Antenatal care in general practice, Trondheim, Norway

In this study from the city of Trondheim during 1979-81 nulliparae were found to be younger, higher educated, and more actively working outside the home than parous women. Most women were examined by their GP during the first trimester, and were seen about 10 times on average during the pregnancy. Women who smoked tended to consult later in pregnancy than the non-smokers. Drugs were prescribed for 33% of the women during their pregnancy, 10% during the first trimester. Medication was most frequently prescribed for genitourinary disorders. Sick leave was often the result of low-back-pain and lasted on average 5 weeks longer in parous women. Hospitalization was most often due to hypertension and threatened premature labour and lasted on average longer among nulliparae. Controlled trials are needed to evaluate future antenatal care provision in the light of pregnancy outcome.     

子痫前期患者肝肾功能的改变及对胎儿的影响

目的 探讨子痫前期患者肝肾功能指标的改变及对妊娠结局的影响.方法 选择我院100例轻度子痫前期患者、110例重度子痫前期患者以及100例正常晚孕妇女（对照组）,回顾性分析其临床资料,检测所有受试者肝肾功能生化指标的变化情况并分析其与妊娠结局的关系.结果 三组研究对象在年龄、孕周、分娩方式方面差异均有统计学意义（P均＜ 0.05）.三组间除总胆红素和胱抑素C外,其他肝肾功能指标水平差异均有统计学意义（P均＜ 0.05）,轻度子痫前期组与对照组比较,除碱性磷酸酶（alkaline phosphatase,ALP）、尿酸（uric acid,UA）外,其余肝肾功能指标水平差异均无统计学意义（P均＞ 0.05）;重度子痫前期组与对照组比较,除直接胆红素外,其余肝肾功能指标水平差异均有统计学意义（P均＜ 0.05）;重度与轻度子痫前期组比较,除ALP、胆碱酯酶、尿素氮和UA外,其他肝肾功能指标水平差异均有统计学意义（P均＜ 0.05）.子痫前期患者分娩孕周与Apgar评分、新生儿体重呈正相关关系（r=0.754,r=0.860,P均＜0.05）.结论 子痫前期患者肝肾功能生化指标有明显改变,并严重影响妊娠的进展及胎儿的生长发育.     

TPOAb、HbA1c、PLGF及血脂水平对妊娠期糖尿病孕妇妊娠结局的影响

目的 探讨妊娠期糖尿病(GDM)孕妇抗甲状腺过氧化物酶抗体(TPOAb)、糖化血红蛋白(HbA1c)、胎盘生长因子(PLGF)、血脂等水平及意义.方法 选取在南京市妇幼保健院治疗的GDM患者180例为观察组;选取同期在南京市妇幼保健院产检的健康产妇180例为对照组.于妊娠24～27周,采集空腹静脉血,检测TPOAb、H...     

子宫内膜及子宫内膜-肌层交界区超声参数对IVF-ET妊娠结局的预测价值

目的 探讨子宫内膜及子宫内膜-肌层交界区（EMI）超声参数对体外受精-胚胎移植（IVF-ET）患者妊娠结局的预测价值。方法 回顾性研究于本院生殖医学科进行IVF-ET的不孕妇女112例，在ET日对所有患者进行子宫内膜及EMI形态和血流监测，根据是否妊娠将其分为妊娠组和未妊娠组，比较两组间各参数的差异，并评价EMI超声参数对IVF-ET妊娠结局的预测价值。结果 两组患者EMI平均厚度、EMI形态、EMI容积、内膜VI、内膜FI、内膜VFI差异均有统计学意义（P均＜0.05）。其中内膜FI、EMI平均厚度和EMI形态是妊娠结局的独立影响因素，以此建立预测模型：Logit（P）=0.227×内膜FI+1.608×EMI平均厚度-1.056×EMI形态-8.315，该模型经评估后对妊娠结局预测效能良好。结论 子宫内膜及EMI超声参数对IVF-ET患者妊娠结局有预测价值。     

妊娠糖尿病孕妇健康教育干预的效果

目的探讨健康教育在控制妊娠糖尿病(gestational diabetes mellitus,GDM)孕妇孕期血糖和改善妊娠结局中的作用,并摸索针对GDM孕妇的孕期教育模式。方法对干预组60例GDM孕妇进行糖尿病相关知识的问卷调查并实施糖尿病系统化教育和治疗,同时设60例常规产前护理的GDM孕妇为对照组,就其血糖变化和妊娠结局进行比较。结果实施糖尿病系统化教育前后,GDM孕妇的相关知识水平有了极大的提高(P<0.01),干预组的血糖控制与对照组相比有显著差异(P<0.01),其妊娠结局也明显优于对照组(P<0.01)。结论对GDM孕妇实施健康教育能使她们更好地控制血糖,改善妊娠结局,从而保证母婴健康。     

妊娠糖尿病患者尿液8-oxo-Gsn表达水平及其对妊娠结局预测价值研究

目的 探讨妊娠糖尿病（gestational diabetes mellitus,GDM）患者尿液RNA氧化标志物8G-氧化鸟苷（8-oxo-7,8-dihydroguanosine,8-oxo-Gsn）的水平及与妊娠结局的关系。方法 选取2018年2月～2021年2月汉川市中医医院收治的106例GDM患者为观察组,根据妊娠结局情况分为妊娠结局良好组和妊娠结局不良组。另选取同期进行体检的90例健康孕妇为对照组。收集所有孕妇的临床资料并进行比较。采用同位素稀释高效液相-串联质谱法（isotope dilution high performance liquid phase-tandem mass spectrometry,ID-LC-MS/MS）分析尿液中8-oxo-Gsn水平。采用ROC曲线评估8-oxo-Gsn对GDM患者不良妊娠结局的评估价值。多因素回归分析影响GDM患者不良妊娠结局的危险因素。结果 与对照组相比,观察组尿液8-oxo-Gsn水平（3.89±0.63μmol/mol vs 2.26±0.47μmol/mol）及不良妊娠结局的发生率（29.25%vs 11.11%）明...     

Thrombosis, thrombophilia, and thromboprophylaxis in pregnancy

Normal pregnancy is accompanied by changes in coagulation that have likely evolved to protect women from the bleeding challenges of miscarriage and childbirth. Consequently, pregnant women are at an increased risk of thrombosis. The most important risk factors are thrombophilia and a history of thrombosis. Most thromboses in pregnancy occur in the left lower extremity, but pelvic vein thromboses are not uncommon. Thrombophilia increases not only the risk of maternal thrombosis but also the risk of poor pregnancy outcome. All pregnant women should be asked about a personal or family history of thrombosis and the details of their obstetrical history. Some women should undergo laboratory testing, particularly those with a personal history of thrombosis or a history of poor pregnancy outcome. The purpose of testing is to help determine which women should receive anticoagulation therapy, which is used not only to treat venous thromboembolism, but also to prevent thromboembolism and reduce the risk of poor pregnancy outcome in women with thrombophilia. Low-molecular-weight heparins are preferred over unfractionated heparin because they have a longer half-life and are presumed to have fewer side effects. Their longer half-life is a disadvantage around the time of delivery when unfractionated heparin, with its shorter half-life, is easier to manage. The risk of thrombosis is higher postpartum than during pregnancy, so anticoagulation therapy is usually continued for at least 6 weeks after delivery.     

针对性护理对多次体外受精失败患者心理状态的影响

目的:探讨针对性护理对多次体外受精失败患者心理状态的影响。方法:选取2018年1月1日~3月31日收治的90例多次体外受精失败患者为对照组,采取常规护理;选取2018年4月1日~6月30日收治的93例多次体外受精失败患者为研究组,在常规护理基础上采用针对性护理。比较两组干预前后焦虑、抑郁情况[采用汉密顿焦虑量表(HAMA)、汉密顿抑郁量表(HAMD)]、妊娠结局及护理满意度。结果:干预后,研究组HAMA、HAMD评分均低于对照组(P<0.01);研究组流产率低于对照组(P<0.05),妊娠成功率、护理满意度均高于对照组(P<0.01,P<0.05)。结论:将针对性护理应用于多次体外受精失败患者护理中,其心理状态及妊娠结局改善明显,护理满意度高。     

创建以人为本的产科新模式:孕期全程服务

目的探索新的以人为本的产科服务模式,改善医患关系,优化妊娠结局。方法取2000年1月至12月的产前门诊1 200名孕妇为实验组,选择一对一孕期全程服务,取1999年1月至12月产前门诊1000名孕妇为对照组,常规检查,将两组孕妇分娩结局进行统计学比较。结果两组的产检率、高危管理率,围产儿死亡率、患者投诉及患者满意度经卡方检验,均差异有统计学意义(P<0.05)。结论孕期全程服务模式能改善妊娠结局。     

个性化健康教育在妊高症42例护理中的应用

目的:对妊娠高血压综合征患者采用个性化健康教育的效果进行探究.方法:选择本院收治的妊娠高血压综合征患者84例作为本次研究的纳入对象,时间为2019年4月至2020年4月.按照随机处理的方式对其予以分组,其中甲组42例,乙组42例.通过常规护理的方式对甲组予以护理,以此为基础,通过个性化健康教育的方式对乙组予以护理.比较...     

Outcome expectancies, functional outcomes, and expectancy fulfillment for patients with shoulder problems

OBJECTIVES: This study was conducted to evaluate the relationship among patient outcome expectancies, perceived shoulder function changes, and perceptions of expectancy fulfillment. METHODS: Patients (n = 199) treated for shoulder problems at one orthopedic surgeon's office completed a baseline survey comprised of measures of outcome expectancies, shoulder function, health status, and demographics. At 1 month, 2 months, and 3 months, patients completed a mailed follow-up survey comprised of all baseline measures except demographic variables. At 3 months, a measure of expectancy fulfillment was added. A general linear modeling approach was used to assess the significance and effect size of 1) outcome expectancies on changes in shoulder function; and (2) outcome expectancies, shoulder function changes, and their interaction on perceptions of expectancy fulfillment. RESULTS: Outcome expectancies significantly predicted changes in shoulder function and accounted for 10% of the variance in functional improvement. The improvement difference between patients with high expectancies compared with those with low expectancies was clinically relevant (4.57 points), as it was greater than the minimal clinically important difference (3.02 points). Outcome expectancies and shoulder function changes significantly predicted patients' perceptions of fulfilled expectancies, but their interaction was not statistically significant. CONCLUSIONS: Results highlight the importance of patient expectancy in medical encounters. The findings suggest the need for interventions targeting patient expectancies such as including discussions about expectancy in patient-physician negotiations of therapeutic plans. Results also underscore the need for the development of better measures of outcome expectancies and expectancy fulfillment.     

妊娠合并Graves病对妊娠结局的影响

目的 探讨妊娠合并Graves病对妊娠结局的影响.方法 回顾统计分析比较60例妊娠合并Graves病患者、60例正常对照者的妊娠结局及其影响因素.结果 Graves病组60例中妊娠结局不良48例;20例在孕32～37周内由于重症而提前终止妊娠.孕期发生妊娠高血压综合征(妊高征)10例,其中重度妊高征并心力衰竭3例;甲状腺危象2例,胎膜早破6例,贫血10例,无产后出血.妊娠合并Graves病组与正常对照组相比,妊娠周数、新生儿评分、新生儿体质量均降低(P＜0.05).结论 妊娠合并Graves病对妊娠结局有不良影响.Graves病患者孕前未控制或孕前、孕期自行停药,均可导致母儿严重并发症.加强甲状腺功能的监测,及时调整用药剂量,可以减少不良妊娠结局的发生.     

自然受孕与辅助生殖受孕妊娠期糖尿病患者围生期结局的回顾性队列研究

目的 比较不同受孕方式的妊娠期糖尿病患者围生期结局。方法 选取2015年2月—2018年2月在本院分娩的的1 839例妊娠期糖尿病患者资料进行回顾性队列研究,其中辅助生殖组298例,自然受孕组1 541例,比较2组间母婴围生期结局。结果 与自然受孕组相比,辅助生殖组孕妇年龄偏高,超重率偏低,差异有统计学差异（P<0.05）。辅助生殖组孕妇妊娠期高血压、严重子〗前期、剖宫产以及早产发生率高于自然妊娠组,差异有统计学意义（P<0.05）。结论 通过辅助生殖受孕的妊娠期糖尿病患者妊娠期高血压、严重子〗前期、剖宫产以及早产等不良分娩结局风险增加。     

孕中期血清载脂蛋白CⅢ、Apelin、Chemerin水平及对妊娠期糖尿病诊断和不良妊娠结局的影响

目的观察孕中期血清载脂蛋白CⅢ(apo CⅢ)、Apelin、Chemerin水平,并探讨三者对妊娠期糖尿病(GDM)的诊断价值及与妊娠不良结局的关系。方法选取2017年8月—2019年8月经筛查确诊为GDM的87例孕妇作为观察组,另选取同期筛查正常的孕妇80例作为对照组。比较两组血清apo CⅢ、Apelin、Chemerin水平,三者之间的相关性采用Pearson相关分析;受试者工作特征(ROC)曲线分析三者对GDM的诊断价值;影响GDM不良妊娠结局的危险因素采用多因素Logistic回归分析。结果观察组血清apo CⅢ、Apelin、Chemerin水平均高于对照组(P<0.01)。血清apo CⅢ、Apelin、Chemerin之间均呈正相关性(P<0.01)。血清apo CⅢ、Apelin、Chemerin及三者联合诊断GDM的ROC曲线下面积分别为0.841、0.718、0.785及0.861,三者联合诊断的敏感度为63.2%,特异度为93.7%。不良妊娠结局GDM患者血清apo CⅢ、Apelin、Chemerin水平均高于正常妊娠结局GDM患者(P<0.05);孕中期血清apo CⅢ、Apelin、Chemerin水平升高均是影响GDM患者不良妊娠结局的独立危险因素(P<0.05,P<0.01)。结论孕中期GDM血清apo CⅢ、Apelin、Chemerin均呈高表达,三者联合对GDM具有较高的诊断价值,且是影响GDM患者不良妊娠结局的独立危险因素。     

血糖控制对妊娠期糖尿病患者妊娠结局的影响

目的探讨血糖控制对妊娠期糖尿病患者妊娠结局的影响。方法对104例妊娠期糖尿病（GDM）患者给予糖尿病规范化治疗,依据血糖控制情况分为观察组73例和对照组31例。比较两组治疗后的妊娠并发症发生率和围生儿结局情况。结果观察组妊高症、羊水过多和巨大儿、早产儿、新生儿窒息发生率明显降低,与对照组比较,差异具有显著性（P〈0．05）;而孕妇感染、产后出血、剖宫产及胎儿窘迫、新生儿低血糖发生率组间比较无显著性差异（P〉0．05）。结论良好的血糖控制对GDM患者妊娠结局有着积极有利的影响,应重视GDM的早期治疗和血糖的定期检测。     

EMAb、血清β-HCG及黄体酮联合预测早孕先兆流产结局

目的 探讨抗子宫内膜抗体(EMAb)、人绒毛膜促性腺激素(β-HCG)、黄体酮联合检查预测早孕先兆流产结局的价值.方法 将早孕先兆流产120例病例根据保胎治疗后的妊娠结局分为两组,即保胎成功组78例、保胎失败组42例,分别检测治疗前后两组血清中EMAb,β-HCG及黄体酮的含量,以评价早孕先兆流产的预后.结果 检测两组患者血清中EMAb阳性率,保胎成功组为7.69%,保胎失败组为38.10%,保胎成功组中EMAb阳性率低(P<0.05);检测两组患者血清中β-HCG及黄体酮水平,在治疗前后保胎成功组均较保胎失败组高(P<0.05);两组患者经保胎治疗后血清β-HCG均较治疗前升高(P<0.05),而黄体酮无明显变化.结论 EMAb、β-HCG、黄体酮联合检查可更准确预测先兆流产结局,为临床诊疗提供理论依据.     

Reproductive issues in HIV-seropositive women: a survey regarding counseling, contraception, safer sex, and pregnancy choices.

Sixty-nine HIV-seropositive women were surveyed with regard to the reproductive counseling they had received, contraception, safer sex practices, pregnancy histories, and pregnancy plans. Of the women surveyed, 84% and 90%, respectively, felt that they had access to the birth control and safer sex methods of their choice. Less than half felt that their physician had adequately counseled them about birth control. Women primarily cited social workers (46.4%) or nurses (34.8%) as the counseling source for birth control and safer sex. When informed about the reduced risk of vertical transmission with zidovudine (AZT), 33 women indicated that information regarding AZT would affect their future pregnancy decisions. Health care professionals need to be aware of this and counsel patients accordingly.     

不同孕次和卧位对异位妊娠保守治疗效果的影响

目的分析不同孕次及卧位对异位妊娠者保守治疗效果的影响,为实施有针对性的护理措施提供依据。方法将216例行保守治疗的异位妊娠者根据不同孕次分为3组,每组再分为平卧位组和斜坡卧位组,比较不同孕次及卧位对治疗效果的影响。结果总体上分析,二次妊娠者成功率最高（93．6％）,其次为初次妊娠者（90．0％）,最差的是多次妊娠者（73．4％）;斜坡卧位的效果优于平卧位。进一步分析,保守成功率最高的为初次妊娠斜坡卧位的患者（成功率为97．8％）,其次为二次妊娠斜坡卧位患者（成功率为96．8％）。结论异位妊娠保守治疗对于初次妊娠、二次妊娠的患者更有效,同时配合下肢屈曲的斜坡卧位护理效果更好。     

Association of Implementation of a Comprehensive Preconception-to-Pregnancy Management Plan With Pregnancy Outcomes Among Chinese Pregnant Women With Type 1 Diabetes: The CARNATION Study

OBJECTIVETo investigate the effect on pregnancy outcome of integrating a comprehensive management plan for patients with type 1 diabetes (T1D) into the World Health Organization universal maternal care infrastructure.RESEARCH DESIGN AND METHODSA comprehensive preconception-to-pregnancy management plan for women with T1D was implemented in 11 centers from 8 Chinese cities from 2015 to 2017. Sequential eligible pregnant women (n = 133 out of 137 initially enrolled) with T1D and singleton pregnancies attending these management centers formed the prospective cohort. The main outcome was severe adverse pregnancy outcome comprising maternal mortality, neonatal death, congenital malformations, miscarriage in the second trimester, and stillbirth. We compared pregnancy outcomes in this prospective cohort with two control groups with the same inclusion and exclusion criteria: a retrospective cohort (n = 153) of all eligible pregnant women with T1D attending the same management centers from 2012 to 2014 and a comparison cohort (n = 116) of all eligible pregnant women with T1D receiving routine care from 2015 to 2017 in 11 different centers from 7 cities.RESULTSThe rate of severe adverse pregnancy outcome was lower in the prospective cohort (6.02%) than in either the retrospective cohort (18.30%; adjusted odds ratio [aOR] 0.31 [95% CI 0.13–0.74]) or the contemporaneous comparison cohort (25.00%; aOR 0.22 [95% CI 0.09–0.52]).CONCLUSIONSThe substantial improvements in the prospective cohort are evidence of a potentially clinically important effect of the comprehensive management plan on pregnancy outcomes among Chinese pregnant women with pregestational T1D. This supports the development of similar approaches in other countries.     

Patients' fears, worries, and concerns when visiting an out-patient clinic

In an out-patient clinic for specialised medical care, 30 patients were questioned about their worries prior to the visit. The purpose of the study was to obtain basic knowledge about emotional experiences of patients visiting a doctor. The theoretical viewpoint was that of social interaction and social construction of reality. The statements of the patients were categorized as follows: before the encounter, the social interaction, the outcome of the encounter, and unspecific worries. A tool for measuring the degree and profile of the worries will be developed. Some of the worries described will be studied in depth. An education programme for all staff members is planned.