四种宫腔内人工授精时机对妊娠结局影响的对比研究

目的探讨不同授精时机对宫腔内人工授精(intrauterine insemination,IUI)妊娠结局的影响。方法回顾性分析2015年1月至2019年12月于广州医科大学附属第三医院妇产科门诊行IUI患者的临床资料。共纳入2202个周期、1235对夫妇,按授精时机分为4组:排卵前单次组(476个周期)、排卵前双次组(241个周期)、排卵前后各1次组(1078个周期)和排卵后单次组(407个周期)。比较4组研究对象的一般资料及妊娠率、活产率、流产率、异位妊娠率、双胎率等妊娠结局。结果 4组的妊娠率分别为13.9%、15.3%、17.6%、16.0%;活产率分别为10.9%、13.2%、15.4%、12.8%;流产率分别为15.1%、2.7%、11.6%、14.1%,以上差异均无统计学意义(P0.05)。4组的双胎率分别为3.0%、13.5%、18.4%、4.7%;异位妊娠率分别为6.1%、10.8%、1.0%、4.7%;对排卵日成熟卵泡进行亚组分析,提示仅有单个成熟卵泡时4组患者异位妊娠率分别为0、20%、3.9%、0,以上差异均有统计学意义(P0.05)。结论四种授精时机的妊娠率、活产率相似;双次授精的双胎率较高,原因与卵泡个数相关;排卵前行双次授精的异位妊娠率最高;进行IUI时机选择时,应综合考虑。     

新旧产程标准对母儿结局的影响

目的探讨新旧产程标准对母儿结局的影响。方法采用回顾性分析的方法,将按照旧产程标准管理的孕妇5 385例设为对照组,按照新产程标准管理的孕妇6 836例设为研究组,排除经产妇、瘢痕子宫、双胎妊娠、前置胎盘、骨盆狭窄、胎儿畸形及合并严重妊娠合并症等具有绝对剖宫产指征的病例。比较两组孕妇一般资料、剖宫产原因、孕妇分娩结局及新生儿结局。结果研究组和对照组剖宫产率分别为25.19%(1 722/6 836)和28.79%(1 550/5 385),两组比较,差异有统计学意义(P0.05),其中研究组因活跃期停滞行剖宫产742例(43.09%),对照组757例(48.83%);研究组因第二产程延长行剖宫产64例(3.72%),对照组93例(6.00%),两组比较差异均有统计学意义(P0.05)。母儿预后方面:研究组和对照组产钳助产例数分别为113例(1.65%)和110例(2.04%);产后出血分别为534例(7.81%)和407例(7.56%);绒毛膜羊膜炎例数分别为96例(1.40%)和58例(1.08%);新生儿窒息例数分别为69例(1.01%)和42例(0.78%);新生儿感染性肺炎分别为9例(0.13%)和6例(0.11%),两组以上母儿预后指标比较,差异均无统计学意义(P0.05)。结论新产程应用后剖宫产率降低,主要是活跃期停滞、第二产程延长为指征的剖宫产率降低,孕妇产后并发症及新生儿结局无显著影响。     

妊娠合并大动脉炎对母儿结局的影响

目的:探讨妊娠合并大动脉炎（TA）对母儿结局的影响。方法:回顾性分析2012年1月至2020年12月郑州大学第一附属医院收治的17例TA合并妊娠并最终终止妊娠患者的临床资料和母儿结局。结果:17例TA患者的24例次妊娠中,初产11例次（46%,11/24）,经产13例次（54%,13/24）;妊娠前慢性高血压4例次（1...     

新旧产程标准对母儿结局的影响

【摘要】 目的 探讨新旧产程标准对母儿结局的影响。方法 采用回顾性分析的方法,将按照旧产程标准管理的孕妇5 385例设为对照组,按照新产程标准管理的孕妇6 836例设为研究组,排除经产妇、瘢痕子宫、双胎妊娠、前置胎盘、骨盆狭窄、胎儿畸形及合并严重妊娠合并症等具有绝对剖宫产指征的病例。比较两组孕妇一般资料、剖宫产原因、孕妇分娩结局及新生儿结局。结果 研究组和对照组剖宫产率分别为25.19%（1 722/6 836）和 28.79%（1 550/5 385）,两组比较,差异有统计学意义（P＜0.05）,其中研究组因活跃期停滞行剖宫产742例（43.09%）,对照组757例（48.83%）;研究组因第二产程延长行剖宫产64例（3.72%）,对照组93例（6.00%）,两组比较差异均有统计学意义（P＜0.05）。母儿预后方面：研究组和对照组产钳助产例数分别为113例（1.65%）和110例（2.04%）;产后出血分别为534例（7.81%）和407例（7.56%）;绒毛膜羊膜炎例数分别为96例（1.40%）和58例（1.08%）;新生儿窒息例数分别为69例（1.01%）和42例（0.78%）;新生儿感染性肺炎分别为9例（0.13%）和6例（0.11%）,两组以上母儿预后指标比较,差异均无统计学意义（P＞0.05）。结论 新产程应用后剖宫产率降低,主要是活跃期停滞、第二产程延长为指征的剖宫产率降低,孕妇产后并发症及新生儿结局无显著影响。     

延期妊娠引产对母儿结局的影响

目的:探讨引产对延期妊娠母儿结局的影响.方法:回顾性分析延期妊娠孕妇437例,其中引产组276例,自然临产组16l例.结果:①引产组的剖宫产率、平均住院日明显高于自然临产组,差异有统计学意义(P<0.05);②引产组和自然临产组的产后出血发生率、产褥病率、产时损伤发生率比较差异无统计学意义(P>0.05);③羊水Ⅲ度粪染发生率、新生儿窒息发生率两组比较差异有统计学意义(P<0.05).结论:对延期妊娠孕妇是否进行引产,需进行综合评价,选择适合孕妇的期待或引产方案.     

妊娠期血小板减少程度对母儿结局的影响

Objective To investigate the perinatal outcomes of pregnancies complicated with varying degrees of thrombocytopenia.Methods Clinical data of 305 pregnant women with thrombocytopenia,who admitted to Peking University People's Hospital from January 1,2000 to January 31,2010 were retrospectively analyzed.The etiological diagnosis of them were gestational thrombocytopenia (GT),idiopathic thrombocytopenic purpura (ITP) or undetermined.The patients were divided into 4 groups according to the minimal level of platelets in pregnancy ( platelets count was lower than 100 ×109/L at least twice) : groupⅠ,(50-100) ×109/L (n=101) ; group Ⅱ,(30-50) × 109/L (n = 85); group Ⅲ,(10-30) × 109/L (n = 87); group Ⅳ,< 10 × 109/L (n = 32).Demographic data such as pregnancy complications,treatment,neonates and follow-up results of the patients in each group were compared with ANOVA,Spearman rank correlation analysis,Chirsquare test and Chi-square trend test in SPSS 17.0.Results Medical complications in pregnancy of these patients included hypertensive disorder complicating (n = 35,11.48%) and abnormal glucose metabolism (n=23,7.54%),no difference was found in the incidence of these diseases among the four groups.There were 68 patients complicated with anemia (22.30%),40 preterm delivery (13.11%),60 postpartum hemorrhage (19.67%); there were significant differences in the incidence among the four groups (P＜0.05),the incidence increased with the aggravation of thrombocytopenia (P＜0.05).There were 2 cases of puerperal infection (0.66%),no maternal deaths.Fifty-one patients (16.72%) accepted treatment of corticosteroids or Gamma globulin during pregnancy.There were 116 cases (38.03%) of vaginal delivery and 189 cases (61.97%) of cesarean section.The postpartum bleeding amount within 24 hours increased with the aggravation of thrombocytopenia.Two hundred and eleven (69.18%) patients were followed up and platelet count regained normal,among which 152 cases recovered within six months after delivery.The recovery rates were 90.59% (77/85),82.36% (42/51),46.16% (24/52) and 39.13% (9/23) from group Ⅰ to group Ⅳ,as declined with the aggravation of thrombocytopenia in pregnancy ( x2trend = 42.616,Ptrend =0.000).Among the 306 perinatal fetuses,neonatal outcomes included 301 live births,5 fetal deaths,4 early neonatal deaths,4 low birth-weight infants after term birth,1 intracranial hemorrhage and 18 (5.98%) neonatal thrombocytopenia cases.Incidence of neonatal thrombocytopenia increased with the aggravation of maternal thrombocytopenia.Sixteen cases of neonatal thrombocytopenia recovered at 3-8 weeks after birth,but two cases did not recover within three years during followed up.Conclusions The perinatal outcomes are different in pregnancies complicated with varying degrees of thrombocytopenia.As thrombocytopenia in pregnancy become worse,the risk of anemia,premature delivery,postpartum hemorrhage and neonatal thrombocytopenia increases.While,perinatal outcomes may be better under close perinatal care.     

妊娠期血小板减少程度对母儿结局的影响

Objective To investigate the perinatal outcomes of pregnancies complicated with varying degrees of thrombocytopenia.Methods Clinical data of 305 pregnant women with thrombocytopenia,who admitted to Peking University People's Hospital from January 1,2000 to January 31,2010 were retrospectively analyzed.The etiological diagnosis of them were gestational thrombocytopenia (GT),idiopathic thrombocytopenic purpura (ITP) or undetermined.The patients were divided into 4 groups according to the minimal level of platelets in pregnancy ( platelets count was lower than 100 ×109/L at least twice) : groupⅠ,(50-100) ×109/L (n=101) ; group Ⅱ,(30-50) × 109/L (n = 85); group Ⅲ,(10-30) × 109/L (n = 87); group Ⅳ,< 10 × 109/L (n = 32).Demographic data such as pregnancy complications,treatment,neonates and follow-up results of the patients in each group were compared with ANOVA,Spearman rank correlation analysis,Chirsquare test and Chi-square trend test in SPSS 17.0.Results Medical complications in pregnancy of these patients included hypertensive disorder complicating (n = 35,11.48%) and abnormal glucose metabolism (n=23,7.54%),no difference was found in the incidence of these diseases among the four groups.There were 68 patients complicated with anemia (22.30%),40 preterm delivery (13.11%),60 postpartum hemorrhage (19.67%); there were significant differences in the incidence among the four groups (P＜0.05),the incidence increased with the aggravation of thrombocytopenia (P＜0.05).There were 2 cases of puerperal infection (0.66%),no maternal deaths.Fifty-one patients (16.72%) accepted treatment of corticosteroids or Gamma globulin during pregnancy.There were 116 cases (38.03%) of vaginal delivery and 189 cases (61.97%) of cesarean section.The postpartum bleeding amount within 24 hours increased with the aggravation of thrombocytopenia.Two hundred and eleven (69.18%) patients were followed up and platelet count regained normal,among which 152 cases recovered within six months after delivery.The recovery rates were 90.59% (77/85),82.36% (42/51),46.16% (24/52) and 39.13% (9/23) from group Ⅰ to group Ⅳ,as declined with the aggravation of thrombocytopenia in pregnancy ( x2trend = 42.616,Ptrend =0.000).Among the 306 perinatal fetuses,neonatal outcomes included 301 live births,5 fetal deaths,4 early neonatal deaths,4 low birth-weight infants after term birth,1 intracranial hemorrhage and 18 (5.98%) neonatal thrombocytopenia cases.Incidence of neonatal thrombocytopenia increased with the aggravation of maternal thrombocytopenia.Sixteen cases of neonatal thrombocytopenia recovered at 3-8 weeks after birth,but two cases did not recover within three years during followed up.Conclusions The perinatal outcomes are different in pregnancies complicated with varying degrees of thrombocytopenia.As thrombocytopenia in pregnancy become worse,the risk of anemia,premature delivery,postpartum hemorrhage and neonatal thrombocytopenia increases.While,perinatal outcomes may be better under close perinatal care.     

头位胎膜早破对母儿结局影响的分析

胎膜早破是产科常见的并发症,与感染、头盆不称、机械因素和其他因素均有关。本文研究363例头位胎膜早破的初产妇,探讨头位胎膜破裂对妊娠结局及新生儿的影响,现报告如下。     

妊娠期血小板减少程度对母儿结局的影响

目的 比较妊娠期不同程度血小板减少对母儿结局的影响.方法 回顾性分析2000年1月1日至2010年1月31日本院收治的妊娠期血小板减少病例305例,病因学诊断分别为妊娠期血小板减少症、特发性血小板减少性紫癜及部分病因不明者.根据孕期最低血小板计数分成4组:I组:(50～100) ×109/L;Ⅱ组:(30～50)×109/L;Ⅳ组:(10～30)×109/L;Ⅳ组:＜10×109/L.Ⅰ～Ⅳ组病例数依次为101、85、87和32例.比较各组患者孕期并发症、治疗、新生儿结局和随访情况.应用SPSS 17.0统计软件进行数据处理,采用方差分析、Spearman等级相关分析、卡方检验、趋势卡方分析.结果 305例孕妇并发贫血68例(22.30%),早产40例(13.11%),产后出血60例(19.67%),患病率均随血小板减少程度加重而升高(P均＜0.05),产后24 h内出血量随血小板减少程度加重而增多.孕期并发妊娠期高血压疾病35例(11.48%),糖代谢异常23例(7.54%),各组患病率差异均无统计学意义.产褥感染2例(0.66%),无孕产妇死亡.305例产妇随访血小板恢复者共211例(69.18%),产后半年内母体血小板恢复正常率Ⅰ～Ⅳ组依次为90.59%(77/85)、82.36%(42/51)、46.16%(24/52)和39.13%(9/23),随孕期血小板减少程度加重而恢复率下降(x2趋势=42.616,P趋势=0.000).活产儿301例,胎死宫内5例,早期新生儿死亡4例,新生儿血小板减少18例(5.98%),颅内出血1例.随母体血小板减少程度加重,新生儿血小板减少患病率增高(x2趋势=17.806,P趋势=0.000);16例新生儿血小板减少在出生后3～8周恢复正常,2例随访3年未恢复.结论 随着血小板减少程度加重,母体贫血、早产、产后出血及新生儿血小板减少的患病风险均有增加.严密的围产期保健可改善不同程度血小板减少患者的母儿结局.

Abstract：

Objective To investigate the perinatal outcomes of pregnancies complicated with varying degrees of thrombocytopenia.Methods Clinical data of 305 pregnant women with thrombocytopenia,who admitted to Peking University People's Hospital from January 1,2000 to January 31,2010 were retrospectively analyzed.The etiological diagnosis of them were gestational thrombocytopenia (GT),idiopathic thrombocytopenic purpura (ITP) or undetermined.The patients were divided into 4 groups according to the minimal level of platelets in pregnancy ( platelets count was lower than 100 ×109/L at least twice) : groupⅠ,(50-100) ×109/L (n=101) ; group Ⅱ,(30-50) × 109/L (n = 85); group Ⅲ,(10-30) × 109/L (n = 87); group Ⅳ,< 10 × 109/L (n = 32).Demographic data such as pregnancy complications,treatment,neonates and follow-up results of the patients in each group were compared with ANOVA,Spearman rank correlation analysis,Chirsquare test and Chi-square trend test in SPSS 17.0.Results Medical complications in pregnancy of these patients included hypertensive disorder complicating (n = 35,11.48%) and abnormal glucose metabolism (n=23,7.54%),no difference was found in the incidence of these diseases among the four groups.There were 68 patients complicated with anemia (22.30%),40 preterm delivery (13.11%),60 postpartum hemorrhage (19.67%); there were significant differences in the incidence among the four groups (P＜0.05),the incidence increased with the aggravation of thrombocytopenia (P＜0.05).There were 2 cases of puerperal infection (0.66%),no maternal deaths.Fifty-one patients (16.72%) accepted treatment of corticosteroids or Gamma globulin during pregnancy.There were 116 cases (38.03%) of vaginal delivery and 189 cases (61.97%) of cesarean section.The postpartum bleeding amount within 24 hours increased with the aggravation of thrombocytopenia.Two hundred and eleven (69.18%) patients were followed up and platelet count regained normal,among which 152 cases recovered within six months after delivery.The recovery rates were 90.59% (77/85),82.36% (42/51),46.16% (24/52) and 39.13% (9/23) from group Ⅰ to group Ⅳ,as declined with the aggravation of thrombocytopenia in pregnancy ( x2trend = 42.616,Ptrend =0.000).Among the 306 perinatal fetuses,neonatal outcomes included 301 live births,5 fetal deaths,4 early neonatal deaths,4 low birth-weight infants after term birth,1 intracranial hemorrhage and 18 (5.98%) neonatal thrombocytopenia cases.Incidence of neonatal thrombocytopenia increased with the aggravation of maternal thrombocytopenia.Sixteen cases of neonatal thrombocytopenia recovered at 3-8 weeks after birth,but two cases did not recover within three years during followed up.Conclusions The perinatal outcomes are different in pregnancies complicated with varying degrees of thrombocytopenia.As thrombocytopenia in pregnancy become worse,the risk of anemia,premature delivery,postpartum hemorrhage and neonatal thrombocytopenia increases.While,perinatal outcomes may be better under close perinatal care.     

不同断脐时间新生儿结局的临床分析

目的探讨不同断脐时间对新生儿结局的影响。方法收集正常单胎阴道分娩孕妇444例,分为早断脐组(215例)和延迟断脐组(229例)。早断脐组在新生儿娩出后立即断脐;延迟断脐组在新生儿娩出后1min断脐。比较两组新生儿d的结局。结果延迟断脐组新生儿血红蛋白(Hb)值[(178.75±30.21)g/L]高于早断脐组[(149.96±23.79)g/L],延迟断脐组胆红素峰值[(11.21±2.13)μmol/L]高于早断脐组[(10.15±2.21)μmol/L],差异均有统计学意义(P0.05);延迟断脐组新生儿贫血发生率(3.49%,8/229)低于早断脐组(9.77%,21/215),差异有统计学意义(P0.05);两组病理性红细胞增多症比较,差异无统计学意义(P0.05)。结论胎儿娩出后1min断脐,可以减少新生儿贫血,未增加新生儿病理性黄疸。     

延迟断脐、断脐前新生儿放低位置对新生儿黄疸的影响

目的:探讨延迟断脐、断脐前新生儿放低位置对新生儿黄疸的影响。方法:选取足月经阴分娩新生儿,随机分为3组:对照组74例(娩出后20～30s内断脐)、延迟断脐组60例(延迟断脐2～3min,断脐前新生儿传统放置位置)、延迟断脐并低位组87例(延迟断脐2～3min、断脐前新生儿放在低于分娩床20cm的接生台上)。新生儿出生后1～5天每天经皮测量胆红素浓度,对经皮胆红素浓度偏高的新生儿抽血测定血清胆红素浓度。结果:对照组、延迟断脐组和延迟断脐并低位组新生儿出生后第1、2、3、4、5天的经皮胆红素浓度差异均无显著性(P0.05),各组的新生儿血清高胆红素发生率也无显著差异。结论:延迟断脐或延迟断脐同时放低新生儿位置不加重新生儿黄疸的程度,不增加新生儿血清高胆红素发生率。     

引产对孕41周孕妇的母儿结局影响

目的 探讨引产对孕41周、无妊娠合并症孕妇母儿结局的影响.方法 选择北京协和医院妇产科2002年9月至2007年4月收治的孕41-41周+0、无妊娠合并症的初产妇374例,按临产与否分为引产组225例,其中药物(包括应用缩宫素和地诺前列酮)引产173例,人工破膜引产5例,人工破膜+药物引产47例;自然临产组149例.分别对两组孕妇的一般情况、分娩方式、产后并发症、新生儿窒息发生情况、住院天数及费用等进行回顾性分析.结果 (1)引产组的剖宫产率(44.0%,99/225)明显高于自然临产组(18.1%,27/149),两组比较,差异有统计学意义(P<0.05).(2)引产组及自然临产组产后出血发生率分别为2.7%(6/225)和1.3%(2/149)、产褥病率分别为0.9%(2/225)和0.7%(1/149)、切口延期愈合发生率为0.9%(2/225)和0.7%(1/149)、尿潴留发生率分别为4.4%(10/225)和3.4%(5/149)、产时损伤发生率分别为0.4%(1/225)和0、羊水Ⅲ度污染发生率分别为11.6%(26/225)和13.4%(20/149)、新生儿窒息发生率分别为1.3%(3/225)和2.0%(3/149),两组孕妇以上各指标分别比较,差异均无统计学意义(P>0.05).(3)在阴道顺产中,第一产程时间引产组平均为413 min,自然临产组平均为461 min,两组比较,差异无统计学意义(P>0.05);第二产程时间引产组平均为40 min,自然临产组为48 min,两组比较,差异有统计学意义(P<0.05);引产组阴道顺产中第二产程超过60 min的发生率为17.1%(20/117),自然临产组为28.8%(34/118),两组比较,差异有统计学意义(P<0.05);引产组急产发生率为5.1%(6/117),自然l临产组为0,两组比较,差异有统计学意义(P<0.05).(4)住院天数自然临产组平均为(5.7±1.9)d,引产组为(6.9±2.7)d,两组比较,差异有统计学意义(P相似文献   

潜伏期硬膜外产时镇痛对母儿结局的影响

目的了解潜伏期硬膜外镇痛是否存在对母儿的不良影响。方法回顾性分析273例初产妇病历资料,潜伏期镇痛(潜伏期组)124例,活跃期镇痛(活跃期组)共149例作为对照组。比较两组产程经过、分娩方式及结局。结果两组的年龄、妊娠次数、分娩前一周内羊水指数、分娩孕周及新生儿体重无统计学差异。需人工破膜或催产素加强宫缩、产程中排尿困难需导尿处理和产后尿潴留的比例,及镇痛后下肢麻木、产后出血、胎心异常、羊水变化、脐动脉血pH异常的发生率和Apgar评分异常的比例两组均无差异。潜伏期组中阴道顺产、产钳、剖宫产分别为71(57·3%)、20(16·1%)、33(26·6%)例,活跃期组则分别为89(59·7%)、33(22·1%)、27(18·2%)例(P=0·169);阴道分娩者第一产程时间潜伏期组和活跃期组分别为(556·8±206·3)min和(558·5±198·4)min,(P=0·950),第二产程分别为(54·0±30·6)min和(53·1±36·4)min,(P=0·860),第三产程分别为(9·1±6·1)min,(8·1±6·5)min,(P=0·276),两组发生活跃期停滞、活跃期延长、第二产程延长和第二产程中胎位异常的比例均无统计学差异。两组产程图均位于Friedman产程图左侧,潜伏期组平均每小时宫口开大2·1cm,活跃期组每小时宫口开大1·8cm(P=0·091)。结论较活跃期镇痛比较,潜伏期镇痛未增加对母儿的不良影响;镇痛过程中的关键是注意药物浓度,镇痛起始时间应因人而异。     

妊娠期B族链球菌感染现状及对母儿结局的影响

目的:探讨孕妇孕晚期B族链球菌(GBS)的定植率、基因分型、感染高危因素、母儿围产结局及药敏情况,以期为临床诊疗提供参考。方法:2016年6月至2017年6月在上海交通大学医学院附属新华医院产科进行产前检查、孕35～37周行GBS筛查的孕妇3475例,采用细菌培养和PCR两种方法筛查。GBS显色培养平板结果为阳性的154例为感染组,阴性995例为对照组,感染组临产后应用抗生素预防感染。回顾分析两组的临床资料及围产结局。对154株GBS菌株进行多位点序列分型(MLST)和药敏实验。结果:孕妇的GBS总体定植率为11.7%(406/3475),GBS显色培养平板阳性率高于PCR(12.3%vs 9.9%)。MLST分型主要为ST-366、687、15、32、19、12、24和27。年龄大、文化程度低、有流产史的孕妇感染GBS的机率大;GBS感染组和对照组孕妇的围产结局,如胎膜早破、羊水粪染、胎儿窘迫、产后出血、Apgar评分等比较,差异均无统计学意义(P0.05);感染GBS的孕妇发生早产、低出生体重儿及剖宫产的概率增加(48.1%vs 56.7%、1.3%vs 5.7%、5.2%vs 6.5%,P均0.05)。GBS对氨苄西林、万古霉素、青霉素、头孢曲松完全敏感;而对喹诺酮类、大环内酯类、四环素类抗生素有一定的耐药性。结论:孕晚期常规GBS筛查及分娩期预防性使用抗生素治疗能减少母儿不良围产期结局的发生,推荐GBS显色培养基为首选检测方法,头孢类抗生素可作为预防及治疗GBS感染的首选药物。     

单脐动脉对妊娠结局影响的临床研究

目的 研究单脐动脉对妊娠期并发症及新生儿结局的影响.方法 对171例本院分娩的单脐动脉病例进行回顾性分析,比较同期胎儿非单脐动脉孕妇(1 123例)及足月分娩的单脐动脉新生儿(84例)与同期分娩的非单脐动脉新生儿(336例)的母婴结局.结果 单脐动脉孕妇并发双胎妊娠为8.2％(14/171),子痫前期为9.4％(16/...     

足月胎膜早破的引产时机对妊娠结局的影响

目的：探讨足月胎膜早破孕妇引产时机对妊娠结局的影响。方法：选取青岛大学附属医院和临沂市中心医院2015年1月—2017年12月足月妊娠胎膜早破孕妇1 474例，根据宫颈评分及引产时间分为4组。A组，Bishop评分≥6分，破膜2 h未临产缩宫素引产；B组，Bishop评分≥6分，破膜12 h未临产缩宫素引产；C组，Bishop评分＜6分，破膜2 h未临产缩宫素引产；D组Bishop评分＜6分，破膜12 h未临产缩宫素引产。回顾性分析4组的妊娠结局。结果：A、B两组间阴道分娩率差异无统计学意义（P＞0.05）；而D组阴道分娩率高于C组，差异有统计学意义（P＜0.05）。A组的产褥期感染率、引产并发症总发生率明显低于B组（P＜0.05），而C组孕妇引产并发症总发生率、胎儿窘迫率、新生儿转科率高于D组（P＜0.05）。结论：足月胎膜早破孕妇，宫颈成熟者可破膜后2 h引产，宫颈不成熟者，可期待至破膜后12 h引产。     

妊娠期营养及体质量管理对母儿不良结局的影响

正如今,虽然人们的生活水平不断提高,居民膳食结构较过往发生了明显的改变,但以微量元素缺乏为主的\"隐性饥饿\"问题却愈加严重。既往研究发现,体内维生素、矿物质、微量元素的缺乏可导致产科并发症、合并症及胎儿出生缺陷。妊娠期女性由于血容量和红细胞数量的增加,循环中营养物质的结合蛋白和微量营养素水平有所降低,加上孕妇的新陈代谢水平还要满足胎儿生长的需求,孕妇作为一个高营养需求群体,对各种营养的需求量都有所增加。同时由于部分孕妇不合理饮食结构,使孕期体质量的管理变得困     

足月胎膜早破的引产时机对妊娠结局的影响

目的:探讨足月胎膜早破孕妇引产时机对妊娠结局的影响。方法:选取青岛大学附属医院和临沂市中心医院2015年1月—2017年12月足月妊娠胎膜早破孕妇1 474例,根据宫颈评分及引产时间分为4组。A组,Bishop评分≥6分,破膜2 h未临产缩宫素引产;B组,Bishop评分≥6分,破膜12 h未临产缩宫素引产;C组,Bishop评分6分,破膜2 h未临产缩宫素引产;D组Bishop评分6分,破膜12 h未临产缩宫素引产。回顾性分析4组的妊娠结局。结果:A、B两组间阴道分娩率差异无统计学意义(P0.05);而D组阴道分娩率高于C组,差异有统计学意义(P0.05)。A组的产褥期感染率、引产并发症总发生率明显低于B组(P0.05),而C组孕妇引产并发症总发生率、胎儿窘迫率、新生儿转科率高于D组(P0.05)。结论:足月胎膜早破孕妇,宫颈成熟者可破膜后2 h引产,宫颈不成熟者,可期待至破膜后12 h引产。     

早发型重度子痫前期对母儿的影响及围产结局

对早发型重度子痫前期发病孕周、终止妊娠孕周、孕周延长时间、母亲严重并发症发生情况及小于孕龄儿发生情况等进行阐述.认为发病孕周是影响胎儿及新生儿病死率的主要因素,发病孕周早围生儿预后差.在终止妊娠前短期的保守治疗(期待疗法)是安全有效的,能明显降低围生儿死亡率及提高生存率.     

多胎妊娠选择性减胎术的时机对妊娠结局的影响

目的 比较不同孕周实施减胎术后的妊娠结局,分析选择性减胎术(简称减胎术)的手术时机对妊娠结局的影响. 方法 选择2002年1月至2012年2月期间,在山东大学附属省立医院产科就诊的辅助生殖技术(assisted reproductive technology,ART)后妊娠的双(多)胎妊娠孕妇302例,其中减胎组为三胎和四胎妊娠孕妇152例,分别于妊娠12～13+6(91例)、14～15+6(32例)、16～24+6周(29例)接受了减胎术,对照组为ART后妊娠的双胎妊娠孕妇150例.手术方法采用超声引导下经腹胎儿心脏注射氯化钾.采用回顾性分析方法,记录分娩孕周和新生儿出生体重,观察妊娠期糖尿病和妊娠期高血压疾病的发病情况.采用t检验、单因素方差分析或x2检验进行统计学分析. 结果 减胎组流产率(14.5％,22/152)高于对照组(6.7％,10/150),差异有统计学意义(x2=4.857,P＜0.05);妊娠16～24+6周减胎组流产率(31.0％,9/29)分别高于妊娠12～13+6周减胎组(8.8％,8/91)和对照组,差异均有统计学意义(x2分别为7.212、12.749,P＜0.05);妊娠12～13+6和14～15+6周减胎组流产率(15.6％,5/32)分别与对照组比较,差异均无统计学意义(x2分别为0.370、1.739,P＞0.05).减胎组和对照组的平均分娩孕周分别为(36.9±1.8)周和(37.0±1.8)周,重体重儿出生体重分别为(2720.4±455.0)g和(2729.1±413.8)g、轻体重儿出生体重分别为(2409.2±412.6)g和(2416.2±436.8)g,差异均无统计学意义(t分别为 0.346、-0.163、-0.136,P＞0.05).减胎组和对照组妊娠28～34周分娩率分别为6.2％(8/130)和6.4％(9/140)、胎儿生长不均称发生率分别为12.3％(16/130)和11.4％(16/140)、妊娠期糖尿病发病率分别为3.1％(4/130)和2.1％(3/140),妊娠期高血压疾病发病率分别为11.5％(15/130)和8.6％(12/140),差异均无统计学意义(x2分别为0.009、0.050、0.659、0.010,P＞0.05). 结论 实施选择性减胎术将多胎妊娠减至双胎,术后存在流产风险.掌握适宜的手术时机,在妊娠16周前手术,能够存一定程度上降低流产率.