孕妇牙周炎与新生儿早产低体重的关联

牙周炎是人类最常见的感染性疾病之一,也是口腔患病率最高的两大疾病之一,还是我国成人牙齿丧失的首因.近十余年的研究发现,牙周组织的健康状况与全身健康有着紧密的联系,可成为全身诸多系统性疾病潜在的重要危险因素.现已确定的相关疾病有:糖尿病、心血管疾病、代谢综合征、胃溃疡、呼吸道感染、类风湿关节炎和早产低出生体重(preterm low birth weight,PLBW)新生儿等.     

重度子痫前期早产与自发性早产临床结果的对比分析

目的通过对不同类型重度子痫前期早产和自发早产临床结果的对比分析,探讨重度子痫前期早产的母儿结局。方法回顾性分析2001年1月至2005年12月我院收治的119例孕周<36周因重度子痫前期及其并发症而终止妊娠的单胎早产活产孕妇(研究组)的诊断,处理和母儿结局,并与243例单胎自发性早产孕妇(对照组)进行孕产妇及围生儿结局对比分析。结果研究组的剖宫产率为95.8%(114/119例),明显高于对照组的21.0%(P<0.01)。研究组和对照组的孕28～31~( 6)周的规律产前检查率分别为42.9%和52.8%,均明显低于孕32～36周的81.3%和88.9%(P值均<0.05)。研究组和对照组的新生儿死亡均发生在孕28～31~( 6)周,病死率分别为4.2%和2.5%,两组间差异无统计学意义(P>0.05)。研究组的新生儿平均出生体质量[(1921.5±610.5)g]明显低于对照组[(2449.5±530.7)g,P<0.05],小于孕龄儿(43.7%)、新生儿呼吸窘迫综合征(5.9%)、重度窒息发生率(16.8%)、新生儿监护室住院天数[(20.1±7.1)d]均明显高于对照组[分别为4.1%、0.8%、2.1%、(8.8±3.8)d,P值均<0.05]。结论良好的产前监护对降低早期早产的发生有重要的临床意义;早发型重度子痫前期严重影响胎儿生长;不论重度子痫前期早期早产还是自发性早期早产,新生儿死亡率均较高。     

Social adversity, low birth weight, and preterm delivery

A prospective study of 483 pregnant women was undertaken to examine possible associations of social and psychiatric factors with both low birth weight (less than 2500 g) and preterm delivery (less than 37 weeks' gestation). As few babies were born before term (n = 14) or with a low birth weight (n = 14) further analyses were conducted to investigate predictors of absolute birth weight and gestational age. Low income was found to be an independent predictor of birth weight when birth weight was treated both as a dichotomous and as a continuous variable. Unemployment was found to be associated with absolute birth weight. Although this effect was statistically accounted for by low income, a low income was frequently caused by unemployment. Smoking independently predicted absolute birth weight and tended to be associated with preterm delivery. None of the factors investigated was associated with gestational age. In contrast with previous findings, factors such as social class, adverse life events, and psychiatric state were not associated with birth outcome. The mechanism underlying the association between low income and low birth weight requires further investigation.     

314例医源性早产临床分析

目的：研究医源性早产的高危因素及发生率,探讨不同孕周对早产儿预后的影响。方法回顾性分析2009年1月至2014年12月哈尔滨市第一医院收治的314例医源性早产病例的临床资料,对发生率、相关发生因素等进行分析。结果医源性早产发生率为6．76％,占早产总数的31．06％,医源性早产的发生率呈上升趋势。医源性早产的发生因素分别为妊娠期高血压疾病,胎盘因素性出血,双胎妊娠,子宫因素,胎儿因素及产科合并症。分娩时间≥34周较＜34周并发症及围生儿死亡率均显著降低（P＜0．01）。结论医源性早产已成为早产的重要原因。为改善早产儿预后,产科医师应制定个体化治疗方案,适当延长孕周至34周及以后。     

人工生殖技术与生育权的实现

人工生殖技术是生殖领域的一次革命,它为不育夫妇提供了伦理关怀和技术支持,帮助他们实现了人类与生俱来的基本权利--生育权,医学实践证明人工生殖不存在遗传缺陷,其不仅不违背现代伦理观念,而且有助于实现伦理规范的终极目标-最大多数人的最大幸福,人工生殖技术应该得到社会的认可和法律的保护.     

影响早产和痉挛型脑性瘫痪发生的多因素分析

目的探讨影响早产及痉挛型脑性瘫痪发生的因素。方法采用病例对照研究设计,对265名脑瘫儿童和272名正常儿童的性别、出生体质量、出生胎龄、脑瘫类型、孕母年龄、分娩史、文化程度和经济状况等调整后进行非条件Logistic回归分析。结果在早产儿童中,经济状况中等及以上、文化程度较高及出生体质量〈2.5 kg等具有统计学意义（P〈0.05）;痉挛型脑性瘫痪儿童中,女童、经济状况中等及以上、出生胎龄〈32周、出生体质量〉4 kg等具有统计学意义（P〈0.05）。结论早产受社会因素的影响,经济状况中等及受教育程度较高可能是避免早产的因素。     

孕妇羊水同型半胱氨酸、叶酸及Vit B_(12)与胎儿畸形的关系

目的:测定胎儿畸形孕妇羊水tHcy、叶酸及Vit B12的水平,了解其与胎儿畸形的关系。方法:根据有无胎儿畸形将研究对象分为两组,病例组(n=68)及对照组(n=68)。采用全自动荧光偏振免疫发光法测定两组孕妇羊水中tHcy水平,同时用离子捕捉免疫分析法测定其羊水中叶酸水平,用微粒子酶联免疫分析法测定其羊水中Vit B12水平。结果:病例组的年龄显著小于对照组(P<0.001),抽取羊水的孕周大于对照组(P<0.05),病例组羊水tHcy水平高于对照组(P<0.05),羊水叶酸水平低于对照组(P<0.05),羊水Vit B12水平则显著低于对照组(P<0.001)。结论:胎儿畸形患者羊水中tHcy明显升高,而叶酸及Vit B12水平降低,高tHcy增加了胎儿畸形发病的风险,补充叶酸及Vit B12是降低胎儿畸形发生率的有效措施。     

早产相关因素323例临床分析

目的 分析与人工早产和自然早产有关的危险因素。方法 我院1993年1月～1999年12月间分娩的自然早产274例和人工早产49例,分别与同期分娩的足月对照组323例相比,进行早产的因素分析。结果 孕期母亲未作产前检查、胎膜早破、多胎、产前出血、中重度妊高征、内科合并症等均与早产有关;人工早产者产前检查率最低,剖宫产率最高,并主要与产前出血、中重度妊高征、多胎有关;自然早产者产前检查率低于足月对照组,其主要与胎膜早破、不明原因早产有关。结论 孕期多种因素与早产有关,且自然早产和人工早产具有不同的危险因素。     

早产儿低血糖与胎龄、体重、脑损伤关系的分析

目的探讨早产儿胎龄、体重与低血糖的关系,以及早产儿低血糖与脑损伤发生率的关系。方法对129例早产儿进行血糖监测及头颅B超检测,根据胎龄、体重、血糖分组,对其低血糖、脑损伤发生情况进行χ2检验,并比较分析。结果①胎龄<31周和31~33周早产儿比较,低血糖发生率差异无统计学意义(P>0.05);前两组均比34~36周早产儿低血糖发生率增高,差异有统计学意义(P<0.05)。②体重<1500g和1500g~1999g早产儿低血糖发生率比较差异无统计学意义(P>0.05);前两组分别与2000~2800g早产儿比较,低血糖发生率均高于后者,差异有统计学意义(P<0.05)。③低血糖组脑损伤发生率高于正常血糖组,差异有统计学意义(P<0.05)。结论胎龄<34周及体重<2000g的早产儿低血糖发生率高,低血糖可导致早产儿脑损伤发生率增高,应注重早产儿的血糖早期动态检测,及时发现、纠正低血糖,减少脑损伤发生。     

子痫前期的治疗性早产与胎儿问题

子痫前期是妊娠期特有的并发症,严重威胁母儿的健康。目前唯一有效治疗子痫前期的方法是终止妊娠,过早终止妊娠,治疗性早产率增高,围生儿预后差。平衡母体并发症与胎儿预后的关系,选择最佳的终止妊娠时机,争取获得最佳的妊娠结局是治疗子痫前期的关键。     

Serum zinc level in preterm low birth weight babies and its comparison between preterm AGA and preterm SGA babies

Low birth weight (LBW) is a major child health problem in Bangladesh and continuing to great threat to child health and child survival in Bangladesh. LBW is a silent emergency but crisis is real and its persistence has profound and frightening impact on neonatal mortality. This observational study was conducted in Dhaka Shishu Hospital, Dhaka, Bangladesh during July 2004 to June 2005. Serum zinc levels were estimated between two groups: group-I preterm AGA (n=50), group II preterm SGA (n=50) babies. Blood samples were collected from the study population in neonatal unit and serum zinc levels were measured by flame atomic absorption spectrophotometry in Atomic Energy Center, Dhaka, Bangladesh. Observed data were made comparison among groups by Students 't' test. It was observed serum zinc level (60.2+/-15.2) in group I and (62.1+/-12.4) in group II. Serum zinc level was in lower limit of normal range in both groups with more lower level in preterm AGA babies but their difference was not statistically significant (p>0.05). So zinc supplementation may enhance the growth of preterm LBW babies in their early months of lives.     

解脲脲原体与早产关系的探讨

目的 探讨孕妇感染解脲脲原体 (UU)是否是引起早产的因素之一。方法 采用聚合酶链反应技术分别对108例早产产妇和100名足月分娩产妇的宫颈分泌物及胎盘进行UU检测 ,并对上述208例胎盘进行病理检查。结果 早产组胎盘UU感染率及胎盘绒毛膜羊膜炎发生率明显高于足月分娩组 ,两组差别有显著性意义(P<0.01) ;两组宫颈分泌物UU感染率差别无显著性意义 (P>0.01) ;早产组中有绒毛膜羊膜炎的胎盘UU感染率明显高于无绒毛膜羊膜炎的胎盘UU感染率 (P<0.01)。早产产妇UU感染率随着早产儿出生体重的降低而明显增高 (P<0.01)。 结论 解脲脲原体通过感染胎盘引起胎盘绒毛膜羊膜炎 ,并导致早产 ,是孕妇早产的危险因素之一。     

孕前体质指数与早产的关系

目的：探讨孕前体质指数（body mass index, BMI）与早产的关系。方法： 以在北京市海淀区妇幼保健院住院分娩的174例早产儿为病例,382例足月儿为对照,收集孕妇身高、孕前体重、分娩前最后一次体重、孕周、家族史、疾病史以及孕期并发症等信息,运用多因素Logistic回归模型调整混杂因素,分析孕前BMI等因素与早产的关系,并估计调整后的比值比（odds ratio,OR）和95%可信区间（confidence interval,CI）。结果： 通过对早产相关因素的Logistic回归分析,发现孕前肥胖是早产的危险因素,调整后的OR值为2.461（95% CI：1.174~5.159, P=0.017）,未发现孕前超重或孕前偏瘦与早产的关联;妊娠期糖尿病、妊娠期高血压和早产儿家族史是早产的危险因素,调整后的OR值分别为1.781（95% CI：1.025~3.095, P=0.040）、3.831（95% CI：2.044~7.180, P<0.001）和3.675（95% CI：1.358~9.942, P=0.010）。结论： 孕前肥胖是早产的危险因素,为了降低早产的发病率,孕妇需要加强孕前保健,在备孕期应控制孕前BMI在正常范围内。     

早发型和晚发型严重子痫前期合并早产198例临床分析

目的探讨早产合并早发型与晚发型严重子痫前期妊娠结局。方法选取2004年11月至2012年1月于遵义医学院第五附属(珠海)医院及广州医科大学附属第三医院重症孕产妇救治中心收治的单胎早产合并严重子痫前期的198例患者的临床资料进行回顾性分析,以孕34周为界,将早发型严重子痫前期患者作为观察组(n=121),晚发型严重子痫前期患者作为对照组(n=77),比较两组患者的临床特点及妊娠结局。结果观察组未定期产检率及疤痕子宫发生率明显高于对照组(62.0%vs 42.9%,20.7%vs 1.3%,P0.05);观察组和对照组母亲合并症/并发症总的发生率分别为65.3%和50.6%,比较差异有统计学意义(P0.05);其中,观察组心功能不全发生率较对照组显著升高(18.2%vs 7.8%,P0.05);以胎盘早剥为最常见并发症(15.7%vs 14.3%,P0.05)。两组围产儿并发症总的发生率分别为80.2%和63.6%(P0.05),观察组胎儿窘迫及新生儿重度窒息发生率明显高于对照组,差异均有统计学意义(P0.05)。两组其他方面比较差异无统计学意义(P0.05)。结论早产合并早发型与晚发型严重子痫前期相比,早发型孕妇病情重、并发症多,围产儿预后不佳。建议加强孕期保健、定期产检的宣教工作,并应根据母胎情况,适时终止妊娠。     

Association between bacterial vaginosis and preterm delivery

Bacterial vaginosis (BV) is one of most common presentation in women of reproductive age, and its prevalence is relatively high in the obstetric population which is responsible for preterm delivery. The present study tried to explore the association of BV with preterm delivery, and included 100 pregnant women aged 15 to 35 years, between 28 36 weeks of gestation, with abnormal vaginal discharge and clinically suspected of BV, attending obstetrics outpatient department of BSMMU were selected for the study, divided into two groups based on Amsel clinical criteria (63 culture negative and 37 culture positive for BV). Mean ± SD age of BV negative and positive subjects was 24.59 ± 5.18 and 23.89 ± 4.77 years respectively (statistically no significant difference). Likewise, socioeconomic status, educational status and gravida did not show statistically any significant difference between groups. Significantly high number of BV positive women delivered prematurely (73%) compared to BV negative (25.4%) (p<0.001). Mean ± SD gestational age also differed significantly 37.49 ± 2.53 vs. 35.24 ± 2.33 weeks (p<0.001). Our study supported that abnormal bacterial colonization, indicative of bacterial vaginosis, is strongly associated with preterm delivery.