First trimester complications

Vaginal bleeding, abdominopelvic pain, nausea, and vomiting are common presenting symptoms in early pregnancy. All women of reproductive age who present with abdominal or pelvic pain or with vaginal bleeding should be evaluated for possible pregnancy. There should be a high index of suspicion for ectopic pregnancy in women presenting with abdominal pain and bleeding after approximately 7 weeks of amenorrhea. Investigation for the cause of the bleeding should ensue. Gestational trophoblastic disease should be considered as a possible cause. Treatment options for nausea during pregnancy should be discussed with women with this common symptom.     

妊娠不同时期孕妇体成分分析的临床价值

目的探讨妊娠期孕妇体成分的变化及其与孕期体重增加值、新生儿出生体重之间的关系。方法对太原市和介休市两地区共232例健康孕妇进行前瞻性研究,分别于妊娠14~16周、24~26周、30~32周、36~38周在产前检查的基础上利用NQA-PI个体营养分析仪进行四次体成分测量,同时详细记录妊娠结局等相关资料。采用SPSS 19.0软件对数据进行统计分析,P<0.05为差异有统计学意义。结果 (1)两地区孕妇年龄、身高、孕前体重、孕期合并症和并发症发生情况及新生儿出生体重之间比较,差异无统计学意义(P>0.05)。(2)在妊娠14~16周,孕妇去脂体重(r=0.176,P<0.05)、脂肪重(r=0.157,P<0.05)、总体水(r=0.229,P<0.001)与孕期体重增加值之间呈显著正相关关系,孕妇总体水(r=0.271,P<0.05)、肌肉重(r=0.302,P<0.001)、脂肪重(r=0.198,P<0.05)、去脂体重(r=0.312,P<0.001)与新生儿出生体重之间呈显著正相关关系;在孕24~26周,细胞外液与孕期体重增加值之间呈显著正相关关系(r=0.189,P<0.05),细胞内液与孕期体重增加值之间呈显著负相关关系(r=-0.393,P<0.01),总体水(r=0.296,P<0.05)、细胞外液(r=0.265,P<0.05)、细胞内液(r=0.270,P<0.05)、肌肉重(r=0.181,P<0.05)、脂肪重(r=0.286,P<0.05)、体脂百分比(r=0.142,P<0.05)与新生儿体重间呈显著正相关关系;在孕30~32周,脂肪重(r=0.224,P<0.017)、体脂百分比(r=0.184,P<0.05)与新生儿体重间呈显著正相关关系。(3)新生儿出生体重与孕期体重增加值间呈显著正相关关系(r=0.263,P<0.05)。结论妊娠14~16周、24~26周两阶段的体成分分析结果对孕期体重增加值和新生儿体重影响较大,可利用体成分分析结果指导孕妇科学营养,合理控制孕期增重和新生儿出生体重。     

First trimester bleeding evaluation

First trimester bleeding is a common presentation in the emergency room. Ultrasound evaluation of patients with first trimester bleeding is the mainstay of the examination. The important causes of first trimester bleeding include spontaneous abortion, ectopic pregnancy, and gestational trophoblastic disease; 50% to 70% of spontaneous abortions are due to genetic abnormalities. In normal pregnancy, the serum beta hCG doubles or increases by at least 66% in 48 hours. The intrauterine GS should be visualized by TVUS with beta hCG levels between 1000 to 2000 mIU/mL IRP. Visualization of the yolk sac within the gestational sac is definitive evidence of intrauterine pregnancy. Embryonic cardiac activity can be identified with CRL of >5 mm. A GS with a mean sac diameter (MSD) of 8 mm or more without a yolk sac and a GS with an MSD of 16 mm or more without an embryo, are important predictors of a nonviable gestation. A GS with a mean sac diameter of 16 mm or more (TVUS) without an embryo is a sonographic sign of anembryonic gestation. A difference of <5 mm between the mean sac diameter and the CRL carries an 80% risk of spontaneous abortion. Approximately 20% of women with first trimester bleeding have a subchorionic hematoma. The presence of an extra ovarian adnexal mass is the most common sonographic finding in ectopic pregnancy. Other findings include the tubal ring sign and hemorrhage. About 26% of ectopic pregnancies have normal pelvic sonograms on TVUS. Complete hydatidiform mole presents with a complex intrauterine mass with multiple anechoic areas of varying sizes (Snowstorm appearance). Twenty-five percent to 65% of molar pregnancies have associated theca-leutin cysts. Arteriovenous malformation of the uterus is a rare but life-threatening cause of vaginal bleeding in the first trimester. The sonographic findings in a patient with first trimester bleeding should be correlated with serum beta hCG levels to arrive at an appropriate clinical diagnosis.     

Ultrasonographic markers for chromosomal abnormalities in women with negative nuchal translucency and second trimester maternal serum biochemistry.

OBJECTIVE: To analyze the value of second trimester ultrasound examination among those women whose fetuses were indicated to be at low risk of chromosomal anomalies on the basis of both first trimester nuchal translucency measurement and second trimester biochemical screening. METHODS: A retrospective study of 5500 pregnancies carried out at the fetal medicine unit, Royal Free Hospital. During a period of over 3 years 5500 pregnancies underwent a first trimester scan and nuchal translucency measurement which enabled the detection of 62% (20 of 32) of all chromosomal anomalies. From the remaining pregnancies that underwent second trimester biochemical screening, 3548 were considered negative (risk < 1:250; using maternal serum free beta human chorionic gonadotrophin and alpha fetoprotein). The ultrasound markers that were examined were: shortened femur length, echogenic bowel, pyelectasis, choroid plexus cysts and echogenic intracardiac foci. The likelihood ratios for chromosomal aneuploides for each of these markers were calculated. RESULTS: Of the 3548 screen negative pregnancies, 3541 (99.8%) had a normal karyotype. Seven (0.2%) fetuses had an abnormal karyotype including four (0.11%) with trisomy 21, one with trisomy 18 and two with 47XXY. Second trimester ultrasound markers were found in two of the five (40%) with severe chromosomal anomalies compared to 184 of 3541 (5.2%) with normal karyotypes. Detection of one or more ultrasound markers in a screen negative pregnancy increased the possibility of chromosomal aneuploidy and a negative ultrasound decreased the risk by a likelihood ratio of 0.6 (95% confidence interval, 0.3-1.3). The risk was considerably increased when two or more markers were detected and we would recommend karyotyping under these circumstances. CONCLUSION: This preliminary data indicates a possible role for abnormal ultrasound markers in assessing the risk of chromosomal abnormalities in patients considered to be at low risk by nuchal translucency and serum screening. However analysis of a much larger study group will have to be conducted to assess the significance of individual markers.     

Minimising potential side-effects of medication at different ages

When prescribing and administering drugs, it is important to consider the patient's developmental stage. As individuals pass from fetus to a neonate, through infancy to childhood, adolescence, maturity and old age, major changes in anatomy and physiology occur that are reflected in different abilities to handle and respond to drugs.     

Sequential screening for trisomy 21 by nuchal translucency measurement in the first trimester and maternal serum biochemistry in the second trimester in a low-risk population.

OBJECTIVE: To evaluate screening for trisomy 21 in a low-risk population utilizing a combination of nuchal translucency measurement in the first trimester and the triple test in the second trimester. METHODS: This was a retrospective study of 9342 women with singleton pregnancies who booked for delivery in our hospital over a period of 5 years. A nuchal translucency scan was carried out at 10-13 weeks' gestation and for those with a measurement of 3.5 mm or more chorionic villus sampling was performed. All other women were asked to return for the triple test at 16 weeks' gestation. Amniocentesis was offered to women in whom the nuchal translucency was 2.5-3.4 mm, the triple test showed a risk of > or = 1 : 250 and in women aged > or = 35 years. RESULTS: The detection rate using the combined screening method was 95% (18/19) with a screen-positive rate of 7.2%. In comparison, screening by maternal age alone would have identified nine (47%) trisomy 21 pregnancies with a screen-positive rate of 10.7%. CONCLUSION: Our data suggest that the combination of nuchal translucency measurement in the first trimester and the triple test in the second trimester is associated with a very high detection rate of trisomy 21 at a relatively low screen-positive rate.     

Immunologic aspects of acute viral hepatitis at different ages

Patients of different age, among them 103 with viral hepatitis B and 120 with viral hepatitis A, were examined for immunoregulatory subpopulations of T lymphocytes and for the effects of HBsAg preparations and human liver-specific lipoprotein (LSL) on the blood E-RFC content. The patients of both mature and elderly age with viral hepatis A demonstrated insignificant, readily reversible alterations in cellular immunity. The patients with viral hepatitis B, particularly elderly ones, showed an evident tendency toward the predominance of the suppressor effects, which correlated with the disease gravity. During incubation of lymphocytes with HBsAg, the stimulating effect was mostly revealed. However, in elderly patients experiencing the stage of late convalescence, there was an increase in HBsAg-specific suppression depending on the disease gravity. The suppressive action of LSL was only recorded in single cases.     

不同年龄患儿应用静脉留置针并发症发生情况观察

目的探讨不同年龄患儿应用静脉留置针并发症的发生情况。方法选择住院患儿160例,按年龄不同分成新生儿组(<1个月)、婴幼儿组(1个月～3周岁)、学龄前期组(3～6周岁)和学龄期组(6～12周岁)4组,各40例。比较4组留置过程中堵塞、脱出、外渗、静脉炎等并发症的发生情况及留置时间。结果新生儿组和学龄期组出现并发症的总发生率和外渗的发生率明显低于婴幼儿组和学龄前期组,留置时间长,经统计学处理有显著性差异(P<0.01)。结论不同年龄患儿,并发症的发生情况不同,应根据患儿的年龄特点给予针对性的护理,保证静脉留置针的应用。     

不同年龄健康者不同部位骨密度分析

目的:分析不同年龄健康志愿者腰椎及髋部不同部位骨密度结果,提高早期诊断骨质疏松的依据。方法:对300名健康志愿者,年龄30～79岁,男110名,女190名,应用双能X线骨密度吸收仪测定腰椎及髋部不同部位(股骨颈、Ward’s三角、大转子)骨密度,并按不同年龄组进行结果分析。结果:①女性腰椎2～4(L2-4)BMD50岁后下降明显(t=3.96～5.62,P<0.001);股骨颈和Ward’s三角BMD随年龄增加而下降(各组间差异t=2.01～6.91,P<0.05～0.001,t=2.88～7.34,P<0.001);大转子BMD在50岁组和60岁组与其他各年龄组之间有明显的下降(t=4.19～5.24,P<0.01～0.001)。②110名男性L2-4BMD各组间比较无明显差异;股骨3个部位的BMD50岁后随年龄增加而下降(各组间差异t=2.13～0.87,P<0.05～0.001)。③女性BMD4项值与年龄及绝经年限明显负相关(r=-0.312,P<0.01;r=-0.532,P<0.01;r=-0.418,P<0.01;r=-0.642,P<0.001);男性与年龄及BMI的相关性不明显。结论:女性在更年期后以L2-4BMD下降为主;男性以髋部BMD变化为主。骨密度的测定提供了早期诊断骨质疏松的依据。     

不同幼年供体胰段的超微结构观察

背景:随着胰腺移植供体的不足,胰段移植已倍受关注.从解剖学角度认识胰腺各段胰岛和胰岛细胞(A,B细胞)的分布规律,可否得出胰段移植的最佳选择.目的:观察幼年大鼠胰腺胰尾的微细结构,胎尸胰腺胰尾的微细结构,胰岛B细胞胰高血糖素和胰岛素阳性表达面积及胰岛B细胞免疫阳件染色面积,并予以比较.设计、时间及地点:对比观察,于:2006-01/2007-06在福建医科大学人体解剖组织胚胎学系实验室完成.材料:出生1周内健康SD大鼠33只,3～10个月龄胎尸胰腺80个,每月龄10个.胰高血糖素抗血清为武汉博士德生物工程公司产品,胰岛素抗血清为北京中山金桥生物技术公司产品,图像处理系统(Videopro32型)由福建医科大学人体解剖实验审提供,Hu-12A型透射屯镜为日本电子株式会社产品.方法:随机选择30只大鼠,取胰尾切片苏木精-伊红染色后光镜观察,显微测微器测量胰岛个数和面积,用胰高血糖素抗血清和胰岛素抗血清进行免疫组织化学染色.另3只大鼠取胰尾组织块铀铅染色,每月龄胎尸各取2例胰尾组织,1例行ABC法胰岛素免疫组化染色,另1例行铀钳染色.主要观察指标:透射电镜观察并比较胎尸胰及幼年大鼠胰腺B细胞及胰岛形态和数量、结构及其分泌颗粒.结果:幼年大鼠胰尾组织中胰岛B细胞内分泌颗粒多,内质网、高尔基复合体和线粒体等细胞器发达,胰岛数目分布多,胰岛B细胞的免疫阳性染色面积大.胎尸胰尾有较多而密的胰岛B细胞散在分布,胰岛B细胞分泌颗粒多.结论:幼年大鼠和胎尸胰腺细胞的分泌活动均旺盛的,消化功能强,适宜作为胰腺胰段胰岛移植供体,且以胰尾为最佳.     

Renal excretion of cystathionine and creatinine in humans at different ages

The renal excretion of cystathionine is not age-dependent when related to body surface. Regarding the urinary creatinine concentration as reference, the excretion of cystathionine in adults is lower than in infants and children. However, this is probably due to a higher urinary concentration of creatinine in adults compared to that in children. Premature infants excrete more cystathionine in their urine than mature infants. The same is true for premature infants on a methionine-enriched formula compared to premature infants on a low methionine formula.