米非司酮对早孕妇女血清一氧化氮和子宫局部血流的影响

探讨米非司酮对早孕妇女血清一氧化氮及子宫局部血流的影响。方法 利用镀铜镉还原法测定服用米非司酮前,后的早孕妇女及正常非孕妇女血清ＮＯ浓度,同时利用彩色多普勒超声显像监测子宫局部血流变化,并观察流产后绒毛和蜕膜组织的超微结构。结果早孕妇女血清ＮＯ浓度明显高于正常非孕妇女,服米非司酮后血清ＮＯ浓度明显低于服药前;服米非司酮后子宫动脉和滋养层动脉血流的指数,收缩期血流峰值与舒张期血流最小值的比值,较服药     

VEGF、sFlt-1与药物流产不全的相关性研究

目的:探讨血管内皮生长因子(VEGF)及其可溶性受体(sFlt-1)的变化与药物流产的相关性,及药物流产不全的可能原因。方法:选取因早孕行药物流产的165例患者,其中完全流产者94例,不全流产者42例。采用酶联免疫吸附法(ELISA)测定孕妇血清VEGF及sFlt-1水平,并比较服药前后以及完全流产组与不全流产组服药后的血清VEGF及sFlt-1水平。结果:服米非司酮前后,孕妇血清VEGF及sFlt-1水平比较,差异有统计学意义(P0.05);服米非司酮后,完全流产组与不全流产组的血清VEGF及sFlt-1水平比较,差异均有统计学意义(P0.05)。结论:VEGF及sFlt-1的变化,与药物流产具有相关性,并且可能是药物流产不全的原因之一。     

B超、宫腔镜、病理、生殖激素测定在药物流产后出血病因诊断中的应用

目的 :探讨药物流产后长时间出血的原因及常用检查手段在药物流产出血病因诊断中的价值。方法 :选择药物流产后出血≥ 14天的患者 4 8例作为研究组 ,作B超、宫腔镜及病理检查。选择平时月经正常的 2 0例妇女作对照组 ,两组均测血FSH、LH、E2 、P值。结果 :研究组中不全流产率 83 33% ,子宫内膜炎发生率与流血时间长短呈正相关 (P <0 .0 5 ) ,不全流产患者垂体FSH、LH显著低于完全流产患者 (P <0 .0 5 ) ;完全流产组E2 显著高于对照组 (P <0 .0 5 )。对不全流产的诊断 :B超灵敏度为 91 6 7% ,宫腔镜检查灵敏度为 10 0 %。结论 :药物流产后长时间出血的首位因素是不全流产 ,子宫内膜炎多为长期出血的继发性病变 ,完全流产后长期出血患者子宫内膜修复、发育不良是其出血的主要原因。宫腔镜用于药物流产出血的病因诊断准确性高于B超 ,且可定位刮宫。     

白血病抑制因子在早期妊娠、先兆流产及难免流产患者蜕膜组织中表达的研究

目的探讨白血病抑制因子(LIF)在蜕膜组织中的表达,及其与早期妊娠、流产的关系. 方法采用放射免疫方法检测正常早孕妇女(正常早孕组)、先兆流产妇女(先兆流产组)及难免流产妇女(难免流产组)的血清孕酮及人绒毛膜促性腺激素(hCG)水平,并采用逆转录-聚合酶链反应(RT-PCR)技术对3组孕妇蜕膜组织中LIF-mRNA的表达进行定量分析.结果 (1)孕酮及hCG水平在3组孕妇间的比较正常早孕组孕妇血清中孕酮、hCG水平分别为(91.5±27.2) nmol/L、(69.9±14.9) kU/L,先兆流产组孕妇分别为(88.4±24.7) nmol/L、(57.6±11.2) kU/L,两组孕妇血清孕酮、hCG水平比较,差异均无显著性(P>0.05);而难免流产组孕妇血清孕酮、hCG水平分别为(33.1±19.6) nmol/L、(10.3±3.2) kU/L,与前两组分别两两比较,差异均有极显著性(P<0.01).(2)LIF-mRNA平均相对含量在3组孕妇间的比较正常早孕组孕妇为2.10±0.32;先兆流产组孕妇为1.92±0.20;难免流产组孕妇为0.70±0.06.正常早孕组与先兆流产组比较,差异无显著性(P>0.05).而难免流产组与前两组分别行两两比较,差异均有显著性(P<0.05).结论 LIF-mRNA在早期妊娠蜕膜组织中的表达量降低,可能是导致hCG及孕酮分泌下降,最终造成难免流产的原因之一.     

彩色多普勒超声（ODFI、PD）在不全流产诊断中的应用价值分析

目的：探讨彩色多普勒超声（CDFI、PD）在不全流产诊断中的应用价值。方法：142例早孕流产（包括药物流产、人工流产、自然流产）后阴道不规则出血患者，对其进行彩色多普勒超声（CDFI、PD）检查，记录其声像图及血流分布特征，后对所有患者行清宫术，刮出物送病理检查，最后总结分析病理结果与彩色多普勒超声（CDFI、PD）之间的关系。结果：CDFI宫腔内残留物周边及内部显示血流信号者94例；CDFI、PD宫腔内残留物周边及内部显示血流信号者115例，病理证实刮出物112例可见绒毛组织，3例未见绒毛组织；CDFI、PD宫腔内均未显示血流信号者27例，刮出物为黏膜组织碎片及陈旧的积血。结论：彩色多普勒超声二维图像结合（CDFI、PD）诊断不全流产准确率高，方便、经济，为诊断不全流产的首选检查方法。     

子宫腺肌病子宫动脉栓塞术治疗前后血流动力学的变化

目的　了解子宫动脉栓塞术 (UAE)治疗子宫腺肌病前后血流动力学的变化。方法　对3 0例用明胶海绵为栓塞剂行UAE治疗的子宫腺肌病患者 ,于UAE前 1周内和UAE后 7、3 0、90d行经腹部彩色多普勒超声检查 ,测量双侧子宫动脉平均流速 (Vm)、阻力指数 (RI)、搏动指数 (PI) ,并用能量图 (CDE)观察正常子宫肌层和病灶内的血流情况。结果　 ( 1)与UAE前相比 ,UAE后Vm、RI、PI均明显减少 (P <0 0 1) ,以UAE后 7d下降最为明显 ,其中Vm下降了 63 % [UAE前为 ( 41± 11)cm/s,UAE后 7d为 ( 15± 9)cm/s],差异有极显著性 (P <0 0 1) ;UAE后 3 0、90d虽逐步上升 ,其中Vm较UAE前仍分别下降 41% [( 2 4± 9)cm/s]和 41% [( 2 4± 10 )cm/s],与UAE后 7d比较 ,差异有显著性 (P<0 0 5 )。( 2 )UAE后 7d ,正常子宫肌层血流稀少 ,病灶内血流稀少或无血流 ;UAE后 3 0、90d ,正常子宫肌层的血流逐渐增多 ,病灶内血流仍稀少或无血流。结论　用明胶海绵行UAE治疗子宫腺肌病后7～ 3 0d ,子宫肌层的血液供应逐渐恢复 ,病灶的血液供应绝大部分不能恢复     

复发性流产患者子宫动脉血流的超声多普勒变化

目的:探讨复发性流产(RSA)患者子宫动脉血流超声的血流参数及频谱波形的特征。方法:共纳入87例早孕妇女,其中有RSA史妇女41例,无流产史早孕妇女(对照组)46例,所有对象均行阴道超声多普勒测量子宫动脉血流参数,测量指标有:收缩期峰值流速/舒张末期流速(S/D)、搏动指数(PI)、阻力指数(RI)。随访妊娠结局,排除无流产史妇女中发生难免流产者。根据受试者工作曲线(ROC)比较各参数诊断价值,另将子宫动脉波形进行分类,同时比较RSA组和对照组波形的分布差异。结果:正常对照组排除难免流产7例后为39例。RSA组患者平均年龄29.7±3.4岁,正常对照组28.2±4.2岁。RSA组的子宫动脉S/D、PI、RI分别为6.98±1.67、1.46±0.12、0.84±0.04;正常对照组分别为5.30±1.05、1.31±0.15、0.81±0.12。RSA组的子宫动脉S/D与PI均高于对照组,差异有统计学意义,RI值组间差异无统计学意义(P0.05)。ROC曲线下面积三者均0.8,其中以PI最大;血流频谱波形A、0型的发生率较对照组高。结论:RSA患者的S/D、PI明显高于正常早孕妇女,高阻力血流波形发生率明显高于正常早孕妇女。     

子宫位置与胎物残留的关系

为探讨药物流产后胎物残留是否与子宫位置有关 ,现将我院妇产科门诊 1999年 6月 1日至 2 0 0 0年 5月 30日间 ,771例药物流产的资料进行分析 ,现将结果报道如下。1　资料与方法1.1　一般资料771例年龄 19～ 4 4岁 ,妊娠≤ 4 9天 ,在本地居住或工作 ,自愿要求行药物流产的健康妇女 ,均符合药物流产适应证。服药方法 :米非司酮 75ｍｇ ,每日 1次 ,共 2天 ,空腹凉开水送服。于第 3日上午 8时空腹来院服米索前列醇6 0 0 μｇ ,凉开水送服。门诊观察 6小时。1.2　子宫位置划分标准根据子宫纵轴与人体纵轴的角度不同[1,2 ] 分为子宫前倾位、子宫前…     

不同剂量米非司酮配伍米索前列醇药物流产的研究

目的　探讨米非司酮配伍米索前列醇药物流产的方法 ,以提高药物流产的完全流产率。方法　 2 0 0 0年 7月 1日至 2 0 0 3年 12月 31日解放军 2 0 5医院将 2 0 32例早孕 35～ 4 9d行药物流产的妇女随机分为 4组 :即观察 1组、观察 2组、观察 3组和对照组。对照组 30 0例 ,米非司酮每日 5 0mg顿服连用 3d ,第 3次服药后 2 4h服米索前列醇 6 0 0 μg ;观察 1组 30 0例 ,观察 2组 82 4例 ,观察 3组 6 0 8例 ,米非司酮常规服药 2 4h后分别加服 5 0、75和 10 0mg ,米索前列醇用法同对照组。结果　按照观察 1组、观察 2组、观察 3组及对照组的顺序 ,完全流产率分别为 90 6 7%、99 88%、99 5 1%和 80 6 7%。胎囊排出时间分别为 (5 0 6± 1 5 6 )h、(2 74± 1 2 1)h、(2 6 9±1 19)h和 (6 4 5± 1 36 )h。阴道流血时间分别为 (10 80± 4 2 3)d、(7 81± 3 2 2 )d、(7 90± 2 91)d和 (13 90±5 4 2 )d。观察组完全流产率较高 ,胚囊排出时间和阴道流血时间较短 ,差异有显著性意义 (P <0 0 1)。观察 1组分别与观察 2组、观察 3组比较 ,完全流产率较低 ,胚囊排出时间和阴道流血时间较长 ,差异有显著性意义 (P <0 0 1)。观察 2组与观察 3组相近 ,差异无显著性意义 (P >0 0 5 )。 4组副反应及月经复潮时间     

血清β-hCG、孕酮值下降速度与不全性药物流产的关系

目的:探讨药物流产后子宫异常出血手术(清宫)的时机。方法:以我院近2年要求药物流产且资料完整的318例妇女的病历资料为研究对象,回顾性分析药物流产服药前、后静脉血β-hCG、孕酮(P)水平;同时分析比较药流后完全流产组(n=240)和不全流产组(n=78)血清β-hCG、P值下降程度、超声与清宫的关系。结果:血β-hCG于药物流产前、后第8日下降幅度在完全流产组和不全流产组间比较无统计学差异(P>0.05),完全流产组下降百分比(95.98%)明显高于不全流产组(86.87%),组间比较有显示性差异(P<0.05);而P下降幅度组间比较无统计学差异(P>0.05),但不全流产组血P值第8日高于对照组,且处于较高水平。不全流产组超声显示宫内有中强回声或强光带。结论:药流后第8日血β-hCG下降百分比≤90%,P值处于较高水平,可能是预测不全流产需要清宫的指标。再结合超声显示宫内中强回声或强光带者应尽早行清宫术,以解除流产后子宫异常出血的根本原因,从而降低药物流产的并发症。     

彩色多普勒监测妊高征孕妇子宫胎盘血流变化

应用彩色多普勒血流显像技术监测了３１例妊高征孕妇及７４例正常孕妇子宫胎盘血流，同时测定血中雌三醇、胎盘泌乳素、血栓素代谢产物、前列环素代谢产物及ＴＸＢ２／６ＫＰ比值。结果表明：正常孕妇子宫动脉及胎儿脐动脉的时间平均血流速度及血流量明显高于妊高征孕妇。     

彩色多普勒血流显像对药物流产后宫内残留物诊断的应用价值

目的彩色多普勒超声血流显像（CDFI）对宫内残留物的检测方法与临床价值研究。方法对151例应用经腹、经阴道超声诊断出宫内残留物的病例，将其超声诊断结果与清官后病理结果对照分析。结果在151例超声诊断出宫内残留物的病例中，经病理检查证实残留绒毛、蜕膜或同时残留者为146例，占总病例数的97％（146／151），其中约95％（138／146）的病例在超声检查时见到子宫肌壁近内膜处有丰富的局灶性血流信号，仅有约5％（8／146）的病例未见到血流信号。结论药物流产后，CDFI对近子宫内膜处血流的探测结果，是诊断宫内残留物的关键依据，它为临床提供了重要信息。     

Misoprostol and dinoprostone therapy for labor induction: a Doppler comparison of uterine and fetal hemodynamic effects

OBJECTIVE: To compare the effect of misoprostol (PGE(1)) versus dinoprostone (PGE(2)) on blood flow in uteroplacental circulation during labor induction. STUDY DESIGN: Eighty-four women with indications for induction of labor were assigned to receive either misoprostol 50 microg per vagina every 4 h as needed or 0.5 mg doses of dinoprostone given intra-cervically every 6 h by means of a randomization table generated by computer. Doppler velocimetry of umbilical, uterine and arcuate arteries was performed immediately before and 2-3 h after the administration of misoprostol or dinoprostone. The SAS system was used to perform statistical analysis. RESULTS: There were no significant changes of pulsatility index (PI), resistance index (RI) and systolic/diastolic (S/D) ratio in umbilical arteries after both prostaglandin compounds. Vaginal application of misoprostol significantly increased all ratios in arcuate artery and S/D ratio in uterine artery. Intra-cervically dinoprostone significantly increased PI, RI and S/D ratio in arcuate and uterine arteries. CONCLUSIONS: Our results indicate that vaginal misoprostol and cervical dinoprostone administration increases uteroplacental resistance but does not affect umbilical blood flow. Misoprostol would be as safe and effective agent as dinoprostone for cervical ripening and labor induction.     

Uterine vascular resistance during compression of the umbilical arterial and/or venous circulation in sheep

Total umbilical cord occlusion and selective occlusion of the umbilical arteries and veins is associated with changes in uterine blood flow. In the present study, the resistance to uterine blood flow during selective occlusions of the umbilical arteries and/or veins was analysed in five chronically instrumented pregnant sheep in the last third part of pregnancy. An occluding device which allows separate occlusion of umbilical veins and arteries was applied to the umbilical cord. Median uterine artery blood flow was measured using an electromagnetic flow meter. Maternal pressures were measured in a branch of the uterine artery and vein. Two occlusions of the umbilical veins and/or arteries with a duration of 30-60 s were performed in each animal. Selective occlusion of the umbilical arteries resulted in a small increase in uterine blood flow from 637 +/- 79 ml/min during control toward 664 +/- 77 ml/min at the end of occlusion (p less than 0.05). Uterine perfusion pressure (uterine arterial pressure - uterine venous pressure) did not change. No changes were observed in calculated uterine vascular resistance (Poiseuille equation). Selective occlusion of the umbilical veins on the other hand caused a decrease in uterine blood flow from 617 +/- 75 ml/min during control to 546 +/- 69 ml/min at the end of occlusion (p less than 0.001), and a return to control value at 1 min after occlusion. The uterine perfusion pressure increased from 40.1 +/- 6.8 mmHg during control to 42.8 +/- 7.0 mmHg at the end of occlusion (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)     

Evaluation of red blood cell deformability and uterine blood flow in pregnant women with preeclampsia or iugr and reduced uterine blood flow following the intravenous application of magnesium.

OBJECTIVE: Red blood cells (RBC) deformability is one of the factors determining microcirculation. In preeclampsia (PE) and some cases of intrauterine growth restriction (IUGR), RBC deformability and, consequently, microcirculation appear to be impaired. Magnesium sulfate is administered to reduce the risk of seizures in PE. The aim of our study was to detect the effect of 24-hour intravenous (IV) magnesium on RBC deformability and on uterine artery blood flow in pregnant patients with preeclampsia or IUGR and pathologic uterine blood flow. METHODS: Magnesium IV (1 g/h) was administered to 25 pregnant women with reduced uterine blood flow for a period of at least 24 hours. The RBC deformability was measured by uterine artery Doppler. Measurements were taken before the start of magnesium therapy and 24 h later. Magnesium plasma levels were measured at the same time. RESULTS: High plasma levels of magnesium improve RBC deformability from E = 0.109 (SD +/- 0.023) to E = 0.115 (SD +/- 0.021) after 24 h IV magnesium (p = 0.043). There is no correlation of E to the plasma magnesium level either before or after 24 h magnesium treatment. Blood volume flow in the uterine arteries increased significantly from 5.09 mL/s (SD +/- 3.03) to 10.02 mL/s (SD +/- 5.86) after 24 h magnesium (p = 0.0002). The differences in the resistance index do not significantly differ from 0 (p = 0.46). CONCLUSION: A high IV dosage of magnesium over a period of 24 hours dilates the uterine arteries of pregnant women with PE and/or IUGR, reduces uterine blood flow and improves the deformability of RBC. Both parameters enhance the oxygen supply to the fetus, a clinical parameter in these pregnancies. Thus magnesium might not only be effective as phrophylaxis against seizures but also in cases of IUGR with a reduced uterine blood flow. The clinically observed beneficial effect of magnesium in PE could be due to the improved blood supply for the fetus.     

子宫良性病变保留子宫内膜和子宫动脉上行支的术式探讨

目的:探讨治疗子宫良性病变,保持下丘脑-垂体-卵巢-子宫内分泌轴完整性新术式的有效性和安全性。方法:对50例子宫良性病变需子宫切除者进行保留子宫内膜和双侧子宫动脉上行支的手术,分别测定手术前后子宫动脉上行支、子宫动脉卵巢支血流情况及手术前后血清性激素水平（研究组）。选同期行全子宫切除术32例为对照组,比较2组术中出血量、手术时间、术后病率有无差异。结果:研究组术后月经量明显减少,子宫动脉上行支、子宫动脉卵巢支保留完好,血流量降低,提示由子宫肌瘤引起的子宫血流动力学改变有所恢复;手术前后血清性激素水平无改变,提示此术式对卵巢功能无影响;术中出血量、手术时间、术后病率与对照组无差异。结论:保留子宫内膜和子宫动脉上行支的手术是以子宫肌瘤为代表的子宫良性病变可供选择的好的保守手术方法。     

Misoprostol's effect on uterine arterial blood flow and fetal heart rate in early pregnancy

OBJECTIVE: To determine whether a single oral dose of misoprostol is associated with change in Doppler resistance indices (RIs) of the uterine artery in early pregnancy. METHODS: Forty pregnant women seeking legal termination of pregnancy at 7-15 completed gestational weeks were each given a single oral dose of 200 microg misoprostol. Resistance indices (A/B ratio) and pulsatility index (PI) of the uterine arteries (UA) and fetal heart rate (FHR) were assessed by Doppler ultrasound before and 1 hour after administration of misoprostol. RESULTS: Doppler RIs (UA-A/B and UA-PI) of the right and left uterine arteries increased significantly 1 hour after misoprostol administration. The right UA-A/B increased from 7.16 +/- 1.09 (mean +/- SEM) to 10.26 +/- 0.67 (P < .001), and the left UA-A/B increased from 7.40 +/- 0.72 to 9.21 +/- 0.82 (P = .04). The right UA-PI increased from 2.38 +/- 0.11 to 2.90 +/- 0.12 (P < .001), and the left UA-PI increased from 2.38 +/- 0.17 to 2.70 +/- 0.18 (P = .03). No significant changes in FHR were noted 1 hour after misoprostol administration. None of the fetuses died during that time. CONCLUSION: Doppler RIs of the uterine arteries increased significantly after single oral doses of misoprostol during the first trimester, implying a reduction in arterial blood flow. Those changes were not associated with fetal death, possibly explaining congenital abnormalities associated with misoprostol in early pregnancy.     

Effects of therapeutic amniocentesis on uterine and umbilical artery velocimetry in cases of severe symptomatic polyhydramnios

The objective of this study was to determine the effects of removal of amniotic fluid in cases of symptomatic severe polyhydramnios on Doppler waveform indices of the uterine and umbilical arteries and flow velocities of the uterine arteries. Nine women underwent therapeutic amniocentesis during ten pregnancies for symptomatic polyhydramnios due to Beckwith-Wiedemann Syndrome (n = 1), esophageal atresia (n = 2), chorioangioma (n = 1), twin–twin transfusion syndrome (n = 3), a presumed autosomal recessive syndrome (n = 2), and an unbalanced double translocation (n = 1; partial dup 3q and partial del 9p syndrome). An average of 2.78 ± 0.9 (range 1–4) 1 of fluid were removed at each procedure between the gestational ages of 18 and 34 weeks (mean of 28 weeks). The systolic/diastolic (S/D) ratio, pulsitility index (PI), and resistance index (RI) of the uterine and umbilical arteries were obtained before and after the procedure using color and pulsed Doppler. After angle correction, the peak systolic velocity (PSV) and mean velocity (MV) in centimeters/second (cm/s) of the uterine arteries were also determined. The presence or absence of a uterine artery waveform notch was determined. Dominant uterine arteries were defined as those with lower impedance indices or higher flow velocities. Statistical analysis was performed with the Wilcoxon signed-rank test. Significance was set at P < 0.05. There was a significant increase in the median value of the uterine artery MV (43.8 vs. 81.1 cm/s, P = 0.005) and PSV (74.2 vs. 125.5 cm/s, P = 0.007) after amniocentesis. The uterine S/D (3.0 vs. 1.84, P = 0.007), PI (1.12 vs. 0.68, P = 0.008), and RI (0.60 vs. 0.45, P = 0.005) impedance indices significantly decreased following amniocentesis. When uterine arteries were categorized as dominant vs. nondominant, there were greater improvements in impedance indices and flow velocities in the nondominant uterine arteries. There were three cases of unilateral and one case of bilateral early diastolic notches of the uterine artery waveforms which either resolved (n = 4) or improved (n = 1). There was no effect on the umbilical artery impedance indices. Therapeutic amniocentesis significantly improved uterine artery impedance indices and resulted in improved flow velocities, while there was no effect on umbilical artery waveform indices. The procedure resulted in the disappearance or improvement of the uterine waveform notch. Our findings suggest that in cases of severe polyhydramnios abnormal uterine artery velocimetry may not be due to lack of trophoblastic invasion of the spiral arteries but to increased intrauterine pressure secondary to polyhydramnios.