. The results indicate that both the short treatment intervals and large doses are involved in tolerance to dopaminergic agonist and the tolerance is more easy to develop with constant than with intermittent treatment.     

Magnetic resonance imaging investigation of the mixing-segregation process in a pharmaceutical blender.

Magnetic Resonance Imaging (MRI) was used to study the mixing process of binary mixtures of free flowing sugar beads in a Turbula mixer. In order to make particles MRI-sensitive, some reference beads were doped with an organic oil. Doped and undoped particles were mixed and MRI was used to non-destructively image the particle bed for a given number of mixer rotations (NR), bead diameter ratio (R=d(ref)/d(i)) and rotation speed (V). All the results were quantified on the basis of image analysis to characterise the degree of mixing. Studies showed that for binary mixtures of identical particle size, the mixing was complete after 30 rotations, whereas for beads of different size (R=2.8) a segregated steady state was obtained after nearly 10 rotations. Experiments revealed that segregation appeared as soon as R=0.9. Moreover, the lower the rotation speed, the more segregated the final state was. It appeared that for a filling level greater than 80%, dead regions appeared in the centre of the powder bed. In conclusion, when the particles are non-cohesive, the Turbula blender perfectly mixes identical beads but segregation occurs for beads of different size after just a few rotations.     

连续给予阿扑吗啡引起单侧黑质毁损大鼠的快速耐受

在用左旋多巴（ｌｅｖｏｄｏｐａ）治疗帕金森病的长期过程中,许多患者都受到长期用药所致的运动障碍副作用的困扰．这种药物反应很可能反映了由于长期受药物刺激,多巴胺（ＤＡ）系统的反应性发生了改变,因为在左旋多巴治疗早期的病人和用１－甲基－４－苯基－１,２,...     

吴江地区新生儿脐血汞与胎发汞含量的分析与评价

目的:评价吴江地区新生儿宫内汞暴露情况及疫苗接种后血汞的变化.方法:选择2009～2010年在吴江市第一人民医院出生的新生儿102例,作脐血汞和胎发汞含量测定,其中38例入住新生儿科病房者,出生时已接种乙肝疫苗,在出生第5d时做血汞测定.结果:102例新生儿脐血汞平均值为(2.96±1.20) μg/kg,胎发汞平均值为(281.77±113.17) μg/kg,两者呈正相关(r=0.452,P＜0.05);38例已接种乙肝疫苗新生儿脐血汞平均值为(2.86±1.57) μg/kg,胎发汞平均值为(279.71±135.79) μg/kg,两者之间呈显著正相关(r=0.486,P＜0.05).38例已接种乙肝疫苗新生儿出生第5d血汞平均值为(3.06±1.61) μg/kg,与出生时脐血汞比较差异无统计学意义(t=0.55,P＞0.05).结论:吴江地区尚未发现地区性的汞污染.新生儿脐血汞与胎发汞均能比较准确地反映胎儿宫内汞暴露情况,可取其中一项标本检测.新生儿接种乙肝疫苗后血汞水平无显著升高.     

Hair analysis--a biological marker for passive smoking in pregnancy and childhood.

Passive smoking has been shown to adversely affect the health of infants and children. We used hair analysis for nicotine and its metabolite cotinine as a biological marker for exposure to smoking in these two groups. Using radioimmunoassay we measured maternal and fetal hair concentrations of nicotine and cotinine in the mother-infant pairs belonging to three different groups based on the mother's smoking habits. The three groups were: active smokers, passive smokers and nonsmokers. There was a significant correlation between maternal and neonatal hair concentration for both, nicotine and cotinine. Mothers and infants in the smoking groups, both active and passive, had significantly higher hair concentrations of both, nicotine and cotinine than in the control, nonsmoking group. In an older cohort, we compared two groups: 78 asthmatic children were compared to 86 healthy children exposed to similar degrees of passive smoking. By using objective, biological markers, our study aimed at verifying whether asthmatic children are different from nonasthmatic children in the way their bodies handle nicotine. Our results show, that, despite the fact that parents of asthmatic children tend to smoke a lower number of cigarettes per day, their children had an average twofold higher concentrations of cotinine in their hair then the control, nonasthmatic children. These studies document the importance of hair analysis as a tool for measuring exposure to cigarette smoke.     

Developmental disturbances of the fetal brain in guinea-pigs caused by methylmercury

Pregnant guinea-pigs of Hartley strain were orally administered methylmercuric chloride once at a dose of 7.5 mg Hg/animal (weighing 500–800 g) on one of days 21, 28, 35, 42 or 49 (3–7 weeks) of gestation. They were killed on day 63 (9 weeks) and their fetuses were removed. Both maternal and fetal blood, brain, liver and kidney, and fetal hair, urine, gastric content and amniotic fluid as well, were sampled for mercury analysis. The fetal brains were also examined pathologically. The maternal kidney contained mercury at a high concentration but the fetal kidney did not. The mercury concentration was strikingly high in the fetal hair, but fairly low in the urine, gastric contents and amniotic fluid. Mercury distributed unevenly in various brain regions of both dams and fetuses after treatment at 6 and 7 weeks of pregnancy (3 and 2 weeks before sampling). The concentration was high in the neopallium and archipallium, followed by the paleopallium, diencephalon and mesencephalon, but low in the rhombencephalon, including cerebellum. Mercury contents were relatively low and distributed almost evenly in various brain regions of both the dams and fetuses following treatment at 3, 4, and 5 weeks of pregnancy. Morphologically, the fetal brains were disturbed in the development following treatment at 3, 4 and 5 weeks of pregnancy. The cerebral cortex was thinned, the nucleus caudatus putamen and the hippocampal formation were reduced in size, and the lateral ventricles were dilated. However, the histological architecture of the cerebral cortex was not strikingly maldeveloped; only a slight disarrangement of the cellular alignment was noted. Following treatment at 6 and 7 weeks of pregnancy, focal degeneration of the neuronal cells was observed in the fetal neocortex; the severe cases showed spongy degeneration and dysgenetic hydrocephalus.