慢性高血压合并妊娠患者的母儿结局及其影响因素

目的通过分析慢性高血压合并妊娠患者的母儿结局,探讨导致母儿不良预后的高危因素。方法2000年1月至2005年12月北京大学第一医院分娩产妇14127例,其中慢性高血压合并妊娠患者121例,分为慢性高血压并发子痫前期组（PE组,64例）和未并发子痫前期组（N-PE组,57例）,对两组患者的母儿结局进行分析,找出导致母儿不良预后的高危因素。结果（1）慢性高血压合并妊娠的发病率为0．86％（121／14127）。（2）胎盘早剥、肺水肿和视网膜病变的发生率：PE组分别为16％（10／64）、11％（7／64）和41％（26／64）,N-PE组分别为2％（1／57）、0和16％（9／57）,两组分别比较,差异均有统计学意义（P〈0．05）。（3）早产率和〈32周的早产率：PE组分别为55％（35／64）和27％（17／64）,N—PE组分别为16％（9／57）和2％（1／57）,两组分别比较,差异均有统计学意义（P〈0．01）。（4）小于胎龄儿（SGA）发生率：PE组为31％（20／64）,N-PE组为7％（4／57）,两组比较。差异有统计学意义（P〈0．01）。（5）围产儿病死率和新生儿转重症监护室的发生率：PE组分别为11％（7／64）和33％（21／64）,N-PE组分别为0和5％（3／57）,两组分别比较,差异有统计学意义（P〈0．01）。（6）单因素分析表明,慢性高血压病史≥4年、未系统治疗、未定期产前检查和有子痫前期病史等是影响慢性高血压并发子痫前期母儿结局的高危因素（P〈0．05）。而多因素logistic回归分析表明,只有慢性高血压病史≥4年是影响慢性高血压合并子痫前期母儿结局的独立危险因素（P〈0．05）。结论慢性高血压合并子痫前期患者的母儿病率和围产儿病死率明显高于未合并子痫前期者。慢性高血压病史≥4年是导致慢性高血压合并子痫前期的独立危险因素。     

妊娠期血小板减少程度对母儿结局的影响

目的 比较妊娠期不同程度血小板减少对母儿结局的影响.方法 回顾性分析2000年1月1日至2010年1月31日本院收治的妊娠期血小板减少病例305例,病因学诊断分别为妊娠期血小板减少症、特发性血小板减少性紫癜及部分病因不明者.根据孕期最低血小板计数分成4组:I组:(50～100) ×109/L;Ⅱ组:(30～50)×109/L;Ⅳ组:(10～30)×109/L;Ⅳ组:＜10×109/L.Ⅰ～Ⅳ组病例数依次为101、85、87和32例.比较各组患者孕期并发症、治疗、新生儿结局和随访情况.应用SPSS 17.0统计软件进行数据处理,采用方差分析、Spearman等级相关分析、卡方检验、趋势卡方分析.结果 305例孕妇并发贫血68例(22.30%),早产40例(13.11%),产后出血60例(19.67%),患病率均随血小板减少程度加重而升高(P均＜0.05),产后24 h内出血量随血小板减少程度加重而增多.孕期并发妊娠期高血压疾病35例(11.48%),糖代谢异常23例(7.54%),各组患病率差异均无统计学意义.产褥感染2例(0.66%),无孕产妇死亡.305例产妇随访血小板恢复者共211例(69.18%),产后半年内母体血小板恢复正常率Ⅰ～Ⅳ组依次为90.59%(77/85)、82.36%(42/51)、46.16%(24/52)和39.13%(9/23),随孕期血小板减少程度加重而恢复率下降(x2趋势=42.616,P趋势=0.000).活产儿301例,胎死宫内5例,早期新生儿死亡4例,新生儿血小板减少18例(5.98%),颅内出血1例.随母体血小板减少程度加重,新生儿血小板减少患病率增高(x2趋势=17.806,P趋势=0.000);16例新生儿血小板减少在出生后3～8周恢复正常,2例随访3年未恢复.结论 随着血小板减少程度加重,母体贫血、早产、产后出血及新生儿血小板减少的患病风险均有增加.严密的围产期保健可改善不同程度血小板减少患者的母儿结局.

Abstract：

Objective To investigate the perinatal outcomes of pregnancies complicated with varying degrees of thrombocytopenia.Methods Clinical data of 305 pregnant women with thrombocytopenia,who admitted to Peking University People's Hospital from January 1,2000 to January 31,2010 were retrospectively analyzed.The etiological diagnosis of them were gestational thrombocytopenia (GT),idiopathic thrombocytopenic purpura (ITP) or undetermined.The patients were divided into 4 groups according to the minimal level of platelets in pregnancy ( platelets count was lower than 100 ×109/L at least twice) : groupⅠ,(50-100) ×109/L (n=101) ; group Ⅱ,(30-50) × 109/L (n = 85); group Ⅲ,(10-30) × 109/L (n = 87); group Ⅳ,< 10 × 109/L (n = 32).Demographic data such as pregnancy complications,treatment,neonates and follow-up results of the patients in each group were compared with ANOVA,Spearman rank correlation analysis,Chirsquare test and Chi-square trend test in SPSS 17.0.Results Medical complications in pregnancy of these patients included hypertensive disorder complicating (n = 35,11.48%) and abnormal glucose metabolism (n=23,7.54%),no difference was found in the incidence of these diseases among the four groups.There were 68 patients complicated with anemia (22.30%),40 preterm delivery (13.11%),60 postpartum hemorrhage (19.67%); there were significant differences in the incidence among the four groups (P＜0.05),the incidence increased with the aggravation of thrombocytopenia (P＜0.05).There were 2 cases of puerperal infection (0.66%),no maternal deaths.Fifty-one patients (16.72%) accepted treatment of corticosteroids or Gamma globulin during pregnancy.There were 116 cases (38.03%) of vaginal delivery and 189 cases (61.97%) of cesarean section.The postpartum bleeding amount within 24 hours increased with the aggravation of thrombocytopenia.Two hundred and eleven (69.18%) patients were followed up and platelet count regained normal,among which 152 cases recovered within six months after delivery.The recovery rates were 90.59% (77/85),82.36% (42/51),46.16% (24/52) and 39.13% (9/23) from group Ⅰ to group Ⅳ,as declined with the aggravation of thrombocytopenia in pregnancy ( x2trend = 42.616,Ptrend =0.000).Among the 306 perinatal fetuses,neonatal outcomes included 301 live births,5 fetal deaths,4 early neonatal deaths,4 low birth-weight infants after term birth,1 intracranial hemorrhage and 18 (5.98%) neonatal thrombocytopenia cases.Incidence of neonatal thrombocytopenia increased with the aggravation of maternal thrombocytopenia.Sixteen cases of neonatal thrombocytopenia recovered at 3-8 weeks after birth,but two cases did not recover within three years during followed up.Conclusions The perinatal outcomes are different in pregnancies complicated with varying degrees of thrombocytopenia.As thrombocytopenia in pregnancy become worse,the risk of anemia,premature delivery,postpartum hemorrhage and neonatal thrombocytopenia increases.While,perinatal outcomes may be better under close perinatal care.     

妊娠期血小板减少程度对母儿结局的影响

Objective To investigate the perinatal outcomes of pregnancies complicated with varying degrees of thrombocytopenia.Methods Clinical data of 305 pregnant women with thrombocytopenia,who admitted to Peking University People's Hospital from January 1,2000 to January 31,2010 were retrospectively analyzed.The etiological diagnosis of them were gestational thrombocytopenia (GT),idiopathic thrombocytopenic purpura (ITP) or undetermined.The patients were divided into 4 groups according to the minimal level of platelets in pregnancy ( platelets count was lower than 100 ×109/L at least twice) : groupⅠ,(50-100) ×109/L (n=101) ; group Ⅱ,(30-50) × 109/L (n = 85); group Ⅲ,(10-30) × 109/L (n = 87); group Ⅳ,< 10 × 109/L (n = 32).Demographic data such as pregnancy complications,treatment,neonates and follow-up results of the patients in each group were compared with ANOVA,Spearman rank correlation analysis,Chirsquare test and Chi-square trend test in SPSS 17.0.Results Medical complications in pregnancy of these patients included hypertensive disorder complicating (n = 35,11.48%) and abnormal glucose metabolism (n=23,7.54%),no difference was found in the incidence of these diseases among the four groups.There were 68 patients complicated with anemia (22.30%),40 preterm delivery (13.11%),60 postpartum hemorrhage (19.67%); there were significant differences in the incidence among the four groups (P＜0.05),the incidence increased with the aggravation of thrombocytopenia (P＜0.05).There were 2 cases of puerperal infection (0.66%),no maternal deaths.Fifty-one patients (16.72%) accepted treatment of corticosteroids or Gamma globulin during pregnancy.There were 116 cases (38.03%) of vaginal delivery and 189 cases (61.97%) of cesarean section.The postpartum bleeding amount within 24 hours increased with the aggravation of thrombocytopenia.Two hundred and eleven (69.18%) patients were followed up and platelet count regained normal,among which 152 cases recovered within six months after delivery.The recovery rates were 90.59% (77/85),82.36% (42/51),46.16% (24/52) and 39.13% (9/23) from group Ⅰ to group Ⅳ,as declined with the aggravation of thrombocytopenia in pregnancy ( x2trend = 42.616,Ptrend =0.000).Among the 306 perinatal fetuses,neonatal outcomes included 301 live births,5 fetal deaths,4 early neonatal deaths,4 low birth-weight infants after term birth,1 intracranial hemorrhage and 18 (5.98%) neonatal thrombocytopenia cases.Incidence of neonatal thrombocytopenia increased with the aggravation of maternal thrombocytopenia.Sixteen cases of neonatal thrombocytopenia recovered at 3-8 weeks after birth,but two cases did not recover within three years during followed up.Conclusions The perinatal outcomes are different in pregnancies complicated with varying degrees of thrombocytopenia.As thrombocytopenia in pregnancy become worse,the risk of anemia,premature delivery,postpartum hemorrhage and neonatal thrombocytopenia increases.While,perinatal outcomes may be better under close perinatal care.     

妊娠期血小板减少程度对母儿结局的影响

Objective To investigate the perinatal outcomes of pregnancies complicated with varying degrees of thrombocytopenia.Methods Clinical data of 305 pregnant women with thrombocytopenia,who admitted to Peking University People's Hospital from January 1,2000 to January 31,2010 were retrospectively analyzed.The etiological diagnosis of them were gestational thrombocytopenia (GT),idiopathic thrombocytopenic purpura (ITP) or undetermined.The patients were divided into 4 groups according to the minimal level of platelets in pregnancy ( platelets count was lower than 100 ×109/L at least twice) : groupⅠ,(50-100) ×109/L (n=101) ; group Ⅱ,(30-50) × 109/L (n = 85); group Ⅲ,(10-30) × 109/L (n = 87); group Ⅳ,< 10 × 109/L (n = 32).Demographic data such as pregnancy complications,treatment,neonates and follow-up results of the patients in each group were compared with ANOVA,Spearman rank correlation analysis,Chirsquare test and Chi-square trend test in SPSS 17.0.Results Medical complications in pregnancy of these patients included hypertensive disorder complicating (n = 35,11.48%) and abnormal glucose metabolism (n=23,7.54%),no difference was found in the incidence of these diseases among the four groups.There were 68 patients complicated with anemia (22.30%),40 preterm delivery (13.11%),60 postpartum hemorrhage (19.67%); there were significant differences in the incidence among the four groups (P＜0.05),the incidence increased with the aggravation of thrombocytopenia (P＜0.05).There were 2 cases of puerperal infection (0.66%),no maternal deaths.Fifty-one patients (16.72%) accepted treatment of corticosteroids or Gamma globulin during pregnancy.There were 116 cases (38.03%) of vaginal delivery and 189 cases (61.97%) of cesarean section.The postpartum bleeding amount within 24 hours increased with the aggravation of thrombocytopenia.Two hundred and eleven (69.18%) patients were followed up and platelet count regained normal,among which 152 cases recovered within six months after delivery.The recovery rates were 90.59% (77/85),82.36% (42/51),46.16% (24/52) and 39.13% (9/23) from group Ⅰ to group Ⅳ,as declined with the aggravation of thrombocytopenia in pregnancy ( x2trend = 42.616,Ptrend =0.000).Among the 306 perinatal fetuses,neonatal outcomes included 301 live births,5 fetal deaths,4 early neonatal deaths,4 low birth-weight infants after term birth,1 intracranial hemorrhage and 18 (5.98%) neonatal thrombocytopenia cases.Incidence of neonatal thrombocytopenia increased with the aggravation of maternal thrombocytopenia.Sixteen cases of neonatal thrombocytopenia recovered at 3-8 weeks after birth,but two cases did not recover within three years during followed up.Conclusions The perinatal outcomes are different in pregnancies complicated with varying degrees of thrombocytopenia.As thrombocytopenia in pregnancy become worse,the risk of anemia,premature delivery,postpartum hemorrhage and neonatal thrombocytopenia increases.While,perinatal outcomes may be better under close perinatal care.     

重度子痫前期终止妊娠时间对母儿预后的影响

目的探讨重度子痫前期患者终止妊娠时间对母儿预后的影响。方法回顾分析2000-01—2005—06，福建医科大学附属第一医院妇产科收治的91例重度子痫前期患者的资料，按入院确诊至终止妊娠的时间分为三组。A组：确诊后24h终止妊娠，B组：确诊后24—48h终止妊娠，C组：确诊后〉48h终止妊娠。对三组患者母儿预后进行分析。结果（1）三组患者实验室检查均提示有凝血功能及肝肾功能障碍，三组患者间终止妊娠前低蛋白血症及蛋白尿发生率比较差异有显著性意义（P〈0．05）。（2）C组患者HEUP综合征发生率低，与其他两组比较差异有显著性意义（P〈0．05）。（3）三组围生儿结局比较，C组胎儿生长受限（FGR）及早产儿发生率最高，分别是48．6％和68．6％。（4）三组间分娩方式的比较差异有显著性意义（P〈0．05），三组患者剖宫产率均高于阴道分娩率，C组剖宫产率达91．4％。结论重度予痫前期患者应根据病情轻重、发病孕周及胎儿宫内状况采取个体化的治疗方案，选择恰当的时机终止妊娠，能取得较好的母婴结局。保守治疗时应实施严密监护。     

21年糖尿病合并妊娠88例母儿结局的临床分析

目的：研究糖尿病患者孕期血糖控制对妊娠结局的影响。方法：回顾性分析1981－2001年间88例糖尿病孕妇孕期血糖水平与妊娠结局的关系。88例患者中2例行中期引产，1例行人工流产，将其余85例分为两组：孕期血糖控制满意者42例（A组），血糖控制不满意或未控制者43例（B组）。结果：B组胎死宫内5例，其中3例发生在围产期，A组无一例发生胎死宫内（P值为0．069）。B组妊高征及早产发生率分别为44．2％和30．2％，显著高于A组的21．4％和9．2％（P值分别为0．026和0．017）；B组新生儿窒息发生率为24．4％，显著高于A组的4．8％（P值为0．011）；新生儿畸形9例（10．2％）。结论：加强糖尿病患者孕前及孕期血糖控制和监测，可明显地减少孕产妇合并症、围产儿病率及死亡率，改善母儿结局。     

妊娠合并甲状腺功能亢进症对妊娠结局的影响

妊娠合并甲状腺功能亢进症是产科的常见病,最常见病因为Graves病。国内报道妊娠合并甲状腺功能亢进症发病率为0.1％～0.2％。该病可以导致妊娠相关并发症的发生风险增加,导致流产、早产、胎儿生长受限、妊娠期高血压疾病以及低出生体重儿等不良妊娠结局。     

妊娠合并风湿性心脏病患者心功能状态对妊娠结局的影响

目的探讨妊娠合并风湿性心脏病患者心功能状态对妊娠结局的影响。方法对1993年1月至2006年7月在我院产科分娩的、资料齐全的65例妊娠合并风湿性心脏病患者的临床资料进行回顾性分析。根据患者的二尖瓣狭窄程度分为二尖瓣正常组20例（瓣口面积〉4．0cm^2）、轻度狭窄组11例（瓣口面积2．5—4．0cm^2）、中度狭窄组14例（瓣121面积1．5—2．5cm^2）以及重度狭窄组20例（瓣口面积〈1．5cm^2）;根据是否伴有肺动脉高压分为正常压力组33例[肺动脉压〈30mmHg（1mmHg=0．133kPa）]、轻度升高组18例（肺动脉压31—49mmHg）、中度升高组7例（肺动脉压50～79mmHg）和重度升高组7例（肺动脉压≥80mmHg）;根据孕前是否进行心脏手术分为心脏手术组14例和非心脏手术组51例;根据患者的不同心功能状态分为Ⅰ级组24例、Ⅱ级组13例、Ⅲ级组13例、Ⅳ级组15例,观察各组的围产儿结局。分析以上各种因素对妊娠合并风湿性心脏病患者妊娠结局的影响。结果（1）二尖瓣正常组患者心功能Ⅰ～Ⅱ级者为80％（16／20）,Ⅳ级组患者中,80％（12／15）在中度狭窄组（6例）及重度狭窄组（6例）,与二尖瓣正常组和轻度狭窄组的心功能Ⅳ级发生率（20％,3／15）比较,差异有统计学意义（P〈0．05）。（2）正常压力组患者心功能Ⅰ～Ⅱ级者为73％（24／33）,重度升高组患者心功能Ⅳ级的发生率（6／7）明显高于心功能Ⅰ级的发生率（1／7）,两者比较,差异有统计学意义（P〈0．05）。（3）心脏手术组患者心功能Ⅰ～Ⅱ级发生率为71％（10／14）,Ⅲ级和Ⅳ级的发生率均为14％（2／14）,前后两者比较,差异有统计学意义（P〈0．05）;非心脏手术组患者Ⅰ～Ⅳ级心功能发生率之间分别比较,差异均无统计学意义（P〉0．05）。（4）心功能Ⅰ～Ⅲ级组患者的平均孕周及新生儿平均出生体重分别比较,差异无统计学意义（P〉0．05）;而心功能Ⅳ级组平均孕周为（34．6±3．1）周,新生儿平均出生体重为（2176±186）g,明显低于心功能Ⅰ级组,两组比较,差异有统计学意义（P〈0．05）。心功能Ⅲ～Ⅳ级组患者中,共发生医源性流产和引产9例（14％,9／65）,医源性早产18例（28％,18／65）,胎儿生长受限4例（6％,4／65）,围产儿死亡3例（5％,3／65）;而心功能Ⅰ～Ⅱ级组患者以上指标均为0。（5）65例妊娠合并风湿性心脏病患者中合并心房纤颤者7例,其心功能Ⅲ～Ⅳ级（心功能衰竭）的发生率为6／7。结论妊娠合并风湿性心脏病患者伴中、重度二尖瓣狭窄、重度肺动脉压升高及心房纤颤,容易发生心功能衰竭危及生命,不宜妊娠。已妊娠者应尽早终止妊娠;心功能Ⅲ～Ⅳ级的妊娠合并风湿性心脏病患者的医源性流产、早产和围产儿病率均增加,围产儿结局不良。     

重度子癎前期终止妊娠时间对母儿预后的影响

目的探讨重度子癎前期患者终止妊娠时间对母儿预后的影响。方法回顾分析2000-01-2005-06,福建医科大学附属第一医院妇产科收治的91例重度子癎前期患者的资料,按入院确诊至终止妊娠的时间分为三组。A组:确诊后24h终止妊娠,B组:确诊后24~48h终止妊娠,C组:确诊后>48h终止妊娠。对三组患者母儿预后进行分析。结果(1)三组患者实验室检查均提示有凝血功能及肝肾功能障碍,三组患者间终止妊娠前低蛋白血症及蛋白尿发生率比较差异有显著性意义(P<0·05)。(2)C组患者HELLP综合征发生率低,与其他两组比较差异有显著性意义(P<0·05)。(3)三组围生儿结局比较,C组胎儿生长受限(FGR)及早产儿发生率最高,分别是48·6%和68·6%。(4)三组间分娩方式的比较差异有显著性意义(P<0·05),三组患者剖宫产率均高于阴道分娩率,C组剖宫产率达91·4%。结论重度子癎前期患者应根据病情轻重、发病孕周及胎儿宫内状况采取个体化的治疗方案,选择恰当的时机终止妊娠,能取得较好的母婴结局。保守治疗时应实施严密监护。     

剖宫产术时全身麻醉对妊娠合并严重血小板减少产妇母儿结局的影响

目的 探讨全身麻醉在妊娠合并严重血小板减少产妇剖宫产术时对母儿结局的影响.方法 选取2003年1月至2008年12月在北京大学人民医院产科因血小板计数<50×10~9/L、孕周>35周而住院分娩的单胎妊娠产妇65例,随机选取其中35例采用全身麻醉行剖宫产分娩(全身麻醉组),30例采用局部浸润麻醉行剖宫产分娩(局部麻醉组).观察全身麻醉组产妇麻醉诱导至胎儿娩出时间,并比较两组产妇从切开皮肤至胎儿娩出的时间、手术时间、麻醉前后血氧饱和度、术中出血量、新生儿Apgar评分、新生儿出生体重、脐动静脉血气分析结果.结果 全身麻醉组产妇麻醉诱导至胎儿娩出时间平均为(9.7±3.5)min.(1)全身麻醉组产妇从切开皮肤至胎儿娩出的时间[(7.7±2.5)min]显著短于局部麻醉组[(12.5±3.0)min],两组比较,差异有统计学意义(P<0.01);但总手术时间两组比较,差异无统计学意义(P>0.05).(2)麻醉前后血氧饱和度在全身麻醉组产妇分别为(97.9±1.3)%及(98.1±1.1)%,局部麻醉组产妇分别为(98.3±1.2)%及(98.6±0.8)%,两组分别比较,差异均无统计学意义(P>0.05).(3)全身麻醉组及局部麻醉组产妇剖宫产术中出血量[分别为(471±245)及(452±213)ml]比较,差异无统计学意义(P>0.05).(4)两组新生儿1分钟Apgar评分比较,差异无统计学意义(P>0.05);5分钟Apgar评分均为10分.(5)局部麻醉组有2例发生新生儿轻度窒息,全身麻醉组无新生儿窒息发生;两组新生儿出生体重比较,差异无统计学意义(P>0.05).(6)两组新生儿血气分析结果比较,差异无统计学意义(P>0.05).结论 对妊娠合并严重血小板减少产妇选择全身麻醉行剖宫产术是安全的,对母儿结局无不良影响.     

妊娠合并大动脉炎的回顾性分析

目的:分析妊娠合并大动脉炎(TA)的妊娠结局，了解TA与妊娠之间的相互影响。方法:回顾性分析2012年1月至2022年2月在北京协和医院妇产科住院分娩的34例妊娠合并TA患者的35次妊娠的临床特征、实验室检查、影像学结果、治疗方案、妊娠并发症和母儿结局等。分析TA类型、TA活动性与不良妊娠结局及母儿结局的相关性，以及妊娠前后TA的活动性变化。结果:患者平均年龄为30.00±4.05岁。活产率为94.3%,活产病例分娩孕周为36.63±2.50周。不良母儿结局的发生率为37.1%(13/35),其中子痫前期占14.3%(5/35),流产或早产占37.1%(13/35),胎儿窘迫占17.1%(6/35),胎儿生长受限占20.0%(7/35)。8.6%(3/35)的病例在妊娠期间发生心衰，2.9%(1/35)发生肺动脉高压。9例次活动性TA患者的早产或流产、心衰和(或)肺动脉高压的发生率高于26例次非活动性TA的孕妇，差异有统计学意义(P<0.05)。TA不同分型组间子痫前期的发生率比较，差异有统计学意义(P<0.05)。31例次孕前确诊TA的患者在妊娠期间与妊娠前相比，TA的活...     

子宫畸形合并妊娠母儿妊娠结局临床分析

目的探讨妊娠合并子宫畸形对于母儿妊娠结局的影响。方法选取北京大学人民医院收治的妊娠合并子宫畸形患者108例,并以372例正常子宫妊娠患者作为对照,对其临床资料进行回顾性分析。结果①在29245例分娩的病例中,妊娠合并子宫畸形共108例,发生率约为0.4%。其中以子宫纵膈最为常见,占49.1%,其次为双子宫,占21.3%;②子宫畸形合并妊娠的患者中,胎位异常发生率（46.3%）及剖宫产率（73.2%）均显著升高;③子宫畸形组的平均孕周（37.2周）,新生儿平均出生体重（2873g）显著低于对照组,而早产率（24.1%）及足月低体重儿发生率（6.5%）均显著高于对照组;④纵膈子宫、单角子宫（83.3%合并残角子宫）、双角子宫、及双子宫在终止妊娠方式上存在差异,剖宫产率在纵膈子宫为最低（64.2%）。各组在早产率、孕周、胎儿体重方面差异无统计学意义（P〉0.05）。结论子宫畸形对于妊娠结局可产生不良影响,临床医生应加强孕前及孕期管理。     

延期妊娠引产对母儿结局的影响

目的:探讨引产对延期妊娠母儿结局的影响.方法:回顾性分析延期妊娠孕妇437例,其中引产组276例,自然临产组16l例.结果:①引产组的剖宫产率、平均住院日明显高于自然临产组,差异有统计学意义(P<0.05);②引产组和自然临产组的产后出血发生率、产褥病率、产时损伤发生率比较差异无统计学意义(P>0.05);③羊水Ⅲ度粪染发生率、新生儿窒息发生率两组比较差异有统计学意义(P<0.05).结论:对延期妊娠孕妇是否进行引产,需进行综合评价,选择适合孕妇的期待或引产方案.     

妊娠合并子宫肌瘤的母儿结局分析

目的 探讨子宫肌瘤与妊娠、分娩及新生儿结局的关系。方法 采用回顾性分析方法对199l～2000年132例妊娠合并子宫肌瘤单胎分娩活婴出院病史进行分析，同时选择同期分娩无子宫肌瘤孕妇144例作对照比较。结果 妊娠合并子宫肌瘤(观察组)的孕期合并症发生率及产时并发症分别为44．70％和53．79％，对照组分别为1．39％和9．03％。两组相比，观察组新生儿Apgar评分≤7分者高于对照组，观察组低体重儿发生率高，早产儿增多。结论 子宫肌瘤明显增加了孕期、产时及围生儿并发症的可能性。     

双胎妊娠合并贫血与妊娠结局的分析

目的：探讨双胎妊娠合并贫血对妊娠结局的影响，方法：将496例双胎妊娠分为两组，妊娠合并贫血者（贫血组）共321例，其余175例为对照组，对两组病的妊高征，产前出血，产后出血，早产，胎膜早破发生率与平均孕周，平均出生体重分别进行对照分析。结果：贫血组妊高征，产后出血，早产，胎膜早破发生率显著高于对照组（P＜0．05），且贫血严重程度与妊高征，产后出血发生率呈正相关（P＜0．05），与平均孕周呈负相关（P＜0．05）。两组新生儿平均出生体重无显著差异（P＞0．05），但重度贫血病例的新生儿平均出生体重与对照组比较，有显著性差异（P＜0．05）。结论：双胎妊娠合并贫血时各种并发症发生率成倍增加，特别是重度贫血对孕产妇和围生儿有严重的威胁。     

妊娠合并大动脉炎

大动脉炎是一种原因不明的,慢性非特异性全身闭塞性动脉炎。主要累及主动脉及其分支和肺动脉、肾动脉。好发于育龄女性。大动脉炎可能导致动脉高血压、脑血管意外和心衰等。妊娠期间的大动脉炎可能导致妊娠期高血压疾病,胎儿生长受限,胎死宫内等不良妊娠结局。妊娠期应及时诊治,应根据孕周及具体病情,确定诊治方案。     

妊娠合并糖代谢异常并发先兆子痫对母儿结局影响的分析

目的 :探讨妊娠合并糖代谢异常并发先兆子痫母、儿的结局。方法 :收集1981至 2 0 0 3年糖代谢异常孕妇 12 0 2例的临床资料 ,其中 15 1例孕妇并发先兆子痫 ,按照有无先兆子痫的发生将孕妇分为先兆子痫组 (Ⅰ组 )和非先兆子痫组 (Ⅱ组 )。回顾分析比较两组孕妇、新生儿的结局。结果 :(1)I组孕妇早产、羊水过多、酮症、手术产的发生率明显高于II组 ,发生率分别为 2 1.2 %vs 6 .0 %、13.9%vs 6 .2 %、15 .2 %vs 7.4 %、71.5 %vs6 0 .7% (P <0 .0 1) ;两组孕妇胎死宫内、胎儿窘迫、宫内感染、产后出血的发生率比较 ,差异无统计学意义 (P >0 .0 5 ) ;(2 )I组与II组的新生儿结局比较 :两组新生儿患病率有明显差异 (P <0 .0 5 ) ,新生儿窒息、畸形、红细胞增多症、低血糖和高胆红素血症发生率分别为12 .0 %vs 3.9%、7.3%vs 3.1%、8.7%vs 2 .2 %、15 .3vs 5 .7%和 18.0 %vs 12 .3% ;两组大于胎龄儿和小于胎龄儿发生率分别为 17.2 %vs 11.3%、10 .6 %vs 1.9% ;新生儿转科(41.0 %vs 19.6 % ) ,差异有显著性 (P <0 .0 5 ) ;新生儿呼吸窘迫综合征 (NRDS)及围产儿死亡的发生率两组无统计学差异 (P >0 .0 5 )。结论 :妊娠合并糖代谢异常的孕妇一旦并发先兆子痫将增加糖代谢异常孕妇的并发症及新生儿的患病率。     

妊娠合并肝功能损害对妊娠结局的影响

目的探讨妊娠合并肝功能损害(妊娠肝损)对妊娠结局的影响.方法分析比较了80例妊娠肝损患者及同期随机抽查的56例非肝损患者(对照组)的临床资料.结果肝损组新生儿体重、分娩孕周均显著低于对照组(P＜0.05);肝损组羊水污染率明显高于对照组(P＜0.05),肝损组新生儿窒息率高于对照组,但无统计学差异;肝损组血ALT＞500nmoL@S-1/L患者与ALT＜500nmoL@S-1/L的患者相比,早产儿发生率明显增加(P＜0.05).结论妊娠肝损可影响新生儿的体重,且羊水污染机会明显增加,积极正确的处理可以使肝损患者安全度过围产期并能提高围生儿的生存质量.     

妊娠合并乙型肝炎病毒感染与母儿预后的关系

乙型病毒性肝炎(乙肝)是一种常见传染病，我国是乙肝高发区，感染率达10％。妊娠合并乙肝是常见的高危妊娠之一，对母亲可致产后出血、DIC，甚至引起孕产妇死亡，对围生儿可致早产、死胎、新生儿死亡和母婴传播。为探讨妊娠期HBV感染对母儿的影响，本文对我院147例妊娠合并HBV感染的病例进行回顾性分析，现报道如下。     

妊娠合并重度血小板减少病因分析及血小板水平对母儿结局的影响

目的:探讨妊娠合并重度血小板减少的病因及患者血小板水平对母儿结局的影响。方法:收集广州医科大学附属第三医院2014年1月至2017年6月收治的73例妊娠合并重度血小板减少患者,对其临床资料进行分析。进入围产期患者61例,根据妊娠期血小板计数(PLT)最低值分为两组:10×10~9/L组和(10～30)×10~9/L组,分析不同PLT水平对母儿结局的影响。结果:73例妊娠合并重度血小板减少患者中特发性血小板减少性紫癜占76. 71%,其次是妊娠相关性血小板减少症占9. 59%。进入围产期患者中位分娩孕周37周,剖宫产率55. 74%,产后出血发生率14. 75%;新生儿平均出生体质量2702 g,新生儿血小板减少7例。PLT 10×10~9/L组患者中位分娩孕周36周,分娩方式以剖宫产为主(P=0. 01),产后出血量明显增多(P=0. 04)。对患者分娩前PLT与产后出血量作相关分析,发现患者分娩前PLT与产后出血量呈负相关(r=-0. 32,P=0. 01)。分别对患者孕期最低PLT及分娩前PLT与新生儿PLT作相关分析,发现该两因素与新生儿PLT均无相关性(r=0. 29,P=0. 54; r=0. 18,P=0. 10)。结论:特发性血小板减少性紫癜和妊娠期血小板减少症是妊娠合并重度血小板减少的主要病因。尽早明确病因,提升血小板水平,可降低产后出血风险,改善母儿结局。