360例妊娠期高血压疾病及其并发症妊娠结局分析

目的通过对360例妊娠期高血压疾病分类比较分析,探讨新的诊断标准下妊娠期高血压疾病对母儿的影响。方法选择我院2007年1月1日～2009年8月1日在我院住院分娩的孕妇为研究对象,按新诊断标准分类分组：妊娠高血压组、轻度子痫前期组、重度子痫前期组,对比分析三组间母儿发生早产、产后出血、胎盘早剥、胎儿生长受限（FGR）、胎儿窘迫、新生儿窒息情况。结果妊娠高血压组胎儿窘迫、早产的发生率显著低于轻度组;轻度组孕产妇FGR、并发症、围产儿死亡率显著低于重度组（P〈0.01）;妊娠期高血压组产后大出血的发生率显著低于轻度组,轻度组产后出血、早产、新生儿窒息、胎儿窘迫显著低于重度组（P〈0.05）。结论妊娠期高血压疾病严重影响妊娠结局,加强孕期保健以改善母儿不良结局。     

血清miR-210水平与妊娠期高血压疾病患者不良妊娠结局的相关性

目的:探讨血清微小RNA(microRNA,miR)-210水平与妊娠期高血压疾病(Hypertensive disorders in pregnancy,HDP)患者不良妊娠结局的相关性。方法:选取2018年5月至2019年5月我院收治的93例HDP患者,采用实时荧光定量PCR方法检测入院时血清miR-210水平,记录不良妊娠结局。结果:回归分析检验结果显示,舒张压、收缩压、血清miR-210过表达与HDP患者不良妊娠结局有关(OR>1,P<0.05);血清miR-210表达水平对HDP患者不良妊娠结局风险有一定预测价值。结论:血清miR-210过表达与HDP患者不良妊娠结局相关。     

高龄产妇并发妊娠期高血压疾病对围生期结局的影响

目的探讨孕高龄产妇并发妊娠期高血压疾病对围生期结局的影响。方法对43例35岁或以上的妊娠期高血压疾病孕妇（观察组）进行了回顾性分析并与同期分娩的35岁以下的妊娠期高血压疾病孕妇238例（对照组）作对照分析。结果观察组子痫前期、子痫的发生率与对照组比较差异有非常显著性（P〈0.01）;观察组胎盘早剥、HELLP综合征、妊娠高血压心脏病等严重并发症的发生率与对照组比较无显著性差异（P〉0.05）;观察组早产、胎儿生长受限、围产儿死亡的发生率比对照组高,差异有显著性（P〈0.05）;新生儿窒息、胎儿窘迫的发生率两组比较,差异无显著性（P〉0.05）,观察组剖宫产率较对照组明显增加,两组间差异有显著性（P〈0.05）。结论高龄产妇并发妊娠期高血压疾病病情重,对母儿危害大,恰当的围产期管理并适时终止妊娠是治疗成功的关键。     

妊娠合并妊娠期高血压疾病晚期妊娠258例临床分析

目的探讨妊娠期高血压疾病对晚期妊娠的影响。方法选取我院3年来孕28w以上住院分娩病例,以妊娠合并妊娠期高血压疾病258例作观察组,随机抽取正常妊娠孕妇480例作对照组,对比分析胎盘早剥、早产、胎儿窘迫、胎儿宫内发育迟缓、死产、产后出血发生率、新生儿窒息率、剖宫产率和对孕妇的影响。结果观察组的胎盘早剥、早产、胎儿窘迫、胎儿宫内发育迟缓、死胎、新生儿窒息率、产后出血发生率、剖宫产率等母婴并发症均明显高于对照组（P〈0．05）。结论妊娠期高血压疾病对晚期妊娠的母婴结局有许多不良影响。     

妊娠期高血压疾病及其并发症与母婴结局的关系

目的：统计和分析妊娠期高血压疾病及其并发症对母婴结局的临床影响情况。方法随机择取2010年06月~2013年06月以来,在我院妇产科进行分娩的妊娠期高血压疾病产妇136例(观察组),并选择同期正常产妇136例(对照组),对两组产妇及新生儿的临床情况进行回顾性分析。结果统计学分析显示,观察组产妇的剖宫率(80.88%)、产后出血率(12.50%)、产后高血压率(20.59%)以及新生儿窒息率(52.21%)、死亡率(1.47%)均明显高于对照组(33.09%,3.68%,0,9.56%,0),组间比较具有统计学意义(P<0.05)。结论妊娠期高血压疾病及其并发症对母婴的健康安全影响较大,因此,产妇在妊娠期间应积极预防和及时治疗妊高征及其并发症,从而更好的确保母婴健康安全。     

妊娠期糖尿病的筛查、干预与妊娠结局的关系

目的通过对妊娠期糖尿病的筛查,了解本市妊娠期糖尿病的发病率及妊娠期糖尿病干预后的妊娠结局。方法回顾分析2008年10月～2009年9月在本所进行高危筛查时行血糖筛查的孕妇2675例,孕周24～28周,筛查出糖代谢异常孕妇72例。对所有血糖异常者进行相应干预和密切随访;与2006年1月～2006年12月间未干预的妊娠期糖尿病孕妇50例进行分析,比较两组间的妊娠结局。结果妊娠期糖尿病的发病率为2.69%。干预组与未干预组妊娠期糖尿病的母儿并发症有明显差异,差异有显著意义（P〈0.01）。结论对所有孕妇进行血糖筛查,有利于早期诊断与治疗妊娠期糖尿病,减少母儿并发症。     

妊娠高血压疾病对双胎妊娠早产儿结局的影响

目的 调查妊娠高血压疾病对双胎妊娠早产儿结局的影响。方法 回顾性分析2010年1月至2018年12月复旦大学附属妇产科医院分娩的胎龄为28～36+6周双胎儿的临床资料。结果 本研究共纳入1299对双胎儿,其中妊高症组332对,非妊高症组967对,双胎妊娠合并高血压疾病发生率为25.56%,两组产妇年龄差异无统计学意义(P>0.05)。妊高症组产妇剖宫产率、试管婴儿(IVF)率及双绒毛膜双胎比例显著高于非妊高症组(97.6%vs94.3%,χ²=5.755,P=0.016;49.1%vs 39.1%,χ²=10.183,P=0.001;74.4%vs 67.2%,χ²=9.253,P=0.010)。妊高症组产妇妊娠合并低蛋白血症发生率、胎儿生长受限(FGR)发生率显著高于非妊高症组产妇(5.7%vs 0.6%,χ²=34.089,P<0.001;8.1%vs 4.7%,χ²=5.713,P=0.017),低出生体重儿发生率、新生儿低血糖发生率、红细胞增多症发生率均显著...     

妊娠期糖尿病的临床治疗与妊娠结局的关系

目的探讨妊娠期糖尿病（GDM）的临床治疗,并分析与妊娠结局的关系。方法比较我院30例经收入院治疗的GDM孕妇和同期因各种原因未得以收入院治疗的GDM孕妇的临床资料,分析围生儿的并发症的发生及孕妇的分娩方式与对照组比较,并进行统计学分析。结果治疗组新生儿窒息、低血糖、围生儿死亡、巨大儿及分娩方式与对照组比较,差异有统计学意义（P〈0.05）。结论GDM应早期诊断和治疗,使血糖维持在正常水平是GDM治疗的关键,可以减少母婴并发症的发生。     

妊娠期高血压疾病外周血IL-12、TNF-α水平变化及其与妊娠结局的相关性

为探讨妊娠期高血压疾病(hypertensive disorder of pregnancy, HDP)患者外周血炎性因子水平变化及与妊娠结局的相关性,选取192例HDP患者为HDP组,其中妊娠期高血压患者64例、轻度子痫前期患者82例、重度子痫前期患者46例,另选取同期100例正常产检孕妇为对照组。采用ELISA检测外周血IL-2、IL-10、IL-12、TNF-α、IFN-γ水平,免疫透射比浊法测定CRP水平。比较HDP组与对照组的炎性因子水平和不良妊娠结局;比较HDP患者妊娠结局良好组与不良组炎性因子水平,并分析其与不良妊娠结局的相关性;绘制ROC曲线,分析炎性因子对不良妊娠结局的预测价值。结果显示,不同HDP分期组患者外周血IL-2、IL-12、TNF-α水平较对照组升高(P<0.05),IL-10水平较对照组降低(P<0.05);重度子痫前期组IL-12、TNF-α水平高于其他HDP分期组(P<0.05)。HDP组有指征的剖宫产、产后出血、早产或过期产、低体重儿、新生儿窒息发生率均显著高于对照组(P<0.05)。HDP患者中妊娠结局良好组外周血IL-1...     

妊娠合并梅毒孕期干预治疗对妊娠结局的影响

目的 探讨妊娠合并梅毒的孕期干预治疗及妊娠结局.方法 对87例妊娠合并梅毒的临床资料进行回顾性分析,根据接受治疗的情况,将87例患者分为2组,66例孕期接受规范治疗为第1组,21例孕期未接受规范治疗为第2组,比较二组孕妇的妊娠结局.结果 1组妊娠成功率为95.45%(63/66),围生儿先天性梅毒17.46%(11/63).2组妊娠成功率为42.86%(9/21),围生儿先天性梅毒80.95%(17/21).结论 梅毒是导致不良妊娠结局的重要因素,是危害围生儿的严重并发症,早期规范的治疗可提高妊娠成功率,减少先天性梅毒的发生.     

拉贝洛尔治疗妊娠高血压疾病的临床疗效及对免疫球蛋白的影响

目的观察拉贝洛尔对妊娠高血压疾病的临床疗效,以及对血清中免疫球蛋白含量的影响。方法选取诊断为妊娠高血压疾病的产妇60例,随机分为试验组和对照组各30例。入院后两组患者均给予基础治疗,试验组在基础治疗的基础上应用拉贝洛尔100mg加入到5%葡萄糖溶液250m L中静脉滴注,控制血压后改用口服拉贝洛尔100mg,3次/d至患者分娩前;对照组用生理盐水或5%葡萄糖溶液40m L+盐酸尼卡地平注射液10mg/静脉滴注,起始均以0.5μg/(kg·min)静脉给药,血压平稳于目标血压24h后给予盐酸尼卡地平缓释胶囊服,40mg每日2次。测量两组治疗前后的免疫球蛋白含量。结果试验组患者的收缩压及舒张压明显降低,血清中免疫球蛋白的含量升高,临床疗效较好。结论拉贝洛尔可明显改善妊娠高血压患者的临床症状,提高患者免疫球蛋白含量,具有较好的治疗效果。     

妊娠糖尿病规范化治疗与妊娠结局的临床分析

目的观察妊娠糖尿病患者经规范化治疗后母婴患病率及不同血糖水平对妊娠结局的影响。方法对86例妊娠糖尿病患者采用规范化治疗后,分析其妊娠结局。结果妊娠糖尿病规范化治疗后与正常孕妇母婴患病率无显著性差异;空腹血糖在4.0~4.8mmol/l、餐后2h血糖在4.8~7.0mmol/l、糖化血红蛋白在5%~6.2%范围内妊娠糖尿病患者母婴患病率最低。结论妊娠糖尿病经规范化治疗能减少母婴并发症,妊娠结局与血糖及糖化血红蛋白水平密切相关。     

护理干预对于妊娠糖尿病孕妇妊娠结局的意义

目的：对妊娠糖尿病孕妇采取护理干预的效果探讨。方法对2012年1月~2013年1月80例妊娠糖尿病(GDM)孕妇临床资料进行回顾性分析。结果治疗组的孕产妇及新生儿并发症发生率明显低于对照组,差异具有统计学意义(P<0.05)。结论早期筛查发现,并给予饮食控制、血糖监测、运动疗法、胰岛素治疗、健康教育等正确的临床干预,是改善妊娠结局的关键。     

The Risk Factors and Pregnancy Outcomes of 48 Cases of Heterotopic Pregnancy from a Single Center

The purpose of this study was to investigate risk factors that are associated with heterotopic pregnancy (HP) following in vitro fertilization (IVF)-embryo transfer (ET) and to demonstrate the outcomes of HP after the surgical treatment of ectopic pregnancies. Forty-eight patients from a single center, who were diagnosed with HP between 1998 and 2012 were included. All of the patients had received infertility treatments, such as Clomid with timed coitus (n = 1, 2.1%), superovulation with intrauterine insemination (n = 7, 14.6%), fresh non-donor IVF-ET (n = 33, 68.8%), and frozen-thawed cycles (n = 7, 14.6%). Eighty-four additional patients were randomly selected as controls from the IVF registry database. HP was diagnosed at 7.5 ± 1.2 weeks (range 5.4-10.3) gestational age. In six cases (12.5%), the diagnosis was made three weeks after the patients underwent treatment for abortion. There were significant differences in the history of ectopic pregnancy (22.5% vs. 3.6%, P = 0.002). There were no significant differences in either group between the rates of first trimester intrauterine fetal loss (15.0% vs. 13.1%) or live birth (80.0% vs. 84.1%) after the surgical treatment for ectopic pregnancy. The risk factors for HP include a history of ectopic pregnancy (OR 7.191 [1.591-32.513], P = 0.010), abortion (OR 3.948 [1.574-9.902], P = 0.003), and ovarian hyperstimulation syndrome (OHSS) (OR 10.773 [2.415-48.060], P = 0.002). In patients undergoing IVF-ET, history of ectopic pregnancy, abortion, and OHSS may be risk factors for HP as compared to the control group of other IVF patients. The surgical treatment of HP does not appear to affect the rates of first trimester fetal loss or live birth.     

ORIGINAL ARTICLE: Leptin Gene (TTTC)n Microsatellite Polymorphism as well as Leptin Receptor R223Q and PPARγ2 P12A Substitutions are not Associated with Hypertensive Disorders in Pregnancy

Citation Wiedemann A, Vocke F, Fitzgerald JS, Markert UR, Jeschke U, Lohse P, Toth B. Leptin gene (TTTC)_n microsatellite polymorphism as well as Leptin receptor R223Q and PPARγ2 P12A substitutions are not associated with hypertensive disorders in pregnancy. Am J Reprod Immunol 2010; 63: 310–317 Problem Pregnancy‐induced hypertension (PIH) affects up to 15% of all pregnancies. Disturbed placentation is one factor associated with PIH. Leptin and peroxisome proliferator activator receptors (PPAR) seem to play an important role in placentation, fetal development, and blood pressure regulation. Therefore, we investigated polymorphisms in the genes encoding leptin, the leptin receptor, and PPARγ2 in patients with PIH. Method of study In this retrospective case–control study, 103 patients with PIH [gestational hypertension (GH) n = 39; preeclampsia n = 27; eclampsia n = 5; HELLP n = 32] and 100 controls were analyzed for the LEP tetranucleotide repeat (TTTC)_n and the leptin receptor (LEPR) R223Q and PPARγ2 P12A substitutions. Statistical analysis was performed using the chi‐square, Mann–Whitney U‐, and Kruskal–Wallis tests (P < 0.05 significant). Results The frequency of the three possible genotypes did not differ significantly between patients and controls [LEP (TTTC)_n: P = 0.43; LEPR R223Q: P = 0.94; PPARγ2 P12A: P = 0.94]. However, postpartal diastolic blood pressure of PIH patients was significantly higher in homozygous carriers of the LEPR Q223‐encoding allele as compared with patients carrying the wild‐type allele (P < 0.01). Conclusion Hypertensive disorders in pregnancy were not associated with the LEP, LEPR, and PPARγ2 polymorphisms studied. The role of other variations in the LEP and PPAR genes in the pathophysiology of PIH and in exacerbations are the objective of ongoing research.     

Glucose Plasma Levels and Pregnancy Outcomes in Women with HIV

Abstract

Background: There is limited information on the relation between glucose levels in pregnancy and adverse perinatal outcomes in HIV-infected pregnant women. Objective: To evaluate the potential impact of fasting glucose levels on pregnancy outcomes in a large sample of pregnant women with HIV from a national study, adjusting for potential confounders. Methods: Data from the Italian National Program on Surveillance on Antiretroviral Treatment in Pregnancy were used. The main outcomes evaluated in univariate and multivariable analyses were birthweight for gestational age >90th percentile (large for gestational age [LGA]), nonelective cesarean delivery, and preterm delivery. Glucose measurements were considered both as continuous and as categorical variables, following the HAPO study definition. Results: Overall, 1,032 cases were eligible for the analysis. In multivariable analyses, a birthweight >90th percentile was associated with increasing fasting plasma glucose levels (adjusted odds ratio [AOR] per unitary (mg/dL) increase, 1.04; 95% CI, 1.01–1.06; P = .005), a higher body mass index, and parity of 1 or higher. A lower risk of LGA was associated with smoking and African ethnicity. A higher fasting plasma glucose category was significantly associated with LGA occurrence, and AORs for the glucose categories of 90–94 mg/ dL and 95–99 mg/dL were 3.34 (95% CI, 1.09–10.22) and 6.26 (95% CI, 1.82–21.58), respectively. Fasting plasma glucose showed no association with nonelective cesar-ean section [OR per unitary increase, 1.00; 95% CI, 0.98–1.02] or preterm delivery [OR per unitary increase, 1.00; 95% CI, 0.99–1.02]. Conclusions: In pregnant women with HIV, glucose values below the threshold usually defining hyperglycemia are associated with an increased risk of delivering LGA infants. Other conditions may independently contribute to adverse perinatal outcomes in women with HIV and should be considered to identify pregnancies at risk.     

子痫前期预测的现状与展望

子痫前期(PE)是妇女孕期特发的多系统疾病,是导致孕产妇和围产儿患病和死亡的主要原因之一。临床发病多出现在妊娠20周以后,其主要临床表现血压升高、水肿、蛋白尿等与众多因素有关,如何从中找到准确预测PE的方法一直是人们研究的重点。本文对PE预测现状作一综述,并对以后的预测研究作一展望。     

妊高症患者血栓前状态分子标志物变化的临床意义

目的通过观察妊娠期高血压疾病（简称＂妊高症）＂患者分娩前后血浆中各凝血及纤溶系统分子标志物的变化,探讨其临床意义。方法检测正常非孕组、正常晚孕组、妊娠期高血压组、轻度子痫前期组（各30例）及重度子痫前期或子痫组（18例）妇女分娩前后外周血血浆的AT活性、TAT浓度、ProC活性、LPA水平。结果 1.与正常非孕组或正常晚孕组比较,三组妊高症患者分娩前后血浆的TAT及LPA水平显著升高,AT和ProC活性显著降低（P〈0.01）;2.分娩前,正常晚孕组与正常非孕组比较,血浆的TAT及LPA水平显著升高,AT和ProC活性显著降低（P〈0.01）;3.与分娩前比较,正常晚孕组产后血浆TAT及LPA水平轻微降低,AT和ProC活性轻微上升,差异均无显著统计学意义（P〉0.05）;4.与分娩前比较,三组妊高症患者产后血浆TAT及LPA显著降低,AT和ProC活性显著升高（P〈0.01）。结论 1.正常孕晚期妇女分娩前处于轻度的血栓前状态,分娩后短期内无明显改变;2.妊高症患者分娩前存在明显的血栓前状态,分娩后短期内明显缓解。3.妊高症患者血栓前状态随病情加重而加重,并危及胎儿,适时终止妊娠有利于预防血栓形成及减少并发症。