足月妊娠引产时延长地诺前列酮放药时间的疗效观察

目的 研究足月妊娠引产时应用地诺前列酮(普贝生)延长放药时间最长至24小时的疗效及其不良反应.方法 对2007年1月1日至2008年12月31日使用普贝生引产的足月孕妇的病历资料进行回顾性分析,其中12小时内未取药未临产的患者160例作为研究对象,对12小时取出药物者(A组,52例)与继续放药最长至24小时者(B组,108例)进行比较,包括:基本情况、临床疗效(主要包括阴道分娩率、宫颈评分改善情况、催产素使用率).结果 两组基本情况比较差异无统计学意义.在放药12小时未临产且无其他取药指征的产妇中,进一步延长放药时间最长至24小时能显著改善宫颈评分,提高临产率,降低催产素的使用率,最终提高阴道分娩率.而母儿并发症的发生率无显著增加.延长普贝生放药时间提高引产成功率的主要原因在于有许多产妇在放药的12～24小时内发生临产.结论 普贝生用于足月妊娠引产时,如12小时未临产,延长放药时间可以进一步改善宫颈评分、增加阴道分娩率、降低催产素的使用率,且不增加母儿并发症.     

重复剖宫产对妊娠结局的影响

目的 探讨重复剖宫产对孕产妇及围产儿结局的影响.方法 回顾性分析1998年1月1日至2007年12月31日,在北京协和医院妊娠超过28周行再(多)次剖宫产手术分娩的产妇共412例,根据剖官产次数分为再次剖宫产组(repeated caesarean section group,RCS组,394例)和多次剖宫产组(multiple caesarean section group,MCS组,18例),随机选取同期行初次剖宫产手术分娩的480例为初次剖宫产组(first caesarean section group,FCS组)作为对照,分析三组孕妇的一般临床资料、产时产后并发症及围产儿结局.结果 近十年我院再次剖官产率为4.1%,呈逐年上升趋势.(1)一般临床资料比较:RCS组及MCS组平均年龄分别为(33.7±4.3)岁,(34.5±5.1)岁,大于FCS组(31.5±4.3)岁(P<0.05).RCS组及MCS组平均孕次分别为(3.5±1.4)次,(4.7±1.5)次,多于FCS组(2.1±1.2)次(P<0.05).(2)盆腔粘连发生率:RCS组及MCS组分别为13.5%和50.0%,高于FCS组(0.4%)(P<0.05).(3)子宫破裂发生率:RCS组(1%)高于FCS组(0%)(P<0.05).(4)RCS组及MCS组平均分娩孕周分别为(38.1±1.8)周,(37.3±2.5)周,与FCS组[(38.9±2.1)周]比较差异有统计学意义(P<0.05).结论 再 (多)次剖宫产发生率逐年上升,其显著增加盆腔粘连及子官破裂的发生率,但并不增加围产儿并发症的发生率.     

应用阴道超声测量骨盆及胎头径线指数预测相对头盆不称的研究

目的探讨应用阴道超声测量胎儿头盆指数，诊断相对头盆不称的方法。方法对１９０例初产妇分为阴道分娩组（１１７例）和手术分娩组（７３例）。在孕２８～３５周时应用阴道超声行骨盆测量，在分娩前１周行超声测量胎儿双顶径和头围，计算出径线，周长和面积的头盆指数，并与分娩结果比较。结果各种头盆指数在手术分娩组和阴道分娩组间均有显著性差异。其中定义为骨盆中腔前后径与横径的均值与胎儿双顶径之差的径线头盆指数（ＣＩＤ）准确率最高（７７．９％）。ＣＩＤ≤１５．８ｍｍ时，８３．０％的孕妇需手术分娩，ＣＩＤ＞１５．８ｍｍ时，７２．６％的孕妇可顺利经阴道分娩。结论应用阴道超声行骨盆测量和ＣＩＤ预测相对头盆不称，是一种简单实用的方法，可协助产科临床恰当地选择分娩方式。     

PREGNANCY AND ITS OUTCOME IN WOMEN WITH MALFORMED UTERUS

To analyze the clinical characteristics of fertility and pregnancy in women with congenital uterine malformations and explore optimal treatments to improve the prognosis.Methods. A retrospective study was conducted on the fertility and obstetric outcome in 153 patients with uterine malformations treated in our hospital from January 1984 to December 1998. Twenty - seven cases with other kinds of genital and/or urinary anomalies but with normal uterus during the same period were enrolled as the control group.Results. The infertility rate was 26. 6% (34/128), the miscarriage rate 44. 3% (86/194), premature birth rate 9. 3% (18/194), abnormal fetal presentation rate 28. 4% (29/102), the cesarean section rate 61. 8% (63/102), and the perinatal mortality rate 11. 8% (12/102).Conclusion. Women with congenital uterine malformation usually have higher incidence of infertility and complications during pregnancy and delivery. Bicornuate and septate uterus can be associated with poor obstetric outcome.     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism (n=57) or subclinical hypothyroidism (n = 20) during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74% ,and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control [(3191.8±659.47 g) vs (3301.9±423. 1 g), P<0.05], the incidence of abnormal glucose metabolism was higher (24.6% vs 11.4% ,P<0.05), and small for gestational age infants were more common than in the control group (12. 3% vs 2. 5%, P<0. 05). The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.     

妊娠合并骨髓异常增生综合征4例及文献回顾

目的 探讨妊娠与骨髓异常增生综合征的相互影响.方法 回顾妊娠合并骨髓异常增生综合征4例的情况,并进行文献复习.结果 4例患者中,1例发生早发重度子痫前期胎死宫内,3例成功妊娠.4例患者中有3例发生子痫前期.患者产后病情稳定.文献中妊娠对骨髓异常增生综合征的影响评价不一,可能与亚型及预后评分相关.结论 骨髓异常增生综合征合并妊娠罕见,对于RA亚型的低危病例,在严密监控下,有可能获得较好的妊娠结局.     

胰岛素样生长因子-Ⅰ及胰岛素样生长因子结合蛋白-3与胎儿宫内发育的关系

目的 检测孕妇静脉血、脐血中胰岛素样生长因子－Ⅰ (IGF－Ⅰ )及胰岛素样生长因子结合蛋白-3(IGFBP-3)水平,探讨 IGF－Ⅰ、 IGFBP-3与胎儿宫内发育的关系。方法 采用美国 DSL公司试剂盒。总计 81例孕妇,其中正常孕妇 38例,妊娠糖尿病孕妇 20例,正常妊娠分娩巨大儿孕妇 23例,采用放射免疫方法测定。 结果 正常组及巨大儿组孕妇静脉血 IGF-I与新生儿体重呈正相关 (r=0.653, r=0.640,两组 P均     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism (n=57) or subclinical hypothyroidism (n = 20) during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74% ,and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control [(3191.8±659.47 g) vs (3301.9±423. 1 g), P<0.05], the incidence of abnormal glucose metabolism was higher (24.6% vs 11.4% ,P<0.05), and small for gestational age infants were more common than in the control group (12. 3% vs 2. 5%, P<0. 05). The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism (n=57) or subclinical hypothyroidism (n = 20) during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74% ,and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control [(3191.8±659.47 g) vs (3301.9±423. 1 g), P<0.05], the incidence of abnormal glucose metabolism was higher (24.6% vs 11.4% ,P<0.05), and small for gestational age infants were more common than in the control group (12. 3% vs 2. 5%, P<0. 05). The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.