高龄妊娠对母胎结局的影响

目前高龄孕妇比例越来越高。随着妇女年龄的增长,其生育能力下降,糖、脂代谢异常,内、外科及妇科疾病发病率增加,这些高危因素均可导致高龄孕妇母胎不良结局增加。高龄孕妇的妊娠期糖尿病、妊娠期高血压疾病、前置胎盘、胎盘植入、胎儿畸形、流产、早产、巨大儿、胎儿生长受限等并发症升高。另外,剖宫产率增加,子宫破裂、产后出血、羊水栓塞、产后血栓风险也增加。本文通过分析高龄孕妇诸多高危因素,做好产前评估及孕期管理,是保证母婴安全的关键一步。     

产前B族链球菌感染对母儿的影响

目的　了解孕妇的Ｂ族链球菌（ＧＢＳ）带菌情况及对新生儿的影响。　方法　对１２０ 例产妇产前取阴道后穹窿分泌物,分娩后取胎盘子面分泌物及新生儿胃液分别检测ＧＢＳ,留脐血检测Ｃ反应蛋白、ＩｇＭ、ＩｇＧ 抗体,产后观察母婴情况并随访６ 周。　结果　产前母体ＧＢＳ带菌率１５－８％ ,胎盘带菌率１０ ％ ,新生儿带菌率３－３ ％ ,患病率０－８３ ％ 。ＧＢＳ阳性孕妇既往流产史多,胎膜早破、早产发生率较阴性者高（Ｐ＜ ０．０５） 。产时胎儿窘迫、羊水混浊及新生儿低体重、新生儿肺炎发生率虽比阴性者高,但无统计学意义。脐血Ｃ反应蛋白、ＩｇＭ、ＩｇＧ 无明显升高。　结论　为降低ＧＢＳ感染对围产期母儿的患病率,应对孕妇常规行ＧＢＳ筛检,阳性孕妇应给予预防性治疗并于产前复查,产时应对ＧＢＳ阳性孕妇及新生儿给予适当治疗以避免发生并发症。     

产科领域的弓形体感染

产科领域的弓形体感染中国医科大学附属二院（１１０００３）尚涛弓形体病是一种人畜共患疾病。患弓形体病或受其感染的孕妇除自身患病外，还可以通过胎盘传给胎儿，导致流产、早产、死胎、胎儿畸形，新生儿出现严重并发症。西方一些国家和地区人群感染率较高，故非常重视...     

胎盘对细菌病毒的通过性

孕妇感染后可能引起流早产,先天感染、先天异常、新生儿携带者,能影响后代。母儿垂直感染有意义的是胎内感染及产道感染,广义包括母乳感染。 细菌及病毒到达胎盘的途径与胎内感染途径大致相同,单纯从血行经羊水感染或经阴道上行羊水感染是不存在的。因为经血行或上行羊水感染均包含有胎盘组织。病原微生物经胎盘绒毛侵入胎盘产生胎盘的病理变化即胎盘感染,可经胎盘感染胎儿。     

弓形体感染与妊娠

我院自1988年1月至1969年7月,共收集标本100例,其中早孕97例,晚孕3例;早孕标本包括死胎死产30例,新生儿畸形史17例,多次流产史35例,早孕期发热14例,动物密切接触史1例.以上标本行血清学弓形体酶联免疫吸附试验(ELISA)。测定结果:弓形体IgM阳性者2例,经螺旋霉素治疗分娩正常新生儿。弓形体IgG阳性者19例,分别发生于各不良分娩史组.弓形体是细胞内寄生虫,感染后孕妇只表现轻微的症状,但对胎儿危害较重,易致死胎死产及胎儿畸形,故须引起重视.     

羊水基因芯片在中晚孕期的临床应用价值分析

目的:探讨羊水微阵列比较基因组杂交技术(aCGH)基因芯片在中晚孕期的临床应用价值及可行性。方法:对中晚孕期有介入性产前诊断指征,但孕妇不愿进行脐血穿刺的单胎孕妇进行羊膜腔穿刺术,抽取10ml羊水,应用aCGH进行分析(401例,单一羊水aCGH组),并与传统脐血染色体核型分析的病例(755例,染色体核型分析组)进行异常染色体检出率、检测出报告时间、术后并发症及检测失败率的比较。结果:单一羊水aCGH组的异常染色体检出率(8.5%)高于染色体核型分析组(4.0%),差异有统计学意义(P0.05)。单一羊水aCGH组发放报告的时间为7~10天,短于传统脐血染色体核型分析时间14~21天。单一羊水aCGH组检测失败率(0)低于染色体核型分析组(1.6%)(P0.05)。两组早产、先兆早产及胎死宫内发生率比较,差异无统计学意义(P0.05)。结论:中晚孕期羊水基因芯片分析是可行的,比传统脐血染色体核型分析有一定的优势。     

如何指导孕妇做好梅毒检查

梅毒是一种性病，主要由于男方或女一方患有梅毒，通过性交传染给对方。孕妇患有梅毒，可以通过胎盘使胎儿受染——胎传梅毒。可致流产、早产、死胎、早期新生儿死亡及低出生体重儿、致残率高。孕妇梅毒一、二期传染性最强，胎儿或婴儿预后不良。而早期治疗、彻底治疗可减少胎儿的致畸。     

弓形体病与先天性畸形

弓形体病原体在人体能产生轻微症状,但在孕期可通过胎盘对胎儿有较大威胁。自1986年11月至1987年7月,我们对6例畸形儿及同期有不良生育史者9例作了有关弓形体的研究与测定,以观察先天性弓形体感染与胎儿畸形关系。测定内容1.孕期:采孕妇及其丈夫血作弓形体间接血凝试验(IHA)、间接荧光抗体试验(IFA)、DNA杂交试验(应用DNA 重组技术建立的特异性弓形体探针来检测标本)。2.分娩期:取羊水、脐血测定IHA、IFA 及DNA 杂交试验。     

应用荧光定量聚合酶链反应技术诊断胎儿弓形虫感染

目的　探讨荧光定量聚合酶链反应 (FQ PCR )技术用于产前诊断胎儿弓形虫 (TOX)感染及其防治措施。方法　采用FQ PCR技术 ,检测 70例孕期TOXDNA阳性孕妇的羊水和 (或 )脐血的TOXDNA ,阳性者为胎儿TOX感染。对其中 48例TOX感染孕妇给予螺旋霉素常规剂量治疗 2个疗程 ,观察其治疗效果。结果　 (1) 70例TOXDNA阳性孕妇中 ,胎儿TOXDNA阳性 2 1例 ,胎儿宫内TOX感染率为 3 0 % ,羊水和脐血中的TOXDNA阴、阳性结果一致。 (2 )胎儿宫内TOX感染与孕妇血中TOXDNA含量高低有关 ,孕妇血中TOXDNA含量高时 ,对胎儿危害严重 ,胎儿宫内感染率也最高(5 5 % ) ;TOXDNA含量低时 ,胎儿宫内感染率也最低 (2 0 % ) ,两者比较 ,差异有显著性 (P <0 0 5 )。 (3 )经螺旋霉素治疗的孕妇 ,其胎儿宫内感染率为 2 1% ,明显低于未治疗者的 5 0 % ,两者比较 ,差异有显著性 (P <0 0 5 )。结论　孕妇TOX感染可危害胎儿 ,FQ PCR检测羊水中TOXDNA可准确地诊断胎儿TOX感染 ,孕期治疗可降低宫内TOX感染率     

常见宫内感染的母婴结局及干预对策

病原微生物可以通过下生殖道或胎盘传播进入宫腔，并可能导致多种不良的母婴结局，如流产、死产、早产、先天缺陷和远期后遗症等。其中较常见的感染来源包括性传播感染、经典的“TORCH”感染及一些新兴传染病。文章参考国际上最新研究和指南，对宫内感染机制、母婴结局及干预对策进行阐述，以优化宫内感染的孕期管理。     

孕期人乳头状瘤病毒亚临床感染的母婴传播及对胎婴儿的影响

目的　探讨孕中期、孕晚期人乳头状瘤病毒亚临床感染的母婴垂直传播情况及对胎婴儿的影响。方法　采用多聚酶链反应技术对 42例孕中期、32例孕晚期妇女的宫颈分泌物、母血、胎盘、羊水、脐血、新生儿咽部分泌物标本进行HPV - 6、11、16、18型DNA检测。结果　孕中期 :12例宫颈分泌物HPV阳性 (12 / 42 ) ,11例母血HPV阳性 (11/ 42 ) ,9例胎盘组织HPV阳性 (9/ 42 ) ,2 2例羊水标本中 ,仅 1例羊水HPV阳性 (1/ 2 2 ) ;孕晚期 :2 3例宫颈分泌物HPV阳性 (2 3/ 32 ) ,18例母血HPV阳性 (18/ 32 ) ,12例胎盘组织HPV阳性 (12 / 32 ) ,31例羊水及脐血标本中 ,4例羊水HPV阳性 (4/ 31) ,12例脐血HPV阳性 (12 / 31)。 17例异常胎婴儿中有 3例胎儿窘迫、1例新生儿高胆红素血症及 1例无脑畸形儿的脐血或胎盘组织HPV阳性。结论　孕期HPV感染的母婴传播不但可经产道直接接触传播 ,还可经血液、羊水及胎盘发生宫内传播 ,其宫内传播率的高低主要与母血的HPV感染相关。新生儿脐血的HPV感染主要与母血的HPV感染相关 ,而产时新生儿咽部的HPV感染主要与宫颈分泌物HPV感染相关。妊娠期HPV感染可能与胎儿窘迫、新生儿高胆红素血症、胎儿畸形有关     

Results of fetoscopic examinations at our hospital

From 1983 to 1985, antenatal diagnosis by fetoscopy under ultrasound guidance has been performed at our institute for 17 pregnant women between 15 and 34 weeks of gestation. Indications for fetoscopy were visualization of the fetus, placenta, and amniotic membrane for morphological anomaly and fetal blood sampling for coagulation disorder. The diagnosis, made by visual observation of the fetus, blood coagulation tests, and karyotyping revealed 12 normal fetuses and 5 abnormal fetuses (one having chromosome abnormality, one amniotic band syndrome, one cephalothracopagus, one Beckwith-Wiedemann syndrome, and one sacral tumor). Courses of pregnancy following fetoscopy resulted in four normal full-term deliveries, six premature deliveries due to four hydramnions and two spontaneous ruptures of the membrane more than 14 weeks after fetoscopy. Three other pregnancies were interrupted due to intrauterine fetal death 11 weeks after fetoscopy in one case and to therapeutic abortion for maternal complications such as toxemia of pregnancy in two cases. The outcome of one case was unknown because the mother had moved away. The other pregnancy is still under observation at the third trimester. Although no complications in the fetuses were seen following fetoscopy, complications in the mothers included two cases of genital bleeding, one case of amniotic fluid leakage, and one cases of abruption of the fetal membrane. Symptoms in all four cases disappeared during several days of bed rest. These results demonstrate the importance of fetoscopy in prenatal diagnosis.     

应用套式聚合酶链反应技术诊断人巨细胞病毒宫内感染

用套式聚合酶链反应（ＲＴ－ＰＣＲ）技术，对妊娠早、中期各３０例及妊娠晚期３１例孕妇进行母血、脐血及胎盘人巨细胞病毒（ＨＣＭＶ）ＤＮＡ测定。结果：早期妊娠妇女中，２０例ＨＣＭＶ阳性，其中８例发生宫内传播（绒毛组织中ＨＣＭＶ－ＤＮＡ阳性）；妊娠中期妇女中，２１例ＨＣＭＶ阳性，其中７例发生宫内传播（胎盘、脐血ＨＣＭＶ－ＤＮＡ阳性）；妊娠晚期妇女中，２３例ＨＣＭＶ阳性，其中１８例发生宫内传播。提示：套式Ｐ     

Prenatal diagnosis of fetal cytomegalovirus infection.

Twelve fetuses were evaluated with a combination of ultrasonography, amniocentesis, and blood sampling for possible cytomegalovirus infection. In seven the mother had a documented primary cytomegalovirus infection. All seven women had normal ultrasonographic findings and one fetus was found to be infected. In the other five cases fetal cytomegalovirus infection was diagnosed in association with abnormal ultrasonographic findings. There was no history of maternal infection in the latter group. All positive and negative diagnoses were confirmed and none of the six infected fetuses survived. In this series, the most reliable parameters of infection were the isolation of the virus from amniotic fluid and elevations of total immunoglobulin M and gamma-glutamyl transpeptidase in fetal blood. In the majority of infected fetuses cytomegalovirus-specific immunoglobulin M was not detected in blood. Prenatal diagnosis of fetal cytomegalovirus infection is possible with a combination of amniocentesis and fetal blood sampling.     

Acid-base relationship between mother and fetus in gestosis (pre-eclampsia) and in pregnant women with a labile blood pressure.

Simultaneous blood microsamples were taken from the maternal ear and uterine cervix and the fetus of healthy pregnant women, those with labile hypertension, and those with severe gestosis (pre-eclampsia). The po2, pH, BE and pco2 were studied. The fetuses showed no signs of asphyxia. The differences in BE values between the women withe gestosis and their fetuses were significantly greater than in the cases of healthy pregnancy. No differences were seen between healthy and gestotic gravida groups in po2, pH and pco2 values. This favours the opinion that in gestosis of the mother the fetus has a tendency to metabolic acidosis, which apparently places it in a poorer position than the fetuses of healthy mothers, should acute asphyxia occur. At the time of study the po2 of the fetuses of gravidas with a labile blood pressure was lower than that of fetuses of healthy gravidas.     

Role of peripheral blood mononuclear cell transportation from mother to baby in HBV intrauterine infection

Purpose

We aimed to investigate the role of peripheral blood mononuclear cell transportation from mother to baby in hepatitis B virus (HBV) intrauterine infection.

Methods

Thirty HBsAg-positive pregnant women in the second trimester and their aborted fetuses were included in this study. Enzyme-linked-immunosorbent-assay was utilized to detect HBsAg in the peripheral blood of pregnant women and the femoral vein blood of their aborted fetuses. HBV-DNA in serum and peripheral blood mononuclear cells (PBMC) and GSTM1 alleles of pregnant women and their aborted fetuses were detected by nested polymerase chain reaction (PCR) and seminested PCR, respectively. We also examined the location of placenta HBsAg and HBcAb using immunohistochemical staining. The expression of placenta HBV-DNA was detected by in situ hybridization.

Results

For the 30 aborted fetuses, the HBV intrauterine infection rate was 43.33 %. The HBV-positive rates of HBsAg in peripheral blood, serum, and PBMC were 10 % (3/30), 23.33 % (7/30), and 33.33 % (10/30), respectively. Maternal–fetal PBMC transport was significantly positively correlated with fetal PBMC HBV-DNA (P = 0.004). Meanwhile, the rates of HBV infection gradually decreased from the maternal side to the fetus side of placenta (decidual cells > trophoblastic cells > villous mesenchymal cells > villous capillary endothelial cells). However, no significant correlation between placenta HBV infection and HBV intrauterine infection was observed (P = 0.410).

Conclusions

HBV intrauterine infection was primarily due to peripheral blood mononuclear cell maternal–fetal transportation in the second trimester in pregnant women.     

Toxoplasmosis in pregnancy is still an open subject

OBJECTIVE: To assess the consequences of a systematic screening for toxoplasma infection in pregnant women in a potentially high risk population. METHODS: We have investigated all consecutive women with likely toxoplasma seroconversion in a referral center setting. Data were obtained from 68 women for whom an acute infection during pregnancy was considered likely or definite. They were all treated with antibiotics in the first instance and offered, if in the first or second trimester, amniocentesis for detection of vertical transmission (PCR and IFAT). Third trimester seroconversions and positive cases after amniocentesis were offered more aggressive antibiotic treatment. RESULTS: Five fetuses/neonates (7%) were found to be infected. Four of them were diagnosed prenatally at amniocentesis, two women decided for termination of pregnancy, two were treated and gave birth to seronegative, normally developing children. One case was found postnatally, after a third trimester conversion; this developed into hydrocephalus with neurologic impairment. DISCUSSION: Prenatal screening and antibiotic treatment of mothers infected with toxoplasmosis showed good feasibility in our infection-susceptible population. However, there were some weak points; for example, the high number of invasive procedures and the questionable prevention of mother to child transmission in the second to third trimester.     

抗磷脂综合征和前置胎盘的相关性研究

目的:探讨抗磷脂综合征(APS)和前置胎盘的关系。方法:选取我院180例APS孕妇,并随机选取同期正常孕妇360例作为对照组,分析两组前置胎盘的发生率,以及比较APS合并前置胎盘孕妇与单纯前置胎盘孕妇的妊娠结局。结果:APS组的前置胎盘发生率显著高于对照组(P<0.05);APS合并前置胎盘组的早产发生率、1分钟Apgar评分、羊水污染、产时出血量较单纯前置胎盘组显著增高(P<0.05)。结论:APS孕妇的前置胎盘的发生率以及早产、产后出血等较正常孕妇及单纯前置胎盘孕妇显著增高,早期诊治APS可减少不良妊娠结局的发生。     

Incidence of toxoplasmosis in 5532 pregnant women in Crete, Greece: management of 185 cases at risk

OBJECTIVES: To study the incidence of toxoplasmosis in pregnant women in Crete and to test a designed protocol for handling those at risk of delivering congenitally infected infants. STUDY DESIGN: Pregnant women were screened serologically over a period of 5 years. Cases with suspected acute toxoplasmosis were treated, peripheral blood (PB), and amniotic fluid (AF) tested by polymerase chain reaction (PCR) and culture, and fetuses monitored by ultrasonography. The absence of congenital infection in infants was confirmed by serology and clinical evaluation. RESULTS: Of the 5532 pregnant women followed, 70.57% remained seronegative, 29.45% were seropositive, and there was direct evidence of seroconversion in six cases. Acute toxoplasmosis was suspected in 185 cases, maternal parasitemia was detected in five cases and positive amniotic fluid in one case. Congenital infection was excluded in all infants followed, based on the absence of ultrasound findings in utero, lack of clinical symptoms at birth, negative Western blotting (WB) at birth and 3 months later, and descending serology for a year. CONCLUSION: Overall, 29.45% of the pregnant women followed were seropositive, 3.3% with suspected acute toxoplasmosis, and in 0.02% cases there was evidence of maternofetal transmission. The protocol tested allowed differentiation between acute and latent toxoplasmosis, safe management of the cases at risk and assisted in avoidance of unwarranted pregnancy terminations.