125例妊娠并发弥散性血管内凝血原发病因与预后分析

目的:探讨妊娠并发弥散性血管内凝血(DIC)患者的原发病因及其预后.方法:对2004年1月至2009年12月我院收治的125例妊娠并发DIC患者的病因及其死亡原因进行回顾性分析.结果:①125例妊娠并发DIC患者主要病因为产后出血49例(39.2％)、胎盘早剥25例(20.0％)、妊娠期急性肝病15例(12.0％)、重度子痫前期或子痫10例(8.0％)、羊水栓塞10例(8.0％).②26例死亡患者引起死亡的主要病因为羊水栓塞(50.0％,5/10)、妊娠期急性肝病(40.0％,6/15),产后出血(16.3％,8/49),胎盘早剥(16.0％,4/25).③不同病因的DIC死亡患者出现功能障碍的器官不一样.结论:妊娠并发DIC原发病因中以产科因素为主;不同原发病因DIC患者死亡率有明显差异,累及的系统或器官不同.提示临床工作中可根据不同原发病因采取相应的预防和治疗措施.     

产后出血后弥散性血管内凝血导致子宫切除术后短暂性尿崩症一例

报道临床工作中遇到的1例特殊病例,患者因相对性头盆不称行剖宫产术,发生严重产后出血、弥散性血管内凝血行子宫切除术后出现垂体后叶功能障碍,表现为短暂性尿崩症,临床上极为罕见,对其进行临床分析并复习文献,旨在提高对产后出血后出现类似希恩综合征症状如短暂性尿崩症病例的了解和认识,为临床工作者提供参考。希恩综合征是由于产后大出血引起的缺血性垂体坏死而发生的,通常在产后多年才被诊断出来。而产后很快地出现垂体机能减退引起短暂性尿崩症,临床上不常见,应引起临床工作者的重视,在评估严重产后出血后出现多尿多饮的患者时,应始终警惕中枢性尿崩症的可能性,探讨其原因及治疗方法,以便迅速开展适当的治疗。     

产科DIC诊断中国际ISTH标准与日本标准的评价分析

目的:比较国际血栓与止血委员会显性DIC标准(简称ISTH标准)、日本卫生福利部标准(简称JMHW标准)和日本危重病协会标准(简称JAAM标准)的DIC诊断评分在产科DIC诊断中的可行性,评价其对产科并发DIC的适用性.方法:对产科中因并发症进行DIC筛查的患者230例进行相关凝血指标的测定,分析凝血指标的变化与3种DIC诊断得分标准间的关系.结果:ISTH标准诊断敏感性4.3%,JMHw标准诊断敏感性5.2%,JAAM标准诊断敏感性12.6%.JAAM、JM-HW、ISTH标准各凝血指标均值异常改变程度比较,差异有统计学意义(P<0.05).诊断为DIC时ISTH、JMHW和JAAM标准的各凝血指标的均值分别为:PTR 1.5、1.45、1.3;PLT 59.9× 10~9/L、61.7×10~9/L,71.7 × 10~9/L;FIB 1.558g/L、1.664 g/L、2.262 g/L;FDP 166.6 mg/L、166.2 mg/L、122.9mg/L,与其诊断界值不相符合.结论:J从M标准诊断的敏感性是三者中最高的;现有的3种DIC诊断评分标准对产科DIC的诊断可能不合适;临床需要寻找适合于不同孕周及围生期的各项凝血指标DIC诊断界值,并建立适合产科这一特殊人群的DIC诊断标准.     

Intravascular Coagulation in Uterine Venous Blood of Toxemic Patients

Coagulation profile was investigated in blood drawn from the uterine vein of 12 patients undergoing cesarean section for moderate to moderately severe preeclampsia, and blood drawn peripherally at the same time. An identical study was made in a control group of 12 nontoxemic patients undergoing routine repeat cesarean section. In the control group, platelet counts and fibrinogen levels were always within normal limits, and there was no major difference between peripheral and uterine vein blood; fibrin degradation products (FDP) were uniformly absent. Compared to control patients, the preeclamptic patients showed in the peripheral blood drops in the platelet counts of 17 percent and in fibrinogen level of 5 percent, and in the uterine venous blood drops in the platelet counts of 43 percent and in fibrinogen level of 18 percent. FDP were present once in the peripheral blood and three times in the uterine venous blood. It appears that when blood passes through the toxemic placenta first there is consumption of thrombocytes, second fibrinogen to fibrin conversion, and then FDP formation.     

The Antiphospholipid Antibody Syndrome: An Overview

The antiphospholipid antibody syndrome is characterized by the presence of maternal anticardiolipin antibodies and/or the lupus anticoagulant in association with recurrent pregnancy loss, thrombotic events, and/or thrombocytopenia. This disorder occurs rarely, but pregnant patients with antiphospholipid antibodies are at risk for adverse maternal and perinatal outcomes. This article reviews the antiphospholipid antibody syndrome, including its pathophysiology, clinical sequelae, diagnostic criteria, medical treatment, and nursing care.     

PRIMARY CARE FOR WOMEN: An Overview of the Role of the Nurse-Midwife

The nurse-midwife's past, present, and future roles in the primary care of women are explored using a recent Institute of Medicine report on primary care as a framework for discussion. Primary care, the scope of services, and the role of the primary care clinician are described, and specific strategies for a primary care emphasis in basic nurse-midwifery education are addressed. The nurse-midwife's future roles in collaborative practice for the primary care of women and the need for continuing education opportunities in primary care are also discussed.     

Artificial Insemination: An Overview

This article presents an overview of the indications for and techniques of artificial insemination, including artificial insemination of husband's/partner's sperm and artificial insemination of donor sperm. Important issues related to psychologic, legal, and ethical concerns are addressed, as well as long-term ramifications and implications for nursing     

Research Utilization: An Overview

Nursing practice needs to be research based, not only to provide the best possible care to patients but also to ensure that nursing as a profession continues to grow. Criteria to help nurses determine how and when to implement research-based practice changes are presented. Forces that facilitate research utilization are discussed, as are barriers to research utilization. Areas of research that are ready to be implemented in women's health, obstetric, and neonatal nursing are presented.     

Alternative Health Care: An Overview

One-third of the patients seen in health care settings in a year also use alternative therapies. This article outlines ways to evaluate alternative therapies, including general resources that may be used for future reference, and discusses implications for practice and policy. Integrating alternative therapies into practice at several levels, from assessment to research, is examined, as are guidelines for helping patients chose alternative therapies.     

The Nurse Role in Parent-Infant Bonding Overview, Assessment, Intervention

The recognition of appropriate and inappropriate attachment behavior is vital to maternal health and self-stem and effective infant growth and development. An overview of parent-infant bonding is presented, followed by a discussion of the principles and methods of assessment and intervention.     

Bacterial Vaginosis: An Overview for 2009

Bacterial vaginosis has been appreciated as a unique clinical entity for well over 50 years. Its essential manifestations are well established: a loss of the normal bacterial population of the vagina and their replacement by other species. Investigations into this condition have led to a better understanding of its prevalence and epidemiology. Microbiologic and biochemical studies have exposed the remarkably complex pathophysiologic events that occur with bacterial vaginosis. Several major morbidities accompany this condition. Advances have been made in treatment, including the recent availability of a new therapeutic agent, tinidazole. However, the root cause of the condition is elusive, and as a result managing bacterial vaginosis and its complications is unsatisfactory; moreover, data suggest that therapy now is less successful than in the past. This article brings together the current fund of knowledge about bacterial vaginosis in a way that offers clinicians a realistic view of our capabilities and concerns.Key words: Bacterial vaginosis, Haemophilus vaginalis, Gardnerella vaginalis, Metronidazole, TinidazoleThe condition known in the 1950s as nonspecific vaginitis (NSV) was studied extensively by Gardner and Dukes.¹ They described the associated discharge, pH increase, odor, and granular borders of the squamous cells (clue cells) found by microscopy in the vaginas of patients with this condition. They consistently identified a small, pleomorphic, Gram-negative bacillus in 311 patients with NSV, and in none of 78 normal controls. They named the organism Haemophilus vaginalis, and attributed NSV to its presence. Most importantly, they transmitted the condition to 11 of 15 volunteers via intravaginal inoculation of discharge from patients with NSV, and to only 1 of 13 via intravaginal inoculation of pure H. vaginalis cultures.^1,2In the decades that have followed their work, H vaginalis has been reassigned first to the genus Corynebacterium and then Gardnerella, NSV has been renamed bacterial vaginosis (BV), morbidities and pathophysiologic events associated with BV have been identified, and much has been learned about normal and abnormal vaginal flora. However, the cause of BV remains unknown, and treatments for BV, by all appearances, have become less effective. This article describes the knowledge we have gained relevant to BV, draws conclusions where plausible, and discusses current treatment options and expectations.     

An Overview of Infertility

Infertility is a significant problem affecting one in every six couples in the United States. More recently and more appropriately, the emotional care of the couple has begun to receive greater attention. The nurse can play a key role in the care of infertile individuals by being knowledgeable about current tests, being aware of the emotional stresses surrounding the couple, and assisting with the necessary educational and counseling encounters which must take place.     

Twin Pregnancy and Antenatal Examination: An Overview

Total twinning rate has increased dramatically during the past 20 years, especially in Europe and the United States. This increase is mainly attributed to the widespread implementation of assisted reproductive techniques (ART). Twin gestation presents hazards at all ranges of gestational period, including risk for fetal wastage, fetal growth restriction, preterm labor, congenital abnormalities, twin-to-twin transfusion syndrome (TTTS) regarding monochorionic twins, and increased mortality rates. This review presents a summary of the appropriate antenatal examination strategy in twin pregnancies and, in parallel, emphasizes the main clinical problems that still pose controversies. Detection of chorionicity, measurement of nuchal translucency, fetal growth assessment based on twin-adjusted customized charts, structural anomaly scan, invasive procedures, non-stress test, biophysic profile, and MRI performance are the main issues analyzed. Finally, because twin gestations represent a challenging reality of modern obstetrics, this review also elucidates on the domains characterized by lack of evidence-based consensus, therefore raising the need for further research.