Occupational risk of human parvovirus B19 infection for school and day-care personnel during an outbreak of erythema infectiosum

Human parvovirus B19, the cause of erythema infectiosum, has recently been associated with adverse fetal outcomes. During a large outbreak of erythema infectiosum in Connecticut, a survey was conducted on 571 (90%) of 634 school and day-care personnel to determine the risk of acquiring B19 infection. Serologic evidence of B19 infection was determined by using an enzyme-linked immunosorbent assay. Of the school and day-care personnel, 58% had evidence of previous B19 infection. The minimal rate of B19 infection in susceptible personnel during the outbreak was 19%. The risk was increased for teachers and day-care providers who had contact with younger children and with greater numbers of ill children. These results suggest that B19 infection is an occupational risk for school and day-care personnel.     

HBV-DNA的含量与宫内感染的关联性

目的：探讨孕妇血清中HBV—DNA含量与胎儿宫内感染及造成宫内感染的相关因素．方法：用ELISA方法筛选HBsAg阳性孕妇228例,并用定量PCR技术检测HBsAg阳性孕妇血清以及脐血中HBV—DNA．新生儿根据有无HBV感染分为胎儿感染组及非感染组（对照组）,调查宫内感染的相关因素,结果：HBsAg,HBeAg、抗HBc阳性孕妇的新生儿脐血HBV—DNA捡出率21％（14／68）;HBsAg．抗HBe,抗HBc阳性者为1．7％（2／117）;HBsAg和HBeAg双阳性者为20％（3／15）;HBsAg和抗HBc阳性者为11％（2／19）;HBsAg单一抗原阳性者脐血中未捡出HBV—DNA．胎儿总感染率为9,2％（21／228）．胎儿宫内感染率随孕妇血清中HBV—DNA含量增加而升高,宫内感染的危险性越大．胎儿感染组与非感染组在多种临床相关因素中先兆早产孕妇胎儿感染者多于非感染组（P〈0．05）．结论：孕妇不同的感染状态影响宫内HBV感染率,HBeAg与HBV—DNA高滴度是胎儿宫内感染的高危因素．孕妇出现先兆早产使胎儿的感染率增加．     

人类微小病毒B19感染的最新进展

人类微小病毒B19主要侵袭人体骨髓造血系统,损害人体多种脏器,是儿科出疹性疾病——传染性红斑的病原。还可使慢性溶血患者发生再障危象、关节病、血管性紫癜和雷诺肢端综合征等。在免疫缺陷患者,可造成持续感染。妊娠期受到病毒侵害,引发宫内感染,可导致流产、胎儿水肿和死胎。此外,还与多种造血系统异常(中性粒细胞减少症和血小板减少症等)有关。     

妊娠晚期孕妇生殖道B族溶血性链球菌感染及对妊娠结局的影响

目的：探究妊娠晚期孕妇生殖道B族溶血性链球菌(GBS)感染对妊娠结局的影响。方法随机选取该院2015年1-7月收治的妊娠晚期孕妇100例作为该次研究对象,其中50例为GBS阳性孕妇作为实验组,50例为GBS阴性孕妇作为对照组,对比2组妊娠晚期孕妇妊娠结局的差异性。结果实验组GBS阳性孕妇剖宫产的发生率(36.00%)、胎膜早破、宫内感染、早产、羊水污染的总发生率(46.00%)以及胎儿宫内窘迫、新生儿感染的总发生率(70.00%)明显高于对照组GBS阴性孕妇剖宫产的发生率(56.00%)、胎膜早破、宫内感染、早产、羊水污染的总发生率(26.00%)以及胎儿宫内窘迫、新生儿感染的总发生率(40.00%),P<0.05,差异具有统计学意义。结论 GBS是危害母婴健康的一种致病菌,其会对妊娠结局造成不良的影响,加强围产期GBS的筛查,给予孕妇相应的预防措施,对改善孕妇的妊娠结局十分有益。     

胎儿先天性心脏病的高危因素及产前超声诊断

目的　探讨胎儿先天性心脏病 (CHD)的高危因素及彩色超声诊断胎儿先天性心脏病的适应证。方法　彩色超声仪检查 2 780例孕妇 ,回顾分析胎儿CHD发病的高危因素 ;比较高危、低危孕妇组胎儿先天性心脏病的发病率。结果　孕妇孕期上呼吸道感染、高龄、先兆流产、早孕期接触X线等是胎儿CHD发病的高危因素。高危组胎儿先天性心脏病发病率为 6 81% ,低危组发病率为 1 5 4 % ,两组胎儿CHD发病率间差别有显著性意义 (P <0 0 1)。结论　胎儿先天性心脏病存在高危因素 ,对高危孕妇常规及适时地进行胎儿心脏超声产前诊断 ,及早发现复杂性胎儿先天性心脏病 ,可减少出生缺陷。     

系统性红斑狼疮患者妊娠时机选择与妊娠结局

目的 探讨系统性红斑狼疮(SLE)患者妊娠时机的选择与妊娠结局的相关性.方法 回顾性分析2005年1月-2011年7月我院收治的33例SLE合并妊娠患者临床资料,根据妊娠时机分为孕前持续缓解期(A组)和活动期(B组),比较两组孕期并发症及母婴结局.结果 A组20例中,孕期发生严重并发症者6例(30.0％),足月终止妊娠10例,早产7例,治疗性引产2例,胎死宫内1例,无孕产妇死亡,无新生儿畸形;B组13例中,孕期发生严重并发症11例(84.6％),早产8例,治疗性引产3例,胎死宫内2例.B组孕期发生严重并发症几率增加,妊娠丢失率及早产率高,早产新生儿体重轻,差异有统计学意义(P＜0.05).结论 SLE患者选择病情持续稳定期计划妊娠,孕期严格监测、合理调整用药、适时终止妊娠是减少SLE患者孕期并发症以及改善母婴结局的关键.     

胎儿期心律失常的诊断及其临床意义探讨

目的：探讨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。方法收集产前检查中发现胎儿心律失常的57例孕妇资料,分析孕妇病史、胎儿心电图、胎儿超声心动图、妊娠结局等。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发生率分别为7.0%、3.5%和89.5%。经期待疗法,孕期胎儿心律恢复正常的有21例（36.8%）,出生后新生儿心律迅速恢复正常的有15例（26.3%）,产后7d新生儿心律恢复正常的有14例（24.6%）。4例胎儿（7.0%）发现心脏结构异常。结论大部分胎儿心律失常与胎儿的心脏调节功能尚未完善有关,约91.2%在分娩前或出生后心律恢复正常;胎儿期心律失常预后不良相关的因素为胎儿水肿、持续性心律失常。     

Evaluation on Clinical Application of Three Testing Methods for Human Cytomegalovirus Infection in Pregnancy

Summary:The value of ELISA,N-PCR and RT-PCR in clinical practice for pregnant women withHCMV infection was investigated.5581 pregnant women were screened by ELISA.Among them,100 cases were positive for IgM(group 1),69 for both IgM and serous DNA(group 2)and 69 forboth IgM and mRNA(group 3).The infectious status,maternal-fetal transmission and pregnancyoutcome were monitored.It was demonstrated that the accordance rate of group 3 and group 2 withgroup 1 was 56.25％ and 43.75％,respectively.The maternal-fetal transmission rate in the group1,2 and 3 was 19.00％,40.58％ and 46.15％,respectively,with a significant difference foundbetween group 2,3 and group 1(P<0.01).Incidence of spontaneous abortion,fetal death,fetalabnormality and neonatal death in group 1,2 and 3 was 10.00％,15.94％ and 30.77％,respec-tively,and that of group 3,2 was 4 and 2 times as much as that of group 1,respectively(OR=4.00,P<0.001;OR=2.343,P<005,respectively).It was concluded that HCMV-IgM(+)can on-ly be considered as an screening in     

乙型肝炎病毒宫内感染对胎儿生长发育的影响.

目的：探讨乙型肝炎病毒宫内感染对胎儿生长发育的影响。方法：回顾性分析194例HBsAg阳性的孕妇及其新生儿的临床资料,并随机选取296例HBsAg阴性的孕妇及其新生儿作为对照组,分析这两组的妊娠并发症,围产儿结局及胎儿发育指标。结果：1. HBsAg阳性孕妇所生新生儿出生体重和胎盘体积较HBsAg阴性孕妇小。孕妇HBV感染状态与胎儿出生体重,身长及FGR发生率无明显关系;孕妇HBV-DNA阳性组的胎盘体积较阴性组小,ALT异常组的胎盘体积大于ALT正常组。2. 新生儿HBsAg阳性组的出生体重、身长,胎盘体积均较阴性组低,FGR发生率较阴性组高。3.新生儿HBeAg阳性组FGR发生率较阴性组高,胎盘体积较阴性组小。4.新生儿HBsAb阳性组胎盘体积较阴性组大。结论：乙型肝炎病毒感染可导致胎盘体积缩小,出生体重降低,新生儿HBsAb对胎盘有一定的保护作用。     

非免疫性胎儿水肿的诊疗新进展——2018年《非免疫性胎儿水肿的调查和管理指南》解读

胎儿水肿是较为棘手的胎儿医学问题,2018年加拿大妇产科医生协会（SOGC）发布了《非免疫性胎儿水肿的调查和管理指南》（以下简称2018版指南）,与2014年美国母胎医学会发布的指南相比较,2018版指南结合近年来的主要研究成果,对非免疫性胎儿水肿（NIFH）进行总结,并提出了一些新的诊治意见。快速及时的诊治可显著改善胎儿贫血、胎儿心律失常等原因导致的水肿胎儿的预后,2018版指南更加强调了水肿胎儿及时转诊的重要性,建议一旦发现胎儿水肿立即转诊到三级医院进行诊疗;推荐对所有NIFH胎儿进行微阵列比较基因组杂交技术检测及大脑中动脉血流超声评估以明确病因;2018版指南还强调了对死亡胎儿或新生儿尸检的重要性,对代谢病引起的胎儿水肿进行了详细的描述。本指南是近4年来唯一发表的NIFH专题指南,对临床有一定指导意义。     

国人细小病毒B19感染相关疾病谱

目的：探讨我国人细小病毒Ｂ１９感染引起的相关疾病谱。方法：用聚合酶链反应（ＰＣＲ）技术及原位杂交技术对６６例先天性心脏病（ＣＨＤ）心肌组织标本及１０８例血小板减少性紫癜（ＴＰ）、４７例急性再生障碍性贫血（ＡＡＡ）、５例传染性红斑（ＥＩ）及４０例缺铁性贫血（ＩＤＡ）患儿的外周血、骨髓标本进行了Ｂ１９－ＤＮＡ检测,并随机对其中２３例Ｂ１９－ＤＮＡ阳性标本作巨细胞病毒（ＣＭＶ）、单纯疱疹病毒（ＨＳＶ）、     

胎儿畸形超声探测与产后对照分析

目的 了解胎儿畸形的发生率以及超声诊断的符合率，为早期临床干预提供依据。方法 采用彩色多普勒超声仪随机对5213例孕19～42周胎儿进行多系统的常规探查，所得结果与产后尸体解剖及临床对照。结果 共查出胎儿畸形221例，畸形率为42．39‰。胎儿畸形前5位依次为：胎儿水肿(27．15％)、体表(17、20％)、心血管(16．29％)、神经管(10．41％)、泌尿系(9．95％)。产后对照，畸形的超声诊断符合率达90％以上的有胎儿水肿、心血管、腹壁裂及神经管畸形。结论 胎儿畸形并非少见，超声及早发现对优生尤为重要。     

用荧光探针定量多聚酶链反应技术检测乙肝病毒宫内传播的研究

目的探讨孕妇血中乙肝病毒(HBV)DNA数量与宫内传播的关系.方法用荧光探针定量多聚酶链反应(FQ-PCR)方法,检测76例乙肝病毒表面抗原(HBsAg)阳性孕妇血清中HBV DNA数量.26例HBV DNA阳性者肌注乙肝免疫球蛋白,新生儿出生后24h内取末梢静脉血检测HBV DNA.结果孕妇血中HBV DNA阳性者其宫内感染率为33.3%,宫内感染与孕妇血中HBV DNA数量有关,HBV DNA数量高易导致胎儿宫内感染,乙肝免疫球蛋白免疫注射后可降低HBV宫内感染率.结论孕妇血中HBV DNA数量高易导致胎儿宫内感染,孕期应用乙肝免疫球蛋白可减少宫内传播.     

Hydrops fetalis: report of 3 cases

Ultrasound is a well recognized imaging modality for prenatal diagnosis of fetal congenital anomalies. Reported cases are hydrops fetalis diagnosed during ultrasonic evaluation of fetal condition in the Center for Nuclear Medicine and ultrasound (CNMU), Mymensingh. Only fetal ascites was detected in one case of 26 +/- 2 wks of gestation, fetal ascites with hydramnios and thick placenta was seen in another case of 28 +/- 2 wks of gestation. In third case, there was fetal ascites, scalp edema, hydrothorax and myelomeningocele with oligohydramnios at 20 +/- 2 wks of gestation; sonographic diagnosis was hydrops fetalis with myelomeningocele. Follow up was advised in first two cases and third case was terminated electively. To decrease the mortality rate and to improve the outcome of hydrops fetalis cases appropriate prenatal investigations and therapy is needed. Recent advances in prenatal ultrasound have made possible the early detection of hydrops fetalis which is helpful for proper management in time.     

The changing pattern of fetal hydrops.

Fetal hydrops (hydrops fetalis) remains a significant cause of fetal and neonatal mortality. The decreased incidence of rhesus iso-immunisation due to prophylaxis with rhesus immune globulin (anti-D), improved antenatal ultrasound screening, and advances in neonatal intensive care have greatly altered the clinical outlook in this condition. A retrospective review of all 27 liveborn cases of hydrops in the Royal Maternity Hospital, Belfast in the period 1974-89 showed that in the last five years 40% of cases were non-immune in origin. The mortality rate fell from 100% in the first part of the study to 50% in the second.     

先天性巨细胞病毒感染与胎儿畸形关系的研究

通过1002份孕妇血清和372份新生儿脐血巨细胞病毒(CMV)IgM和IgA抗体的检测,发现青岛地区孕妇活动性及先天性CMV感染率均较高,分别为20.95%和9.14%。孕妇活动性巨细胞病毒感染传播给婴儿的危险度为36.96%。在110例活动性巨细胞感染孕妇所娩婴儿短期临床随访中发现,活动性巨细胞病毒感染孕妇所娩胎儿出现早产、死胎和发育异常现象显著多于非感染对照组。研究结果认为采用ELISA法检测孕妇血清中CMV-IgM和IgA可用于预测和监视先天性巨细胞病毒感染所致发育异常婴儿出生的危险程度,并可作为优生门诊防止畸形儿出生的一种检测手段。     

产前诊断胎儿水肿(附2例报告)

本文报告2例B型超声产前诊断胎儿水肿两例,并讨论了胎儿水肿的病因、发生率、特点、B型超声图象特点及胎儿水肿的预后及治疗。     

乙型肝炎病毒感染孕妇胎盘绒毛病理形态研究

通过分析妊娠合并乙型肝炎病毒 (HBV)感染孕妇的胎盘绒毛及血管的病理变化 ,探讨其与胎儿预后的关系。 1 )对 2 0例妊娠期HBV表面抗原 (HBsAg)、HBVe抗原 (HBeAg)、HBV核心抗体 (HBcAb)和HBVDNA均阳性、肝功能正常的孕妇及其新生儿 (研究组 ) ,1 8例无肝炎病毒感染、肝功能正常的孕妇及新生儿 (对照组 ) ,取胎盘进行病理检查 ,并利用图像分析仪对胎盘绒毛横截面总面积和总周长 ,单个绒毛的横截面面积、周长和等圆直径 ,单个绒毛内血管数目及血管占绒毛的面积比值进行形态定量分析。 2 )计算 2组胎儿宫内窘迫的发生率。发现 :1 )研究组胎盘绒毛横截面总面积与对照组相比 ,无显著差异 ,绒毛总周长明显小于对照组 (P <0 .0 5 )。 2 )研究组胎盘单个绒毛横截面面积、周长和等圆直径均明显大于对照组 (P <0 .0 5 )。 3 )研究组胎盘单个绒毛内血管数目明显多于对照组 (P <0 .0 5 ) ,血管占绒毛的面积比值明显小于对照组 (P <0 .0 5 )。 4)研究组胎儿宫内窘迫发生率为 5 5 .0 % ,对照组为1 1 .1 %。结果提示 :妊娠合并HBV感染 ,可引起胎盘绒毛膜血管病 ,这可能是胎儿发生宫内窘迫的主要原因     

Lyme disease during pregnancy

Lyme disease is an increasingly recognized tick-borne illness caused by a spirochete, Borrelia burgdorferi. Because the etiologic agent of Lyme disease is a spirochete, there has been concern about the effect of maternal Lyme disease on pregnancy outcome. We reviewed cases of Lyme disease in pregnant women who were identified before knowledge of the pregnancy outcomes. Nineteen cases were identified with onset between 1976 and 1984. Eight of the women were affected during the first trimester, seven during the second trimester, and two during the third trimester; in two, the trimester of onset was unknown. Thirteen received appropriate antibiotic therapy for Lyme disease. Of the 19 pregnancies, five had adverse outcomes, including syndactyly, cortical blindness, intrauterine fetal death, prematurity, and rash in the newborn. Adverse outcomes occurred in cases with infection during each of the trimesters. Although B burgdorferi could not be implicated directly in any of the adverse outcomes, the frequency of such outcomes warrants further surveillance and studies of pregnant women with Lyme disease.     

乙型肝炎病毒感染对妊娠期肝内胆汁淤积症的影响

目的 探讨无症状乙型肝炎病毒(HBV)感染对妊娠肝内胆汁淤积症(ICP)的发生率、病情、并发症及妊娠结局的影响.方法 采用回顾性方法 分析2011年1月～2011年12月期间在我院住院治疗的307例ICP孕妇,其中合并乙肝病毒感染的73例为HBV+ICP组,无乙肝病毒感染的234例为单纯ICP组.通过对比分析,无症状乙型肝炎病毒 (HBV)感染对妊娠肝内胆汁淤积症(ICP)的发生率、病情、并发症及妊娠结局的影响.结果 所有住院孕妇中未合并 HBV感染的孕妇ICP发病率4.27%,合并HBV感染的孕妇ICP发病率14.25%,二者差异有统计学意义(P<0.001).HBV+ICP组瘙痒出现时间明显早于单纯ICP组,分别为(29.2±4.8)周及(32.6±3.9)周(P<0.01).二者血清胆汁酸和胆红素的结果 差异无统计学意义.两组ICP孕妇的早产、胎儿窘迫、新生儿窒息、小于胎龄儿发生率的差异无统计学意义(P>0.05),但合并HBV组产后24h阴道出血量明显增多,两组差异有统计学意义(P相似文献