妊娠合并糖尿病患者胎儿宫内安全监测

妊娠合并糖尿病增加了母儿疾病的发生风险,如妊娠期高血压疾病、羊水过多、巨大胎儿、肩难产、胎儿畸形、胎儿生长受限、胎儿窘迫和胎死宫内、新生儿低血糖、新生儿高胆红素血症以及新生儿远期并发症.对妊娠合并糖尿病患者规范化、专业化及多学科合作的血糖管理,有助于降低母婴并发症发生的风险,合理的宫内监测有助于及早发现胎儿的异常,进而...     

妊娠期室性心律失常269例临床分析

目的探讨妊娠合并室性心律失常对孕妇和新生儿结局的影响。方法对269例住院分娩的妊娠合并室性心律失常患者的临床资料进行回顾性分析。结果 269例孕妇中,妊娠合并偶发性室性期前收缩占69.1%(186/269),频发性室性期前收缩占30.9%(83/269);非器质性心脏病占93.7%(252/269),心功能均为Ⅰ~Ⅱ级;器质性心脏病占6.3%(17/269)。17例器质性心脏病室性心律失常孕妇中,剖宫产率、医源性早产和新生儿低体质量儿分别占4.5%(12/269)、4.5%(12/269)和4.1%(11/269),与无室性心律失常组比较,差异有统计学意义(P0.05)。妊娠合并器质性心脏病频发性室性期前收缩患者的剖宫产和医源性早产率(4.8%,4/83)与偶发室性期前收缩组(2.2%,4/186)比较,差异有统计学意义(P0.05)。结论妊娠合并室性心律失常患者的妊娠结局与器质性心脏病密切相关;妊娠合并器质性室性心律失常患者医源性早产和新生儿低体质量儿均明显增加。     

胎儿心律失常致新生儿死亡一例

大多数的胎儿心律失常是心脏胚胎发育中的良性过程,呈一过性,预后良好。而持续性的胎儿心律失常或伴有心脏结构缺陷、胎儿水肿的心律失常,可致围生儿不良结局。报道1例合并胎儿水肿的持续性快速型室上性心律失常病例,治疗期间病情反复,于妊娠36周行剖宫产术终止妊娠,新生儿出生后3 d死亡。通过回顾患者的一般情况及诊疗过程,总结经验教训,加强临床医生对疾病及其治疗方案的认识,对于胎儿心律失常的患者应当加强围生期母儿监护,制定个体化治疗方案,以改善不良妊娠结局。     

妊娠合并心脏病与猝死

猝死是指平素看来健康或病情基本稳定 ,无明显外因 ,非创伤也非自伤 ,意料不到的突然死亡。导致猝死最常见机制是室性快速心律失常 ,继之为慢性心律失常或心搏停顿[1] 。猝死在围生期也可发生 ,尤其妊娠合并心脏病是引起围生期猝死的常见原因。　　妊娠合并心脏病是产科中非常重要的问题 ,妊娠可使心脏病的的病情加重。妊娠 32～ 34周、分娩期及产褥期的最初 3日内 ,心脏负担最重 ,是患有心脏病孕产妇最危险的时期 ,极易发生心力衰竭 ,甚至猝死。而严重心脏病 ,心功能不良则不利于胎儿生长 ,导致围生儿疾病发生率和围生儿死亡率增加。因此 ,…     

妊娠合并血液肿瘤疾病的处理

正妊娠是育龄期妇女正常的生理过程,妊娠合并血液肿瘤疾病是一种突发的疾病状况。妊娠合并血液肿瘤疾病在诊断、治疗、家庭和伦理等方面都存在诸多特殊问题,如何处理妊娠合并血液肿瘤疾病,要充分考虑治疗相关的母儿风险及患者是否继续妊娠的意愿。这对患者及医生而言都是个难题,需要多学科医疗团队的合作。血液肿瘤常急需治疗,孕早期化疗可增加胎儿死亡和畸形的风险,但这种风险会随着孕期的增长而下降。另一方面,血液疾病本身和治疗相     

风湿免疫性疾病的妊娠管理进展

风湿免疫性疾病是一类可累及骨、软骨、肌肉、血管及各种软组织的系统性炎症性疾病,主要包括抗磷脂综合征、系统性红斑狼疮、干燥综合征、类风湿关节炎等。该类疾病好发于育龄期女性,妊娠期及产后激素水平的变化,可能出现疾病的加重或复发。风湿免疫性疾病也增加自然流产、妊娠期高血压疾病、胎儿生长受限、胎儿心律失常、死胎等不良妊娠结局的风险。目前,风湿免疫性疾病患者妊娠期临床治疗方案通常包括抗凝治疗、免疫抑制治疗等,具体根据疾病种类及病情决定用药方案。终止妊娠时机应根据母胎病情决定,原则上不宜超过预产期。若无产科指征,原则上可经阴道分娩,但需加强监护。风湿免疫性疾病患者产后可能出现疾病的加重或复发,应至风湿免疫科接受规范治疗。产科抗磷脂综合征、系统性红斑狼疮患者产后可能发生深静脉血栓、肺栓塞,应至血管外科门诊就诊。因此,风湿性免疫疾病患者的妊娠及产后需要由产科、风湿免疫科、血液科、血管外科、新生儿科等组成的多学科团队共同管理。做到有计划妊娠,做好孕前咨询、妊娠期及产褥期监测与管理。本文对风湿免疫性疾病的妊娠管理进行综述。     

妊娠合并急性白血病一例临床分析

目的：探讨妊娠合并急性白血病的临床特点,以提高对该疾病的诊治水平,改善母婴不良结局。方法：回顾性分析南方医科大学深圳医院收治的1 例妊娠晚期合并急性髓系白血病患者的诊治过程,并结合相关文献对该疾病进行分析。结果：本例患者于妊娠晚期发现急性髓系白血病,给予纠正贫血、促胎肺成熟、保护脑神经细胞等对症处理,于妊娠32＋1周行子宫下段剖宫产术娩出一活女婴。术后行白血病常规化疗。文献显示妊娠早期发现白血病应立即终止妊娠后进行常规白血病治疗;妊娠中晚期暴露于化疗药物会增加胎儿生长受限和早产的风险,但并不增加胎儿畸形的风险,可根据孕周大小制定治疗方案。结论：妊娠合并白血病的治疗应兼顾疾病本身、母体、胎儿及患者意愿等多方面因素,需要多学科团队合作,选择最佳的治疗方案以降低孕产妇不良妊娠结局的发生风险。     

肾脏病史女性孕前保健

慢性肾脏病（CKD）妊娠不良结局包括流产、并发子痫前期、胎儿发育异常、胎儿生长受限、早产等。CKD女性妊娠需多学科共同管理,调整使用对胎儿影响较小的药物;帮助CKD患者选择合适的妊娠时机;指导患者调整生活状态,适应孕期的生理变化。     

胎儿心律失常围产结局分析及其临床管理

目的:探讨心律失常胎儿围产结局及其临床管理.方法:回顾性分析2011年1月至2019年8月四川大学华西第二医院收治入院的76例妊娠合并胎儿心律失常病例的临床资料,分析胎儿心律失常临床处理及围产结局.结果:入院治疗的76例心律失常胎儿,有19例予经胎盘转运药物宫内治疗,3例内科治疗,11例引产,65例(85.53％)成功...     

妊娠合并急性白血病一例临床分析

目的:探讨妊娠合并急性白血病的临床特点,以提高对该疾病的诊治水平,改善母婴不良结局。方法:回顾性分析南方医科大学深圳医院收治的1例妊娠晚期合并急性髓系白血病患者的诊治过程,并结合相关文献对该疾病进行分析。结果:本例患者于妊娠晚期发现急性髓系白血病,给予纠正贫血、促胎肺成熟、保护脑神经细胞等对症处理,于妊娠32~(+1)周行子宫下段剖宫产术娩出一活女婴。术后行白血病常规化疗。文献显示妊娠早期发现白血病应立即终止妊娠后进行常规白血病治疗;妊娠中晚期暴露于化疗药物会增加胎儿生长受限和早产的风险,但并不增加胎儿畸形的风险,可根据孕周大小制定治疗方案。结论:妊娠合并白血病的治疗应兼顾疾病本身、母体、胎儿及患者意愿等多方面因素,需要多学科团队合作,选择最佳的治疗方案以降低孕产妇不良妊娠结局的发生风险。     

Takayasu arteritis in pregnancy: safe management options in antenatal care. Case report

Takayasu arteritis is a nonspecific chronic inflammatory vascular disease of unknown etiology with a higher incidence during the child-bearing years. It usually involves the branches of the aortic arch. Most of the patients enter the pregnancy being already diagnosed as having the disease and being on medication. The state of the disease in early pregnancy is a definitive factor for determining its management. Although it seems that pregnancy is a state favorable to this disease, nevertheless, complications should be anticipated, and close multidisciplinary maternal and fetal surveillance is mandatory. Early-onset hypertension is the commonest complication, and its magnitude during the late gestational period is the second definitive factor for the management of these pregnancies. A vaginal delivery should be aimed at term with continuous electronic fetal monitoring. The immediate postpartum period is usually uncomplicated despite the circulatory alterations that take place.     

妊娠合并再生障碍性贫血围产期管理

再生障碍性贫血是一种严重而少见的妊娠合并症,在妊娠和分娩过程中可引起孕产妇贫血、感染、出血及胎儿生长受限、胎死宫内等风险。孕前对病情全面详尽的评估,掌握妊娠的最佳时机;妊娠后多学科联合管理和治疗,必要的支持或药物治疗;围分娩期根据病情考虑计划分娩时机和分娩方式,积极预防产后出血和感染;分娩后血液内科严格随诊等措施的实施有望改善产妇及新生儿的结局,最大限度地减轻疾病负担和并发症。     

Cardiac arrhythmias in pregnancy

As more women with repaired congenital heart disease survive to their reproductive years and many other women are delaying pregnancy until later in life, a rising concern is the risk of cardiac arrhythmias during pregnancy. Naturally occurring cardiovascular changes during pregnancy increase the likelihood that a recurrence of a previously experienced cardiac arrhythmia or a de novo arrhythmia will occur. Arrhythmias should be thoroughly investigated to determine if there is a reversible etiology, and risks/benefits of treatment options should be fully explored. We discuss the approach to working up and treating various arrhythmias during pregnancy with attention to fetal and maternal risks as well as treatment of fetal arrhythmias. Acute management in stable patients includes close monitoring and intravenous pharmacologic therapy, while DC cardioversion should be used to terminate arrhythmias in hemodynamically unstable patients. Long-term management may require continued oral antiarrhythmic therapy, with particular attention to fetal safety, to prevent complications associated with arrhythmias.     

妊娠合并肺动脉高压的早期识别及管理

妊娠合并肺动脉高压(pulmonary hypertension)是一类严重危及母儿生命的妊娠合并症,目前任何原因引起的肺动脉高压均被列为妊娠禁忌证.孕产妇死亡多与肺动脉高压危象、右心衰竭、栓塞有关,对胎儿的影响主要包括胎死宫内、流产、早产、胎儿生长受限等.肺动脉高压妇女妊娠后,早期临床症状不典型,易与妊娠状态混淆,对...     

妊娠合并先天性心脏病的综合管理

医学进步使得更多先天性心脏病妇女可以生存至生育期年龄。妊娠后母体和胎儿并发症风险都会增加,心脏功能也会进一步损害。风险取决于先天性心脏病类型、血流动力学受损程度及并发症情况。加强对此类患者的综合管理,进行仔细的个体化、多学科的风险评估,制定详细的妊娠期随访、分娩和产后治疗计划可降低风险,改善围产结局,对降低孕产妇病死率具有重要的意义。     

Combined maternal and congenital myotonic dystrophy managed by a multidisciplinary team

Myotonic dystrophy is a rare autosomal dominant degenerative neuromuscular and neuroendocrine disease. Pregnancy can aggravate the maternal disease. Obstetrical complications include stillbirth, premature labor, polyhydramnion, abnormal presentation, prolonged labor, increased operative delivery, postpartum hemorrhages and anesthetic accidents. If the fetus is affected severe neonatal morbidity and mortality with arthrogryposis and mental retardation is common. We present a case where the family chose continuation of pregnancy with a known diagnosis of maternal and severe fetal myotonic dystrophy. A multidisciplinary team was used in the management of pregnancy and counseling the patient.     

H?matologische Erkrankungen in der Schwangerschaft

The management of hematologic disorders in pregnancy presents diagnostic and therapeutic challenges requiring a multidisciplinary approach. Iron deficiency is the most common cause of anemia in pregnancy. Gestational thrombocytopenia is defined by mild, asymptomatic thrombocytopenia and usually requires no therapy. Autoantibody-induced idiopathic thrombocytopenia is treated with steroids and high-dose immunoglobulins in patients with platelet counts below 30,000/??l during pregnancy and below 50,000/??l before delivery. The most common hematologic neoplasias in pregnancy include Hodgkin??s disease, aggressive non-Hodgkin??s lymphomas, and acute leukemias. Cure for the mother depends on consistent intensive chemotherapy. Chemotherapy can be administered during the second and third trimester with reasonable safety, though there is an increased fetal risk. It is important to balance the potential fetal risk against the maternal risk of an untreated neoplasia.     

Maternal arrhythmia: a case report and review of the literature

Pregnant patients with maternal arrhythmias can be challenging and difficult to treat. Medication choices may be limited in patients who are pregnant. Pregnancy carries with it a unique and complex physiology, coupled with fetal concerns. We describe a pregnant patient with an arrhythmia to illustrate treatment thought process and options. We also present a comprehensive review of the literature in regard to treatment of maternal arrhythmias and their potential adverse fetal and maternal outcomes. These treatments include antiarrhythmic medications, electrical cardioversion, and radiofrequency ablation. Antepartum and intrapartum monitoring will also be addressed along with delivery planning and postpartum considerations. The most important aspect in treating these patients is the use of a multidisciplinary approach. The decision of what therapy to use must be addressed on a case-by-case basis with special attention to the patient's individual issues and concerns. TARGET AUDIENCE: Obstetricians and gynecologists, family physicians, emergency room physicians LEARNING OBJECTIVES: After completion of this educational activity, the obstetrician/gynecologist should be better able to assess and council patients on the risks and complications of maternal arrhythmias in pregnancy. Evaluate the current treatment options available for health care providers caring for pregnant patients with maternal arrhythmia, and manage the antepartum course, labor, and delivery in these patients.     

Surgical management of valvular heart diseases in pregnancy

Heart disease in pregnancy remains one of the important causes for maternal and fetal mortality and morbidity. Cardiac surgery undertaken in pregnancy presents specific additional issues for both the mother and fetus; especially cardiopulmonary bypass and the factors associated with it. Successful outcome of cardiopulmonary bypass surgery during pregnancy depends upon the multidisciplinary management of the patient, which is frequently under reported from the developing world. We present our experience of two cases where cardiopulmonary bypass surgery for cardiac valve replacement was successfully performed during pregnancy without any maternal or fetal mortality. A review of published literature is also undertaken in order to present evidence based recommendations for undertaking such procedures in pregnancy.     

Successful pregnancy outcome with cardiac and severe restrictive lung disease requiring mechanical ventilation: a case report and literature review

The prognosis for pulmonary hypertension as a single entity is poor, but when it is superimposed on the physiological changes of pregnancy, it produces a lethal condition, with maternal mortality rates greater than 50%. We present a successfully managed case followed by a review and discussion of the available literature on this subject. A 24-year-old woman, a primigravida, was mechanically ventilated for severe restrictive lung disease. Her pregnancy required close surveillance of her labile cardiopulmonary status as well as fetal well-being. Her delivery was scheduled for induction at 34 weeks' gestation, but she required an emergency Cesarean section, which was productive of a healthy infant. Her recovery was complicated by recurrent fever. There is limited literature on restrictive lung disease and pulmonary hypertension with regards to their management during pregnancy. Nevertheless, successful pregnancy outcomes may result with careful multidisciplinary management.