Valvular heart disease in pregnancy: maternal and fetal outcome

The aim of this study was to evaluate the maternal and fetal outcome of pregnancy in Valvular Heart Disease (VHD). A better understanding of the effects of valvular abnormalities on pregnancy outcome is of value for risk assessment and the design of a therapeutic plan from the available information of a series of patient. A multicenter prospective study was carried out over a period of 5 years (2005-2009) involving 60 pregnant patients with valvular heart disease. Thirty eight patients (64%) had single valve involvement and mitral stenosis was the most predominant lesion (50%). Ten patients (16.7%) had undergone interventional and surgical correction prior to the pregnancy. Fourteen (24%) patients were identified as a NYHA class III-IV. Women with VHD had 8.35% pulmonary edema, 15.03% developed different types arrhythmia. The incidence of preterm birth and small for gestational age newborn was 11.69% and 13.36% respectively. There was one (1.67%) maternal death. Pregnancy in women with valvular heart disease is associated with remarkable unfavourable effect on maternal and fetal outcome which are related to severity of disease.     

妊娠中期母血清唐氏综合征三联筛查4 680例与不良妊娠结果分析

Currentlythetriplemarkerscreenoffetoprotein(AFP),unconjugatedestriol(uE3)andhumanchori onicgonadotropin(hCG)testcandetectapproximately60%(58%-82%)ofthepregnanciesaffectedbytri somy21,withafalsepositiverateofabout5%-10%[1].Currentlyprenatalscreeningforfeta…     

母体因素导致妊娠晚期胎儿生长受限的预测及新生儿转归

目的:分析妊娠晚期胎儿生长受限(FGR)的母体因素及对妊娠结局的影响。方法:选取中日友好医院产科2013年10月~2017年10月产检并分娩的妊娠晚期FGR产妇47例、拟诊FGR分娩后排除的产妇42例及对照组产妇45例,分析母体因素对FGR的影响。结果:FGR组剖宫产率、新生儿住院率、住院时间均显著高于非FGR组(均P<0.05)。合并与未合并子痫前期的FGR组相比,剖宫产率、分娩孕周及新生儿预后均有统计学差异(均P<0.05)。FGR组与非FGR组前白蛋白水平有统计学差异(P<0.05),合并与未合并子痫前期的FGR组白蛋白水平有统计学差异(P<0.05)。结论:子痫前期是FGR新生儿预后不良的重要母体因素,及早发现FGR是子痫前期患者高危管理的重要组成。前白蛋白在评估孕妇特别是拟诊FGR孕妇的营养状况及FGR预测方面值得关注。     

妊娠早期不同一性发育双胎的妊娠结局

目的:评估双胎妊娠早期两胎儿不同一性发育的妊娠结局.方法:回顾性研究在216对双胎妊娠中共有19例(不同一组),41例为对照组.用方差分析和Fisher's exact test比较两组胎儿生长受限(IUGR)发生率、新生儿不同一性发生率和早产发生率情况.结果:不同一组IUGR发生率、新生儿不同一性发育发生率以及早产发生率分别为57.2%,35.7%,78.6%,显著高于对照组24.4%,7.5%和30%(P值分别为0.03,0.02和0.01),不同一组先天畸形的发病率高于对照组,当双胎不同一性比率(A-B/A)＞25%时,有显著性差异(P=0.039).所有发现的畸形均为易于识别的严重畸形.结论:双胎不同一性发育可发生于妊娠早期.双胎不同一性程度＞25%时,胎儿畸形率增高且为易识别的显著畸形.早期不同一性发育双胎的IUGR发生率、新生儿不同一性发生率和早产发生率均增高.     

孕晚期干预支持对孕产妇认知行为及分娩结局的影响分析

目的研究孕晚期干预支持对孕产妇认知行为及分娩结局的影响。方法选择我院符合自然分娩指征的孕产妇300例,随机分为接受干预支持的观察组（150例）和接受常规处理的对照组（150例）,观察产妇的负面情绪、分娩态度和分娩知识、分娩方式以及产后出血量。结果观察组分娩前HAMD、HAMA评分、分娩过程中VAS评分均明显低于对照组（P〈0.05）,分娩态度、分娩知识、产时应对行为得分以及顺产例数均明显高于对照组（P〈0.05）,产后2 h出血量明显少于对照组（P〈0.05）。结论在孕晚期给予干预支持能够有效改善产妇的分娩态度和分娩知识,缓解产妇的负面情绪,提高顺产率、减少产后出血量,是妊娠期行之有效的干预措施。     

妊娠早期巨大子宫肌瘤术后分娩1例并文献复习

目的 探讨妊娠早期子宫肌瘤切除术的可行性及妊娠期肌瘤术后分娩方式和时机的选择。方法 回顾性分析山东第一医科大学附属省立医院妊娠早期巨大子宫肌瘤切除术后足月经阴分娩1例患者的临床资料,并进行文献复习。结果 患者于妊娠32 d行全麻下子宫肌瘤切除术,孕期正规产检,过程顺利,于孕41周人工破膜后经阴分娩一活婴,产后恢复好,顺利出院。结论 妊娠期早期子宫肌瘤切除手术是可以尝试的,可于妊娠36～38⁺⁶周择期剖宫产。肌瘤切除过程中子宫肌层完整性未受到显著破坏者,可严密监护下阴道试产,分娩孕周可延长至41周。子宫肌瘤切除术后的催引产需谨慎,不建议40周以后的引产。     

循证护理应用于早期先兆流产患者效果观察

目的探讨循证护理应用于早期先兆流产患者的效果。方法随机将100例早期先兆流产患者分为试验组和对照组各50例,试验组引进循证护理理念,制订护理计划,进行护理实践;对照组采用传统护理方法进行护理。观察2组患者的不适症状和相关并发症。结果 2组患者发生的不适症状和相关并发症有明显统计学差异。结论循证护理作为一种科学的护理模式,较传统护理方法更能有效地减轻先兆流产患者的不适症状,降低并发症发生率。     

Maternal outcome after open fetal surgery. A review of the first 17 human cases

A few fetal diseases may benefit from surgical treatment before birth, but hysterotomy and subsequent delivery by cesarean section pose a risk to the otherwise unaffected mother. To assess maternal risk of mortality, morbidity, and reproductive potential after fetal surgery, we reviewed our experience with 17 highly selected women who underwent fetal surgery. Fifteen of these procedures were performed for one of two congenital anomalies: severe bilateral hydronephrosis and congenital diaphragmatic hernia. There were no deaths or serious maternal injuries. In the 14 women who continued pregnancy after hysterotomy, uterine irritability and preterm labor were frequent complications, requiring early confinement in most cases. There has been no detectable effect on future fertility, as indicated by eight subsequent normal pregnancies. We conclude that hysterotomy for fetal surgery can be accomplished without unduly endangering the mother's life or her future reproductive potential. However, morbidity related to premature labor remains a serious problem, and our ability to control uterine contractions after hysterotomy remains the limiting factor in human fetal surgery.     

T cell non-Hodgkin's lymphoma presenting in the first trimester of pregnancy.

This case report details of the presentation of a young woman in the first trimester of her pregnancy with lethargy, weakness, vomiting, pyrexia and lymphadenopathy. Extensive investigation revealed an advanced T cell lymphoma and only the second reported case in pregnancy to our knowledge. We discuss her management and subsequent chemotherapy in the context of a short review of the literature spanning the last decade.     

Life support for 10 weeks with successful fetal outcome after fatal maternal brain damage

A 31 year old woman in whom subarachnoid and intracerebral haemorrhage occurred during the second trimester of pregnancy was sustained in intensive care with a respirator for 10 weeks. Computed tomography of the brain showed bilateral intraventricular haemorrhages. Because of drug resistant hypotonic episodes at 31 weeks' gestation caesarean section was performed, and a boy was delivered. The woman died of spontaneous cardiac arrest two days after caesarean section, and the boy showed normal development. Life support can be continued for several weeks in a modern intensive care unit after fatal insult to the brain even in a pregnant woman without affecting the fetus.     

正常孕中期胎儿脊柱长度与胎龄关系的探讨

目的：探讨超声成像中胎儿脊柱长度与胎龄的关系。方法：采用超声仪对259名正常单胎孕13-23周胎儿脊柱长度、股骨长、双顶径进行测量，建立相关线形回归方程。结果：脊柱和胎龄的线形回归方程为：脊柱长度（mm）=7．086孕周-39．176，相关系数为0．956。并建立脊柱长度与股骨长及双顶径线形回归方程。结论：在孕中期，脊柱长度与胎龄之间有较好的相关，脊柱长度可以作为参数之一估算胎龄，评估胎儿生长发育状态。