亚临床甲状腺早衰症与不良妊娠结局

目的由于人类甲状腺也会逐渐衰老,甲减发病率持续上升,因此早期干预,尤其是妊娠期甲状腺衰老的积极治疗,对于预防身体过早衰老有重要的价值。本研究同时探讨经左旋甲状腺素(L-T4)替代治疗的亚临床甲状腺早衰症(甲减)对妊娠结局及胎儿的影响。方法选取2017年1月至2018年12月于北京医院分娩的妊娠期亚临床甲状腺早衰症(甲减)并接受L-T4替代治疗的孕妇共144例,作为观察组。并随机选取同期分娩的甲状腺功能正常的孕妇共150例,作为对照组。比较两组间年龄、孕前体质量指数(BMI)、甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb),妊娠期贫血、妊娠期糖尿病、妊娠期高血压疾病、自然流产史、不孕症病史、早产、胎膜早破、产后出血、新生儿低Apgar评分及胎儿生长受限的差异性。结果亚临床甲状腺早衰症组甲状腺自身抗体及不孕症病史阳性率较对照组显著升高,妊娠期贫血发生率较对照组降低。两组间年龄、BMI、其他妊娠合并症发生率及胎儿结局无显著性差异。结论甲状腺自身抗体阳性是妊娠期亚临床甲状腺早衰症的重要发病因素。当以TSH≥4.0mIU/L为诊断标准时,经过L-T4替代治疗的妊娠期亚临床甲状腺早衰症孕妇妊娠合并症风险较甲状腺功能正常孕妇无明显升高,妊娠期无需增加产前检查频次。因此针对妊娠期甲状腺衰老的积极治疗,对于抗衰老有重要意义。     

NICE guidance on diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period. NICE clinical guideline 63. London,March 2008

The care of pregnant women with disorders of glucose metabolism is a satisfying part of diabetes care but outcomes remain less than ideal. The evidence base to improve care has grown over subsequent decades and clinicians will welcome up‐to‐date NICE guidance on this topic. This review looks at the guidance from the perspective of a secondary care diabetes team.     

妊娠高血压综合征并发妊娠肾病综合征22例临床分析

目的探讨分析妊娠肾病综合征临床特点和治疗方法.方法采用回顾分析方法,对2001年3月-2005年3月收治的22例妊娠高血压综合征(妊高征)并发妊娠肾病综合征与167例妊高征临床资料进行比较.结果妊娠肾病综合征发病孕周(27.8周)早于妊高征(31.4周,P<0.05).妊娠肾病综合征低蛋白血症发病率(100.0%),明显高于妊高征(42.0%,P<0.01).妊娠肾病综合征24 h尿蛋白定量(7.5 g/24 h)明显高于妊高征(4.1 g/24 h,P<0.05).妊娠肾病综合征血清清蛋白浓度(26.9 g/L)明显低于重度妊高征(30.6 g/L,P<0.05).妊娠肾病综合征胆固醇浓度(9.17 mmol/L)明显高于妊高征(7.4 mmol/L,P<0.05).妊娠肾病综合征新生儿出生体重(1 490 g)与妊高征(2 640 g)相比,有统计学意义(P<0.01).结论妊娠肾病综合征发病早,病情重,严重威胁孕产妇和胎儿安全.     

Drug use in pregnancy

Expected drug effects may be enhanced or lessened in a pregnant woman, and the known side effects may become more likely. Possibly devastating effects on the fetus must be considered. In the care of a pregnant patient and her unborn, medications should be used only when absolutely necessary (Figure 2). Sound advice is the old medical adage, "Primum non nocere"--first do no harm.     

Ectopic pregnancy--a brief review

Despite the advent of improved methods of diagnosis and therapy, ectopic pregnancy remains a significant cause of morbidity and mortality worldwide. The diagnosis is often difficult to make clinically, but should be included in the differential of any woman of gestational age presenting with lower abdominal pain, even with a normal menstrual history. With a high index of suspicion, improving methods of diagnosis such as the immunoassays for B-hCG and ultrasonography may lower mortality rates by enabling more diagnoses to be made before rupture. The significant infertility rate following ectopic pregnancy remains a problem despite newer, more conservative approaches to surgical therapy.     

Management of high risk cardiac conditions in pregnancy: Anticoagulation,severe stenotic valvular disease and cardiomyopathy

Cardiovascular disease contributes to approximately one third of all maternal mortality and remains a significant source of peri? and postpartum morbidity. As more women at risk for and with cardiovascular disease are desiring pregnancy, it is imperative that general cardiologists and obstetricians participate collaboratively in preconception counseling and are more facile with management of these lesions during peri? and postpartum periods. This review aims to address this growing need and highlights the management strategies for some of the major high risk cardiac conditions encountered during pregnancy including anticoagulation, cardiomyopathies as well as severe mitral and aortic stenosis; aortopathy, pulmonary hypertension, and severe congenital heart lesions will not be addressed.     

胚胎移植后第14天血清β-HCG水平预测妊娠结局的价值

目的评估胚胎移植（ET）后第14天单次血清β-HCG水平对妊娠结局的预测价值。方法选取因不孕症行ET后第14天测血清β-HCG证实为生化妊娠（β-HCG≥5IU／L）的患者共121例,分析其妊娠结局与血清β-HCG水平的关系。结果双胎妊娠者β-HCG水平明显高于单胎妊娠者,双胎和单胎妊娠者β-HCG水平明显高于早期流产和异位妊娠者。以β-HCG 180IU／L作为早期流产和正常妊娠的分界点,其阳性预测值为77．8％、阴性预测值为93．8％;以β-HCG〉650IU／L界定为双胎妊娠,其阳性预测值为90．9％、阴性预测值为95．2％。结论ET后第14天单次血清β-HCG水平是早期预测妊娠结局的良好指标。     

Diabetes in pregnancy outcomes: A systematic review and proposed codification of definitions

Rising rates of diabetes in pregnancy have led to an escalation in research in this area. As in any area of clinical research, definitions of outcomes vary from study to study, making it difficult to compare research findings and draw conclusions. Our aim was to compile and create a repository of definitions, which could then be used universally. A systematic review of the literature was performed on published and ongoing randomized controlled trials in the area of diabetes in pregnancy between 01 Jan 2000 and 01 Jun 2012. Other sources included the World Health Organization and Academic Society Statements. The advice of experts was sought when appropriate definitions were lacking. Among the published randomized controlled trials on diabetes and pregnancy, 171 abstracts were retrieved, 64 full texts were reviewed and 53 were included. Among the ongoing randomized controlled trials published in ClinicalTrials.gov, 90 protocols were retrieved and 25 were finally included. The definitions from these were assembled and the final maternal definitions and foetal definitions were agreed upon by consensus. It is our hope that the definitions we have provided (i) will be widely used in the reporting of future studies in the area of diabetes in pregnancy, that they will (ii) facilitate future systematic reviews and formal meta analyses and (iii) ultimately improve outcomes for mothers and babies. Copyright © 2015 John Wiley & Sons, Ltd.     

Intrahepatic cholestasis of pregnancy with marked elevation of transaminases in a black American

Summary A case of intrahepatic cholestasis of pregnancy (ICP) in a black American is presented. This is the first case reported in a black. Marked elevation of transaminases with mild biochemical evidence of cholestasis was initially suggestive of viral hepatitis. A clinical course characterized by pruritis with minimal constitutional symptoms, rapid resolution of biochemical abnormalities after delivery, and negative hepatitis A and B serologies was consistent with the diagnosis of ICP. Review of the classic features of ICP with emphasis on some unusual aspects of the disorder is included.     

妊娠晚期生殖道感染检测分析及对妊娠结局的影响

目的分析妊娠晚期生殖道微生物感染状况及其对妊娠结局的影响,为临床防治提供理论依据。方法选取2015年3月—2019年3月我院收治的286例妊娠晚期妇女为研究对象,入组孕妇均进行生殖道病原微生物感染的检测,分析生殖道微生物感染状况,并观察妊娠晚期生殖道感染对妊娠结局的影响。结果入组286例妊娠晚期妇女,52例(18.18%)出现生殖道病原微生物感染,其中2.10%(6/286)为滴虫感染,11.89%(34/286)为解脲支原体感染,1.40%(4/286)为沙眼衣原体感染,6.64%(19/286)为假丝酵母菌感染,共11例合并有2种或2种以上微生物感染,占3.85%;此外,妊娠晚期生殖道存在微生物感染者早产、胎膜早破、产褥期感染、胎儿窘迫、新生儿窒息和新生儿感染等不良妊娠结局发生率均明显高于无微生物感染者(P均<0.05);多重微生物感染者早产发生率明显高于单一微生物感染者(P<0.05);治愈组不良妊娠结局发生率明显低于无效组(P<0.05)。结论妊娠晚期生殖道微生物感染以解脲支原体、假丝酵母菌较为常见,且妊娠晚期生殖道微生物感染会增加孕妇不良妊娠结局发生风险,多重微生物感染会增加妊娠妇女的早产发生率,临床上可据此为妊娠期妇女制定合理的防治方案,对确保母婴良好结局有重要临床意义。     

Serum proinsulin in normal and gestational diabetic pregnancy

Summary The concentration of proinsulin-like components (PLC) in serum has been determined by gel filtration on samples obtained from eight normal pregnant women and eight nonobese gestational diabetics. The normal women were investigated early in pregnancy and all subjects were investigated in mid pregnancy, late pregnancy, and postpartum. At each occasion, samples were obtained after an overnight fast and after glucose ingestion. In both groups, the concentration of PLC in serum after overnight fast rose with gestation as well as after glucose ingestion, but there were no significant differences between mean levels of PLC of the normals and the gestational diabetics. With gestation, serum insulin rose in parallel with PLC in either group. The proportion of total insulin immunoreactivity composed by PLC thus remained constant and, furthermore, the proportions of PLC in gestation were equal to those observed postpartum. Four to six weeks after delivery, the basal concentration of PLC in serum was higher in the gestational diabetics than in the normals, whereas the concentrations of insulin were equal. Since the biological potency of proinsulin is much less than that of insulin, the results exclude the possibility that the decrease of glucose tolerance in normal pregnant women and gestational diabetics is due to an increased concentration of proinsulin in serum.     

Pregnancy before and after the diagnosis of inflammatory bowel diseases: retrospective case-control study

BACKGROUND AND AIM: Inflammatory bowel diseases (IBD) commonly affect women during the reproductive years. The aim of the present study was to evaluate the reproductive histories of patients with ulcerative colitis (UC) and Crohn's disease (CD) considering pregnancies occurring before and after the diagnosis. METHOD: Case-control study evaluating IBD patients, interviewed by questionnaire about outcome of pregnancy and course of disease. RESULTS: A total of 502 pregnancies from 199 patients in the prediagnosis group and 121 pregnancies from 90 patients in the post-diagnosis group were respectively compared with 996 and 204 pregnancies recorded in a control population. In prediagnosis pregnancies, CD was associated with increased risk of preterm delivery (odds ratio [OR] 4.62, 95% confidence interval [CI] 2.77-7.73; P < 0.001 vs controls and OR 3.52, 95% CI 1.75-7.07; P < 0.001 vs UC) and lower birthweight (P < 0.001 vs UC and controls). In post-diagnosis pregnancies, the rate of live births was lower, but not statistically significant in IBD (OR 0.22, 95% CI 0.04-1.25; P = 0.08) and the birthweight was significantly lower in CD than in UC (P < 0.03) and in controls (P < 0.02). In post-diagnosis pregnancies, a higher incidence of congenital abnormalities was found in IBD patients (5.5% vs 0.0%). The spontaneous abortion rate and therapeutic abortions were significantly higher in post than in prediagnosis pregnancies. Neither disease activity at conception nor treatment appeared to influence the outcome of pregnancy. CONCLUSIONS: CD in the preclinical phase has some influence on pregnancy. In patients with IBD our data suggest that conception should not be discouraged. However, because of a modest increase in mild congenital abnormalities and abortions rates, pregnancy in IBD patients should be closely monitored.     

Acute myocardial infarction during pregnancy: A clinical checkmate

Acute myocardial infarction (AMI) in pregnancy is associated with high morbidity and mortality. Management of these patients can be challenging as little is known about the optimal management strategy. Medications routinely used may have harmful effects on the pregnancy outcome. In addition, AMI could occur in the absence of atherosclerotic disease. We describe optimal management strategy by eliciting the management of a 45-year-old female with ST segment elevation myocardial infarction. We recommend early use of coronary angiography to define the pathology in such cases. Radial artery assess should be preferred. Pregnant patients with AMI due to atherosclerotic disease should be given a 325 mg of aspirin and 600 mg of clopidogrel and either balloon angioplasty or bare metal stent should be used for revascularization. Percutaneous coronary intervention with heparin is preferred over bivalirudin and later should be reserved for patients with severe heparin allergy.     

抗反转录病毒治疗时机选择对妊娠合并HIV感染者妊娠结局影响的研究

目的研究抗反转录病毒治疗时机选择,明确其对妊娠合并HIV感染者妊娠结局的影响。方法选取2015年1月—2018年1月我院收治的103例妊娠合并HIV感染者作为研究对象,根据抗反转录病毒治疗时机不同分为2组,其中在孕28周以内行抗反转录病毒治疗的患者作为研究组(n=74例);在孕28周及以后行抗反转录病毒治疗,且至分娩间隔时间不少于1个月的患者作为对照组(n=29例)。观察2组患者抗病毒治疗效果、妊娠结局及18月龄儿HIV感染随访情况。结果行抗反转录病毒治疗后,分娩前1 d研究组患者病毒载量下降幅度大于对照组(P<0.05);研究组患者早产比例为2.70%,显著低于对照组(P<0.05)。结论妊娠合并HIV感染者尽早实施抗反转录病毒治疗对于降低母体病毒载量和胎儿早产率具有重要意义。     

Fertility and pregnancy in inflammatory bowel disease

INTRODUCTION Inflammatory bowel disease(IBD)is a chronic disorder affecting young adults in the reproductive years.It is comon for both female and male patients with IBD to ask questions about IBD's effect on their relationships,sexual and reproductive function,in particular fertility,the outcome of pregnancy and its possible effets on the disease.An open discussion of the social situation and education targeted at these issues therefore forms an essential part of the management of any young person with IBD.the questions that are most commonly asked are summarised in Table 1.In order to answer these questions we need evidence.There are few large prospective case controlled studies to provide the information which is required but the available data,some of it from small observational studies,will be summarised in this chapter.