Volume and Type of Alcohol During Early Pregnancy and the Risk of Miscarriage

Background: Research on alcohol consumption during pregnancy and miscarriage spans over three decades, yet the relationship is still not well-understood. Objectives: To assess the relationship between volume and type of alcohol consumed during pregnancy in relation to miscarriage. Methods: We utilized data from a population-based cohort study of pregnant women (n = 1061) of which 172 (16%) women had a miscarriage. Upon study entry, participants were asked about their alcohol consumption during pregnancy. Based on the average number of drinks per week, women were categorized into one of three categories: four or more drinks per week (n = 32, 3%), less than four drinks per week (n = 403, 38%), and no alcohol intake (n = 626, 59%). In addition, women were categorized by the type of alcohol beverage they consumed: beer only (n = 47, 4%), spirits only (n = 56, 5%), wine only (n = 160, 15%), or a combination of two or more types of alcohol (n = 172, 16%). Results: A significant increased risk of miscarriage (adjusted hazard ratio (aHR): 2.65; 95% confidence interval (CI): 1.38, 5.10) was found for women who drank four or more drinks a week. Our findings also suggest the relationship between alcohol intake during pregnancy and miscarriage is strongest for miscarriage occurring prior to 10 weeks of gestation. In addition, women who drank only spirits had more than a two-fold increased risk of miscarriage compared to women who abstained (aHR: 2.24; 95% CI: 1.32, 3.81). Conclusions/Importance: Future research assessing the factors that may contribute to an increased risk of miscarriage should consider the type of alcohol consumed.     

胎儿纤维连接蛋白在预测复发性流产患者早期妊娠胚胎丢失中的作用

目的探讨检测胎儿纤维连接蛋白（fetal fibronectin,fFN）在预测复发性流产患者早期妊娠胚胎丢失中的临床价值。方法分析2008年至2011年就诊于我院有复发性流产史的早期妊娠患者84例作为实验组,另选取3l例正常早期妊娠者作为对照组。两组均行fFN检测,并追踪随访至妊娠14周,记录妊娠结局。结果两组患者年龄、孕龄、孕次相比较无统计学差异（P〉0．05）。实验组WN阳性率为57．14％,明显高于对照组的12．90％,差异有统计学意义（P〈0．01）。实验组本次妊娠结局为自然流产者共17例,发生率为20．24％,对照组3例发生自然流产,发生率为9．68％,差异无统计学意义。实验组fFN（＋）患者流产发生率为29．17％,fFN（-）患者流产发生率仅为8．33％（3／36）,差异有统计学意义（P〈0．05）。实验组fFN阳性预测流产发生的敏感性、特异性分别为82．35％、49．25％。复发性自然流产患者中,年龄在36～39岁的患者,fFN阳性率、流产率均高于35岁以下的患者。结论在早期妊娠阶段,复发性自然流产患者进行fFN检测,预测流产的敏感性高,有助于评估安胎结局。在临床工作中,应加强高龄复发性流产患者的监测。     

Psychopharmacological prescribing practices in pregnancy for women with severe mental illness: A multicentre study

There is little known about real world psychopharmacological prescribing practices in managing pregnant women with severe mental illness (SMI). This study utilised a sample of 535 women with a SMI across two hospitals in Australia. This included women with psychotic disorders, bipolar disorder and a range of non-psychotic disorders. The majority of women with a SMI in pregnancy were prescribed psychotropic medication as part of their management. Furthermore, more than one class of agent was prescribed for 31% of women with psychotic disorders and 30% of women with bipolar disorder. Differences between sites were identified in prescribing practices across the mental disorders. This included the variation in rates of use of multiple agents and pattern of use across pregnancy. This study also identified that women with a SMI had elevated rates of gestational hypertension, gestational diabetes mellitus, smoking and obesity in pregnancy and neonates admitted following delivery compared with the Australian average. These findings suggest that studies that examine associated risks for severe mental disorders or their treatments on pregnancy and infant outcomes should take into account the prescribing practices including the likelihood of exposure to polypharmacy and a range of potential confounding co-morbidities and exposures. The discrepancies in reported findings for pregnancy and infant outcomes following use of antipsychotic and mood stabiliser agents such as lithium may be at least partially accounted for by the complexity of multiple exposures that includes use of multiple psychopharmacological agents, co-exposures such as smoking and co-morbid conditions such as obesity.     

影响先兆流产妊娠结局的相关因素分析

目的探讨影响先兆流产妊娠结局的相关因素分析。方法选取2006年1月至2011年1月在我院妇产科就诊的患者,全部患者均接受调查和登记妊娠年龄、既往流产史、流产后是否休息、从事职业、夫妻关系等情况,均接受妇科B超和血肿的液体集聚量检测。结果 270例患者中良好妊娠结局患者共190例,良好妊娠率为70.37%,不良妊娠结局80例,不良妊娠率为29.63%;两组患者的早期阴道流血、阴道大量出血、宫内大血肿、高龄妊娠、低收入、污染接触职业因素比较,差异具有统计学意义(P<0.05),说明上述因素良好妊娠结局组发生率均明显低于不良妊娠结局组。结论先兆流产的不良妊娠结局发生率较高,受多种相关因素影响,因此需多加注意。     

盐酸利托君和硫酸镁应用于前置胎盘治疗中疗效对比

目的：对比盐酸利托君和硫酸镁应用于前置胎盘治疗中的临床疗效。方法80例前置胎盘孕妇随机分为盐酸利托君组和硫酸镁组各40例,分别给予静滴盐酸利托君和硫酸镁治疗。对比两组孕妇的保胎效果和不良反应发生情况。结果盐酸利托君组40例孕妇用药后阴道出血停止35例,保胎成功39例,妊娠至足月33例,新生儿平均Apgar评分（8.72±0.78）分;硫酸镁组40例孕妇用药后阴道出血停止26例,保胎成功32例,妊娠至足月24例,新生儿平均Apgar评分（6.87±0.76）分。两组所有指标比较均有统计学差异（P＜0.05）;两组药物不良反应发生率无明显差异,但不良反应类型不同。结论盐酸利托君应用于前置胎盘治疗能有效抑制宫缩,较之硫酸镁,其止血、保胎作用显著,值得推广应用于临床。     

Drugs prescribed for people aged 85 and over living in their own homes in an area of inner London

This study investigated drugs prescribed for people aged 85 and over and living in their own homes in an area of inner London, and explored associations between drug use and other factors including use of general medical practitioner (GP) services, mobility, mortality and self-perceived health. Data were collected by structured interview of 630 participants in their own homes, with a follow-up interview of survivors three years later. Respondents were taking a mean of 2.2 different drugs; 23 per cent were taking no prescribed drugs and 11 per cent were taking five or more. Of those on two or more drugs, 45 per cent were taking potentially interacting combinations. Although respondents on more drugs were more likely to have seen their GP recently, some on many different drugs had not. Nearly 15 per cent reported some sort of difficulty with their medication. There was no significant difference between the mean number of drugs prescribed, at the begining of the study, for survivors and for non-survivors. However, there was an inverse relationship between prescribed medication and mobility, self-perceived health and satisfaction with other aspects of life. Very elderly people living in their own homes, like those in institutions, will frequently be on drug regimens that should be monitored regularly for drug-related problems. Because of rising numbers, the provision of a cost-effective service would require the identification of those most likely to experience problems with their medication.     

Consumer attitudes towards community pharmacy services in Saudi Arabia

Objective The purpose of this study was to determine consumer attitudes towards community pharmacy and their preferences for the introduction of new services. Methods A self‐completion questionnaire was developed and 1,144 consumers in 55 community pharmacies were invited to complete it. The questionnaire covered consumers' choice of pharmacy; their perceptions of, and actual interactions with, community pharmacists; advice from pharmacists about general health and prescribed medicines; and privacy in the pharmacy. Respondents were asked for their views about five possible new services. Setting The study was based in community pharmacies in Riyadh City, Saudi Arabia. Key findings The response rate was 79.6%. Fifty‐nine per cent of respondents often or sometimes visited a particular pharmacy. One‐quarter of respondents perceived community pharmacists as having a good balance between health and business matters, while 56.1% thought pharmacists were more concerned with the business. The majority of respondents (69.7%) said they felt comfortable asking the pharmacist for advice. Just under half (44.8%) felt that pharmacists allowed them enough time to discuss their problem fully and listened well. In addition, 58.5% of respondents indicated that their pharmacists showed sensitivity to privacy by speaking more quietly across the counter. In 14.4% of situations pharmacists were reported to use a private area within the pharmacy when discussing personal or private matters. Most respondents (65.2%) indicated that their pharmacist was willing to discuss their health problems and tried to understand their feelings. Consumers' priorities for new services were: monitoring blood pressure; measuring weight, height and temperature; monitoring blood sugar; and monitoring cholesterol. Conclusion This study showed that most pharmacy customers feel comfortable seeking advice from their pharmacist. Although many pharmacists were reported to show sensitivity to a possible lack of privacy in the pharmacy, few respondents reported that their pharmacy had a private area for discussion. Customers' views on possible new services were generally positive, with the exception of patient medication records.     

Survey on the attitudes of pregnant and lactating women about the use of drugs

The purposes of this survey were to determine the attitudes and the extent of anxiety of pregnant and lactating women about drug use, and to research priority issues for pharmacists' intervention. Postpartum lactating women and mothers with children in a Growing Care Unit (GCU) in hospitals certified as Baby Friendly Hospital (BFH) were surveyed. The questions included the images the respondents had of drugs before pregnancy, the extent of anxiety about drug use, and ways to relieve it. The highest number of respondents (49.1%) did not want to use drugs often before pregnancy, but said "physician-prescribed drugs are fine". 24.5% had no negative images, and they "take drugs when necessary without worrying". An additional 14.2% did not like drugs, and "avoid them whenever possible", followed by 9.4% who did not want to use drugs, but were willing to take health food and other over-the-counter items. The respondents reported that the extent of anxiety about drug use was 79.3% during pregnancy, which was higher than 71.7% during lactation. It was not influenced by birth experience and age. "The images of drugs before pregnancy" and "the extent to which the anxiety was relieved during pregnancy" were extracted as factors related to the extent of anxiety, verifying that negative images of drugs and low degrees of relief from anxiety raise the anxiety of pregnant women. The above shows that pharmacists need to understand the anxiety of pregnant and lactating women about drug use, and the images they had of drugs before pregnancy, thereby they are expected to work actively to determine and relieve the anxiety.     

72例输卵管妊娠临床分析

我院1998年1月至2003年6月间手术并经病理检查证实的输卵管妊娠72例,其中输卵管妊娠流产型32例,(44.44%),破裂型40例(55.55%),好发年龄23～30岁为多见,共45例(62.5%)。输卵管妊娠与孕产次、流产史均有密切关系,孕产次越多或有反复人流史发病率越高。破裂与流产型比较,破裂型病情重,晕厥与休克较流产型多见,而且出现明显体征,腹腔内出血量有明显的差别﹙P<0.01,认为输卵管妊娠如能及早做出诊断,及时手术治疗,疗效最好。     

米福配伍米索前列醇终止早孕720例临床分析

目的评估米非司酮胶囊（Ⅱ）（米福）50mg配伍米索前列醇600μg终止早孕的疗效和安全性。方法第一日晨9点,口服米福5粒（25mg）,晚9点,口服米福5粒（25mg）;第二日空置;第三日晨9点,口服米索前列醇3粒（600μg）。对720例怀孕〈7周者妇女终止早孕,观察孕囊排出时间、阴道出血量和出血时间以及不良反应。结果米福50mg配伍米索前列醇终止早孕720例,完全流产率98.1%,不全流产率1.9%。99%在服用米索后6h内排出胚胎。90.3%流产后阴道出血量少于月经。98.1%流产后出血时间小于7d,1.9%出血时间7～10d。服用米福后仅1.5%出现阴道少量出血。结论低剂量米非司酮（米福）50mg配伍米索前列醇是一种安全、有效的终止早孕方法 。     

血清孕酮测定在预测早期先兆流产妊娠结局中的价值

目的探讨血清孕酮测定在预测早期先兆流产妊娠结局中的价值。方法选取我院2012年3月-2014年3月收治的80例早孕先兆流产患者为研究对象,根据保胎成功与否将其分为保胎成功组（n=50）与保胎失败组（n=30）,并选择同期问诊的90例正常妊娠孕妇为对照组,测定并比较三组孕妇血清孕酮水平。结果保胎成功组、正常妊娠组孕妇血清孕酮值均明显高于保胎失败组,差异有统计学意义（P〈0.05）。保胎成功组与正常妊娠组血清孕酮值差异无统计学意义（P〉0.05）。此外,血清孕酮15.68ng/m L可作为先兆流产保胎成功与否的临界值。结论血清孕酮测定在预测早期先兆流产妊娠结局中有较大的价值。     

Substance-misusing Patients in Primary Care: incidence, services provided and problems. A survey of general practitioners in Wiltshire

This research aimed to discover the monthly incidence of patients misusing illicit drugs or alcohol seen by general practitioners; services provided; difficulties encountered; and general practitioner willingness. The total population of general practitioners (n = 210) in the Health Commission for Wiltshire was sent a postal questionnaire: 49% responded (n = 103), and 10% of respondents were interviewed. The number of alcohol-misusing patients seen per month was much higher than illicit drug-misusing patients: 46% of respondents saw fewer than one patient for prescribed opiates, and 71% saw fewer than one solvent misuser, per month; in contrast, only 7% of respondents saw fewer than one alcohol-misusing patient per month. Ninety-two per cent of general practitioners provided general medical services for alcohol misusers, and 86% for illicit drug misusers. Fifty-four per cent of respondents provided substitute medication for illicit drugs, while 42% provided detoxification medication for illicit drugs. Sixty-five per cent provided medication for alcohol detoxification. Difficulties encountered included missed appointments, time-wasting, aggressive behaviour, communication difficulties and upset to other patients. Twelve per cent of general practitioners were willing to provide more services for illicit drug users, compared with 27% for alcohol users. The greater unwillingness to work with illicit drug users appeared disproportionate to the number previously encountered. Interventions to improve the situation for general practitioners and substance-misusing patients are discussed.     

Substance-misusing Patients in Primary Care: incidence,services provided and problems. A survey of general practitioners in Wiltshire

This research aimed to discover the monthly incidence of patients misusing illicit drugs or alcohol seen by general practitioners; services provided; difficulties encountered; and general practitioner willingness. The total population of general practitioners (n = 210) in the Health Commission for Wiltshire was sent a postal questionnaire: 49% responded (n = 103), and 10% of respondents were interviewed. The number of alcohol-misusing patients seen per month was much higher than illicit drug-misusing patients: 46% of respondents saw fewer than one patient for prescribed opiates, and 71% saw fewer than one solvent misuser, per month; in contrast, only 7% of respondents saw fewer than one alcohol-misusing patient per month. Ninety-two per cent of general practitioners provided general medical services for alcohol misusers, and 86% for illicit drug misusers. Fifty-four per cent of respondents provided substitute medication for illicit drugs, while 42% provided detoxification medication for illicit drugs. Sixty-five per cent provided medication for alcohol detoxification. Difficulties encountered included missed appointments, time-wasting, aggressive behaviour, communication difficulties and upset to other patients. Twelve per cent of general practitioners were willing to provide more services for illicit drug users, compared with 27% for alcohol users. The greater unwillingness to work with illicit drug users appeared disproportionate to the number previously encountered. Interventions to improve the situation for general practitioners and substance-misusing patients are discussed.     

Clinical experience with a low dose oral contraceptive containing norethisterone and ethinyl oestradiol

Summary

The results are presented of a clinical investigation of an oral contraceptive containing 0.5?mg norethisterone and 0.035?mg ethinyl oestradiol. The medication was administered orally as a 21-day cyclic regimen in 1, 168 women. Duration of use was from 1 to 53 cycles with an overall total of 16, 345 cycles. When the preparation was taken as directed, no pregnancies occurred. Three women conceived during the course of this study; however, these subjects missed 3, 2, and 1 prescribed tablets, respectively, and their pregnancies are thus judged due to patient failure. The overall pregnancy rate was 0.22 per 100 woman years of use calculated as a Pearl Index. Intermenstrual bleeding (spotting and/or breakthrough bleeding) was noted primarily in the early cycles, soon tapering off to a lower and stable level. The overall cumulative cyclic incidence of amenorrhoea was 1.0%.     

Knowledge of and attitudes to medicines in the Southampton community.

A 1 in 200 sample of the Southampton electorate was sent a postal questionnaire in January, 1984. Of the 740 adults surveyed, 443 (59.9%) returned completed questionnaires. One hundred and eighty-eight (42.4%) of those replying had been prescribed a medicine within the previous month. Two hundred and seventy-five respondents (62%) felt that not enough was explained about medicines by doctors or pharmacists. Consistent with this, was the fact that 37% were unaware of safe methods of disposal of leftover medicines. In addition, 112 of 154 (72.7%) people currently taking a prescribed medicine knew of no side-effects which could result from this. Eighty-three per cent of respondents thought an information leaflet would be helpful. Of nine items which previous authors had suggested should be included, seven were thought to be important by more than 75% of those replying. Although 54% of people wanted detailed information, 43% stated a preference for short, summarized points. We conclude that most patients need to have more information about prescribed medicines and they would welcome written leaflets. However, further work is necessary to determine the best format for such leaflets.     

Infant weaning and community pharmacy — the pharmacist's perspective

Community pharmacists' awareness of the COMA report on “Weaning and the weaning diet” and their knowledge of its recommendations was assessed in a questionnaire distributed to all (n=81) community pharmacists in the Western Health and Social Services Board in Northern Ireland. Sources of information and adequacy of training on childhood nutritional issues were determined. A knowledge score was computed for each pharmacist depending on their responses to questions based on key issues in the COMA report. Completed questionnaires were returned by 48 pharmacists (59 per cent). The COMA report had been read by 14.5 per cent of respondents while 12.5 per cent knew of its recommendations. Others had heard of it but not read it (52 per cent) or had never heard of it (21 per cent). The mean knowledge score was 66 per cent (±17.5). Scores ranged from 18 per cent to 90 per cent, indicating wide variability in pharmacists' knowledge of key recommendations for weaning. Only 29 per cent of pharmacists felt that they were adequately trained to give advice on weaning; 50 per cent felt that they did not have sufficient knowledge and 21 per cent were unsure. Pharmacists indicated that, on average, parents approached them weekly about a weaning topic, which emphasises the need for them to be well informed about current weaning recommendations.     

一次性宫腔组织吸引管用于终止早期妊娠临床观察

目的 通过对比观察,寻找终止早期妊娠的最佳方法.方法 采用一次性宫腔组织吸引管终止早期妊娠,同时与药物流产、传统金属吸引管加局部浸润麻醉法进行比较,观察完全流产率、术中疼痛、出血量、并发症等.结果 一次性宫腔组织吸引管终止早期妊娠无疼痛或少疼痛,流血时间l～6 d,平均3.5 d,均少于月经量,完全流产率100%,无其他并发症.术后月经恢复时间25～40 d,平均32.8 d,在观察的各个指标上均优于药物流产、宫颈局部浸润麻醉的人工流产术.结论 一次性宫腔组织吸引管终止早期妊娠,时间可提前到35 d,减少了孕妇的痛苦和紧张等待心情,该方法不需扩张宫颈,吸引轻,出血少,孕妇无痛苦或少痛苦,无并发症,恢复快,而且操作简便安全,是终止早期妊娠理想的方法.