围产期TORCH感染脐血宫内诊断21例临床分析

围产期母血检测到相关病毒的IgM抗体，提示孕期该病毒原发或复发性感染，因母胎间病毒可垂直传播，胎儿有先天感染的可能。近年我们对孕期弓形虫（toxoplasma，TOXO）、风疹病毒（rubellt virus，RV）、巨细胞病毒（clnomaglo virus，CMV）、单纯疱疹病毒Ⅱ型（herpes simplex virus,HSV-H）四种特异性抗体阳性的21例孕妇，进一步行胎儿脐静脉穿刺宫内诊断，现将结果报道如下。     

TORCH感染筛查、诊断与干预原则和工作流程专家共识

近年来,国内外均发表了与TORCH感染相关的临床实践指南,但仍有内容需要加以补充和明确。国内部分专家就TORCH感染筛查、诊断及干预的临床路径进行了专题研讨,达成共识如下：（1）不是所有的TORCH病原体都需要孕前或孕期筛查;对围孕期妇女不需要进行单纯疱疹病毒抗体分型检测,若无临床症状,不需要等待其IgM抗体转阴再妊娠。（2）检测TORCH-IgM、IgG抗体时应采用定量技术,保存检测过的剩余血清样本对可能的后续诊断有不可替代的参考价值。（3）不能依据血清学筛查阳性结果而做出终止妊娠的决定。（4）重视对巨细胞病毒再次感染的孕期监测。（5）慎重使用介入性产前诊断技术,在确认孕期TORCH感染的5~7周并可见胎儿影像学异常后,孕18周后采取羊水标本进行病原体DNA或RNA的检测,可以结合脐血样本的IgM抗体检测进行产前诊断;超声及MRI检查有助于评估宫内感染的胎儿预后。（6）注意孕妇和胎儿的弓形虫感染治疗方法不同。（7）胎儿非免疫性水肿或不明原因胎死宫内的孕妇需要检测微小病毒B19抗体状态,对确诊贫血的存活胎儿有微小病毒B19宫内感染时,可给予宫内输血治疗。     

TORCH孕前咨询及产前诊断和处理要点

通过孕前咨询指导血清学筛查及后续处理,需注意：（1）血清学筛查应同时定量检测病原体IgG、IgM水平,双份血清检测有助于明确诊断。（2）孕前3个月常规行风疹病毒血清学筛查。（3）巨细胞病毒、弓形虫易感者分别于妊娠20周内、整个孕期监测抗体转化。（4）有中-重度感染症状的巨细胞病毒感染儿出生后服用缬更昔洛韦半年。     

孕期TORCH感染治疗与胎婴儿状况的初步观察

目的：观察孕期TORCH（弓形虫、风疹病毒、巨细胞病毒、单纯疱疹病毒，其他病原体）感染治疗与未治疗对围产儿的影响。方法：用ELISA方法检查TORCH抗体，筛查出阳性血清孕妇。分治疗与非治疗两组，分别于分娩时观察新生儿体重，有无畸形以及留脐带血查相应抗体，两组进行比较。结果：TOX和HSV感染，治疗组与非治疗组垂直传播差异有统计学意义，早产、畸形地、围产儿死亡及新生儿体重两组比较均有统计学意义。结论：早、中孕发现孕妇有TORCH感染有治疗的必要。     

人类轮状病毒宫内感染的初步研究

孕妇易感染风疹病毒、巨细胞病毒、单纯疱疹病毒,并可引起胎儿宫内感染,进一步导致流产、早产、胎儿畸形、宫内发育迟缓等。有研究发现,孕妇与健康妇女比较,血清人类轮状病毒（ＨＲＶ）抗体水平不仅几何平均滴度明显低下,而且有部分孕妇缺乏ＨＲＶ抗体。为探讨ＨＲＶ...     

孕期TORCH感染对婴幼儿远期发育的影响

影响胎儿发育的因素很多 ,除遗传因素外 ,先天性宫内感染也是导致出生缺陷的一个重要因素。 2 0世纪 70年代Ｎａｈｍｉａｓ首先发现引起宫内感染导致胚胎发育异常的一组病原体 ,即巨细胞病毒 (ＣＭＶ)、弓形虫 (ＴＯＸ)、风疹病毒 (ＲＵＶ)、单纯疱疹病毒 (ＨＳＶ)及其他病原体 (Ｏｔｈｅｒ) ,取上述各病毒英文首字母 ,缩写为ＴＯＲＣＨ。本研究旨在探讨孕期ＴＯＲＣＨ感染对胎儿发育的远期影响。现将结果报道如下。一、资料与方法1 对象与分组 :选择 1995年 9月至 1996年 12月 ,在我院就诊的孕妇及其婴幼儿分为如下 3组 :( 1)孕期感染组 :…     

胎儿先天性心脏病和风疹病毒感染的关系

目的 探讨和分析孕妇风疹病毒感染与胎儿先天性心脏病(简称先心病)的关系,为提高先天性风疹综合征产前诊断率寻求方法.方法 对超声心动图诊断并要求引产的38例先心病胎儿行脐带穿刺,采用酶联免疫吸附试验测定脐血风疹病毒特异性抗体IgM. 结果 38例先心病胎儿中18例脐血风疹病毒IgM(+),占47.4%,其余20例IgM(-).18例风疹病毒IgM(+)胎儿按心脏异常结构出现频率排序:室间隔缺损10例、肺动脉发育异常9例、房室瓣异常6例、大动脉转位5例、主动脉骑跨4例.IgM(+)和IgM(-)组中属于圆锥动脉分隔异常或圆锥动脉干间隔旋转不足或方向相反的病例数分别为11例(61.1%)和5例(25.0%)(P<0.05). 结论 风疹病毒与胎儿先心病的发生有一定关联,可能影响胎儿心室分隔和圆锥动脉干发育.B超提示胎儿室间隔缺损、肺动脉发育异常、心肌瓣膜异常、大动脉转位时,应考虑到风疹病毒感染的可能.     

胎儿原发性巨细胞病毒感染的产前诊断

为寻找对妊娠原发性巨细胞病毒(CMV)感染可靠的产前诊断方法,对63例血清学检查CMVIgG和IgM阳性的孕妇(包括2例双胎)进行研究。母体原发性感染的定义为孕前CMV IgG和IgM皆阴性,而孕期两种抗体皆阳性或存在IgM而IgG滴     

孕期中药治疗对巨细胞病毒感染孕妇子代生长发育的影响

目的 探讨孕期中药治疗对巨细胞病毒(CMV)活动性感染孕妇子代生长发育的影响。方法 1996年1月至2002年6月,采用前瞻性随机对照研究方法,从有异常妊娠史的孕妇中筛查出CMV活动性感染孕妇240例,随机分组。观察组122例给予中药治疗,对照组118例不给予治疗,比较两组孕妇转阴率、胎盘和胎儿感染率以及子代生长发育情况。结果 观察组孕妇CMV IgM和CMV nRNA转阴率77.05％(94/122)、胎盘感染率48.98％(48/98)、宫内传播率21.74％(10/46),对照组分别为38.14％(45/118)、67.50％(54/80)和52.63％(20/38),两组差异均具有统计学意义(P均<0.01)。观察组子代出生时35例正常,11例异常;对照组20例正常,18例异常(P<0.01)。观察组6月龄婴儿智力发育指数和精神运动发育指数均高于对照组,但差异无统计学意义(P>0.05)。结论 孕期中药治疗在改善CMV活动性感染孕妇子代生长发育方面具有一定的意义。     

宫内感染与胎儿发育异常

宫内感染是指孕妇受病原体感染后所引起的胎儿感染。引起宫内感染的病原体有 :①病毒 ,如巨细胞病毒、风疹病毒、单纯疱疹病毒、人乳头瘤病毒、人类微小病毒Ｂ19、乙肝病毒、丙肝病毒、柯萨奇病毒、人类免疫缺陷病毒、带状疱疹病毒、腮腺炎病毒、流感病毒等 ;②原虫 ,如弓形虫 ;③衣原体 ,如沙眼衣原体 ;④支原体 ,如解脲支原体 ,肺炎支原体等 ;⑤螺旋体 ,如梅毒螺旋体 ;⑥细菌 ,如Ｂ族链球菌等。孕妇感染上述病原体后 ,多数无特殊症状或症状轻微 ,但有可能对胎儿造成严重后果 ,引起流产、早产、胎儿宫内发育迟缓、死胎、畸形等。在胎儿发育…     

Adolescent sexuality and the internet: the good, the bad, and the URL

The Internet has become a widely used resource for sexual health information, especially among adolescents. The appeal lies in the ease and anonymity with which online seekers can obtain advice and reassurance, particularly regarding sensitive topics. This article reviews the positive and negative influences of the Internet on this age group. Specific aspects of how this medium affects adolescents as well as how it can be used to assist them are discussed.     

Prolonged pregnancy: surveillance of the fetus and the neonate and the course of labor and delivery

The perinatal events in 184 term control pregnancies and 129 prolonged pregnancies were prospectively compared. Fetal surveillance consisted of weekly biophysical profile testing. Thirty-two infants were dysmature, and 10 of these had advanced dysmaturity. The incidence of advanced dysmaturity rose quickly after 44 weeks. This group was at greater risk for fetal distress, lower Apgar scores, and emergency cesarean section. The combination of oligohydramnios, a suboptimal nonstress test, and a low profile score was highly predictive of a neonate with advanced dysmaturity. In the control pregnancies, the rate of induction of labor was 13.81% compared with 39.84% in the prolonged pregnancies. The induced labor group had a 51.32% cesarean section rate. Our approach to prolonged pregnancy consists of elective induction of labor when the cervix is favorable and biweekly profile testing when it is not; however, the high incidence of advanced dysmaturity after 44 weeks warrants delivery.     

Early- and late-onset preeclampsia and the tissue-specific epigenome of the placenta and newborn

IntroductionPreeclampsia (PE) carries increased risks of cardiovascular- and metabolic diseases in mothers and offspring during the life course. While the severe early-onset PE (EOPE) phenotype originates from impaired placentation in early pregnancy, late-onset PE (LOPE) is in particular associated with pre-existing maternal cardiovascular- and metabolic risk factors. We hypothesize that PE is associated with altered epigenetic programming of placental and fetal tissues and that these epigenetic changes might elucidate the increased cardiovascular- and metabolic disease susceptibility in PE offspring.MethodsA nested case-control study was conducted in The Rotterdam Periconceptional Cohort comprising 13 EOPE, 16 LOPE, and three control groups of 36 uncomplicated pregnancies, 27 normotensive fetal growth restricted and 20 normotensive preterm birth (PTB) complicated pregnancies. Placental tissue, newborn umbilical cord white blood cells (UC-WBC) and umbilical vein endothelial cells were collected and DNA methylation of cytosine-guanine dinucleotides was measured by the Illumina HumanMethylation450K BeadChip. An epigenome-wide analysis was performed by using multiple linear regression models.ResultsEpigenome-wide tissue-specific analysis between EOPE and PTB controls revealed 5001 mostly hypermethylated differentially methylated positions (DMPs) in UC-WBC and 869 mostly hypomethylated DMPs in placental tissue, situated in or close to genes associated with cardiovascular-metabolic developmental pathways.DiscussionThis study shows differential methylation in UC-WBC and placental tissue in EOPE as compared to PTB, identifying DMPs that are associated with cardiovascular system pathways. Future studies should examine these loci and pathways in more detail to elucidate the associations between prenatal PE exposure and the cardiovascular disease risk in offspring.     

Read between the lines--mass media and the making of public opinion--medicine and the media

There has been a continuous change of civilization and communication in our society since the mid-nineties of the last century. Even medicine has to accept new fields of activity and bring up to date its response in the cooperation with the media. Both, medicine in general and gynaecology in particular will have to get used to a close relationship between public relation and professional skills. That is to say, communication, criteria and system, must undergo permanent reconsideration and development. Excellent knowledge of communication both in theory and practice together with the know-how of handling media and journalists are therefore required. The author of the following dissertation will make an effort to explain and to cover the wide range of public relation spreading between newspaper reports and interviews. Doctors whatever and wherever their job is but gynaecologists in particular must realize that co-operation with the media will be a challenge and a duty in the years ahead.     

The concentration of collagen and the collagenolytic activity in the amnion and the chorion

Fetal membranes obtained from second-trimester abortions, elective Caesarean sections and after normal deliveries were studied. The hydrolytic activity against a DNP-peptide expressing the collagen turn-over was found to be very high in the second trimester and relatively high at term of pregnancy. The activity in the chorion was twice that in the amnion. The concentration of another collagen-degrading enzyme, leukocyte elastase, which is present during inflammatory reactions was high at the site of rupture. The collagen concentration given as micrograms hydroxyproline per mg dry weight was unchanged throughout pregnancy and labour in both fetal membranes. The concentration in amnion was twice that in the chorion. After delivery, the collagen content given as microgram/cm2 in the chorion was decreased at the rupture line. This was due to decreased thickness of the membrane, whereas the hydroxyproline concentration (microgram/mg dry weight) was unchanged. The amnion was thinner than the chorion, but the decreasing collagen content (micrograms/cm2) at the rupture line was less pronounced. The thinning of especially the chorionic membrane might be secondary to the mechanical stress of pregnancy and labour and/or, as our results suggest, due to enhanced catabolism.