唐氏综合征筛查和出生缺陷的临床效应与发展前景

目的开展孕母孕中期唐氏综合征筛查可减少唐氏综合征儿出生,保证家庭生活质量,减少家庭及社会负担,达到提高出生人口素质,确保人类健康水平。方法取孕15-23W孕母外周血,以专用检测试剂盒检测其血清中Free-AFP、Free-β-HCG的浓度值,结合孕母的年龄、孕周、体重和孕育生产史情况输入专用分析软件进行综合分析。结果高危人群进一步做胎儿羊水脱落细胞染色体或羊水Free-AFP检测。结论确诊异常儿行妊娠中止术,可降低新生儿出生缺陷。     

Uterine artery Doppler velocimetry during mid-second trimester to predict complications of pregnancy based on unilateral or bilateral abnormalities

We performed this study to evaluate uterine artery Doppler velocimetry (UADV) measurement of unilateral or bilateral abnormalities as a predictor of complications in pregnancy during the mid-second trimester (20-24 weeks). We enrolled 1,090 pregnant women who had undergone UADV twice: once between the 20th and 24th week (1st stage) and again between the 28th and 32nd week (2nd stage) of pregnancy, and then delivered at Yonsei Medical Center. UADV was performed bilaterally. Follow-up UADV was performed between the 28th and 32nd week, and the frequencies of pregnancy-induced hypertension (PIH), fetal growth restriction (FGR), and preterm delivery (before 34 weeks of gestation) were determined. Chi-squared and t-tests were used where appropriate, with p < .05 considered significant. According to the results of UADV performed between 20-24 weeks of gestation, 825 women (75.7%) were included in the normal group, 196 (18.0%) in the unilateral abnormality group, and 69 (6.3%) in the bilateral abnormality group. The incidences of FGR were 8.0%, 10.2%, and 26.1%, and the incidences of PIH were 0.1%, 3.6%, and 14.5%, respectively. The incidence of PIH was significantly lower in the normal group. The incidences of preterm delivery were 2.2%, 5.6%, and 8.7%, respectively. PIH developed in 46.7% of patients with bilateral abnormal findings in both the 1st and 2nd stage tests, and developed in none of the patients with normal findings in both tests. Abnormal results found by UADV performed between the 20-24th weeks of pregnancy, such as high S/D ratios regardless of placental location and the presence of an early diastolic notch, were associated with significant increases in the incidences of intrauterine growth restriction (IUGR) and PIH. This was true for both bilateral and unilateral abnormalities. Abnormal findings in bilateral UADV during the second trimester especially warrant close follow up for the detection of subsequent development of pregnancy complications.     

Contracting COVID-19 in the first and second trimester of pregnancy: what we know – a concise qualitative systematic review

IntroductionRecent medical literature has drawn attention to the possible influence of COVID-19 on the course of pregnancies. As the coherence of results seems to vary, especially in relation to first and second trimester pregnancies, a concise qualitative systematic review can shed light on the most recent data.Material and methodsA structured systematic search was performed to collect all COVID-19 pregnancy-related articles published between January 1 and September 16, 2020. Two independent reviewers evaluated studies using the STROBE statement in combination with the CERQual quality assessment of findings.ResultsIn total 1387 articles were screened and finally 22 studies were evaluated (179 1^st/2^nd trimesters of pregnant women with COVID-19). The majority of reported mothers who contracted COVID-19 during 1^st/2^nd trimesters are yet to complete their pregnancy.ConclusionsEvidently a limited amount of data is available. Usually, mothers and newborns are discharged from the hospital without any serious complications. Further observations are imperative.     

Safety of iPhone retinal photography

Background: With the advancement in mobile technology, smartphone retinal photography is becoming a popular practice. However, there is limited information about the safety of the latest smartphones used for retinal photography.

Aims: This study aims to determine the photobiological risk of iPhone 6 and iPhone 6 plus when used in conjunction with a 20Diopter condensing lens for retinal photography.

Method: iPhone 6 and iPhone 6 plus (Apple, Cupertino, CA) were used in this study. The geometrical setup of the study was similar to the indirect ophthalmoscopy technique. The phone was set up at one end of the bench with its flash turned on at maximal brightness; a 20 Dioptre lens was placed 15?cm away from the phone. The light that passes through the lens was measured with a spectroradiometer and an illuminance probe at the other end to determine the spectral profile, spatial irradiance, radiant power emitted by the phone’s flash. Trigonometric and lens formula were applied to determine the field of view and retinal surface in order to determine the weighted retinal irradiance and weighted retinal radiant exposure.

Result: Taking ocular transmission and the distribution of the beam’s spatial irradiance into account, the weighted retinal irradiance is 1.40?mW/cm² and the weighted retinal radiant exposure is 56.25?mJ/cm². The peak weighted foveal irradiance is 1.61?mW/cm².

Conclusion: Our study concluded that the photobiological risk posed by iPhone 6 indirect ophthalmoscopy was at least 1 order of magnitude below the safety limits set by the ISO15004-2.2.     

唐氏综合征孕中期多指标联合筛查方案适用性评估

目的 对孕中期多种产前筛查方案进行比较、评价,为选择较为适宜的方案提供依据.方法 收集2009年在青岛市产前诊断中心知情同意接受产前筛查的单活胎妊娠30 547例,分别检测母血清中二联或三联血清标记物,均用Lifecycle软件评估胎儿罹患唐氏综合征的风险,对二者的检出率和成本效益进行比较、分析;同时收集64例唐氏综合征妊娠的血清标本,采用二联筛查(double test,DT)+2T-Risks软件计算风险(DT-2T),二联筛查+Lifecycle软件计算风险(DT-LC),三联筛查(triple test,TT)+2T-Risks软件计算风险(TT-2T)和三联筛查+ Lifecycle软件计算风险(TT-LC)4种不同的筛查方案对胎儿罹患唐氏综合征的风险进行评估,并对各种不同的筛查方案进行比较、评价.结果 (1)64例唐氏综合征妊娠的血清标本,采用Lifecycle软件进行风险评估,检出率均高于同样指标筛查而采用2T-Risks软件评估风险方案;三联筛查不适宜使用2T-Risks软件;(2)30 547例单活胎妊娠的筛查中,DT-LC方案和TT-LC方案对于唐氏综合征的检出率分别为56.25%和57.14%;每检出1例唐氏综合征的平均费用DT-LC方案明显低于TT-LC方案,为优选方案.结论 孕中期DT-LC方案是一种利于在全国广泛开展的、经济有效的筛查方案.

Abstract：

Objective To provide basis for selecting the suitable method of Down's syndrome biochemical screening in the second trimester pregnancy. Methods A total of 30 547 singleton pregnancies between 14 and 20+6 weeks of pregnancy were collected and analyzed for maternal serum alpha-fetoproteins (AFP) and human chorionic gonadotrophin,free beta subunit (β-HCG) with or without unconjugated estriol (uE3). The screening risks were calculated using the software Lifecycle. The detection rates and the cost of per Down's syndrome detected were calculated and compared. And four different methods were compared in a series of 64 serum samples from Down's syndrome pregnancies. Results (1) Among the 64 affected cases, the detection rate of Down's syndrome was improved no matter in the double test (DT) or in the triple test (TT) if software Lifecycle (LC) was used to evaluate risks. And it was not suitable to evaluate risks with software 2T-Risks in the triple tests. (2) In the cohort of 30 547 singleton pregnancies, the detection rate of Down's syndrome with project DT-LC, which was double test using AFP and free β-HCG together with software Lifecycle, and project TT-LC, which was triple test using AFP, free β-HCG and uE3 together with software Lifecycle, was 56.25% and 57.14%, respectively. The former project was better because it decreased the false positive rate at a lower running cost. Conclusion The DT-LC is an effective screening strategy for second trimester detection of fetal Down's syndrome in mainland China.     

孕中期检测肱动脉血管内皮功能在预测妊娠期高血压疾病中的价值

目的探讨孕中期检测肱动脉血管内皮功能在预测妊娠期高血压疾病中的价值。方法对260例孕中期孕妇用高分辨率超声行肱动脉内皮依赖性舒张功能（FMD）并随访其妊娠结局分为妊娠期高血压疾病组（高血压组）和正常组。结果260例中34例孕晚期发生妊娠期高血压疾病（高血压组）,而226例未发生妊娠期高血压疾病（正常组）,高血压组孕中期FMD显著低于正常组,差异有显著性（P〈0.01）。重度子痫前期组FMD显著低于轻度子痫前期组,差异有显著性（P〈0.01）。结论妊娠期高血压疾病虽然在孕中期血压正常,但已存在肱动脉内皮依赖性舒张功能减低,可被高分辨超声检测。     

Misoprostol moistened with acetic acid or saline for second trimester pregnancy termination: a randomized prospective double-blind trial

BACKGROUND: This study was conducted to evaluate the efficacy and side effects of a new regimen of 800 microg misoprostol administered intravaginally every 6 h up to a maximum of three doses in 24 h for second trimester pregnancy termination. METHODS: A total of 66 women seeking termination of second trimester pregnancy (30 fetal structural anomaly, six chromosomal abnormality and 30 fetal death) were randomly assigned to one of two treatment groups: (i) intravaginal misoprostol moistened with 3 ml of 5% acetic acid in group A (n = 33); or (ii) intravaginal misoprostol moistened with 3 ml of saline in group B (n = 33). RESULTS: The overall median (range) induction-abortion interval was 10 h (2-46) [10 h (4-35) in 36 live fetuses and 9 h (2-46) in 30 dead fetuses, P = 0.515]. All of the patients in both groups aborted within 48 h (100% success rate). The median (range) induction-abortion interval revealed a significantly faster delivery time (P < 0.001) in group A [8 h (2-24)] than in group B [14 h (3-46)]. CONCLUSIONS: This new regimen of 800 microg of vaginal misoprostol every 6 h for a maximum of three doses in 24 h was an effective alternative method for second trimester abortion. In addition, misoprostol moistened with acetic acid was significantly more effective than misoprostol moistened with saline.     

A comparison of two regimens of intravaginal misoprostol for termination of second trimester pregnancy: a randomized comparative trial

A prospective randomized trial was conducted in 148 women to compare the efficacy of two regimens of vaginal misoprostol for termination of second trimester pregnancy. Women aged 16-40 years requesting termination of second trimester pregnancy were randomized into two groups. Women in group 1 were given vaginal misoprostol 400 microg every 3 h for a maximum of five doses in 24 h. Women in group 2 were given vaginal misoprostol 400 microg every 6 h for a maximum of three doses in 24 h. If women did not abort in 24 h, the same regimen was repeated. The median induction-abortion interval in group 1 (15.2 h) was significantly shorter (P < 0.01) than that in the group 2 (19.0 h). The percentage of women who achieved successful abortion within 48 h in group 1 (90.5%) was also significantly higher (P < 0.02) than that in group 2 (75.7%). The incidence of fever was more common in group 1 (P = 0.01). It is concluded that the regimen of vaginal misoprostol 400 microg every 3 h with maximum of five doses in 24 h was more effective than the regimen of misoprostol every 6 h in termination of second trimester pregnancy.     

9969例孕中期孕妇产前筛查结果分析

目的分析孕中期母体血清hAFP、freeβ-HCG、uE3的变化及产前筛查的应用价值。方法采用时间分辨荧光免疫技术检测孕中期母体血清标志物hAFP、freeβ-HCG、uE3的含量,结合孕妇年龄、孕周、体重等因素用Risk2T软件进行风险评估,根据评估结果,将同孕周高、低风险孕妇的hAFP、freeβ-HCG、uE3含量进行统计分析;同时,建议高风险孕妇进一步确诊。结果低风险母体血清hAFP、uE3含量与孕周呈正相关,freeβ-HCG含量与孕周呈负相关;21-三体高风险母体血清hAFP、uE3含量明显低于低风险母体血清该指标含量,差异有统计学意义（P〈0.01）;而freeβ-HCG含量明显高于低风险时该指标含量,差异有统计学意义（P〈0.01）;18-三体高风险的母体血清hAFP、freeβ-HCG含量均低于低风险时该指标含量,差异有统计学意义（P〈0.01）。9969例孕妇中,筛查出21-三体、18-三体及NTD高风险共288例,筛查阳性率2.9%;107例进行了产前诊断,共确诊19例,确诊率为17.8%,分别为：21-三体6例、18-三体2例,NTD 3例,其他异常儿8例。结论孕中期母体血清3项指标呈规律性变化,检测该指标可发现高风险孕妇;产前筛查结合产前诊断能有效降低出生缺陷率。     

Vit B6在妊娠中期引产后抑制泌乳的探讨

目的:研究Vit B6在妊娠中期引产后抑制泌乳的作用及其临床应用.方法:60例妊娠中期孕妇经羊膜腔内注入雷夫奴尔100mg引产,其中30例术后不服药作为对照组,30例在术后2小时开始服VitB6 60mgtid×5天.两组均于术前及术后4天以RIA法测定血清中PRL、E2及P的水平,对结果作相关分析.同时观察乳汁分泌情况.结果:血清三项激素水平虽在术后均较前明显下降,但服药组PRL下降更为明显(P＜0.001 vs0.05),挤压乳房有泌乳者服药组仅2例,而对照组有9例.结论:妊娠中止后2小时内开始服VitB6能极为有效地抑制乳汁分泌(93.3%),可代替己烯雌酚等传统药物.血清PRL水平的显著下降(42.85%),提供了完善的实验室资料.     

Coelomic fluid chorionic gonadotrophin and protein concentrations in normal and complicated first trimester human pregnancies

Coelomic fluid and maternal serum samples were collected from43 normal pregnancies and 18 missed abortions between 7 and12 weeks of gestation. The samples were analysed for the concentrationsof intact human chorionic gonadotrophin (HCG), free HCG, freeHCG and total protein. The relationships between the biologicalfindings and the ultrasound and pathological features were assessedby regression analysis. In normal pregnancies, intact HCG, freeHCG and free HCG concentrations were respectively 1.3, 185 and33 times higher in coelomic fluid than in maternal serum. Thecoelomic concentrations of intact HCG and free HCG decreasedsignificantly with advancing gestation. No relationship wasfound between coelomic fluid and maternal serum concentrationsof the different variables. These findings suggest that in normalpregnancies, the concentration of HCG in the coelomic fluid,as in maternal serum, is mainly influenced by cytotrophoblasticdifferentiation and that the metabolic clearance of HCG moleculesis slower in the coelomic cavity than in maternal serum. Inmissed abortions, the serum concentrations of intact HCG, HCGand free HCG and the coelomic concentration of total proteinwere significantly lower than in normal pregnancies. In threeout of nine anembryonic pregnancies diagnosed by ultrasound,embryonic remnants were present at histological examination.The coelomic concentration of total protein was extremely lowin all missed abortions with advanced trophoblastic necrosis,whereas the HCG concentration was low when embryonic remnantswere absent. These findings support the concept that embryonicand placental development are closely related in the first trimesterof human pregnancy, placental biological functions persistingonly for a limited period of time after embryonic demise.     

Outcome of pregnancies complicated by severe ovarian hyperstimulation syndrome (OHSS): a follow-up beyond the second trimester

The main aim of this study was to assess the obstetric complications for those pregnancies that are complicated by ovarian hyperstimulation syndrome (OHSS) and continue beyond the first trimester. We checked also for other related serious events that occurred during the first trimester. METHODS: We included only patients whose pregnancies continued beyond the first trimester and compared them with IVF-treated patients displaying moderate ovarian response. RESULTS: We studied 165 patients with OHSS (101 singletons and 64 twins) and 156 IVF control patients (85 singletons and 71 twins). Two serious complications, gestational diabetes mellitus (GDM) and pregnancy-induced hypertension (PIH), were noted in both groups. However, the incidence of these two complications did not differ significantly between the groups. In the OHSS group, GDM presented with an incidence of 9.9% for singletons and 9.4% for twins, and 12.9% and 7.0%, respectively, for the control group. PIH presented as 6.9% for singletons and 10.9% for twins in the OHSS group, and 8.2% and 7.0%, respectively, for the control groups. During the first trimester laparoscopies for suspected ovarian torsion were performed in 13 patients, and in 10 patients the diagnosis were confirmed. CONCLUSIONS: Although patients with OHSS-complicated pregnancies previously reported a relatively high risk of GDM and PIH, the occurrence rates do not differ from a matched control group of normally responding patients who conceived after IVF.     

X射线摄影效应测定尺的研发与应用

目的探讨X射线摄影测量出现误差的原因,提高X射线测量的准确性。方法自行研制X射线摄影效应尺,由底尺、高度尺和活动尺三大部分构成,分别刻以灌注铅胶的刻度,用于实际测量。检测焦片距100cm、物片距20cm时显示图像尺寸与实际尺寸的大小。结果各公司平板显示范围未能达到所标识的43 cm×43 cm,Kodak 7500、GE、佳能、西门子4家公司实际显示范围分别为41.5 cm、40.5 cm、42.5 cm、41.0 cm。而焦片距100 cm、物体厚度20 cm进行曝光时,底尺显示43.0 cm时,实际物体尺寸仅有36.0 cm,7.0 cm的物体盲区未被显示。结论为避免图像放大引起的失真,摄影时使用X射线摄影效应测定尺即可进行准确测量,减少误差。     

DR组织均衡技术在低剂量鼻骨侧位X射线摄影中的应用

目的探寻在鼻骨侧位X射线摄影中利用数字化X射线摄影(DR)组织均衡技术获取满足诊断需要的图像并降低患者辐射剂量的研究。方法利用人体模型进行常规的鼻骨侧位摄影,然后固定千伏值,在原有的mAs值上分别降低0.4、0.8、1.2 mAs进行摄片,再将降低剂量的图像采用DR组织均衡技术进行处理,比较不同图像对于满足诊断的需要和患者所接受的辐射剂量。结果常规摄影技术得到的图像需反复调节不同的窗宽、窗位才能显示密度、厚度不同的鼻骨与软组织;降低0.4、0.8 mAs,虽然图像的空间分辨率降低,但是采用DR组织均衡技术可在同一幅图像上清晰显示鼻骨与邻近软组织结构,同时降低患者的辐射剂量;降低1.2 mAs,不但图像的空间分辨率降低,而且无法采用DR组织均衡技术使图像达到满足诊断需要。结论采用DR组织均衡技术不仅能将密度、厚度不同的鼻骨及邻近软组织在同一副图像上清晰显示,而且能够有效降低患者的辐射剂量。     

眼底荧光影像对原发性视网膜色素变性病情严重性的评估作用

目的：探讨眼底荧光影像对原发性视网膜色素变性严重性的评估作用。方法:按准入和排除标准选择患者20名,按国际通用方法进行眼底荧光血管造影,对造影图像的表现及临床病理意义进行分析。结果:全部病例的造影图像均显示斑驳状透见荧光,其它较多的特征有色素斑块所致的荧光遮蔽、因视网膜色素上皮细胞脱离所致的荧光渗漏和沉积,较少表现的还有毛细血管无灌注所致的充盈缺损以及黄斑荧光积存等。结论:眼底荧光影像对原发性视网膜色素变性病情严重性的预示性从轻向重依次为：弥漫性斑驳状透见荧光;荧光遮蔽;充盈缺损;视网膜荧光素池样积存;黄斑荧光积存。     

孕早期人母-胎免疫耐受机制的研究

目的：探讨孕早期母胎免疫耐受调节机制。方法;应用流式细胞仪分析（ＦＡＣＳ）蜕膜及孕妇外周血淋巴细胞亚群;采用改进的乳酸脱氢酶释放试验测定蜕膜淋巴细胞细胞对Ｋ５６２的自然杀伤活性;同时以滋养鲺蜕膜淋巴细胞共同培养,研究平体免疫系统对滋养细胞抗原免疫应管状态。结果：蜕膜组织中Ｄ５６＾＋ＮＫ细胞含量高于孕妇及对照组外周血ＣＤ５６＾＋细胞比例（Ｐ〈０．０５）,蜕膜组织中ＮＫ细胞杀伤活性明显低于孕妇及对照组     

First trimester bleeding in clinical IVF pregnancies

First trimester bleeding has been investigated in 72 pregnantwomen undergoing in-vitro fertilization and embryo transferand was compared to 70 pregnant patients in whom ovula tionwas induced, in addition to 70 spontaneous pregnancies. Abortionrates did not differ significantly between the first two groupsbut were significantly higher in comparison to normal pregnancies.Furthermore, among IVF pregnancies that continued, a high incidenceof first trimester bleeding occurred (P < 0.01). This complicationwas mainly related to luteal insufficiency and multiple pregnancies,whereas hyperstimulation was the major risk factor for bleedingin pregnancies arising from HMG-induced ovulation. Other currentlyunknown, aetiological factors for first trimester bleeding inIVF pregnancies remain to be investigated.     

Randomized comparison of vaginal (200 microg every 3 h) and oral (400 microg every 3 h) misoprostol when combined with mifepristone in termination of second trimester pregnancy

It is known that when misoprostol is given at 200 microg every 3 h after mifepristone pretreatment, the vaginal route is more effective than the oral route. However, women prefer the oral route. This randomized study was to test our hypothesis that oral misoprostol 400 microg is as effective as vaginal misoprostol 200 microg when given every 3 h in termination of second trimester pregnancy after priming with mifepristone. A total of 142 patients was randomly assigned to group 1 (200 mg mifepristone + 400 microg oral misoprostol every 3 h up to five doses) or group 2 (200 mg mifepristone + 200 microg vaginal misoprostol every 3 h up to five doses). The incidence of side-effects and the preference study were assessed through a standardized questionnaire during and after the abortion. For the oral group, both the incidence of diarrhoea (40.0 versus 23.2%, P = 0.03) and the amount of drug used (1734 compared with 812 microg, P < 0.0001) were significantly higher than that of the vaginal group but the incidence of fever appeared to be lower (not significant). There was no significant difference in complete abortion rate: 81.4% in the oral group and 75.4% in the vaginal group. The median induction-abortion interval was similar in the two groups (10.4 versus 10.0 h). The percentage of women who aborted in 24 h was also similar: 57/70 (81.4%) in the oral group and 58/69 (87.0%) in the vaginal group. Overall, 82.0% of women preferred the oral route. Oral misoprostol (400 microg) given every 3 h up to five doses, when combined with mifepristone, was as effective as the vaginal (200 microg) route in second trimester termination of pregnancy. This regimen could also be offered to those women who found repeated vaginal administration unacceptable.