上海市浦东新区妇女绝经年龄及行经年限调查与影响因素分析

目的 调查上海市浦东新区妇女的自然绝经年龄、行经年限,观察初潮年龄与生育次数对自然绝经年龄和行经年限的影响.方法 2007年1月至2008年7月,以参加上海市浦东新区宫颈癌筛查的、年龄≥56岁的15 083例自然绝经妇女为研究对象,采用一对一的问卷方式,调查妇女的初潮年龄、生育次数、自然绝经年龄、行径年限等情况.将研究对象按年龄分为56～60、61～65、66～70和>70岁4个组.采用方差分析方法,比较各年龄组绝经年龄和行经年限的差异;采用多因素回归方法分析年龄组别、初潮年龄、生育次数与绝经年龄和行经年限的关系.结果 (1)自然绝经年龄:最小为29岁,最大为61岁,平均为(50.6±3.7)岁.56～60、61～65、66～70和>70岁4个年龄组的平均绝经年龄分别为(50.9±3.4)、(50.7±3.7)、(50.0±4.1)、(49.6±4.0)岁,随着年龄组的年轻化,平均绝经年龄呈逐渐增加趋势,最小年龄组与最大年龄组比较,平均绝经年龄相差1.36岁.(2)行经年限:最长为48年,最短为12年,平均(34.3±4.1)年.56～60、61～65、66～70和>70岁组的平均行经年限分别为(34.6±3.8)、(34.3±4.1)、(33.9±4.6)、(33.2±4.5)年;随着年龄组的年轻化,平均行经年限呈逐渐延长趋势,最大年龄组与最小年龄组比较,相差1.41年.(3)初潮年龄对绝经年龄和行经年限的影响:相关分析显示,初潮年龄与绝经年龄无明显相关性(r=0.02),初潮年龄与行经年限呈负相关(r=-0.43).(4)生育次数对绝经年龄和行经年限的影响:生育1～2次妇女的绝经年龄明显高于生育0次和≥3次的妇女,差异有统计学意义(P<0.05);但生育1次与2次的妇女及生育0次与≥3次的妇女绝经年龄比较,差异均无统计学意义(P>0.05).生育1次的妇女行经年限明显长于生育1次以上的妇女,生育2次的妇女行经年限明显长于生育0次和≥3次的妇女,差异也有统计学意义(P<0.05);生育0次与≥3次者行经年限比较,差异无统计学意义(P>0.05).(5)行经年限的多因素回归分析:初潮年龄与行经年限呈明显的负相关(r=-0.97,P<0.001);不同年龄组别的行经年限相关分析显示,61～65、66～70和>70岁组与56～60岁组比较,差异均有统计学意义(r=-0.18,P=0.020、r=-0.78,P<0.001和r=-1.23,P<0.001);生育1～2次者的行经年限明显长于生育0次和≥3次者.(6)绝经年龄的多因素回归分析:初潮年龄与绝经年龄无相关性(r=0.02);但不同年龄组别的绝经年龄的多因素分析显示,61-65、66～70和>70岁组妇女的绝经年龄与56～60岁组比较,差异也有统计学意义(r=-0.18,P=0.020、r=-0.78,P<0.001、r=-1.23,P<0.001).生育1～2次的妇女绝经年龄明显高于生育0次和≥3次者,但生育1次与2次,0次与≥3次者间比较,差异均无统计学意义.结论 (1)上海市浦东新区妇女的绝经年龄逐渐增加,行经年限呈延长趋势;(2)初潮年龄和生育次数是影响绝经年龄和行经年限的重要因素;(3)随着初潮年龄的年轻化,行经年限逐渐延长;(4)生育1～2次能明显推迟绝经年龄并且延长行经年限,而多次生育(≥3次)对绝经年龄和行经年限均无明显影响.     

绝经前全子宫切除保留卵巢对妇女骨代谢及骨密度的影响

目的 :追踪观察绝经前妇女全子宫切除保留卵巢对远期骨代谢及骨密度的影响。方法 :对比观察绝经前行全子宫切除保留单侧卵巢 4 8例、全子宫切除保留双侧卵巢 15例和正常妇女 30例的血清钙 (Ca)、血清磷 (P)、血清碱性磷酸酶 (AKP)、血清骨钙素(BGP)、空腹尿Ca Cr及尿HYP Cr值、骨密度值的变化和差异。结果 :全子宫切除保留单侧卵巢组血AKP值、BGP值、空腹尿Ca Cr和尿HYP Cr均显著高于对照组 (P <0 0 5 ) ,而骨密度值则显著低于对照组 (P <0 0 5 )。保留双侧卵巢组尿HYP Cr显著高于对照组 (P <0 0 5 )。结论 :子宫全切除保留单侧卵巢者远期骨转换加快 ,导致骨丢失及骨密度下降 ,双侧卵巢保留者骨吸收亦加快 ,但骨密度无下降     

成都市1906名中老年妇女对绝经的认知和接受性

目的 :通过对中老年妇女的绝经状况以及对绝经认识的研究 ,为开展健康保健提供依据。方法 :对成都市城区和郊县的 190 6名 4 4岁以上的妇女进行横断面调查 ,以调查表的形式进行调查 ,对结果进行统计学处理和分析。结果 :调查发现该 190 6名妇女的平均绝经年龄为 4 8 0± 3 8岁。常见的围绝经期症状包括潮热盗汗、情绪不稳定、记忆力下降以及泌尿生殖道不适 ,这些症状的发生 ,在年龄 <5 0岁的妇女明显高于年龄 >6 0岁的妇女 (P <0 0 0 5 )。多数已绝经的妇女认为自己的绝经年龄合适 ,绝经不影响其生活。结论 :妇女在围绝经期前后具有许多健康问题 ,迫切需要健康保健宣传和服务 ,使其平安度过围绝经期。     

两种激素补充治疗方案联合钙剂对绝经后妇女骨密度的影响

目的　研究利维爱 1 2 5mg d和结合雌激素 (CEE) 0 6 2 5mg +安宫黄体酮 (MPA) 2mg联合钙剂对绝经后骨质疏松和低骨量妇女骨密度的影响。方法　绝经后妇女 30人 ,分为利维爱组和CEE组。利维爱组8例为骨质疏松 ,中位年龄 6 4岁 ,中位绝经年限 1 4年 ;9例为低骨量 ,中位年龄 5 2岁 ,中位绝经年限 3年 ,均给予利维爱 1 2 5mg d、Ca -D 6 0 0mg d口服。CEE组中位年龄为 5 1岁 ,中位绝经年限为 2 5年。治疗前及治疗 1年时用DEXA方法检查前臂远端骨密度各 1次 ,做为自身对照 ,对比骨密度变化情况同时每年通过阴道B超监测子宫内膜的厚度。结果　利维爱组骨质疏松患者 ,松质骨骨密度增长中位数为 +4 0 % ,密质骨为 +2 6 % ;低骨量者 ,用利维爱者分别为 0和 - 1 0 % ,用CEE者为 +0 3%和 - 0 7%。所有患者依从性好 ,无明显副作用发生。结论　利维爱 1 2 5mg d联合钙剂能够提高绝经后骨质疏松妇女的前臂骨密度     

绝经后潮热妇女血浆5-羟色胺前体及代谢产物水平的变化

目的　探讨更年期妇女血浆 5 羟色胺 (5 HT)代谢的变化与潮热之间的关系。方法　采用高效液相色谱 荧光检测器 ,测定 2 0例绝经过渡早期 [年龄 (46± 3 )岁 ]、2 6例绝经过渡后期 (绝经≤1年 )、2 8例绝经 1～ 3年、2 4例绝经 3～ 6年及 12例正常育龄 (2 0～ 3 0岁 )妇女血浆中色氨酸 (TP)、5 羟色氨酸 (5 HTP)、5 HT、5 羟吲哚乙酸 (5 HIAA)及绝经后妇女血浆促黄体生成素 (LH)的水平 ;对绝经后妇女采用Kupperman评分法评分 ,其中潮热次数≤ 5次 /d(轻度潮热 )的有 2 0例 ,>5次 /d(重度潮热 )的有 15例 ,无潮热者 17例 ,分析 5 HT代谢变化与绝经时间、LH水平和潮热之间的关系。结果　 (1)绝经过渡早期妇女血浆 5 HT、绝经过渡后期和绝经 1～ 3年妇女的血浆 5 HT及 5 HIAA水平 ,显著高于育龄妇女 (P <0 0 1) ,绝经 3～ 6年妇女的血浆 5 HTP和 5 HT水平高于育龄妇女 ,而 5 HIAA水平则低于育龄妇女 (P <0 0 5 )。 (2 )绝经后妇女血浆 5 HT水平与LH水平间呈正相关 (r2 =0 5 3 0 7,P<0 0 1)。(3 )绝经后有轻度潮热者的血浆 5 HTP水平、重度潮热者血浆 5 HTP和 5 HT水平均高于无潮热者 (P均 <0 0 5 ) ,重度潮热者 5 HIAA/ 5 HT比值则显著降低 (P <0 0 5 )。结论　绝经后妇女 5 HT     

初潮年龄对女性绝经年龄及围绝经期综合征影响的横断面研究

目的分析不同月经初潮年龄对女性绝经年龄及围绝经期综合征的影响。方法:采用多阶段整群随机抽样方法,以在甘肃省居住≥1年的40~55岁女性为研究对象,于2016年3—11月期间展开横断面调查。结果 (1)共调查8 500人,最终纳入分析7 236人。初潮年龄≤12岁者461例(6.4%),13~14岁初潮者2 335例(32.3%),15~16岁初潮者2 838例(39.2%),≥17岁初潮者1 602例(22.1%)。(2)共1 673例女性绝经,平均绝经年龄为(47.9±3.3)岁。随着初潮年龄的增加,绝经年龄增加,单因素方差分析显示组间数据差异有统计学意义(F=12.741,P=0.000),多因素Cox回归分析显示,初潮年龄早是绝经年龄提前的危险因素。(3)随着初潮年龄增加,围绝经期综合征发生率增加,并且中、重度围绝经期综合征发生率增加(P=0.000)。(4)多因素logistic回归分析显示,初潮年龄与围绝经期综合征的严重程度发生无相关性。结论月经初潮年龄越早,绝经发生越早;随着初潮年龄增加,围绝经期综合征发生率增加,初潮年龄与围绝经期综合征严重程度无相关性。     

绝经后妇女雌激素受体基因多态性与骨和脂代谢的相关性研究

目的 :研究绝经后妇女雌激素受体 (ER)基因PvuII、XbaI限制性片段长度多态性与骨和脂代谢的关系。方法 :随机选取 5 7名已排除影响骨代谢、脂代谢疾病的绝经后妇女 ,采空腹血和晨尿 ,用PCR RFLP法对ER基因多态性进行分析 ;DEXA测定腰椎正侧位及股骨骨密度 ,同时检测血骨钙素、尿I型胶原N末端肽和血脂指标。结果 :xx组股骨干(SHAFT)骨密度明显低于Xx组 (P <0 .0 5 )。XbaI限制性片段长度多态性与股骨SHAFT骨密度相关 (r =0 .36 7,P =0 .0 39) ;XX组骨钙素高于xx(P =0 .0 4 1)和Xx(P =0 .0 11)组。apoA1含量和A1/B比值在xx、Xx、XX三组递增 ,各组间差异有显著性 (P <0 .0 5 )。Lp(a)与股骨骨密度 (除SHAFT外 )呈负相关。结论 :ER基因XbaI RFLP是影响绝经后妇女骨和脂代谢的重要因素 ;X基因型可维持股骨骨量 ,xx基因型与低apoA1含量和A1/B比值相关 ,Lp(a)也影响股骨骨密度     

92例40岁以上妇女妊娠与分娩结局分析

目的 :探讨 40岁以上妇女的妊娠及其对分娩的影响。方法 :回顾性分析 1 989年 1 1月至 2 0 0 0年 1 0月分娩的40岁以上的孕妇 92例 (观察组 )及同期妊娠的 2 0～ 2 9岁孕妇 1 94例 (对照组 )。结果 :观察组不孕史、习惯性流产及子宫肌瘤发生率 (分别为 31 .5 %、9.8%、5 .4% )显著高于对照组 (P <0 .0 0 1或P <0 .0 5) ;其妊娠高血压综合征、前置胎盘、早产发生率 (分别为 2 0 .7%、5 .4%、9.8% )显著高于对照组 (P <0 .0 1或P <0 .0 5) ;观察组剖宫产率 (82 .6 % )较对照组 (57.7% )明显增高 (P <0 .0 1 ) ;观察组巨大儿发生率 (9.8% )显著高于对照组 (3.6 % ) (P <0 .0 5)。两组新生儿出生体重、新生儿窒息、新生儿畸形、围产儿死亡率差异无显著性 (P >0 .0 5)。结论 :尽管 40岁以上的高龄孕妇的妊娠合并症、并发症以及剖宫产率明显增加 ,但总的围产儿结局不受母亲年龄的影响。     

围绝经期妇女血清性激素水平与自由基、血脂含量的变化

目的 :观察围绝经期妇女血清性激素的变化及其与自由基、血脂的关系 ,探讨绝经后冠心病发生率上升与性激素变化的可能机制。方法 :调查对象为 4 0岁以上的妇女 ,按月经情况分为 3组 ,第 1组为月经正常者 ,第 2组为月经紊乱者 ,第 3组为绝经者 ,分别测定血清中雌二醇 (E2 )、卵泡刺激素 (FSH)、催乳激素 (PRL)、血脂、超氧化物歧化酶(SOD)、丙二醛 (MDA)、一氧化氮 (NO)含量。结果 :血清E2 、FSH水平 2、3组与 1组间差异有非常显著性 (P <0 .0 1和P <0 .0 0 1) ,第 3组受检者血脂升高 ,血清总胆固醇 (TC)、甘油三酯 (TG)、低密度脂蛋白胆固醇 (LDL C)、载脂蛋白 (ApoB)明显高于第 1组 (P <0 .0 1) ,同时血清SOD、MDA含量两组间也存在明显差异 (P <0 .0 5 )。结论 :围绝经期女性体内性激素紊乱 ,至绝经后更为明显 ,同时伴有血脂紊乱和抗氧化能力降低 ,可能是绝经后妇女冠心病发病率升高的主要因素     

女性不同绝经年龄骨密度和骨强度256例分析

目的　研究绝经年龄对女性骨密度和骨强度的影响 ,为骨质疏松症 (OP)的预防提供科学依据。方法　采用双能X线骨密度仪和骨超声仪 ,测量 2 5 6例绝经年限 10～ 2 5年的健康女性志愿者骨密度 (BMD)和胫骨超声传导速度 (SOS) ,按绝经年龄不同分为Ⅰ组 (绝经年龄 <4 5岁 )、Ⅱ组 (绝经年龄 4 5～ 5 1岁 )、Ⅲ组 (绝经年龄>5 1岁 )进行分析。结果　三组除腰椎正、侧位 ,髋部wards区 ,尺骨和桡骨超远端外 ,其他部位BMD均与绝经年龄呈正相关 (r =0 10 7～ 0 2 11,P <0 0 5或P <0 0 1) ;Ⅱ、Ⅲ组髋部股骨颈、髋部总体、尺骨和桡骨远端 1/ 3段、尺骨和桡骨总体BMD均高于Ⅰ组对应部位 (P <0 0 5或P <0 0 1) ,且OP的患病率均低于Ⅰ组 (P <0 0 5或P <0 0 1) ;Ⅱ、Ⅲ组之间各部位BMD以及OP的患病率差异无显著性意义 ;胫骨SOS值与绝经年龄无相关性 ,且Ⅰ、Ⅱ、Ⅲ组之间胫骨SOS值以及OP的患病率差异无显著性意义 (P >0 0 5 )。结论　绝经年龄早 (<4 5岁 )主要引起皮质骨BMD降低 (腰椎正位除外 ) ,对松质骨BMD影响小 ;正常和晚绝经年龄对BMD影响小 ;绝经年龄对骨强度影响小     

Quiste del canal de Nuck,a propósito de un caso

The descent of initially intra-abdominal structures towards the inguinal region leads to an evagination of the parietal peritoneum, and is called the canal of Nuck. Its incomplete obliteration will allow the passage of liquid or abdominal structures, leading to a hydrocele of the said canal or indirect inguinal hernias. The canal of Nuck cyst appears as a fluctuating, elastic and non-reducible mass, cystic in the ultrasound, and well-defined with a thin echogenic wall and an anechoic content, with no colour Doppler signal. The differential diagnosis includes hernias, adenomegalies, vascular pathology, and tumours. Although the definitive diagnosis is histopathological, ultrasound is an accessible, efficient and reliable technique, which allows dynamic and real-time study.     

妊娠期高血压疾病终止妊娠时机与方式

妊娠期高血压疾病是一组妊娠期特有的多器官损害的临床疾病,严重危害母儿健康。终止妊娠是惟一有效的治疗方法,选择恰当的分娩时机与方式是改善母婴结局的关键。文章复习国内外文献,结合作者的处理经验,就相关问题进行探讨。     

Preeclampsia: Definitions,screening tools and diagnostic criteria in the supersonic era

Preeclampsia is still a major risk factor for maternal-fetal health. Therefore, early identification of pregnant women at risk for preeclampsia is a big priority in obstetrics in order to decrease the mortality and morbidity associated with this disease. On the basis of well known and new pathophysiological mechanisms of preeclampsia, different biochemical and ultrasonographic parameters have been investigated in the literature, without finding an ideal marker for early screening. In this brief review, we present the best studied ultrasonographic markers and the most recent genetic factors and promising emerging biomarkers of preeclampsia, to date. We hope that in the future the combination of these tests will allow us to predict which women are at risk of preeclampsia.     

Thoughts on the popularity of ICSI

PurposeIntracytoplasmic sperm injection (ICSI) is the most widely utilized assisted reproductive technique (ART) worldwide. In this feature, we review the early assisted fertilization attempts that eventually led to the development of ICSI, and discuss its current utilization in cases of male and non-male factor infertility.MethodsWe researched the literature related to the development, indications, and current use of ICSI, such as sperm structural abnormalities, male genetic indications, surgically retrieved sperm, high sperm chromatin fragmentation, oocyte dysmorphism, and preimplantation genetic testing (PGT). We also describe the potential future applications of ICSI.ResultsThis review summarizes the early micromanipulation techniques that led to the inception of ICSI. We also explore its current indications, including non-male factor infertility, where its use is more controversial. Finally, we consider the benefits of future advancements in reproductive biology that may incorporate ICSI, such as in vitro spermatogenesis, neogametogenesis, and heritable genome editing.ConclusionThe versatility, consistency, and reliability of ICSI have made it the most prevalently utilized ART procedure worldwide.     

会阴正中切口左侧切口缝合术临床效果分析

探讨会阴正中切口缝合术与会阴左侧切口缝合术的临床应用效果,根据产妇会阴体的条件,有无产科合并症胎儿的大小等情况,选择最佳的会阴切口方式,以减轻产妇的疼痛,减少切口出血量,分析比较两种切口方式术后并发症和后遗症的发生率。     

Trends and risk factors of stillbirth in New Jersey 1997–2005

Introduction: The purpose of this study was to examine the trends in the rates of stillbirth by race and ethnicity and to determine the risk factors of stillbirth. Methods: We used New Jersey data (1997–2005) for live births and fetal deaths. Cox proportional hazards model was used to estimate the risk of stillbirth associated with maternal risk factors and pregnancy complications. Results: The rate of stillbirth was 4.4/1000 total births (3.4 for white and 7.9 for black non-Hispanics and 4.4 for Hispanics/1000 total births). The rates of stillbirth decreased from 3.8 in 1997 to 2.7/1000 total births in 2005 for white non-Hispanics but remained unchanged for other race/ethnicity groups. Adjusted relative risks for the risk factors associated with stillbirth were 1.3 (95% CI, 1.2–1.4) for maternal age ≥ 35 years, 1.9 (95% CI, 1.7–2.1) for black non-Hispanics, 2.8 (95% CI, 2.4–3.3) for no prenatal care, 40.2 (95% CI, 36.9–43.9) for placental abruption, 5.3 (95% CI, 3.4–8.2) for eclampsia, 3.5 (95% CI, 2.8–4.3) for diabetes mellitus and 1.7 (95% CI, 1.3–2.2) for preeclampsia. Conclusion: There was a decline in the rate of stillbirth but there were persistent racial disparities with the highest rates of stillbirth for black non-Hispanics.     

Comparative study of induction of labor in nulliparous women with premature rupture of membranes at term compared to those with intact membranes: duration of labor and mode of delivery

AIM: To evaluate the effect of premature rupture of membranes (PROM) at term on the duration of labor and mode of delivery in comparison with intact membranes in nulliparous women with an unfavorable cervix whose labor was induced. METHODS: This retrospective cohort study included all term nulliparous women with an unfavorable cervix requiring labor induction over a 2-year period. Prostaglandin E(2) (dinoprostone) and oxytocin were used for labor induction. Criteria for enrolment included (i) singleton pregnancy; (ii) term nulliparous women; or (iii) Bishop score below 6. Statistics were analyzed with Student's t-test, chi(2)-test, Fisher's exact test, and multiple logistic regression. RESULTS: Our study subjects were 82 women whose labor was induced for PROM and 219 women with intact membranes whose labor was induced for social or fetal reasons. The mean durations of active phase of labor were not significantly different between women with PROM and those with intact membranes. However, the women with PROM had a significantly longer mean duration of second stage and a higher rate of cesarean delivery for failure to progress than those with intact membranes. Multiple logistic regression demonstrated that only PROM and fetal macrosomia were significantly associated with an increased risk of cesarean delivery for failure to progress after other confounding variables were adjusted. CONCLUSIONS: Labor induction for PROM at term in nulliparous women with an unfavorable cervix is associated with longer duration of the second stage and a higher risk of cesarean delivery for failure to progress in comparison to those with intact membranes.     

The Museum on the History of Contraception

the history of contraception has been documented for many centuries. It spells out a story of human motivation and creativity in the desire to prevent pregnancy. Very few artifacts had been saved prior to the creation of a museum dedicated to the history of contraception. With over 600 items now in its collection the museum tells the fascinating story of the techniques and beliefs over the centuries in the evolution of the knowledge and products we have available today for effective contraceptive use.     

Perceptions of motherhood: The effect of experience and knowledge on midwifery students

Objective

to explore the factors that influence student midwives’ constructs of childbearing, before and during their undergraduate midwifery programme.

Design

a naturalistic, qualitative study.

Setting

a university in the East Midlands, UK.

Participants

58 women registered on a 3-year midwifery education programme.

Measurements

focus groups were conducted at programme commencement and at 9–12 monthly intervals with two cohorts of midwifery students who were separated into groups of mothers and non-mothers (32 focus groups in total). This paper draws on data from the nine focus groups held at the start of the students’ programme.

Findings

the main themes that emerged from the data were in relation to image during pregnancy, expectations/experiences of childbirth and parenting. In particular, students believed that pregnancy and childbirth should be special. They suggested that a lack of knowledge about sexuality and choice options affected women's ability to be in control. Although normality was the students’ expectation of childbirth, they also assumed that hospital birth was the norm. They were unsure whether the baby's father was the best birth partner. Their mothers were suggested as likely to be more supportive, but there was lack of agreement regarding whether they were the best parenting role models. Students also said that there was a lack of positive images of breast feeding. The overall motivation to become midwives was ‘to make a difference’.

Conclusions

students need to be facilitated early in their programme to explore their belief systems and constructs of childbearing critically so that they are equipped to support parents to have a positive experience, whether childbirth is normal or complex, and so that they can cope with any dissonance between their own expectations and the uncertainties and realities of practice.