胎膜早破与支原体宫内感染

应用解脲支原体ＰＣＲｋｉｔ检测方法，对１９９４年３月至１１月入院分娩妇女１５９例（其中胎膜早破６９例，无胎膜早破者９０例）进行宫颈管内分泌物标本的支原体检查，同时对支原体阳性与阴性者在产妇产褥病率、新生儿黄疸，新生儿肺炎发病等方面进行比较。结果：６９例胎膜早破者中支原体阳性检出２８例，明显高子无胎膜早破者（Ｐ＜０．００５），支原体阳性者中产妇产褥病率、新生儿黄疸发生率明显高于阴性者（Ｐ＜０．００５）．提示。支原体宫内感染是胎膜早破发生的重要原因，也与产妇产褥病率和新生儿黄疸发生有密切关系。     

不孕妇女生殖道支原体感染情况及药敏分析

目的 了解不孕妇女解脲支原体、人型支原体感染状况及其药物敏感情况。方法 对146例不孕妇女进行解脲支原体、人型支原体培养及其药物敏感性试验。结果 不孕妇女解脲支原体阳性率33．56％、人型支原体阳性率18．49％。其对交沙霉素、多西环素、四环素敏感性强，敏感率分别为98．55％、95．65％、92．75％。结论 不孕妇女生殖道支原体感染率高，对多种抗生素耐药，临床有必要做支原体培养与药敏试验。     

宫内节育器放置时间的研究

宫内节育器（IUD）在我国避孕措施中占有重要地位、传统常规放置IUD时间是在月经干净3～7天,仅短短的5天时间。为了探索月经周期中大部分时间放置IUD的可行性,我们观察了在月经期及月经干净7天后至月经周期20天内放置IUD的临床效果和副反应,结果如下。     

解脲支原体与胎儿宫内发育迟缓关系的探讨

目的 探讨孕妇感染解脲支原体对胎儿宫内发育的影响。方法 采用聚合酶链反应（ＰＣＲ）技术,分别对新生儿出生体重小于２５００ｇ的５０例孕妇的宫颈分泌物,新生儿脐血及胎盘（试验组）和正常新生儿出生体垢５０例孕妇的宫颈分泌物,新生儿脐血及胎盘进行解脲支原体检测（对照组）并对两例胎盘进行常规病理检查,结果 试验组新生儿脐血,胎盘解脲支原体的感染例数（３３例）明显高于对照组（７例）两者比较,差异有显著性（Ｐ〉     

女性不孕症患者支原体感染现状及药敏分析

目的：对2012—2013年来本院就诊的不孕症患者阴道分泌物支原体培养及药敏,进一步探讨不孕症患者解脲脲原体（UU）和人型支原体（Mh）的感染情况及其药物敏感性,指导临床合理用药。方法：用珠海丽珠试剂股份有限公司的解脲脲原体和人型支原体培养鉴定药敏试剂盒,对2012—2013年来院就诊的252例不孕症妇女阴道分泌物支原体培养。结果：在就诊病人支原体培养中,单纯解脲脲原体培养阳性112例,阳性率44．4％。单纯人型支原体培养阳性8例,阳性率占3．1％。解脲脲原体和人型支原体均为阳性16例,阳性率6．3％。药敏结果为美满霉素、强力霉素、克拉霉素敏感性最高,其余依次是交沙霉素、阿奇霉素、司帕沙星、左旋氧氟沙星、罗红霉素、氧氟沙星。结论：支原体感染是引起不孕症的重要原因之一,不同地区其耐药性不同,且耐药谱也在不断变化。因此临床应根据药敏结果合理用药。     

放置宫内节育器妇女的血清铁蛋白测定

229名天津健康妇女血清铁蛋白(Fer)正常对照值为35.5ng/ml。60例放置宫内节育器(IUD)妇女于放器前周期为28.5ng/ml;放器后第6、12周期分别显著下降到18.8和18.6ng/ml,P<0.01,缺铁率分别增加到45.5和48.1%,第24周期Fer回升至22.3ng/ml,P>0.05,缺铁率略有减少。但月经血量(MBL)>80ml者例外,其缺铁率持续进行性增高,第24周期达66.7%。文内结合MBL和Hb值,分析放器妇女Fer改变的临床特点和意义,提出使用Fer测定可及早对缺铁状态进行防治的措施。     

不育夫妇支原体感染及相关因素分析

用间接血凝法对２６８例（１３４对）不育夫妇（其中不孕夫妇１０２对，有自然流产史的夫妇３２对）作解脲支原体（ＵＵ）和人型支原体（Ｍｈ）的感染率血清学调查，同时检查了１６５例正常人血清以资对照。结果表明，２６８例不育夫妇支原体抗体ＵＵ阳性率为１６．８％。Ｍｈ阳性率为１２．３％，总阳性率为２６．５％。正常对照组支原体抗体总阳性率为９．１％，二者相比差异非常显著，不育夫妇的支原体抗体滴度显著高于对照组。对不育男性作精液分析，表明支原体抗体阳性病人中４５％的人精子活力（率）异常，１５．０％的人精子形态异常；４３例有生殖系炎症的妇女支原体抗体阳性率为４８．８％，９１例无生殖系炎症的妇女支原体抗体阳性率为２２．０％，二者相比差异有显著意义。这些结果提示在不育人群中有相当一部分人存在着生殖道的支原体感染并成为不育病因之一，尤其当患者有精子活力（率）、形态异常或有生殖系炎症时，应把支原体感染检查作为一项重要的病因诊断参考依据。     

宫颈支原体感染与胎膜早破的关系探讨

目的探讨宫颈支原体感染与胎膜早破的关系及其对妊娠结局的影响。方法对北京市海淀区妇幼保健院2004年6月至2005年6月收治的93例胎膜早破孕妇(观察组)和96例孕足月、无胎膜早破住院待产孕妇(对照组)的宫颈分泌物,进行人型支原体(Mh)、解脲支原体(Uu)培养,并对其妊娠结局进行分析。结果观察组Mh感染率(6.45%)高于对照组(4.17%),但差异无统计学意义(P>0.05);观察组Uu感染率66.67%与对照组感染率55.21%比较,差异无统计学意义(P>0.05),观察组按是否早产再分两组,早产胎膜早破组产妇解脲支原体感染率为100%,明显高于足月胎膜早破组产妇61.73%,差异有统计学意义(P<0.05),早产胎膜早破组人型支原体感染率16.67%与足月胎膜早破产妇感染率2.47%比较,差异无统计学意义(P>0.05),但解脲支原体阳性孕妇分娩新生儿高胆红素血症明显增多,差异有统计学意义(P<0.05)。结论孕妇Mh、Uu感染与胎膜早破相关性不明显;Uu感染对早产的胎膜早破有明显影响,可能是导致早产胎膜早破的重要原因,并可能与新生儿高胆红素血症有关。     

宫内节育器类型及置器年限与女性生殖道感染关系研究

目的 探讨宫内节育器的类型及置器年限与女性生殖道感染的关系。方法 回顾性分析中国医科大学附属盛京医院计划生育门诊于2013年1月至2014年6月行宫内节育器取出术的1350例患者的临床资料,研究宫内节育器的类型及置器年限与女性生殖道感染的相关性,并探讨女性生殖道感染的发生是否与年龄、孕产次及绝经与否有关。结果 带尾丝型宫内节育器置器10年及10年以上的女性生殖道感染的发生率为33.9%,置器10年以下的女性生殖道感染的发生率为14.3%,两者比较差异有统计学意义（P<0.05)。无尾丝型宫内节育器置器10年及10年以上的女性生殖道感染的发生率为20.7%,置器10年以下的女性生殖道感染的发生率为16.9%,两者比较差异无统计学意义（P>0.05)。带尾丝型宫内节育器因置器年限长而导致的女性生殖道感染的高发率与年龄、孕产次及绝经与否无明显关系。年龄较大者女性生殖道感染的发生率略低,为29.4%;妊娠次数少者女性生殖道感染的发生率略低,为26.5%;绝经者女性生殖道感染的发生率略低,为30.7%,但各组间的差异无统计学意义（P>0.05)。结论 带尾丝型宫内节育器置器年限过长,可导致女性生殖道感染的发生率升高。     

解脲支原体宫内感染与胎膜早破关系的研究

目的 探讨解脲支原体(UU)宫内感染与胎膜早破的相关性。方法 运用培养法对妊娠晚期32例胎膜早破孕妇(试验组)和20例正常孕妇(对照组)的剖宫产术中羊水进行支原体培养检测,评价6种抗菌药物对抑制支原体的敏感性;同时运用PCR-微板核酸分子杂交法对上述羊水进行解脲支原体DNA检测。结果 试验组分离培养检测的UU感染阳性率为28.1％,对照组UU感染阳性率为5.0％(P>0.05);6种抗生素药敏试验提示氧氟沙星药物敏感性最弱;在同时进行的PCR-微板核酸分子杂交法试验中,试验组的UU检出率为46.9％,对照组的UU检出率为10.0％,两组比较差异有显著性(P<0.01)。结论 解脲支原体所致的宫内感染是部分妊娠晚期胎膜早破的原因之一。PCR-微板核酸分子杂交法联合培养法,是诊断解脲支原体宫内感染的特异、快速和准确的方法。     

A study exploring UK midwives' knowledge and attitudes towards caring for women who have been sexually abused

Objective

to investigate midwives’ knowledge and attitudes in relation to caring for women who have been sexually abused.

Design

survey using a postal questionnaire. The questionnaire looked at midwives’ knowledge and attitudes towards a range of aspects of sexuality and childbirth. The area of caring for women who have been sexually abused was one aspect of this study. The questionnaire included fixed response and open-ended questions. Quantitative data were analysed using χ²-test, logistic regression, Mann–Whitney U-test, Kruskal Wallis test and Mantel–Haenszel test. Qualitative data were analysed using a modified constant comparative approach as described by Morse and Field [1995. Qualitative research methods for health professionals, second edn. Sage Publications, London].

Setting

four National Health Service trusts within the East and West Midlands.

Participants

489 community and hospital-based midwives.

Findings

372 midwives returned their questionnaire giving a 76% response rate. The majority of midwives in the sample group did not feel adequately prepared to deal with a disclosure of sexual abuse (n=207, 56%), with a further 109 (29%) midwives being ‘unsure’ if they could deal with such a disclosure. Community midwives rated themselves as more able to deal with disclosures of sexual abuse compared with hospital-based midwives (χ²=4.044, df=1, p=0.044). The analysis of the in-depth responses to the open-ended questions showed that a small number of midwives were very knowledgeable about the topic of sexual abuse and had experience in dealing with these situations. In contrast, it emerged that the majority of midwives had little if any education in this area and felt unable to deal effectively with disclosures of sexual abuse.

Key conclusions and implications for practice

the finding that the majority of midwives did not feel adequately prepared to deal with disclosures of sexual abuse may have implications for the quality of care received by survivors of sexual abuse. It is possible that midwives who have been inadequately prepared for dealing with such disclosures may give inappropriate advice, and may inadvertently compound the feelings of powerlessness that women have experienced. Aspects of sexuality and, in particular, caring for women who have been sexually abused should be included in all pre-registration curricula, and post-registration education should include this topic to either update midwives or introduce these topics to qualified midwives. As the incidence of sexual abuse is high and may potentially affect a significant number of childbearing women, it is recommended that further good-quality research should be conducted in this area.     

A double-blind cross-over study of the effect of doxycycline on mycoplasma infection and infertility.

Forty-two couples in an infertility clinic were examined for genital infection with Mycoplasma hominis or Ureaplasma urealyticum (T strains). In 21 couples one or other partner was found to be infected; no chlamydiae, trichomonads, or gonococci were isolated from any of these couples. All patients were then included in a double-blind crossover doxycycline/placebo study lasting 8 months. Pregnancy was achieved in one of the 21 couples who were free of infection. Of the 21 couples who were infected, one achieved a pregnancy while still infected, and 19 lost their infection on doxycycline, of whom four achieved a pregnancy. These four pregnancies all occurred among the 10 couples who received doxycycline first. One further pregnancy occurred after the trial was over. Since 5 of the 7 pregnancies occurred in the first 4 months of the trial, they were probably due to the psychological effect of treatment rather than the effect of the drug on infection.     

丹那唑对子宫内膜异位症脂代谢及内分泌的影响

通过用丹那唑治疗子宫内膜异症患者，观察服用该药前后及停药后脂代谢水平指标及部分内分泌指标变化，结果：血清ＨＤＬ－ｃ，ＨＤＬ２－ｃ，ＨＤＬ３－ｃ及ＡｐｏＡ－Ｉ等水平显著下降，ＬＤＬ－ｃ及ＡｐｏＢ水平显著上升，ＬＤＬ／ＨＤＬ及ＡｐｏＢ／ＡｐｏＡ－Ｉ两比值明显增大，Ｅ２水平显著下降，ＦＳＨ，ＬＨ及Ｔ水平没有明显的变化，停药后２个月各指标均回到利用药前水平，说明就脂代谢变化而言，丹那唑不适作长期连续治疗。     

A randomised controlled trial of educational counselling on the management of women who have suffered suboptimal outcomes in pregnancy

Objectives To study whether proactive educational counselling, in addition to routine clinical care, reduces psychological morbidity and improves quality of life and client satisfaction among women who suffer suboptimal outcomes during childbirth.
Design A randomised controlled trial.
Setting Obstetric unit of a tertiary teaching hospital.
Population Women who had unexpected antenatal, intrapartum or postpartum events leading to suboptimal outcomes during pregnancy and childbirth.
Intervention Educational counselling provided by a trained research nurse in the postnatal ward after delivery. Women in the control group received routine clinical care.
Main outcome measures The Hospital Anxiety and Depression Scale, the General Health Questionnaire and the Clinical Global Impression (before and after counselling, at six weeks and six months post-delivery) and the World Health Organisation Quality of Life scale (WHO-QOL) (at six weeks and six months post-delivery).
Results There was no significant difference in psychological morbidity, quality of life or client satisfaction between the counselling group and the control group. Participants who underwent elective caesarean section and who had the educational counselling had significantly lower depression scores [mean 2.6 (SD 2.6)] compared with those receiving routine care [mean 3.9 (SD 3.2)]. On the other hand, educational counselling may have deleterious effect to women's quality of life in those who had instrumental delivery. Participants allocated to the counselling group had a lower mean score 68 (SD 13) in the physical domain of WHO-QOL than those in the intervention group 74 (SD 13).
Conclusion Educational counselling, given on top of routine clinical care, does not give additional beneficial effects on the psychological wellbeing and quality of life of women who encountered suboptimal outcomes during pregnancy.     

新型固定式宫内节育器与TCu220C的临床效果比较性研究

本文系研究新型固定式宫内节育器（Ｆｉｘ－Ｃｕ３００ＩＵＤ）的临床避孕效果，副反应和可接受性，选用目前公认较为理想的ＴＣｕ２２０Ｃ作对照，采用多中心随机比较性研究，自１９９３年２月到５月共接收合格对象２１０４例（各１０５２例）１年随访率为９９．９５％，使用１２个月结果表明：Ｆｉｘ－Ｃｕ３００ＩＵＤ累积妊娠率为０．０９％，对照组为１．４３％（Ｐ〈０．０１），脱落率分别为０．９５％和２．２８％（Ｐ〈０．     

DNA analysis for phospholipase A2 coding sequences of Mycoplasma hominis isolated from women with a normal pregnancy and women with a pregnancy complicated by preterm labour

A possible cause of preterm labour is an increased synthesis of prostaglandins by a phospholipase A2 (PLA2) activity. PLA2 activity has been detected in Mycoplasma hominis. The aim of this study was to test whether chromosomal DNA of M. hominis contains sequences coding for PLA2. M. hominis was cultured in specimens from 5 women with normal pregnancy and 4 in preterm labour. Using sequence alignment, primer pairs for the active part of PLA2 of different species were designed for PCR analysis. No sequences coding for PLA2 could be amplified. Whatever its role in preterm labour, M. hominis is not involved in causing an increase of prostaglandin synthesis. Received: 21 September 1997 / Accepted: 17 January 1998     

含药含气IUD与TCu 380A IUD临床比较性研究

本文介绍一种新型合药含气IUD，系由硅橡胶、聚乙烯、聚氨酯构成，内含微小空气间隙和定量消炎痛。研究分为两组，组Ⅰ为含药含气IUD408例，与组ⅡTCu380A408例进行随机比较性研究，随访一年两组随访率达100％。结果显示：组Ⅰ与组Ⅱ粗累积存放率分别为97．8％、96．8％；累积妊娠率分别为0．99％和0．49％；累积脱落率分别为0．49％和1．24％。两组因疼痛和出血取出率分别为0．74％（Ⅰ）、1．5％（Ⅱ），上述两组均未显示统计学差异（P＞0．05）。表明含药含气IUD和TCu380AIUD均有较好的安全性、有效性和可接受性，而合药含气IUD出血量则显著低于TCu380A（P＜0．01）。     

A study on cytomegalovirus infection in 199 pregnant women and their infants

Cytomegalovirus (CMV) infection is common in human, and exerts harmful effects during pregnancy upon fetuses. In order to get a clear knowledge of CMV infection rate in pregnant women and their infants and of the relationship between maternal infection and congenital infection in our city, we tried to detect the CMV specific IgG and IgM in 199 paired serum samples of mother and infant. The results showed that 183 maternal serum samples and 179 umbilical cord serum samples were CMV-IgG positive, a positive rate of 92% and 90% respectively. While 6 maternal serum samples and 7 umbilical cord serum sample were CMV-IgM positive, a positive rate of 3.0% and 3.5% respectively. The close correlation of CMV-IgM levels between mothers and their babies indicates that the infant may acquire congenital infection from his CMV-IgM positive mother.     

A qualitative study of the experiences of women who are obese and pregnant in the UK

Objective

to explore the experiences related to obesity in women with a body mass index (BMI)>35 kg/m² during the childbearing process.

Design

a qualitative design was used. Data were collected using semi-structured interviews and field notes. Women were interviewed in the third trimester of pregnancy and between three and nine weeks after the birth. Transcribed data were analysed using framework analysis methods.

Setting

one maternity service in the North of England.

Participants

19 women with BMI>35 kg/m².

Findings

these women highlighted their feelings of humiliation, and the stigma associated with being pregnant, when obese. Interactions with health professionals and the general public reinforced their discomfort about their size. The high-risk status of their pregnancy increased the medicalisation of their pregnancy. The ultrasound scan was a significant source of distress if difficulties imaging the fetus were not clearly explained during the procedure.

Key conclusions

pregnant women who are obese are sensitive of their size. The interactions with health professionals and others that they encounter may increase distress.

Implications for practice

health professionals should be more aware of the psychological implications of being obese. Communication strategies about care should be clear and honest, and conveyed in a sensitive manner. Written comments related to size on ‘hand-held’ notes should be explained at the time of writing.