胎儿及新生儿甲状腺功能异常的产前诊断及管理

胎儿和新生儿甲状腺疾病罕见,部分病例的病情严重。早期诊断和治疗是改善患儿预后的关键。本文介绍了胎儿和新生儿期甲状腺疾病的诊治策略。对于甲状腺肿大的胎儿,主要的临床问题是确定病因是甲状腺功能亢进还是减退,并给予相应的治疗。管理母亲、胎儿和新生儿甲状腺疾病需要经验丰富的多学科团队,该团队应包括成人和儿童内分泌科医生、产科医...     

急性胎儿窘迫的诊断与处理

急性胎儿窘迫是分娩期常见的产科并发症,可以导致围产儿不良结局。围产期使用可靠的胎儿监护手段,早期识别急性胎儿窘迫,及时针对病因进行有效处理,并且决策最优终止妊娠的时机及方式,以期改善新生儿预后并减少远期并发症。     

胎儿炎症反应综合征研究进展

胎儿炎症反应综合征（fetal inflammatory response syndrome，FIRS）是胎儿固有免疫系统被激活的一种亚临床状态，是全身炎症反应综合征（systemic inflammation response syndrome，SIRS）在胎儿期的特殊表现。宫内感染及胎儿宫内慢性缺氧是导致FIRS的两个重要原因。感染或缺氧所致的“失控”的全身性炎症反应是FIRS发生的主要机制。FIRS与早产、支气管肺发育不良、新生儿早发型败血症、新生儿脑损伤、新生儿坏死性小肠结肠炎等新生儿严重并发症密切相关。FIRS宫内表现通常不典型，极易忽视，如不及时干预，新生儿期可能出现脑瘫、多器官功能衰竭、死亡等严重后果。本文就近年FIRS的临床诊断、发病机制和危害等方面的研究进展进行综述。     

胎儿炎症反应综合征研究进展

胎儿炎症反应综合征(fetal inflammatory response syndrome,FIRS)是胎儿固有免疫系统被激活的一种亚临床状态,是全身炎症反应综合征(systemic inflammation response syndrome,SIRS)在胎儿期的特殊表现。宫内感染及胎儿宫内慢性缺氧是导致FIRS的两个重要原因。感染或缺氧所致的"失控"的全身性炎症反应是FIRS发生的主要机制。FIRS与早产、支气管肺发育不良、新生儿早发型败血症、新生儿脑损伤、新生儿坏死性小肠结肠炎等新生儿严重并发症密切相关。FIRS宫内表现通常不典型,极易忽视,如不及时干预,新生儿期可能出现脑瘫、多器官功能衰竭、死亡等严重后果。本文就近年FIRS的临床诊断、发病机制和危害等方面的研究进展进行综述。     

胎膜早破与胎儿-新生儿肺损伤的相关性及其机制

胎膜早破(premature rupture of membrane,PROM)是孕产期常见并发症,严重影响胎儿-新生儿的生长发育和健康成长,甚至导致其死亡,故有关PROM的研究一直受到国内外临床医师的高度重视[1-2].其中,胎膜早破后由于感染与炎症反应等因素所致的肺发育成熟障碍及多种严重肺疾病是导致胎儿-新生儿预后不良甚至死亡的重要原因之一.本文对近年来的相关研究进展作一综述.     

胎儿期心律失常的诊断及其对新生儿预后的影响

目的了解胎儿期心律失常的诊断方法、临床意义及对新生儿预后的影响。方法选择2004年6月至2006年1月于浙江大学医学院附属妇产科医院产前检查中发现胎儿心律失常孕妇57例,分析孕妇病史、胎儿心电图、胎儿超声心动图、妊娠结局。结果胎儿心律失常中胎儿心动过速、胎儿心动过缓和不规则胎儿心律的构成比分别为17.4%、4.3%和78.3%。首次发现胎儿心律失常的孕周及胎儿心律失常的类型与新生儿预后没有显著关联。持续发作心律失常的胎儿,其预后显著差于偶发心律失常的胎儿。经期待疗法,孕期胎儿心率恢复正常的有21例(36.8%),出生后新生儿心率迅速恢复正常的有15例(26.3%),经对症治疗后有14例新生儿恢复正常心率(24.6%)。发现4例(7.0%)胎儿心脏结构异常。59.7%的孕妇合并产科并发症。结论大部分心律失常的胎儿预后良好,在临床上可以密切随访,可在分娩前或出生后恢复正常心率;与胎儿预后不良有关的因素为持续发作心律失常、胎儿伴有水肿。     

阿司匹林防治早产应用的研究进展

早产是造成新生儿死亡和患病的主要原因之一,如何早期预防和干预早产一直是产科领域的研究热点、难点。近年研究发现,阿司匹林可通过抗血小板聚集、改善胎盘循环、降低炎症反应、调节免疫耐受等多方面对抗早产的病理生理过程。本文就阿司匹林参与预防早产发生发展可能机制综述如下。     

早期预警体系与模拟培训在降低严重产科并发症中的作用

产科急重症严重威胁孕产妇及胎儿生命,为保障产科医疗安全,建立早期预警管理体系至关重要。加强产科急重症模拟培训,掌握预警触发标准、反应措施及处置流程。在病情变化的早期进行识别和诊断,并给予及时干预措施,可减少产科严重并发症的发生。     

胎儿生长受限的病因和治疗

胎儿生长受限是产科重要并发症之一,是围产儿死亡和发病的重要原因.该病的病因包括母体、胎儿、胎盘三方面的因素.B超可用于早期诊断.补充营养素,卧床休息,氧疗以及应用阿斯匹林、舒喘宁等药物可能会增加胎儿体重.孕晚期及时处理可以改善胎儿预后.     

胎儿窘迫的真与假——产科永恒的话题

胎儿窘迫是指胎儿在子宫内因缺氧或酸中毒引起的、危及胎婴儿健康和生命的一系列病理状况.临床上如何早期发现并正确诊断胎儿窘迫,是围产医学的重要课题,也是产科永恒的话题.及时处理胎儿窘迫,能使胎儿在重要器官遭受损害之前娩出,从而减少或避免发生新生儿并发症;但同时应避免胎儿窘迫的过度诊断,造成盲目剖宫产、医源性早产等.     

Comparative efficacy of short-term versus long-term cefoxitin prophylaxis against postoperative infection after radical hysterectomy: a prospective study

We report the results of a randomized, double-blind comparison of short-term versus long-term cefoxitin prophylaxis against infections after radical abdominal hysterectomy with pelvic and para-aortic lymphadenectomy. Of 113 evaluable patients, 54 (47.8%) received short-term (three doses) and 59 (52.2%) long-term (12 doses) prophylaxis with intravenous cefoxitin (2 g per dose). No significant differences in demographics, preoperative risk factors, or clinical course were detected between the two groups; nor did we detect significant differences in the incidence of surgical-site-related infections (7.4 versus 5.1%, respectively, P = .61), postoperative urinary tract infection, or other febrile morbidity. We conclude that short-term and long-term cefoxitin prophylaxis are equally effective for the prevention of post-operative surgical-site-related infections after radical hysterectomy.     

Perinatal outcome and long-term follow-up of extremely low birth weight infants depending on the mode of delivery

Objective.?To assess the effect of the mode of delivery (vaginal or cesarean section) on survival, morbidity, and long-term psychomotor development of extremely low birth weight (ELBW) infants.

Methods.?A longitudinal observational study including 138 ELBW infants (73 born by c-section and 65 vaginally) was conducted. We analyzed the survival and short-term morbidity. We also studied the long-term neurocognitive and motor development using the McCarthy Scales of Children's Abilities (MSCA).

Results.?Mortality was significantly higher in newborns delivered vaginally (49.3%) than those delivered by c-section (23.1%). Newborns delivered vaginally had a higher incidence of retinopathy and peri-intraventricular hemorrhage (P-IVH). Children who died had lower gestational age at birth and lower birth weight. After multivariate analysis only birth weight, gestational age at birth and P-IVH were independently associated to mortality. Regarding the long-term evaluation (MSCA), we observed that children born by c-section had lower incidence of abnormal results.

Conclusions.?The mode of delivery does not affect survival. Cesarean section provides lower morbidity and better prognosis for neurodevelopment long-term outcome in ELBW infants     

Long-term childhood outcomes after interventions for prevention and management of preterm birth

Globally, preterm birth rates are rising and have a significant impact on neonatal morbidity and mortality. Preterm birth remains difficult to prevent and a number of strategies for preterm birth prevention (progesterone, cervical pessaries, cervical cerclage, tocolytics, and antibiotics) have been identified. While some of these show more promise, there is a paucity of evidence regarding the long-term effects of these strategies on childhood outcomes. Strategies used to improve the health of babies if born preterm, such as antenatal magnesium sulfate for fetal neuroprotection and antenatal corticosteroids for fetal lung maturation, show evidence of short-term benefit but lack large-scale follow-up data of long-term childhood outcomes. Future research on preterm birth interventions should include long-term follow-up of the children, ideally with similar outcome measures to allow for future meta-analyses.     

Current aspects of symphysiotomy. Apropos of 1 case and review of the literature

Symphysiotomy is regularly performed in developing countries where cesarean section can be a source of significant short-term and long-term morbidity. However, this method can be useful in some rare occasions and should be taught in our countries, at least theoretically. Such a case is presented with a review describing the present surgical technique, its indications and limits with special reference to its possible complications.     

Low birthweight breech infant: short-term and long-term outcome by method of delivery

The effect of the delivery method on the short-term and long-term morbidity and mortality of the very low birthweight breech-presenting infants was evaluated. Although some previous studies question the benefit of cesarean section for the premature breech infants, the mortality rate and the incidence of birth injuries were significantly lower in the abdominally delivered group than in those delivered vaginally. The long-term follow-up clearly demonstrates that the vaginally delivered infants had a substantially higher incidence of cerebral palsy, visual damage, deafness, and severe developmental delay. It is concluded that cesarean section may be the preferred delivery method for the breech-presenting infants weighing 1000 to 1999 gm, offering a better quality of life.     

Prenatal exposure to isolated amniotic fluid disorders and the risk for long-term cardiovascular morbidity in the offspring

Abstract

Amniotic fluid (AF) abnormalities are often associated with short-term adverse pregnancy outcomes, including cardiovascular-related. We sought to assess whether in utero exposure to AF abnormalities increases the risk for long-term cardiovascular morbidity of the offspring. We examined the incidence of cardiovascular disorders in singletons exposed and non-exposed to isolated oligohydramnios or polyhydramnios. Cardiovascular morbidity was assessed up to the age of 18 years according to a predefined set of ICD-9 codes. A Kaplan–Meier survival curves were used to compare cumulative morbidity incidence. A Cox proportional hazards model was constructed to control for confounders. During the study period, 195,943 newborns met the inclusion criteria, of which 2.0% (n?=?4063) were in pregnancies diagnosed with isolated oligohydramnios and 2.9% (n?=?5684) in pregnancies with isolated polyhydramnios. Children exposed to isolated AF disorders had significantly higher rates of long-term cardiovascular morbidity (p=.042). Children exposed to isolated oligohydramnios had higher cumulative incidence of cardiovascular morbidity (log-rank test p=.026) compared to unexposed children, opposing to what was demonstrate when comparing polyhydramnios vs. normal AFV (log-rank test p=.749). In the Cox regression model, while controlling for confounders, isolated oligohydramnios were found to be independently associated with long-term cardiovascular morbidity of the offspring.     

Surgical morbidity associated with radical trachelectomy and radical hysterectomy

OBJECTIVES: To examine intra-operative, short and longer term morbidity associated with Radical Trachelectomy (RT) within our cohort of patients, compared with conventional Radical Hysterectomy (RH). METHODS: A retrospective case note review comprising 29 RT and 50 RH patients. Patients who required adjuvant treatment were excluded. Operative data, short-term and long-term complications were recorded. Long-term problems were included only if they had been of persistent nature. RESULTS: The median age and follow up period for the RH group were 40 years and 60 months and for RT group 30.5 years and 25 months. There were significant differences between RH and RT groups in median operative time (260 versus 187 min), blood loss (1000 versus 400 ml), transfusion requirement (75% versus 12%), analgesic requirement (8 versus 3.5 days) and hospital stay (11 versus 6 days). Bladder hypotonia requiring prolonged catheterisation was more frequent in RH group (P = 0.004). There was no apparent difference in psychosexual problems between the two groups (17 versus 16%). Complications of deep dyspareunia (P = 0.009), excessive vaginal discharge (P = 0.01), and upper thigh parasthesia (P = 0.05) were noted to be significantly higher in the RT group. Specific problems encountered in the RT group included; dysmenorrhea (24%), irregular menstruation (17%), recurrent candidiasis (14%), cervical suture problems (14%), isthmic stenosis (10%) and prolonged amenorrhea (7%). CONCLUSION: RT is associated with less operative and short-term morbidity compared with conventional RH. In addition to specific complications associated with RT, in our experience, there are long-term morbidities that are not as commonly observed in RH.     

Postoperative infections and antibiotic prophylaxis in radical hysterectomy. Retrospective study]

Radical hysterectomy is associated with a high risk of postoperative infectious morbidity. A series of 73 patients who underwent abdominal radical hysterectomy with pelvic lymphadenectomy is presented. Hospital charts were reviewed to determine the influence of surgical characteristics and of different antibiotic prophylaxis regimens on postoperative septic complications. The overall incidence of postoperative infections was 31.5%; in 13 patients had urinary tract infections (17.7%), 3 surgical site-related infections (4.1%) and 6 febrile morbidity (8.2%). There were also 3 cases of phlebitis and 3 infectious events at distant sites. No interaction was observed between the examined risk factors and the overall infectious morbidity. Time of surgical procedure and average blood transfusion show a trend toward increased values in patients with complications compared to patients with regular postoperative course. The most important current controversy about the use of prophylaxis in radical hysterectomy concerns the duration of postoperative treatment. In this series the major part of the subjects received a long-term antibiotic prophylaxis regimen (greater than 72 hours), and only 18% received a perioperative prophylaxis. Women without postoperative complications were more frequently treated with a long-term antibiotic prophylaxis (82%) compared to women with infectious morbidity (65%). Moreover, in patients with complications, the proportion of cases who needed an additional antibiotic therapy was lower in the group receiving long-term prophylaxis (20%) compared to the short-term group (83%).     

Neurodevelopment in children with intrauterine growth restriction: adverse effects and interventions

Intrauterine growth restriction (IUGR) is associated with higher rates of fetal, perinatal, and neonatal morbidity and mortality. The consequences of IUGR include short-term metabolic, hematological and thermal disturbances that lead to metabolic syndrome in children and adults. Additionally, IUGR severely affects short- and long-term fetal brain development and brain function (including motor, cognitive and executive function) and neurobehavior, especially neuropsychology. This review details the adverse effects of IUGR on fetal brain development and discusses intervention strategies.     

子痫的诊断与治疗

子痫是指在子痫前期基础上发生的全身性抽搐,为子痫前期发展至最严重阶段的临床表现。目前,子痫仍是造成孕产妇患病率和死亡率增高的主要原因。本文总结了目前子痫的发病机制、临床表现、诊断、治疗以及母婴近期和远期预后情况的相关进展。