子宫内膜腺体对妊娠早期胎盘发育的潜在作用

在许多物种中,子宫内膜腺体在调节胎盘发育过程中起重要作用,但在人类,随着胚胎植入的完成其作用几乎被忽略,现重新评价其在妊娠早期的作用。在妊娠早期,甚至妊娠中期的早期,胎盘没有母体血液供应时,子宫内膜腺上皮产生的碳水化合物和富含脂质的分泌物为胎盘提供了重要的营养物质来源,其中含有各种生长因子可以调节胎盘的形态,分泌物中的其他成分亦可以调节母胎界面的免疫反应和滋养细胞的浸润,对维持受精卵的存活和正常胎盘发育非常重要。     

子宫内膜异位症子宫内膜细胞对鼠胚体外早期发育的影响

子宫内膜异位症（EMs,内异症）与妇女不育有着密切的关系,约有25％～40％的不孕妇女患内异症,而内异症患者中,不育症约占30％～40％。为探讨子宫内膜异位症患者的子宫内膜是否对胚胎的发育产生不利的影响,本实验将两细胞期鼠胚与内异症妇女子宫内膜细胞体外共培养,观察其对鼠胚早期发育的影响。     

小剂量阿司匹林对促排卵子宫内膜发育的影响

诱发排卵是不孕症最常用的治疗方法。氯米芬等促排卵率为 5 5 %～ 99% ,但其妊娠率仅为 2 5 %左右[1] 。氯米芬可直接[2 ] 及通过减少子宫的血液供应而影响子宫内膜的发育[3 ] ,造成囊胚种植时子宫内膜不良的容受状态 ,使妊娠率降低。本研究于促排卵同时给予小剂量阿司匹林 ,通过增加子宫的血液供应 ,改善氯米芬促排卵时造成的子宫内膜发育不良 ,以提高妊娠率。一、资料和方法1 研究对象及给药方案 :选自本院 2 0 0 0年 9月至 2 0 0 1年 3月收治的不明原因的不孕患者 30例 ,平均年龄 (2 9± 4 )岁 ,平均不孕时间 (4± 3)年 ,月经周期规则 ,…     

hCG对卵泡及子宫内膜发育作用的研究进展

人绒毛膜促性腺激素(hCG)可以改善内膜容受性(ER)、延长种植窗口期,有利于胚胎着床,还可以调节子宫内膜的免疫耐受性,从而提高种植率;在卵泡早期或者中晚期添加低剂量的h CG可以提高卵子以及胚胎质量,从而获得更高的妊娠率。     

子宫内膜异位症对妊娠结局影响的研究进展

子宫内膜异位症（EMs）是一种妇科常见疾病,常发生于育龄期妇女,以盆腔疼痛和不孕为主要表现,严重困扰育龄期妇女的身心健康。近年研究发现EMs不仅可以引起不孕,还可以导致不良的妊娠结局。研究显示EMs患者在妊娠早期发生流产、异位妊娠的风险增加,在妊娠中晚期发生早产、前置胎盘、妊娠期高血压疾病-子痫前期以及小于胎龄儿的风险增加,剖宫产分娩率增加。EMs与上述不良妊娠结局有关,其导致不孕以及不良妊娠结局的机制复杂,涉及EMs发生、发展过程中的病理生理改变,阐明其发生机制对EMs患者不良妊娠结局的防治具有重要意义。     

早期妊娠瘢痕子宫胎盘绒毛植入10例临床分析

目的探讨早期妊娠瘢痕子宫胎盘绒毛植入的诊断和治疗。方法对10例妊娠瘢痕子宫胎盘绒毛植入病例的临床资料进行分析，总结诊断和治疗方法。结果10例均有剖官产史，临床表现为停经后不规则阴道流血，刮宫术中发生阴道大出血。10例中4例行次全子宫切除术，2例行局部病灶切除，4例采用甲氨蝶呤（MTX）保守治疗。结论 早期妊娠瘢痕子宫胎盘绒毛植入是剖官产远期并发症之一，选择保守治疗或手术治疗。     

异位妊娠时子宫内膜的形态变化

目的：探讨异位妊娠时子宫内膜形态变化的规律。方法：回顾分析我院２１７例异位妊娠子宫内膜的形态变化。结果：异位妊娠时子宫内膜变化有７种类型：（１）蜕膜和Ａｒｉａｓ－Ｓｔｅｌａ反应（Ａ－Ｓ反应）；（２）高度分泌反应；（３）分泌反应不同步；（４）部分呈分泌反应、部分呈增生反应，并出现一种“小Ａ－Ｓ”腺体；（５）早、中、晚分泌期；（６）增生反应；（７）腺囊型增生过长。异位妊娠时内膜形态与有无阴道流血、流血时间长短及尿ｈＣＧ水平有关。结论：不能以是否出现蜕膜和Ａ－Ｓ反应做为诊断异位妊娠的依据，须结合病史和实验室检查才能准确判断。     

表皮生长因子及其受体在胎盘发育中的作用

研究表明 ,表皮生长因子及其受体在胎儿、胎盘的生长发育中有一定作用 ,胎儿生长与胎盘的发育直接相关。表皮生长因子受体在胎盘中有很强的表达 ,主要位于合胞体滋养层微绒毛胞质膜顶端 ,微绒毛与母血直接接触 ,是支持母胎之间物质与信息交换 ,并能分泌多种物质的组织。现就表皮生长因子及其受体在胎儿、胎盘发育过程中的作用作一综述。     

Human Early Placental Development: Potential Roles of the Endometrial Glands

There is strong evidence that the endometrial glands play a key role in regulating placental development in many domestic species, but their contribution in the human has largely been ignored once implantation is complete. Here we re-evaluate their role during the first trimester. Connections between the glands and the intervillous space have been observed from day 17 post-conception through to the end of the first trimester. In the absence of a maternal arterial supply to the early placenta it is believed that the carbohydrate- and lipid-rich secretions represent an important source of nutrients during the first trimester, and possibly the beginning of the second trimester. The secretions also contain a variety of growth factors that may regulate placental morphogenesis since their receptors are present on villous and extravillous trophoblast, and villous endothelial cells. Other components of the secretions may modulate immune responses and trophoblast invasion at the materno-fetal interface. We speculate that lactogenic hormones secreted by decidual cells and the syncytiotrophoblast may act in concert with human chorionic gonadotropin to stimulate the secretory activity of glandular epithelial cells during the first trimester. There is circumstantial evidence, but as yet no conclusive proof, that deficient glandular activity is associated with pregnancy failure in the human.     

Fatigue During the First Trimester of Pregnancy

Fatigue is accepted as an early symptom of pregnancy. Fatigue may be due to energy depletion resulting from the physiologic and psychological changes occurring during the first trimester. The following changes are considered: oxygen consumption; fetal growth and development; cardiovascular, respiratory, urinary tract, metabolic, and psychological processes. The goals of nursing therapy for first-trimester fatigue are to help the woman cope with the distress caused by the fatigue and to help minimize or alleviate the fatigue to the degree that is possible. The nursing therapy should include sharing information about the nature of the fatigue, developing an activity-rest program, and sharing information aimed at alleviation of psychological stresses.     

Exposure to Amlodipine in the First Trimester of Pregnancy and During Breastfeeding

Objective: To assess the fetal outcome of three hypertensive women exposed to amlodipine. 5 mg/day, in the first trimester of pregnancy. Case 1: The patient was treated with amlodipine until 7 weeks of gestation. She was also exposed to levosulpiride, aluminum hydroxide gel, magnesium carbonate, and Ginkgo biloba. At 38⁺³ weeks of pregnancy, she delivered a 3750 g healthy female baby, and restarted taking amlodipine, 5 mg/day, while exclusively breastfeeding her daughter. At three months of age, the infant was healthy. Case 2: The patient was treated with amlodipine from 2⁺² to 3⁺⁴ weeks of pregnancy. Her treatment was modified to atenolol until the week 6^{+4 weeks}, when she declined any antihypertensive treatment. At 39⁺⁴ weeks of pregnancy, the patient delivered a 2600 g baby. At 20 months old, the baby presented with intellectual delay and weakness in the left arm and hand grasp. These neurological alterations were not attributed to her exposure to amlodipine early in utero. Case 3: The patient was treated with amlodipine from 7⁺⁶ to 12 weeks of pregnancy. She was also taking sucralfate and lorazepam. At 12 weeks of amenorrhea, ultrasound revealed a 15.3 mm, single fetal pole in the gestational sac without cardiac activity. She underwent dilatation and evacuation of a dead embryo. Conclusion: As reported with other calcium-channel blockers, amlodipine does not appear to be teratogenic and it appears to be compatible with breastfeeding.     

肾上腺髓质素在人类妊娠中的作用研究进展

肾上腺髓质素（adrenomedullin,AM）自1993年发现后受到广泛关注,肾上腺髓质素在全身多个系统中均发挥重要作用,主要作用为扩张血管、调节体内水钠代谢、影响细胞增殖和凋亡、抗肿瘤细胞凋亡、促进肿瘤血管生成等,大量研究表明,肾上腺髓质素及其受体在女性生殖内分泌系统中有表达．并且肾上腺髓质素在正常妊娠的胎盘、子宫、母血和脐血中水平增高,并且发现肾上腺髓质素参与子痫前期、妊娠期糖尿病、胎儿生长受限等病理性妊娠过程,提示肾上腺髓质素在妊娠过程中的作用具有多效性。就肾上腺髓质素及其受体在妊娠中的作用综述。     

Incidental Endometrial Carcinoma Diagnosed at First Trimester Pregnancy Loss: A Case Report

BackgroundAll cases reported to date of endometrioid endometrial adenocarcinoma (EEA) associated with pregnancy have been treated surgically or medically. We describe a case of EEA in pregnancy that was managed expectantly, allowing for observation of the natural course of the disease.CaseA 36-year-old woman, gravida 2 para 1, presented at eight weeks of pregnancy with heavy vaginal bleeding. Ultrasound assessment confirmed a missed abortion, and the patient underwent dilatation and curettage. Tissue pathology primarily suggested grade 1 EEA. The patient chose expectant management. Eight months later, she returned with vaginal bleeding. Hysterectomy was performed and the hysterectomy specimen showed FIGO grade 1 stage 1A EEA.ConclusionTreating EEA associated with pregnancy is challenging. Our experience in the case described here suggests that expectant management should not be undertaken due to a high risk of recurrence.     

Reproducibility of First Trimester Three-dimensional Placental Measurements in the Evaluation of Early Placental Insufficiency

ObjectiveTo evaluate the reproducibility of first-trimester, three-dimensional placental volume and vasculature evaluation by ultrasound in correlation with uterine artery Doppler flow studies.MethodWe performed a prospective study of a cohort of pregnant women undergoing first-trimester ultrasound examination. Uterine artery Doppler and 3-D power Doppler angiography was performed. Placental volume, vascularization index (VI), flow index (FI), and vascularization flow index (VFI) were calculated three times by two independent observers using the virtual organ computer-aided analysis (VOCAL) software. Intra- and interobserver reproducibility was evaluated by Spearman’s correlation test. All parameters between women with low (< 1.5 multiple of median) (MoM) and high (> 1.5 MoM) uterine artery Pourcelot index (PI) were compared by the Mann-Whitney test.ResultsA total of 35 women between 11 and 14 weeks’ gestation were recruited, including 26 who underwent uterine artery Doppler and six with elevated uterine artery PI. We found excellent intraand interobserver reproducibility (R² > 0.85) for all parameters. Women with elevated uterine artery PI had smaller placental volume, VI, FI, and VFI (P < 0.05).Conclusion3-D placental volume and vasculature evaluations during the first trimester are reproducible measures that inversely correlate with uterine artery PI.     

早孕期人绒毛趋化因子CCL2及其受体CCR2的表达

目的:分析人早孕绒毛组织趋化因子CCL2及其受体CCR2的转录和翻译表达。方法:收集人早孕期胎盘组织30例,分离出绒毛组织,采用半定量RT-PCR、免疫组织化学法分析正常人早孕绒毛组织CCL2/CCR2的表达。结果:人早孕绒毛滋养细胞中等水平转录和翻译CCL2及CCR2。结论:CCL2/CCR2表达于母-胎界面的胎儿面绒毛组织,可能参与滋养细胞功能调控。