Medical termination of pregnancy in the early first trimester

Surgical abortion using vacuum aspiration or dilatation and curettage has been the method of choice for termination of pregnancy up to 63 days' gestation since the 1960s. Over the last three decades many studies have explored the use of medical methods for inducing abortion at these gestations. Earlier regimens assessed the systemic and intrauterine injection of prostaglandins. This was followed in the 1980s by the introduction of the antiprogesterone, mifepristone. Since its introduction, the uptake of medical abortion has been steadily increasing in countries where it has been available for routine use. Most current clinical protocols require the use of prostaglandins in combination with anti-progesterones or antimetabolites. The safety, efficacy and acceptability of the medical regimen are now well established at all gestations of pregnancy. Provision of medical abortion increases the choice available to women, in particular those wishing to avoid surgery.     

Significance of transvaginal ultrasonic examination in the first pregnancy trimester

The authors report their results obtained by performing transvaginal sonography in 180 patients in the first trimester of pregnancy. It has been found that both normal and pathological cases could be diagnosed 1 week earlier than had been possible with transabdominal method. Minimum size of the intrauterin gestational sac was found to be 3 mm. Cardiac activity could be evaluated in embrios with a size of 7 mm or greater in all cases. According to them the diagnosis of blighted ovum and missed abortion seems to be confirmed when an "empty sac" is larger than 20 mm, or the absence of heart motion is detected in an embrio greater than 10 mm, without repeated scan. High sensitivity was found in ectopic pregnancies especially in unruptured cases. The possibility of qualitative analysis of "free fluid" in Douglas pouch and diagnosis of congenital anomalies in very early pregnancy are promising. Transvaginal sonography is recommended in all cases when transabdominal technique is equivocal.     

妊娠早期血清脂联素水平对妊娠期糖尿病的预测价值

目的 分析妊娠早期血清脂联素(APN)水平对妊娠期糖尿病(GDM)的预测价值.方法 选取2017年1月—2019年10月在无锡虹桥医院建档的孕妇作为研究对象,留取妊娠早、中期静脉血并随访跟踪至24～28周行口服葡萄糖耐量试验(OGTT),分为GDM组(42例)和对照组(42例).检测两组孕妇妊娠早、中期空腹血糖和APN...     

妊娠早期甲状腺功能及其抗体对自然流产的影响和预测价值

目的探讨妊娠早期甲状腺功能及抗体对自然流产的影响及预测价值。方法选择2014年1~6月因早孕于四川省妇幼保健院检查并同意参加调查的621名育龄妇女的临床资料,常规筛查甲状腺功能,包含血清促甲状腺素(thyroid stimulating hormone,TSH)、血清游离甲状腺素(free thyroxine,FT4)、血清游离三碘甲状腺原氨酸(free triiodothyronine,FT3)及甲功抗体(thyroid auto-antibodies,TA-Ab),并追踪随访至妊娠结束570例。根据TSH的水平分成3组:TSH减低组12例(TSH0.1 ml U/L)、TSH正常组270例(0.1ml U/L≤TSH2.5 m IU/L)和TSH增高组288例(TSH2.5 ml U/L)。根据甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)和甲状腺球蛋白抗体(thyroglobulin antibody,Tg Ab)水平分为两组:TPOAb≥34IU/m L或Tg Ab≥115 IU/m L为TA-Ab阳性组(45例);TPOAb50 IU/m L且Tg Ab115 IU/m L为TA-Ab阴性组(525例)。评价不同甲状腺功能水平及甲功抗体情况对自然流产的影响及预测价值。结果 TSH增高组自然流产率(21.88%)显著高于TSH正常组(7.78%)(P0.05),其中亚临床甲状腺功能减退组孕妇自然流产率为20.21%,显著高于TSH正常组(P0.05)。TA-Ab阳性组自然流产率为66.67%,TA-Ab阴性组自然流产率为10.86%,差异有统计学意义(P0.05)。TSH增高伴TA-Ab阳性组自然流产率为71.43%,TSH正常组自然流产率为8.60%,差异有统计学意义(P0.05)。TA-Ab和TSH预测自然流产的ROC曲线下面积为0.657和0.714,对预测自然流产有统计学意义(P0.05)。结论妊娠早期孕妇TSH水平增高和TA-Ab阳性是妊娠期自然流产的危险因素,均是预测流产的重要指标,两者联合可能有更大的预测价值,因此妊娠早期甲状腺功能筛查应包括甲状腺功能(FT3,FT4,TSH)及甲功抗体(TA-Ab)检测。     

Successful pregnancy outcome using total parenteral nutrition from the first trimester of pregnancy

A 27-yr-old gravida 3, para 2 was supported from the 8th week of pregnancy by intermittent daily total parenteral nutrition (TPN) following the loss of her small bowel. Nutrient intake was adjusted by monitoring nitrogen balance and the rate of increase in fetal cranial enlargement. Maternal calcium balance proved difficult to maintain, since massive urinary Ca+2 losses occurred during infusion of nutrients (576 +/- 2 mg/12 hr on TPN compared to 47 +/- 12 mg/12 hr off). This increase in urine Ca+2 was due to depressed Ca+2 reabsorption by the kidney (87.1 +/- .7 vs 98.1 +/- .3%) and increased filtered load (4623 +/- 241 mg/12 hr vs 2591 +/- 329). Initially calcium balance was -180 mg/day. Nitrogen balance assessed by total stool and urine nitrogen was 1.1 g/24 hr, which was judged to be suboptimal. Deficits were corrected by increasing nitrogen intake, lengthening the duration of infusion and the oral administration of elemental calcium during periods off infusion. A normal fetus was delivered vaginally without complications at 351/2 weeks. This patient demonstrates that normal fetal growth and development as well as appropriate maternal weight gain and nitrogen balance can be maintained throughout pregnancy, including the first trimester, by intermittent daily TPN.     

孕早期妊娠相关焦虑影响因素分析

目的了解孕妇孕早期妊娠相关焦虑发生情况,分析其影响因素。方法收集安徽省20 308名孕妇一般人口统计学特征和孕前半年及孕早期环境暴露因素,采用自编《妊娠相关焦虑量表》评价孕妇孕早期心理卫生状况。结果孕妇孕早期妊娠相关焦虑的发生率为23.2%(4 711/20 308),问卷总得分为(20.57±5.04)分,<25岁孕妇妊娠相关焦虑的发生率最高,为28.4%,高中学历孕妇发生率最高,为27.0%,农业户籍的发生率为24.9%,高于城市户籍;多因素Logistic回归分析结果显示,妊娠相关焦虑的主要危险因素有孕前半年吸烟(OR=1.89,95%CI=1.35～2.65)、饮酒(OR=1.81,95%CI=1.18～2.75),孕早期工作压力大(OR=2.26,95%CI=1.94～2.65),以及非意愿妊娠(OR=2.23,95%CI=2.08～2.60)。结论孕妇孕前半年及孕早期环境暴露因素会对孕妇心理造成不良影响,导致妊娠相关焦虑的发生。     

早孕期胎盘体积及血管化参数预测在复发性流产中的价值

目的探讨早孕期胎盘容积及其血管化参数预测复发性流产者妊娠结局的价值。方法将优生遗传门诊就诊同时自愿进行三维能量多普勒超声测量的孕妇51例分为两组,研究组30例为复发性流产孕妇,对照组21例为正常妊娠孕妇,在早孕期使用三维能量多普勒超声胎盘容积及VI、FI、VFI测量,将两组孕妇所得的数据进行统计学分析比较。结果观察组孕妇早孕期胎盘容积及血管化指数VI、VFI显著低于对照组孕妇,差异有统计学意义(P<0.05),两组孕妇FI差异无统计学意义(P>0.05)。妊娠早期胎盘容积、胎盘血流VI、FI、VFI做为预测持续妊娠≥12周指标的ROC曲线下面积分别为0.771、0.907、0.592、0.771,FI的预测准确度较低,胎盘容积、VFI有一定准确度,VI有较高准确度。结论早孕期胎盘的VI对预测复发性流产者妊娠结局最为敏感,三维能量多普勒在复发性流产监测中有较好的应用价值。     

Changes in dietary intake from the first to the second trimester of pregnancy

Maternal diet may influence outcomes of pregnancy and childhood. Diet in the first trimester may be more important to development and differentiation of various organs, whereas diet later in pregnancy may be important for overall fetal growth as well as for brain development. To our knowledge, no studies have examined individual-level changes in food and nutrient intake from the 1st to 2nd trimester of pregnancy. The objective of this study was to examine changes in dietary intake from the 1st to 2nd trimester of pregnancy. As part of the ongoing US prospective cohort study, Project Viva, we studied 1543 women who completed food-frequency questionnaires that assessed dietary intakes during the 1st and 2nd trimester of pregnancy. For both foods and energy-adjusted nutrients, we examined changes in dietary intake from 1st to 2nd trimester. Reported mean energy intake was similar for the 1st (2046 kcal) and 2nd (2137 kcal) trimesters. Foods and energy-adjusted nutrients from foods whose overall mean intakes increased more than 5% from 1st to 2nd trimester were skim or 1% dairy foods (22%), whole-fat dairy foods (15%), red and processed meat (11%), saturated fat (6%) and vitamin D (7%). Intake of caffeinated beverages (-30%) and alcoholic beverages (-88%) decreased more than 5%. Because mean multivitamin intake increased by 35% from the 1st to 2nd trimester, total micronutrient intake increased appreciably more than micronutrient intake from foods only. Correlations across trimesters ranged from 0.32 for vitamin B12 to 0.68 for fruit and vegetables. In conclusion, for many outcomes of pregnancy and childhood, the incremental information obtained from assessing complete diet in both early and late pregnancy may not outweigh the burden to participants and investigators. However, investigators should assess caffeine, alcohol, and vitamin and supplement use in both the 1st and 2nd trimester, and consider doing so for foods and nutrients for which trimester-specific hypotheses are well substantiated.     

The value of real time ultrasonography in first trimester termination

The value of real time ultrasonography (RTUS) in the management of first trimester elective pregnancy terminations was studied in 120 consecutive patients. RTUS was found essential in determining accurate gestational ages, identifying incomplete pregnancy teminations, diagnosing abnormal pregnancies, and in performing difficult terminations. It is suggested that RTUS be employed in the routine management of first trimester pregnany terminations.     

85例孕早期妇女解整合素-金属蛋白酶12分析

目的:探讨解整合素-金属蛋白酶12(ADAM12)在孕早期妇女中不同孕周的正常参考值范围,为孕早期产前筛查胎儿唐氏综合征提供实验室依据。方法:收集2008年6月～2009年6月在无锡市妇幼保健院自愿参加孕早期产前筛查的孕妇静脉血血清样本共85份,-70℃保存,孕周为5～10周,常规三联产前筛查采用Wallac产筛软件,ADAM12水平检测采用时间分辨荧光免疫法,用SPSS 11.5统计软件、Microsoft Excel软件对结果进行分析。结果:孕早期妇女ADAM12检测结果因孕周而异,本研究孕5周共10例,ADAM12平均值为5.68 ng/ml;孕6周共19例,ADAM12平均值为7.29 ng/ml;孕7周共26例,ADAM12平均值为70.64 ng/ml;孕8周共16例,ADAM12平均值为89.40 ng/ml;孕9周共10例,ADAM12平均值为111.91 ng/ml;孕10周共9例,ADAM12平均值为139.76 ng/ml。ADAM12水平随孕周增加而升高,并因孕周不同呈相关性,P<0.05,但孕早期ADAM12水平整体偏低。结论:ADAM12在孕早期是一种有效的筛查指标,可为提前诊断唐氏综合征提供实验室依据,但目前因标本量不够大,尚不具备条件建立孕早期ADAM12的正常参考值范围。     

150例绒毛产前诊断及随访的研究

目的探讨用绒毛进行早期产前诊断的可行性、准确性及安全性。方法经宫颈盲法抽吸绒毛,采用绒毛直接法或短期培养法制备染色体、G显带。结果150例中发现6例异常核型。35例经羊水、人流绒毛或脐带血染色体复查核型与产前诊断一致。65例出生胎儿随访发育正常。结论绒毛产前诊断是安全可靠的。     

Prepregnancy body mass index and dietary intake in the first trimester of pregnancy

OBJECTIVES: Adequate maternal nutrition is of paramount importance in pregnancy, particularly in the first trimester when fetal development is crucial. It has been reported that heavier women are most likely to fear weight gain associated with pregnancy. Few studies have, however, investigated associations between prepregnancy body mass index (BMI) and nutrient intakes in the first trimester of gestation using detailed, prospective methodologies. The aim of this study was to investigate possible associations between prepregnancy BMI and nutrient intakes in the first trimester of gestation. DESIGN: Seventy-two Caucasian, primiparous nonsmokers of mean age 33.1 years (SD 4.6) were recruited from three London teaching hospitals and they completed a background information questionnaire and a 4- to 7-day weighed inventory food diary during the first trimester of pregnancy. Prepregnancy anthropometric data were extracted from General Practitioner records. RESULTS: Prepregnancy BMI was inversely associated with dietary energy (P = 0.04), Southgate and Englyst fibre (P < 0.01), and iron and folate (P < 0.01). After excluding under-reporters [individual energy intake:basal metabolic rate (estimated) ratio < 1.2], prepregnancy BMI was inversely associated with folate intake (P =0.04). Dietary intakes of Englyst fibre (P = 0.03) were statistically significantly lower than average dietary recommendations in this group. CONCLUSIONS: This study identified that women with a high prepregnancy BMI are more likely to under-report nutrient intakes. The finding that folate intake was significantly lower in heavier women accurately reporting dietary intake is of particular concern.     

Factors affecting delays in first trimester pregnancy termination services in New Zealand

Objective: To identify the factors affecting the timeliness of services in first trimester abortion service in New Zealand. Method: Primary data were collected from all patients attending nine abortion clinics between February and May 2009. The outcome measured was delay between the first visit with a referring doctor and the date of the abortion procedure. Patient records (n=2,950) were audited to determine the timeline between the first point of entry to the health system and the date of abortion. Women were also invited to fill out a questionnaire identifying personal factors affecting access to services (n=1,086, response rate = 36.8%). Results: Women who went to private clinic had a significantly shorter delay compared to public clinics. Controlling for clinic type, women who went to clinics that offered medical abortions or clinics that offered single day services experienced less delay. Also, women who had more than one visit with their referring doctor experienced a greater delay than those who had a single visit. The earlier in pregnancy women sought services the longer the delay. Women's decision‐making did not have a significant effect on delay. Conclusions: Several clinic level and systemic factors are significantly associated with delay in first trimester abortion services. In order to ensure the best physical and emotional outcomes, timeliness of services must improve.     

早孕期经腹绒毛活检产前诊断地中海贫血

目的 探讨绒毛活检在重型地中海贫血早期诊断的应用价值.方法 对40例夫妇双方均为地中海贫血基因携带者的孕妇在孕11～13 w时经腹抽取绒毛,进行地中海贫血基因检测,高龄者同时做粢色体核型分析.结果 40例孕妇绒毛抽吸均一次成功,诊断重型α-地中海贫血7例,重型β-地中海贫血2例,1例孕中期超声检查发现胎儿重度脑积水引产,余30例正常妊娠至足月分娩,新生儿无异常;8例高龄孕妇绒毛染色体检查核型正常.结论 早孕期经腹绒毛活检具有早期、快速和安全的特点,适用于地中海贫血的产前诊断.     

Fetal infection resulting from maternal rubella after the first trimester of pregnancy

We have tried to measure the incidence of prenatal infection in 304 infants whose mothers had had rubella at various times after the first 12 weeks of pregnancy. Two methods of assessment were used: first, serum obtained soon after birth was tested for specific IgM antibody; secondly, serum obtained after the age of eight months was tested for specific IgG. When maternal rubella occurred 12-16 weeks after the last menstrual period specific IgM antibody was detected in 28 out of 50 infants (56%). The proportion fell progressively to 12% after maternal rubella at 24-28 weeks, rose to 19% after rubella at 28-36 weeks and then to 58% when the illness occurred during the last month of pregnancy. In all, IgM antibody was detected in 77 out of 260 infants (29%). The fetus can thus be infected at any time during the second and third trimesters of pregnancy, but the risk varies at different stages.