14例胸廓畸形孕产妇病例分析

妊娠合并严重胸廓畸形患者易并发心肺功能衰竭,可导致孕产妇及围产儿死亡,是高危妊娠研究的课题之一。但临床上重视不够,文献报道也不多。本文回顾性分析14例胸廓畸形合并妊娠,并对1例并发急性呼吸衰竭抢救成功病例进行分析讨论。临床资料一、一般资料:1975年1月至1986年12月间,我院分娩总数3917次,其中妊娠合并胸廓畸形14例,     

脊柱侧凸妇女妊娠的临床特点及处理

妊娠合并脊柱侧凸是较少见的妊娠合并症 ,威胁母婴健康 ,严重者甚至导致母婴死亡。我院 1986年至 2 0 0 1年 9月分娩的 192 0 0例孕妇中 ,有 4例合并脊柱侧凸 ,占同期妊娠分娩的 0 0 2 1%。本研究采用回顾性分析的方法 ,对 4例妊娠合并脊柱侧凸患者的发病原因及治疗情况、妊娠及分娩结局进行分析。现将结果报道如下。一、临床资料例 1　患者 5岁始逐渐出现脊柱弯曲 ,13岁病情发展迅速 ,诊断为特发性脊柱侧凸 ,行手术治疗 (脊柱融合 +矫正术 ,1个月后矫正器因脱落而取出 ) ,术后病情明显好转 ,最终身高 15 0ｃｍ ,平时无自觉不适症状 ,仅劳…     

妊娠合并卵巢肿瘤的诊断方式与处理

妊娠合并卵巢肿瘤亦不少见 ,有时诊断较为困难 ,一旦诊断 ,慎重处理颇为重要 ,因孕期卵巢手术对母亲及胎儿都有一定的危险性 ,而保守处理又顾虑肿瘤扭转、恶变等并发症或影响继续妊娠及分娩。本文分析我院 9年间收治的妊娠合并卵巢肿瘤 5 4例 ,探讨其诊断与处理方法1　临床资料1.1　一般资料　 1991年 10月至 1999年 10月 ,我院分娩总数 90 5 4例 ,同期收治妊娠合并卵巢肿瘤病人 5 4例 ,发生率为 0 6 %。年龄 2 0 42岁 ,孕次 17次。卵巢肿瘤发生在左侧 2 1例 ,右侧 2 2例 ,双侧 11例。1.2　诊断方式及时间　 5 4例妊娠合并卵巢肿瘤诊断方式…     

妊娠合并急性阑尾炎22例临床分析

妊娠合并急性阑尾炎是妊娠期最常见的急腹症之一 ,但因孕妇特殊的生理和解剖改变 ,妊娠合并急性阑尾炎的临床表现常不典型 ,病情发展快 ,并发症多 ,甚至对母婴的生命造成严重威胁 ,本文总结分析我院 5年间 2 2例妊娠合并急性阑尾炎患者的临床表现及处理 ,现报道如下。一、临床资料与分析1 一般资料 :我院 1995年 1月～ 1999年 12月共收治妊娠合并急性阑尾炎 2 2例 ,年龄 :2 0～ 38岁 ,孕周 :6～ 41周。其中初产妇 18例 ,经产妇 4例。均无其他内外科合并症及并发症。2 治疗方法 :本组 2 2例中 16例行阑尾切除术 ,6例行保守、安胎治疗。手术…     

妊娠与结缔组织疾病19例分析

本文分析1970年～1991年收治妊娠合并结缔组织疾病并足月分娩的19例临床资料,其中红斑狼疮9例(SLE7例,DLE2例),硬皮病5例,类风湿关节炎5例。本文中、重度妊高征达52.4％,2例硬皮病孕产妇死于重度妊高征的并发症一脑出血。2例死胎,2例新生儿死亡,6例小于孕龄儿。主要见于红斑狼疮及硬皮病患者。本文对结缔组织疾病与妊娠之相互影响及处理进行了讨论。     

肌萎缩侧索硬化症患者妊娠2次1例报告并文献复习

<正>肌萎缩侧索硬化症(amyotrophic lateral sclerosis,ALS)是一种进行性神经退行性疾病，是上运动神经元和下运动神经元受累导致球部、四肢、躯干、胸部、腹部的肌肉逐渐无力和萎缩，最终进行性瘫痪和呼吸衰竭^[1]。ALS的年发病率为1/10万～3/10万，发病年龄多在40～70岁之间，男女比例为1.5∶1^[1]。因此，妊娠合并ALS的病例非常罕见。     

妊娠晚期合并膈疝一例并文献复习

目的研究妊娠合并膈疝的临床特征及治疗策略。 方法回顾分析广州医学院第三附属医院收治的1例及文献报道的25例妊娠合并膈疝患者的临床表现、诊治方法及妊娠结局。 结果26例妊娠合并膈疝患者中,23例出现膈疝临床症状的时间为晚期妊娠阶段,3例在妊娠中期;25例行影像学检查并确诊,1例根据临床症状诊断。膈肌裂口位于右膈肌2例,位于左膈肌15例,4例位于膈肌中心腱。22例患者因及时诊断、采取有效的处理措施而母子平安,1例因术后毒血症抢救无效导致母亲死亡,1例因孕妇短时间内行2次膈疝修补术而导致胎死宫内,2例因就诊时间较晚或未能及时明确诊断延误治疗而导致母婴死亡。 结论妊娠合并膈疝及时而准确的诊断和治疗需多学科合作,严密观察患者病情变化,可获得良好的妊娠结局。     

妊娠合并慢性骨髓增殖性疾病11例临床分析

目的 探对妊娠合并慢性骨髓增殖性疾病(CMPD)的临床特点及处理、妊娠结局及预后.方法 回顾性分析北京大学人民医院妇产科2000-2009年收治的11例妊娠合并CMPD患者[其中原发性血小板增多症(ET)5例,原发性骨髓纤维化(PMF)1例,慢性粒细胞白血病(CML)5例]的临床资料.结果 11例妊娠合并CMPD患者共妊娠12例次.(1)有规律产前检查者5例次,均行定期血常规等检查,适当给予抗凝治疗,预防并发症发生.其中1例PMF患者为孕前诊断,初次妊娠至32周时发生轻度子痫前期及胎死宫内;2年后再次妊娠,孕早期筛查抗β2糖蛋白Ⅰ抗体升高,给予小剂量阿司匹林口服及低分子肝素抗凝治疗,孕期顺利、足月分娩.(2)无规律产前检查者5例次,其中ET患者2例次,CML患者3例次.1例ET患者于妊娠25周发生重度子痫前期,脐动脉舒张期血流反向,经解痉、降压及抗凝治疗效果不佳,因血压进行性升高、胎盘早剥而紧急行剖官产术终止妊娠,胎儿娩出即死亡.从未产前检查者2例次,均因临产入院,诊断为CML.(3)合并羊水过少4例次,子痫前期3例次,其中重度子痫前期2例次,轻度子痫前期1例次,所有患者均无严重出血及血栓形成等并发症发生.(4)妊娠至足月者8例次,其中4例次剖宫产分娩;4例次阴道分娩.早产2例次,均因羊水进行性减少以剖宫产术终止妊娠.分娩的10例新生儿出生体质量1820～3600 g,除1例并发重度子痫前期者出现胎儿生长受限(FGR)外,其余均为适于胎龄儿.(5)11例患者妊娠期间原有疾病均病情稳定,其中3例CML患者妊娠晚期口服羟基脲治疗,4例ET患者及1例CML患者终止妊娠前进行血小板单采术治疗,效果良好.除1例CML患者分娩后5个月因疾病进展死亡外,余患者产后病情均平稳.结论 妊娠合并CMPD患者多数妊娠结局良好,孕期管理需警惕血栓形成、子痫前期、胎死官内、FGR等并发症.合理应用抗凝等治疗,有助改善母儿结局.     

妊娠并发HELLP综合征(溶血,肝酶升高,血小板减少):以后妊娠的结局及远期预后

报道341例妊娠并发HELLP综合征患者以后妊娠的结局及母体远期预后。1977年8月～1992年7月间,对437例妇女的442次妊娠并发HELLP综合征进行处理(其中5例各有2次妊娠并发HELLP综合征)。除死亡5例,2年内再次分娩38例及失访35例外,对其余341例妇女随访至少2年。随访内容着重于口服避孕药的应用,抽搐史及抗抽搐药物的应用,心血管并发症及以后妊娠结局。     

妊娠合并结核病预后不良四例报告

结核病是可以治愈的 ,妊娠期结核病只要尽早诊断和积极治疗 ,妊娠结局往往是良好的 ;相反若缺乏警惕 ,不能尽早诊断和有效治疗 ,妊娠结局难以预料。我们收集了近 15年来我院 4例妊娠合并肺结核病预后不良患者的临床资料 ,现结合文献总结如下。一、临床资料1.一般资料 :年龄 :2 5～ 38岁。职业 :农民 2例 ,护士、工人各 1例。孕产次 :3例初孕初产 ,1例孕 3产 2。产前检查次数 :3例 8次以上 ,1例 4次。分娩孕周 :3例足月产 ,1例早产。分娩方式 :3例阴道分娩 ,1例剖宫产。围产儿结局 :1例早产儿死亡 ,另 3例新生儿正常。2 .临床表现及诊断 :4例…     

Initial clinical experience using an interdisciplinary management concept for pregnant patients with liver damage

Among 6,404 deliveries in 49 cases (0.8%) a liver disease was diagnosed in the course of pregnancy. The onset of the disease happened exclusively in the last trimester of pregnancy. In 36 pregnant women a hyperbilirubinaemia of diagnostic value was stated. As an informing diagnostic procedure the only determination of the alanine-aminotransferase activity has been proved to be sufficient. In every fifth pregnant woman the liver disease was observed in connection with a preeclampsia. The preterm delivery rate was 16.3%. An intrauterine growth retardation was found in 22.4% of women with hepatopathy during pregnancy. In 5 out of 34 patients asked for a post partum control a manifestation of the liver disease, respectively a cholecystopathia, was present and follow-ups were necessary. An interdisciplinary concept of treatment is emphasized to treat these pregnant women in cooperation with the specialist of internal medicine. Methodically an additional sheet of documentation is used, which contains important data of patients history and all obstetrical, clinical and laboratory results accompanying the pregnant woman during pregnancy and post partum controls.     

Pregnancy outcome in lupus nephropathy

Methods The maternal and fetal outcomes of 55 pregnancies in 24 patients with pre-existing lupus nephritis (LN) were retrospectively analysed. The risk factors for poor fetal outcome were evaluated. The patients were divided into two groups. Patients in Group A had quiescent LN and those in Group B showed clinical evidence of active LN at conception.Results In Group A, of the 36 pregnancies in 16 patients, 11 resulted in term deliveries without complications, 9 in spontaneous abortions, 6 in preterm deliveries, 3 in intrauterine growth retardation (IUGR) and in 2 stillbirths. In Group B, of the 19 pregnancies in 8 patients, there were 6 spontaneous abortions, 3 uncomplicated term deliveries and 10 pregnancies were complicated by hypertension. Gross IUGR occurred in 3 pregnancies. There were 3 stillbirths and 1 neonatal death in the study. Total fetal loss was 38.2% and the perinatal mortality (PNM) rate, 150/1,000 deliveries. Two mothers, both from Group B died in the series, 1 from multisystem failure of systemic lupus erythematosus, 3 days after delivery and the second died from irreversible renal failure 2 months after caesarean section.Conclusions Pregnant women with long-standing LN are at high risk of spontaneous abortions and increased PNM. However, the outlook of pregnancy in patients with stable LN at conception is relatively favourable. The risk of obstetric complications and maternal mortality is high in patients with active lupus nephropathy associated with pre-existing hypertension. Pregnant women with LN require intense fetal and maternal surveillance for the best outcomes of pregnancy.     

Varicella pneumonia complicating pregnancy: a report of seven cases

Background: Pneumonia is the most common complication of varicella-zoster infection in adults and has potentially devastating effects when complicating pregnancy. Due to the significant morbidity and mortality associated with this complication during pregnancy and the small number of reported cases in the literature, we present this report to help educate physicians who care for pregnant women.Cases: Seven patients are presented in this report. These patients presented at various stages in pregnancy, from 17 to 31 weeks of gestation. Three of the patients had unremarkable hospital courses. Three of the patients had hospital stays over 21 days in duration. One patient died from complications of varicella pneumonia after 31 days of hospitalization. The obstetric outcomes of the 7 patients described include 1 non-viable delivery at 20 weeks gestation, 3 term deliveries, 2 preterm deliveries, and 1 patient who has not yet delivered. All of the patients presented were treated with intravenous acyclovir therapy. Of the patients described, 3 required intubation and ventilatory support. Other complications encountered include disseminated intravascular coagulation (DIC), adult respiratory distress syndrome (ARDS), metabolic encephalopathy, pneumothorax, superimposed bacterial pneumonia, and sepsis.Conclusion: The course and treatment of varicella pneumonia complicating pregnancy are discussed. Current recommendations regarding the use of varicella-zoster immune globulin (VZIG) are also reviewed.     

11例妊娠合并白血病患者的临床分析

目的探讨妊娠合并白血病的诊断、处理及预后。 方法对2010年1月至2015年10月广州医科大学附属第三医院收治的11例妊娠合并白血病患者的临床资料进行回顾性分析,分析患者的临床表现、实验室检查、处理方式和随访结果。 结果11例病例中,3例无临床症状,8例表现为典型或不典型症状。11例血常规均异常,骨髓活检确诊为白血病,其中8例为急性白血病,3例慢性粒细胞白血病。6例急性白血病接受化疗,5例存活,1例产后2个月死亡;2例急性白血病患者拒绝化疗后死亡。3例慢性粒细胞白血病患者均接受了化疗,均完全缓解。随访结果：7例患者存活,1例失访;新生儿存活8例。 结论妊娠合并白血病罕见,其症状与妊娠相似,不易及时确诊,处理方式应根据白血病类型、孕龄、孕妇及胎儿状况综合考虑。     

Hyperthyroidism and pregnancy

DESIGN: The aim of our study was to describe a course of pregnancy, delivery and puerperal time in women hospitalized in our Clinic during their pregnancies because of hyperthyroidism. MATERIALS AND METHODS: Sixteen case reports (thirteen pregnant women) were retrospectively analysed. Our study embrace data from the recent ten years. RESULTS: In all cases pregnancies, deliveries and puerperal time proceeded without any serious complications. Infants were delivered in good condition and no congenital defects were reported. CONCLUSIONS: 1. A proper treatment of hyperthyroidism in a pregnant woman determines the correct course of pregnancy, delivery and puerperal time. 2. We have not found any congenital defects, hypotrophy cases and infants' death reports in our material. 3. Hyperthyroidism in pregnancy does not determine cesarean section as a way of delivery.     

Cost-effectiveness of screening and treatment for bacterial vaginosis in early pregnancy among women at low risk for preterm birth

BACKGROUND: Bacterial vaginosis (BV) is an important risk factor for preterm birth. BV is detected in 10-30% of pregnant women and is often asymptomatic. Treatment of BV during pregnancy seems to reduce the risk of preterm delivery among high-risk women. We performed a cost-effectiveness analysis of screening and treatment for BV in early pregnancy among asymptomatic women at low risk for preterm delivery. METHODS: A decision tree was built with two arms. For the screening (and treatment) arm the probabilities were derived from our earlier randomized trial on screening and treatment for BV, consisting of BV-positive women treated with intravaginal clindamycin cream or placebo and also of BV-negative pregnant women. The probabilities of outcomes among these women were collected from antenatal clinic records and hospital records, and for the no-screening arm mainly from the Finnish Perinatal Statistics. The outcomes considered were preterm delivery, mode of delivery, peripartum infections and postpartum complications. The unit costs associated with these outcomes were mainly based on disease-related groups (DRGs). No-screening was compared with two screening programs (one with clindamycin, the other with metronidazole treatment) and subjected to sensitivity analyses. RESULTS: There was no significant difference between screening and no-screening strategies in the costs and in the rate of preterm deliveries but the screening strategy produced significantly fewer peripartum infections and postpartum complications. Sensitivity analyses suggested that the screening strategy may become cost-saving if the rate of preterm deliveries exceeds 3%. CONCLUSION: Screening and treatment for BV in early pregnancy may not reduce costs compared to no-screening in a population at low risk for preterm birth but would produce, at the same cost, more health benefits in terms of fewer peripartum infections and postpartum complications. However, it may be cost-saving if the rate of preterm deliveries is higher than 3%.     

Grand multipara

Grand multiparity is often considered a clinical entity, as certain complications during pregnancy, delivery and puerperium are thought to occur with increased incidence in these women. In this prospective investigation no difference in complications was found between women with up to 6 deliveries and women with 7 or more deliveries. However the incidence of preterm deliveries was significantly higher in the group with up to 6 deliveries.     

Pneumonia during pregnancy: has modern technology improved maternal and fetal outcome?

The maternal death rate and rate of preterm delivery associated with pneumonia during pregnancy have not decreased since the introduction of antibiotics four decades ago. We retrospectively reviewed 25 cases of pneumonia during pregnancy; these cases occurred among 32,179 deliveries. Medical complications included: bacteremia, 16%; empyema, 8%; atrial fibrillation, 4%; respiratory failure necessitating mechanical ventilation, 20%. Obstetric complications occurring during the pneumonia episode included: preterm labor, 44%; preterm delivery, 36%. A patient with cystic fibrosis died; one stillbirth and two neonatal deaths occurred. Underlying maternal disease was significantly associated with maternal medical complications (p = 0.023) and preterm delivery (p = 0.012). Significant medical and obstetric complications continue to occur frequently despite modern antimicrobial, tocolytic, and supportive therapy. Underlying maternal disease, including acquired immunodeficiency syndrome and cystic fibrosis, was associated with preterm delivery and neonatal and maternal death.     

Multiple sclerosis and pregnancy (two additional cases)

The authors made a short analysis of the epidemiology, etiology, pathogenesis, clinical presentation and treatment of multiple sclerosis. There were presented facts about the influence of pregnancy over the progress of this neurological disease, and the effect of multiple sclerosis on the pregnancy and delivery development. There also were described two clinical cases of pregnant women with multiple sclerosis, who delivered in the last 10 years in Clinic of Obstetrics in MBAL-Pleven.