Multiple pregnancy in the Obstetrics and Perinatology AM in Lublin in 1989-1999

A retrospective analysis of 400 twin and 14 triplet pregnancies at the Department of Obstetrics and Perinatology, University School of Medicine in Lublin, from January 1, 1989 to June 30, 1999 was undertaken. A number increase of multiply pregnancies was observed--from 124 in the period 1989-1992 to 181 in the period 1996-1999. A percentage increase of cesarean sections was observed--from 52.42% to 77.34% respectively. The most frequent indications for the cesarean sections were non-vertex presentation of the first twin, threatened intrauterine infection and threatened intrauterine asphyxia.     

妊高征并发多器官功能衰竭20例临床分析

目的：探讨妊高征并发多器官功能衰竭（MOF）的诱因及防治。方法：对20例妊高征并发MOF的临床资料进行回顾性分析。结果：20例均存在2个或2个以上器官或系统发生功能衰竭，诱因为：胎盘早剥（5例）、羊水栓塞（6例）、感染（2例）、产后出血性休克（7例）；孕产妇抢救成功14例，6例死亡，病死率30％；围生儿21例，死亡12例，死亡率57．14％。结论：妊高征并发MOF处理关键是积极治疗原发病，有效地控制诱导的产生，是取得防治成功的前提；适时终止妊娠，保护相关脏器 功能和全身支持疗法至关重要。     

妊娠合并甲状腺功能亢进临床分析

目的 探讨甲状腺功能亢进(甲亢)患者孕前及妊娠期治疗是否能减少妊娠并发症、降低胎儿丢失率及改善母要结局.方法 回顾性分析我院1995年1月至2005年12月共11年间60例妊娠合并甲亢患者孕前及妊娠期治疗及母婴结局.60例患者分为三组:甲亢病史组(Ⅰ组):19例有甲亢病史,孕期监测甲状腺功能未复发组;治疗满意组(Ⅱ组):28例曾应用抗甲状腺药物治疗,终止妊娠时甲状腺功能正常;治疗不满意组(Ⅲ组):13例孕期未系统治疗,就诊时间晚、病情重,终止妊娠时甲状腺功能异常.结果 (1)妊娠合并甲亢进入围产期的发病率为2.25‰(52/23 104),因病情严重28周前终止妊娠8例,胎儿丢失率为11.8%(8/60);(2)Ⅰ组无妊娠并发症发生;(3)Ⅲ组与Ⅱ组相比,重度子(癎)前期(53.9%和10.7%)、甲亢性心脏病(38.5%和3.6%)、胎盘早剥(23.1%和3.6%)的发生率和胎儿丢失率(46.2%和7.1%)均有显著增加(P＜0.05);(4)Ⅲ组与Ⅱ组相比,并发重度子(癎)前期的OR=9.72(95%CI:1.53-71.21)、甲亢性心脏病OR=16.88(95%CI:1.45-826.42)、胎盘早剥OR=8.1(95% CI:0.54-440.44)、胎儿丢失OR=11.14(95%CI:1.45-126.39);(5)Ⅲ组新生儿平均体重明显低于Ⅱ组和Ⅰ组[(2550±573)g和(3211±717)g、(3186±492)g,P＜0.05];(6)Ⅲ组中有一例新生儿发生甲状腺功能减退;三组均无孕妇及围产儿死亡、无新生儿畸形.结论 重视甲亢的孕前及孕期治疗,能有效降低孕期并发症、减少胎儿丢失率及改善围产期母儿结局.     

Transient diabetes insipidus in pregnancy complicated by hypertension and seizures

A case is presented of a primigravida with transient diabetes insipidus, gestational hypertension, and multiple seizures resistant to magnesium sulfate and diazepam. After addition of phenytoin, no further seizures occurred. Transient diabetes insipidus in pregnancy has been previously associated with hypertension, liver dysfunction, and fetal distress. Considered with previous cases, it is suggested that seizures may frequently be part of this syndrome.     

妊娠合并极重度血小板减少26例临床分析

目的 探讨妊娠合并极重度血小板减少患者的病因诊断、临床处理及妊娠结局.方法 回顾性分析2004年1月到2009年3月在北京大学人民医院产科分娩的26例妊娠合并极重度血小板减少患者的临床资料.以孕期至少有2次或2次以上血小板计数<10×109/L为极重度血小板减少诊断标准.进行病因诊断,根据不同病因给予以下临床处理.(1)孕期在无全身自发性出血情况下,维持血小板计数>20×109/L,血红蛋白>70 g/L;(2)血小板<10×109/L或有出血倾向时,输注血小板;红细胞压积(HCT)<25%,血红蛋白<70 g/L时,输注压积红细胞;(3)剖宫产术前或分娩前维持血红蛋白>70 g/L,血小板计数>30×109/L;(4)特发性血小板减少性紫癜(ITP)患者血小板<(20～30)×109/L或有出血倾向时,用泼尼松或联合丙种球蛋白治疗.对于上述治疗无效者,若血小板<10×109/L或有出血倾向时间断输注血小板,无出血倾向者根据孕周严密观察,适时终止妊娠.对患者的一般临床资料、病因诊断、临床处理及妊娠结局进行分析.结果 (1)发病率及发病原因:同期分娩数为9302例,妊娠合并极重度血小板减少患者26例,妊娠合并极重度血小板减少的发生率为0.28%.患者年龄平均29岁.孕前诊断17例,孕期诊断9例.26例患者中,有13例在我院行系统产前检查,初次诊断极重度血小板减少时的平均孕周为24周;无系统产前检查的13例,初次诊断极重度血小板减少时的平均孕周为32周.26例患者中,2例(8%,2/26)病因诊断不明,24例(92%,24/26)病因诊断明确,其中14例(54%,14/26)为ITP,5例为骨髓增生异常综合征(MDS),4例为慢性再生障碍性贫血(CAA),1例为系统性红斑狼疮(SLE).(2)临床处理:所有患者均多次应用血制品.14例ITP患者中6例应用了泼尼松+丙种球蛋白治疗,8例仅应用泼尼松治疗.26例患者中有9例(35%,9/26)出现了妊娠并发症,其中6例(6/9)并发子痫前期,2例发生妊娠期糖尿病,1例为弥漫性肺泡出血.26例患者平均分娩孕周为36周,阴道分娩3例,平均出血量为83 ml;23例剖宫产分娩,平均出血量为410 ml.(3)围产儿结局:26例围产儿中,1例胎死宫内,25例活婴,其中12例为早产儿.平均孕龄36周,平均出生体质量2877 g.2例ITP患者分娩的新生儿出现了重度血小板减少.结论 妊娠合并极重度血小板减少的主要病因是ITP,治疗以泼尼松+丙种球蛋白为主;其次是CAA和MDS,以支持疗法为主.妊娠合并极重度血小板减少并非终止妊娠的绝对指征,可根据不同病因予相应治疗后,在严密的围产期监测下,注意防治妊娠并发症,分娩方式以剖宫产为主,可获得较好的妊娠结局.     

妊娠合并极重度血小板减少26例临床分析

Objective To investigate the etiology and perinatal outcome of pregnancies complicated with extremely severe thrombocytopenia [ at least two times of platelets count (PLT) < 10 × 109/L during pregnancy]. Methods Clinical data, including basic information, etiology, management and outcomes of pregnant women with extremely severe thrombocytopenia, admitted to Peking University People's Hospital from January 2004 to March 2009, were retrospectively collected. The management of these cases varied according to different etiology and the symptoms: (1) PLT were maitained > 20 × 109/L and hemoglobulin> 70 g/L in those women without spontaneous bleeding; (2) PLT transfusion would be required when PLT< 10 × 109/L or bleeding occur and RBC would be supplied when hematocrit <25% and hemoglobulin <70g/L; (3) Hemoglobulin should be > 70 g/L and PLT >30 × 109/L before cesarean section or delivery;(4) Predinisone and/or intravenous immunoglobulin G (IVIG) would be given in women complicated with idiopathic thrombocytopenic purpura (ITP) when PLT < (20-30) × 109/L or bleeding. PLT would be given if all the above management were failed, or PLT < 10 × 109/L, or bleeding. Women without bleeding would be closely monitored and delivery would be planned. Results (1) Twenty-six cases were identified among 9302 deliveries during the study period (0.28%), with an average of maternal age of 29. Seventeen were diagnosed before conception and 9 during pregnancy. Among the 26 women, half received regular prenatal check in our hospital and the average gestations at diagnosis was 24 weeks and the other half without regular prenatal visits and the average gestations at diagnosis was 32 weeks. Etiology was identified in 24 out of the 26 women, including 14(54%) ITP, 5 myelodysplastic syndrome (MDS), 4 chronic aplastic anaemia(CAA) and 1 systemic lupus erythematosus (SLE). (2) Management: All of the 26 women received blood products. Among the 14 ITP cases, 6 received predinisone and IVIG and 8 only took predinisone. Nine of the 26 patients (35%) had pregnant complications, among which 6 (6/9) were preeclampsia. The overall average gestation at delivery was 36 weeks. Only 2 delivered vaginally with the average blood loss of 83 ml and 23 cesarean sections were performed with the average blood loss of 410 ml. (3) Perinatal outcomes:There were 26 perinatal babies, among which 1 died intrauterine and 25 were born alive (12 preterm infants). The average birth weight was 2877 g. Neonatal severe thrombocytopenia presented in 2 newborns whose mother complicated with ITP. Conclusions The main cause of extremely severe thrombocytopenia during pregnancy is ITP, managed mainly by predinisone and IVIG, followed by CAA and MDS, which may require supportive treatment. Pregnancy complicated with extremely severe thrombocytopenia is not an indication of termination. Better maternal and fetal outcomes can be achieved through proper treatment based on the etiology, intensive care in prevention and management of complications and cesarean section.     

妊娠合并极重度血小板减少26例临床分析

Objective To investigate the etiology and perinatal outcome of pregnancies complicated with extremely severe thrombocytopenia [ at least two times of platelets count (PLT) < 10 × 109/L during pregnancy]. Methods Clinical data, including basic information, etiology, management and outcomes of pregnant women with extremely severe thrombocytopenia, admitted to Peking University People's Hospital from January 2004 to March 2009, were retrospectively collected. The management of these cases varied according to different etiology and the symptoms: (1) PLT were maitained > 20 × 109/L and hemoglobulin> 70 g/L in those women without spontaneous bleeding; (2) PLT transfusion would be required when PLT< 10 × 109/L or bleeding occur and RBC would be supplied when hematocrit <25% and hemoglobulin <70g/L; (3) Hemoglobulin should be > 70 g/L and PLT >30 × 109/L before cesarean section or delivery;(4) Predinisone and/or intravenous immunoglobulin G (IVIG) would be given in women complicated with idiopathic thrombocytopenic purpura (ITP) when PLT < (20-30) × 109/L or bleeding. PLT would be given if all the above management were failed, or PLT < 10 × 109/L, or bleeding. Women without bleeding would be closely monitored and delivery would be planned. Results (1) Twenty-six cases were identified among 9302 deliveries during the study period (0.28%), with an average of maternal age of 29. Seventeen were diagnosed before conception and 9 during pregnancy. Among the 26 women, half received regular prenatal check in our hospital and the average gestations at diagnosis was 24 weeks and the other half without regular prenatal visits and the average gestations at diagnosis was 32 weeks. Etiology was identified in 24 out of the 26 women, including 14(54%) ITP, 5 myelodysplastic syndrome (MDS), 4 chronic aplastic anaemia(CAA) and 1 systemic lupus erythematosus (SLE). (2) Management: All of the 26 women received blood products. Among the 14 ITP cases, 6 received predinisone and IVIG and 8 only took predinisone. Nine of the 26 patients (35%) had pregnant complications, among which 6 (6/9) were preeclampsia. The overall average gestation at delivery was 36 weeks. Only 2 delivered vaginally with the average blood loss of 83 ml and 23 cesarean sections were performed with the average blood loss of 410 ml. (3) Perinatal outcomes:There were 26 perinatal babies, among which 1 died intrauterine and 25 were born alive (12 preterm infants). The average birth weight was 2877 g. Neonatal severe thrombocytopenia presented in 2 newborns whose mother complicated with ITP. Conclusions The main cause of extremely severe thrombocytopenia during pregnancy is ITP, managed mainly by predinisone and IVIG, followed by CAA and MDS, which may require supportive treatment. Pregnancy complicated with extremely severe thrombocytopenia is not an indication of termination. Better maternal and fetal outcomes can be achieved through proper treatment based on the etiology, intensive care in prevention and management of complications and cesarean section.     

Inhaled nitric oxide therapy in pregnancy complicated by pulmonary hypertension

The use of nitric oxide as an agent to reduce pulmonary artery pressure in a pregnancy complicated by pulmonary hypertension is reported for the first time. This therapy can reduce pulmonary vascular resistance and therefore potentially enable the right ventricle to better compensate for the physiologic changes of pregnancy.     

Plasma levels of atrial natriuretic peptide during normal pregnancy and in pregnancy complicated by hypertension

To clarify a possible role for atrial natriuretic peptide in the pathophysiology of pregnancy complicated by hypertension, we studied plasma levels of atrial natriuretic peptide in 176 pregnant women with or without hypertension. Plasma atrial natriuretic peptide levels in normal pregnant women showed a gradual increase as pregnancy advanced, but the mean (+/- SD) concentrations in women in each trimester (34.8 +/- 14.7 pg/ml in the first trimester, n = 35; 38.7 +/- 12.2 pg/ml in the second trimester, n = 34; and 43.1 +/- 20.0 pg/ml in the third trimester, n = 71) did not differ statistically from the mean plasma atrial natriuretic peptide level in nonpregnant women (38.2 +/- 13.6 pg/ml, n = 44). In contrast, plasma atrial natriuretic peptide levels were elevated in 9 of the 12 women who had hypertension. The mean plasma atrial natriuretic peptide concentration in these patients (162 +/- 95.2 pg/ml) was significantly (p less than 0.01) higher than in normal pregnant women and in nonpregnant controls. On the other hand, 11 pregnant women with proteinuria or edema but without hypertension had normal plasma atrial natriuretic peptide levels. These results suggest that plasma atrial natriuretic peptide levels are normal in women during uncomplicated pregnancy, while the levels are elevated in pregnancy complicated by hypertension. Increased atrial natriuretic peptide secretion in the latter condition may reflect a mechanism of compensation that operates in response to water and sodium retention.     

重度妊高征并发腹水31例临床分析

妊娠高血压综合征 (妊高征 )并发腹水是产科少见而严重的疾病 ,可导致孕产妇及围生儿不良结局。现就 31例重度妊高征并发腹水的诊断、治疗及对胎儿的影响报道如下。1　临床资料1 1　发病率　 1989年 1月至 1999年 7月我院收治妊高征患者 10 96例 (1989年 1月至 1993年 12月为 6 2 1例 ,1994年 1月至 1999年 7月为 475例 ) ,重度妊高征 1993年前为34 2例 ,1993年后为 2 95例 ,并发腹水者 31例 ,发生率为4 9% (31/6 37)。1 2　年龄与孕产次　年龄 2 0～ 39岁 ,平均 (2 6 5± 3 4)岁。初产妇 2 6例 ,经产妇 5例。 31例中不良孕产史 2例(先兆子…     

单、双胎妊娠并发子痫前期临床分析

目的探讨单、双胎妊娠并发子痫前期的临床特点及妊娠结局。 方法选取2009年1月至2013年4月在广州医科大学附属第三医院产科住院分娩的43例双胎并发子痫前期的孕妇为研究组,362例单胎并发子痫前期产妇作为对照组,回顾性分析两组患者的临床特点及母婴结局的情况。 结果研究组住院时间(13.28±11.23)d,较对照组(9.48±4.97)d延长,t＝2.20,P<0.05。研究组剖宫产率、胎膜早破、产后出血、心力衰竭的发生率分别为97.67%、13.95%、11.63%、11.63%,明显高于对照组(79.83%、5.25%、5.25%和4.14%),差异有统计学意义(P<0.05)。研究组发生新生儿感染和黄疸分别为25.58%和48.84%,高于对照组15.19%和32.60%,差异有统计学意义(P<0.05)。 结论双胎并发子痫前期与单胎并发子痫前期相比,会增加孕产妇的剖宫产、胎膜早破、产后出血、心力衰竭等发生率,同时延长产妇的住院时间。     

Hemoglobin level analysis in the pregnancy complicated by rhesus isoimmunization

In 19 red blood cell isoimmunized pregnancies with the Coombs' titer lower than 1:32, the haemoglobin level was measured. The values were compared to reference ranges of mean for gestational age. In four cases the intravascular transfusion was performed. Six fetuses were Rh negative.     

妊娠合并重症肝炎29例临床分析

目的探讨妊娠合并重症肝炎的发病情况与有关围产期正确处理方式，减少对母儿的威胁。方法对我院近8年来29例妊娠合并重症肝炎的病例进行回顾性分析，通过分析其临床表现、病毒标志物、血生化、B超、病理观察、临床处理与妊娠结局，总结对该病的诊治经验和教训。结果急性重症肝炎7例（乙型3例、乙丙重叠感染1例、乙戊重叠感染2例、戊型1例），亚急性重症肝炎11例（乙型7例、戊型1例、病毒阴性3例），慢性重症肝炎11例（乙型10例、病毒阴性1例）。孕产妇预后：治愈2例、好转13例、未愈自动出院5例、死亡9例，死亡率为31．0％。死胎1例，死产2例，新生儿死亡4例，新生儿存活率占69．2％，围产儿死亡率为43．8％。结论妊娠合并重症肝炎严重危及母婴生命安全，是产科严重的合并症之一，定期产前教育和检查及早发现和处理是关键。     

Reappearance of end-diastolic velocity in a pregnancy complicated by severe pregnancy-induced hypertension

A case is reported in which previously absent end-diastolic velocities in the umbilical artery reappeared after treatment in a pregnancy complicated by hypertension. This observation is not consistent with the suggestion that abnormal waveforms are associated with obliteration of the tertiary stem villus arterioles.     

Triplet pregnancies in materials from the Obstetrics and Perinatology AM in Lublin in 1989-1999

A retrospective analysis of 14 triplet pregnancies at the Department of Obstetrics and Perinatology, University School of Medicine in Lublin, from January 1, 1989 to June 30, 1999 was undertaken. All pregnancies were ended by cesarean section. No difference in Apgar score and in average birth weight between I, II and III foetus was observed. The mean hospitalisation time for mothers was 32.5 +/- 29.01 days and the mean gestational age at delivery was 32.14 +/- 3.44 weeks. The indication for cesarean section in all cases was triplet pregnancy and additional complications: threatened intrauterine infection, threatened intrauterine asphyxia, abruptio placentae, preterm labour. Perinatal mortality rate was 12.82%.