硫酸舒喘灵纠正臀位妊娠的效果分析

臀位经阴道分娩时易致新生儿窒息及产伤 ,积极纠正臀位妊娠对母婴安康有重要意义 .我科采用口服硫酸舒喘灵配合膝胸卧位纠正臀位 ,并与单用膝胸卧位纠正臀位作了比较 ,现报告如下 .1　资料与方法1.1　临床资料　 1998年 8月～ 2 0 0 1年 6月 ,在我院妇产科门诊参加围产保健发现臀位 ,经Ｂ超确诊的孕妇 10 0例 ,孕周 2 8～ 34周 ,均为初产妇 ,均无骨盆畸形、前置胎盘、心脏病、糖尿病等 .分为 2组 :治疗组 5 0例采用口服硫酸舒喘灵配合膝胸卧位 ,对照组 5 0例单纯膝胸卧位 .1.2　方法　两组均膝胸卧位 ,每天 2次 ,每次 15分钟 .治疗组于膝胸…     

卵巢过度刺激综合征10例治疗体会

目的总结卵巢过度刺激综合征的治疗.方法回顾分析10例卵巢过度刺激综合征(以后简称OHSS)的临床资料.结果OHSS经过严密监护输白蛋白或血浆,扩容及放腹水等对症治疗后可治愈.结论OHSS在严密监护下,经过相应的对症治疗可治愈.     

卵巢过度刺激综合征36例临床分析

目的探讨卵巢过度刺激综合征(OHSS)的临床特征和治疗方法.方法对36例OHSS的临床资料进行回顾分析.结果 OHSS全部是发生在超促排卵周期的10～23d.经过监护、扩容、补液、利尿、糖皮质激素、黄体酮、腹腔、胸腔穿刺引流效果满意.结论严密监护OHSS的病情发展,扩容是治疗的关键,适量补液,控制腹水、胸水的穿刺引流.预防,警惕发生OHSS的高危因素,超促排卵时注意个体差异和卵巢的敏感性.     

硫酸舒喘灵在矫正胎位中的优生意义

本文对硫酸舒喘灵辅助膝胸卧位矫正胎位的169例孕妇进行前瞻性研究,结果发现硫酸舒喘灵能提高膝胸卧位矫正胎位的效果,与对照组有显著差异。     

舒适护理在重度卵巢过度刺激综合征中的应用

目的：探讨舒适护理在重度卵巢过度刺激综合征患者中的应用效果。方法对137例重度卵巢过度刺激综合征患者在护理过程采用舒适护理模式。结果患者住院治疗期间生理、心理、社会舒适方面均得到改善,获得较高舒适感,满意度调查为94.9%。结论舒适护理在重度卵巢过度刺激综合征中的应用意义重大,体现了人性化护理,推动了护理服务质量的提高,同时改善了患者治疗过程的舒适度,提高的护理服务的满意度。     

卵巢过度刺激综合征的预测及预防

卵巢过度刺激综合征（OHSS）是一种医源性疾病,常发生于控制性超排卵（COH）病人,OHSS的发生率约5％-10％,严重OHSS发生率约1．4％。OHSS不仅影响妊娠成功率,甚至危及生命。该综合征的发病机制尚未阐明,目前只能对症处理和支持治疗,因此预防和及时发现是治疗的关键。本文就近年来OHSS的预测及预防的研究进展做一综述。     

卵巢过度刺激综合征的基因组学研究进展

卵巢过度刺激综合征（OHSS）是辅助生殖技术中最严重的医源性并发症之一。在控制性促排卵过程中,部分患者发生OHSS,影响辅助生殖治疗的临床结局,增加患者心理和经济负担,严重者危及患者生命安全。目前OHSS的发病机制尚不明确。因此,解析OHSS发病机制的研究对于临床预防和治疗有重大指导意义。近年来基因组学在OHSS研究中取得一定进展,部分研究显示DNA、RNA与OHSS的发生有关。本文就近年来与发生OHSS相关的基因组学研究进展作一综述,系统阐述OHSS发病相关的基因组学如何影响、介导OHSS的发生,然而,这些基因对OHSS的贡献仍然太小,需要重复性研究进一步证实,为OHSS的预防和治疗提供理论基础。     

体外受精妊娠合并重度卵巢过度刺激综合征二例的护理

对2例体外受精-胚胎移植妊娠后发生重度卵巢过度刺激综合征患者采取积极的治疗及护理措施,结果2例患者均康复出院。提示要重视心理疏导及饮食、体位的指导,严密观察病情、做好穿刺放液术的护理,以及监测胚胎发育情况,对减少流产率,预防严重并发症的发生,促进患者的康复至关重要。     

卵巢过度刺激综合征发病机制的研究进展

卵巢过度刺激综合症 (ovarianhyperstimulationsyndrome ,OHSS)是在促排卵过程中发生的常见的医源性并发症 ,总发生率约为 2 3% [1] ,表现为双侧卵巢增大、腹胀、恶心呕吐、胸腹水、甚至血栓形成 ,重度患者存在一定的生命危险。随着近二十余年来辅助生殖技术的开展 ,促排卵药物的使用越来越普遍 ,OHSS的发病率也呈上升趋势。临床上在OHSS的诊断、治疗及预防方面已经积累了一定的经验 ,但仍不能作到完全避免OHSS、尤其是重度OHSS的发生 ,治疗方面也缺乏有效的药物 ,而以缓解症状作为主要的治疗目的。因此 ,对于OHSS发病机制的研究…     

辅助生殖技术中卵巢过度刺激综合征 发生发展预测指标的研究

目的 研究辅助生殖技术中卵巢过度刺激综合征发生发展预测指标。方法 回顾分析2016年8月~2017年8月在我院接受辅助生殖技术（ART）治疗的52例卵巢过度刺激综合征（OHSS）（分为早发组25例和晚发组27例）和40例非OHSS患者,比较两组患者妊娠结局等指标,筛查OHSS发生发展预测指标。结果 OHSS组患者妊娠率、不良妊娠率、多胎妊娠率高于非OHSS组,差异有统计学意义（P＜0.05）;早发组年龄、促性腺激素（Gn）用量、HCG注射日中小卵泡评分与晚发组对比差异有统计学意义（P＜0.05）,妊娠率、不良妊娠率组间对比,差异无统计学意义（P＞0.05）;中小卵泡评分变量与OHSS发生时间相关,OHSS持续时间与是否妊娠或多胎妊娠相关。结论 早发的OHSS与卵巢对外源性HCG过度反应相关,HCG注射日中小卵泡评分可预测OHSS的发生。晚发的OHSS与胚胎中内源性HCG相关,OHSS持续时间可以预测判断妊娠情况。     

Increased early pregnancy loss in IVF patients with severe ovarian hyperstimulation syndrome.

BACKGROUND: Since severe ovarian hyperstimulation syndrome (OHSS) is a potentially life-threatening complication of assisted reproduction, the focus of attention in such cases is placed firmly upon the health of the patient, with the endeavour to achieve a pregnancy being considered of secondary importance. The aim of this study was to focus on the pregnancy rate and pregnancy outcome in IVF patients hospitalized for severe or critical OHSS, in one centre, during a period of 6 years. METHODS: We compared the characteristics of patients with severe OHSS: those who conceived with the ones who did not conceive, and among pregnant IVF patients, those with ongoing pregnancies with those that miscarried. RESULTS: Pregnancy was achieved in 60 of 104 (58%) patients with severe OHSS. Pregnancy continued until delivery in 37 of these 60 patients (62%), whereas the remaining 23 (38%) aborted. The pregnancy and abortion rates in patients with severe OHSS were significantly higher than those of IVF patients without OHSS, during the same time period [23% (1138/4922) and 15% (169/1138) respectively, P < 0.001]. The mean duration of hospitalization for OHSS was significantly shorter in those who delivered compared with those who aborted (5.9 +/- 3.2 versus 10.5 +/- 9.6 days, P < 0.01) and in the non-pregnant patients compared with the pregnant patients (5.2 +/- 3.2 versus 7.6 +/- 6.6 days, P < 0.02). CONCLUSIONS: The clinical pregnancy rate of IVF patients with severe OHSS was significantly higher than that of patients without the syndrome. A longer stay in hospital-reflecting a more severe form of OHSS-was correlated with a higher frequency of abortions. OHSS, necessitating hospitalization, is a detrimental clinical situation not only for the mother but also for the developing pregnancy.     

Metabolic characteristics of women who developed ovarian hyperstimulation syndrome

BACKGROUND: The aim of this study was to investigate whether a higher incidence of hyperinsulinism is found in women who have suffered from ovarian hyperstimulation syndrome (OHSS) as compared with other IVF patients. Additionally, we also assessed whether any abnormalities in the haemostatic system were more frequent in women with a past history of OHSS. METHODS: A pilot study was carried out involving OHSS patients and matched IVF patients. Homeostasis model assessment (HOMA) of insulin sensitivity was calculated. The main outcome measures were: insulin sensitivity, coagulation anomalies, factor V Leiden mutations, methylene tetrahydrofolate reductase (MTHFR) polymorphism and prothrombin gene mutation, protein C and protein S deficiency. RESULTS: No increased incidence in hyperinsulism nor in abnormalities of the haemostatic system were observed. CONCLUSIONS: This pilot study does not provide evidence for an increased prevalence of hyperinsulinism among women who have developed OHSS in the past.     

Dynamic changes of the immunoglobulins in patients with severe ovarian hyperstimulation syndrome: efficacy of a novel treatment using peritoneo-venous shunt

PROBLEM: To evaluate the efficacy of continuous auto-transfusion system of ascites (CATSA) for the treatment of patients with severe ovarian hyperstimulation syndrome (OHSS) at the risk of febrile morbidity, the dynamic changes of immunoglobulins in the sera and the peritoneal fluid from patients with severe OHSS treated by CATSA were estimated. METHOD OF STUDY: Ten patients with severe OHSS after superovulation for in vitro fertilization-embryo transfer (IVF-ET) were treated by CATSA. Immunoglobulin concentrations were examined in the serum and in the peritoneal fluid before and after CATSA. As controls, serum samples from 15 infertile women, who did not develop OHSS after the same superovulation protocol, were obtained on the day of mid-luteal period (Control-1). Serum samples from 15 patients with OHSS, who were treated by albumin infusion without paracentesis, were also obtained before and after the treatment (Control-2). RESULTS: Before the treatments, serum immunoglobulin G (IgG) concentrations in patients with severe OHSS treated with CATSA and those in patients of Control-2 were significantly lower than those in patients of Control-1 (P < 0.01). Following CATSA, the concentration of IgG increased in the sera, while it decreased in the peritoneal fluid. CONCLUSIONS: Serum IgG in patients with severe OHSS exuded into their peritoneal cavity, indicating that they might be at the status of immunodeficiency and at the risk of febrile morbidity. However, non-infectious febrile morbidity attributed to endogenous pyrogenic mechanism might be considerable. It is also suggested that CATSA might be effective in improving hypoimmunoglobulinemia of the patients with severe OHSS by the peritoneo-venous shunt.     

Clinical efficacy of peritoneovenous shunting for the treatment of severe ovarian hyperstimulation syndrome

We investigated prospectively the clinical efficacy of a newly developed continuous autotransfusion system of ascites (CATSA) without protein supplement in patients with severe ovarian hyperstimulation syndrome (OHSS). Peritoneovenous shunting was used to recirculate ascites. The CATSA was performed for 5 h at a rate of 100-200 ml/h once a day. Eighteen patients were treated with the CATSA (CATSA group) and 36 were treated with an intravenous 37.5 g/day of albumin supplement (albumin group). Hospital stay was significantly shorter in the CATSA group than in the albumin group (10.0 +/- 5.7 versus 13.9 +/- 6.2 days, P < 0.01). Haematocrit value reached <40% significantly earlier in the CATSA group (on hospital days 3.9 +/- 3.2 versus 5.9 +/- 2.5, P < 0.01). Using a single procedure, haemoconcentration, urinary output and pulse pressure were markedly improved in the CATSA group compared with the albumin group. Discomfort due to massive ascites diminished promptly and did not recur in nine of 18 CATSA group patients, whereas it persisted in all 36 patients in the albumin group. The serum concentration of protein was maintained in the CATSA group, whereas it did not increase in the albumin group despite daily supplementation with 37. 5 g of albumin. Apparent adverse effects of each procedure were not observed in either group. The mean values of several parameters in the serum pertinent to the coagulation-fibrinolysis system did not change significantly in either group after the procedure. It was concluded that the CATSA procedure expanded circulating plasma volume without exogenous albumin and appeared to lead to a prompt recovery from severe conditions of OHSS.     

Endocrinology: The ovarian hyperstimulation syndrome in in-vitro fertilization: a Belgian multicentric study. I. Clinical and biological features

The multicentric study regroups 128 cases of the ovarian hyperstimulationsyndrome (OHSS) in in-vitro fertilization (IVF) and 256 selectedcontrols. Values of serum oestradiol obtained from differentlaboratories were found to be normally distributed after logarithmictransformation. Comparative study of clinical and biologicalcharacteristics indicates that among OHSS patients (i) meanage was lower; (ii) tubal indications for IVF were less frequent;(iii) polycystic ovary-like conditions (i.e. hyperandrogenism,anovulation, luteinizing hormone/follicle stimulating hormoneratio > 2) were more frequent. OHSS patients displayed ovarianhyper-sensitivity reflected by higher oestradiol peak concentrationsin response to lower dosage of human menopausal gonadotrophinand by a steeper slope of oestradiol increment during stimulation.In these patients, the collection of greater numbers of fertilizableoocytes allowed replacement of more embryos with a good vitalityscore. Ongoing pregnancy rate was found to be higher among theOHSS patients. The following complications were recorded amongOHSS cases: abdominal fluid at echographic examination or clinicalascites (86.7 and 71.1%, respectively); pleural and pericardialeffusion (21 and 3%, respectively); haemoconcentration (71.1%);electrolytic disorders (6.2%). Although significantly differentbetween groups, clinical and biological parameters under studyshowed considerable overlap of their distributions in controland OHSS cases. Therefore, these data must be submitted to discriminantanalysis in order to derive a formula predictive of the riskof OHSS.     

Value of serum and follicular fluid cytokine profile in the prediction of moderate to severe ovarian hyperstimulation syndrome

The aim of this study was to examine the role of serum and follicular fluid pro-inflammatory cytokines and vascular endothelial growth factor (VEGF) in the prediction of ovarian hyperstimulation syndrome (OHSS). A total of 156 consecutive women undergoing in-vitro fertilization were recruited. The study group comprised 12 women who subsequently developed moderate (n = 7) or severe (n = 5) OHSS. The two control groups were comprised of a randomized selection of 12 high-risk and 12 low-risk women in whom OHSS did not develop. Serum was collected on days of human chorionic gonadotrophin, oocyte retrieval, and embryo transfer. Serum and follicular fluid concentrations of interleukin (IL)-6, IL-8, tumour necrosis factor-alpha (TNF-alpha), and VEGF were measured. Follicular fluid IL-6 concentrations at the time of oocyte retrieval and serum IL-8 concentrations at the time of embryo transfer were significantly higher in the OHSS compared to the two control groups (P = 0.026 and P = 0.017 respectively). Serum concentrations of TNF-alpha and VEGF showed no statistically significant difference between the OHSS group and the controls at any studied time point. This study suggests that follicular fluid IL-6 concentrations at the time of oocyte retrieval and serum IL-8 concentrations on the day of embryo transfer may serve as early predictors for this syndrome.     

Day care management of severe ovarian hyperstimulation syndrome avoids hospitalization and morbidity

Severe ovarian hyperstimulation syndrome (OHSS) is a dreadedcomplication of ovulation mductlon for assisted reproductiontreatment. In the past, conservative management has been recommendedand this leads to prolonged hospitalization. A total of 18 patientswho developed severe OHSS were managed according to two protocols.The first group (n=8) was managed conservatively with hospitalization,i.v. hydration and supportive therapy. The average durationof hospitalization was 11 days and the patients were uncomfortablethroughout. A second group (n=10) was managed on an out-patientbasis with early, ultrasound-guided trans-abdominal paracentesis.While the patient was hydrated intravenously, 1–3 I offluid were removed over 2–3 h. The duration of hospitalizationwas between 6 and 7 h and no in-patient stay was required. Promptrelief of symptoms was reported and none of the patients requiredre-tapping. Pregnancy was achieved in 68% of all patients. Daycare management with easy abdominal paracentesis was found tobe simple, safe and effective; patients found it more acceptableas it avoided in-patient hospitalization.     

Criteria of a successful coasting protocol for the prevention of severe ovarian hyperstimulation syndrome

BACKGROUND: The aim of this study is to report a large series of patients (n = 1223) at risk of developing ovarian hyperstimulation syndrome (OHSS) who underwent coasting. METHODS: Coasting started when the leading follicle reached 16 mm and continued until the estradiol (E2) level fell to 3000 pg/ml. RESULTS: The E2 level at the start of coasting was (mean +/ SD) 6408 +/- 446 and it fell to 2755 +/- 650 on the day of HCG injection, after (mean +/- SD) 2.89 +/- 0.94 days. The results were analysed according to the duration of coasting (< or = 3 days, group I: n = 983; >3 days, group II: n = 240). The number of oocytes retrieved was (mean SD) 16.45 +/- 6.25 and 14.93 +/- 6.01 in groups I and II respectively (P < 0.05). The fertilization rates were 63 and 65% in groups I and II respectively (P > 0.05). The implantation and clinical pregnancy rates were 26 and 52% in group I compared to 18 and 36% in group II respectively (P < 0.05). Severe OHSS occurred in 16 cases, which represented 0.13% of all stimulated cycles, and 1.3% of patients who were at risk of developing OHSS. CONCLUSIONS: Our protocol of coasting was an effective measure in the prevention of OHSS, without jeopardizing the ICSI outcome. Coasting for >3 days is associated with a moderate decrease in the pregnancy rate.     

Endocrinology: Predictive value of serum oestradiol concentrations and oocyte number in severe ovarian hyperstimulation syndrome

Ovarian hyperstimulation syndrome (OHSS) is a serious complicationof gonadotrophin usage but it is difficult to accurately predictits occurrence. Previous investigators have identified the combinationof high oestradiol concentrations and oocyte number as beingpredictive in 80% of cases. In this study we sought to identifythe incidence of severe OHSS in patients with high oestradiolconcentrations and large numbers of oocytes and to evaluatethe importance of pregnancy in the development of OHSS. Between1990 and 1993, we studied 139 cycles using two assisted reproductivetechniques [oocyte donor, n =72; in-vitro fertilization (IVF),n = 67] in which either oestradiol (>4000 pg/ml), oocytenumber (>25), or both were elevated. OHSS was diagnosed bystandard criteria. There were no cases of severe OHSS in theoocyte donor group and six in the IVF group. Among 10 patientswith oestradiol concentration >6000 pg/ml and >30 oocytes,only one had OHSS (10%). The relative risk of OHSS with pregnancywas 12 (confidence interval 2.18–66.14). We conclude thatthe risk of OHSS even at high levels of stimulation is lowerthan previously believed. Secondly, donors have a very low riskof OHSS, probably because of the absence of pregnancy. As such,cryopreservation of all oocytes in IVF cycles is a reasonablealternative to cycle cancellation or use of adjunctive medication.