妊娠期TORCH感染与妊娠结局的相关性分析

目的了解妊娠期TORCH感染状况与不良妊娠结局之间的关系。为本地区开展出生缺陷的预防和干预提供数据及建议。方法采用酶联免疫吸附实验（ELISA）检测孕妇血清中TORCH-IgM抗体，对阳性孕妇进行追踪，并随访其妊娠结局。结果1328例受检孕妇中，血清TORCH-IgM阳性33例，总阳性率2．48％。继续妊娠24例，不良妊娠结局16例，占66．67％。结论TORCH感染可致不良妊娠结局，也是造成出生缺陷常见的不良因素。孕前和孕期进行TORCH血清学筛查，并给予适当干预，可减少不良妊娠的发生和预防出生缺陷。     

宫内早孕合并左侧宫外孕1例

患者,37岁.急诊以"早孕,先兆流产"收入我院.孕2产0,一年前有右侧宫外孕手术史.超声所见(如图):膀胱充盈良好.子宫增大,长径98 mm,宽径76 mm,宫内可见65 mm×42 mm妊娠囊回声,内见35 mm×36 mm胚芽组织,未见胎心搏动.     

子宫肌瘤剔除术后妊娠与子宫肌瘤合并妊娠的妊娠结局对照研究

目的对比分析子宫肌瘤剔除术后妊娠孕妇与合并子宫肌瘤合并妊娠孕妇的妊娠结局。方法采用回顾性研究方法选取2014年1月至2016年12月在山东医学高等专科学校附属医院接受产检并分娩的孕妇400例,其中子宫肌瘤合并妊娠孕妇200例纳入A组行子宫肌瘤剔除术后妊娠孕妇200例纳入B组。比较两组孕妇的妊娠结局情况。结果两组孕妇的受孕情况、分娩方式、胎儿窘迫(2.5%vs.3.5%)、低出生体重新生儿(2.5%vs.2.0%)、前置胎盘(0.5%vs.1.0%)、胎盘早剥(1.0%vs.1.0%)比较差异均无统计学意义(P>0.05);但B组孕妇的胎膜早破(1.0%vs.8.5%)、早产(0.5%vs.9.5%)、产后出血率(0.5%vs.8.0%)、产后出血量(249.35±30.75 ml vs.352.41±26.98 ml)显著高于A组差异具有统计学意义(P<0.05)。两组孕妇的子宫肌瘤数量、子宫肌瘤类型、盆腔粘连发生率(22.5%vs.17.5%)比较差异均无统计学意义(P>0.05);但A组孕妇的子宫肌瘤径线高于B组(72.65±5.39mm vs.57.69±7.98 mm)差异具有统计学意义(P<0.05)。结论行子宫肌瘤剔除术后妊娠预后的分娩并发症发生率高于子宫肌瘤合并妊娠孕妇,但子宫肌瘤合并妊娠孕妇的胎儿发育与前者相比无显著差异;建议高龄且有生育要求的合并子宫肌瘤的女性,可以考虑保守治疗和带瘤妊娠。     

Ectopic pregnancy

Ectopic pregnancy occurs at a rate of 19.7 cases per 1,000 pregnancies in North America and is a leading cause of maternal mortality in the first trimester. Greater awareness of risk factors and improved technology (biochemical markers and ultrasonography) allow ectopic pregnancy to be identified before the development of life-threatening events. The evaluation may include a combination of determination of urine and serum human chorionic gonadotropin (hCG) levels, serum progesterone levels, ultrasonography, culdocentesis and laparoscopy. Key to the diagnosis is determination of the presence or absence of an intrauterine gestational sac correlated with quantitative serum beta-subunit hCG (beta-hCG) levels. An ectopic pregnancy should be suspected if transvaginal ultrasonography shows no intrauterine gestational sac when the beta-hCG level is higher than 1,500 mlU per mL (1,500 IU per L). If the beta-hCG level plateaus or fails to double in 48 hours and the ultrasound examination fails to identify an intrauterine gestational sac, uterine curettage may determine the presence or absence of chorionic villi. Although past treatment consisted of an open laparotomy and salpingectomy, current laparoscopic techniques for unruptured ectopic pregnancy emphasize tubal preservation. Other treatment options include the use of methotrexate therapy for small, unruptured ectopic pregnancies in hemodynamically stable patients. Expectant management may have a role when beta-hCG levels are low and declining.     

Ectopic pregnancy

Ectopic pregnancy (EP) is a serious and increasing health problem in the United States and other countries. In the United States, it accounts for 15 percent of maternal deaths, 75 percent of which are estimated to be preventable, and its incidence has increased more than 100 percent for some demographic groups over the past 10 years. There are a number of potential contributing factors to ectopic pregnancy; however, their relationship to actual incidence is unclear in some instances. Nonspecific symptoms increase the difficulty of diagnosis. This article presents an overview of the significance of the problem, contributing risk factors, clinical presentation, diagnostic modalities, treatment and nursing implications.     

Ectopic pregnancy

Ectopic pregnancy is a potentially lethal disorder that is often difficult to diagnose clinically. More than 70,000 ectopic pregnancies are reported annually in the United States, and the incidence is rising. A thorough knowledge of predisposing factors, clinical presentation, common misdiagnoses, and recent advances in diagnostic modalities should help the Emergency Department physician avoid the pitfalls that lead to misdiagnosis with resulting morbidity and, occasionally, mortality.     

Ectopic pregnancy

Ectopic pregnancy occurs in approximately 2% of all pregnancies in the United States, and is the nation's leading cause of first trimester maternal death. Its incidence has increased sixfold in the past 25 years, despite significant improvements in techniques for early diagnosis and management. This article reviews the epidemiology, risk factors, and common clinical presentations of ectopic pregnancy. Both traditional and newly developed strategies for diagnosis and management are described. The primary care physician is in an excellent position to screen for and diagnose ectopic pregnancy, and to counsel patients regarding treatment options and future risks. With the increasing trend toward outpatient nonsurgical management of ectopics, it is expected that the roll of the primary care physician in managing patients with ectopic pregnancy will continue to increase.     

Ectopic pregnancy

Ectopic pregnancy is a high-risk diagnosis that is increasing in frequency and is still commonly missed in the emergency department. The emergency physician needs a high index of suspicion and must understand that the history, physical examination, and a single quantitative beta-hCG level cannot reliably rule out an ectopic pregnancy. Most pregnant patients who present to the emergency department during the first trimester with abdominal or pelvic pain, regardless of the presence of vaginal bleeding, should undergo further evaluation with ultrasonography. Ultrasound findings in conjunction with quantitative beta-hCG levels guide the management of the patient.     

Multiple pregnancy

The incidence of multiple pregnancies has increased considerably over the past 20 years in the western world. The number of twin pregnancies has increased by approximately 25% and the rate of triplet and higher order multiple pregnancies has more than doubled. This is due to the use of ovarian hyperstimulation and assisted reproduction techniques, and to the increasing maternal age. Multiple pregnancy can be considered as the most important adverse outcome of infertility treatment. The main determinant for outcome and management of multiple pregnancies is the chorionicity. This can be determined by ultrasound until 14 weeks of gestation. Twenty percent of all twin pregnancies are monochorionic, and 15% of these develop severe twin to twin transfusion syndrome, which is best treated by LASER separation of the communicating blood vessels. Obstetric complications associated with multiple gestation also occur more frequently in monochorionic twins. They include increased incidence of preterm labor, intrauterine growth restriction and assisted or surgical delivery. Neonatal problems include low birthweight and increased prevalence of congenital malformations. Overall, there has been a decrease in neonatal mortality of twins and triplets over the past 10 years, which is mainly due to the enormous advances in neonatal intensive care.