Pregnancy in the Sickle Cell Disease and Fetomaternal Outcomes in Different Sickle cell Genotypes: A Systematic Review and Meta-Analysis

BackgroundPregnancy is a major concern among women with the sickle cell disease (SCD), and it is associated with increased adverse outcomes. The aim of the present meta-analysis is to report the fetomaternal outcomes in different sickle cell genotypes.MethodsIn this systematic review and meta-analysis, a comprehensive search of databases and search engines such as PubMed, Scopus, Web of Science, ProQuest, Cochrane Library, Science Direct and Google Scholar were performed. Any observational studies that had compared at least one outcome such as maternal outcomes, fetal outcomes, and morbidity between two groups of pregnant women with different types of sickle cell genotypes and pregnant women without SCD were evaluated.ResultsA total number of 9,827 pregnant women with SCD were examined. The results showed that pregnancy in SCD increased the risk of adverse outcomes for the mothers (including postpartum hemorrhage, prematurity, pregnancy-induced hypertension, pre-eclampsia, eclampsia, cesarean section, lower segment cesareansection, maternal death), fetus (including live births, low birth weight, intrauterine growth restriction, APGAR score at 5 min <7, stillbirth, neonatal death, perinatal mortality, acute fetal distress, intrauterine fetal death) and morbidity among the SCD(severe anemia, urinary tract infection, blood transfusion, painful crisis, acute chest syndrome, vaso-occlusive crises).ConclusionAccording to the results of this meta-analysis, pregnancy in the SCD is associated with an increased risk of maternal outcomes, fetal outcomes, and morbidity among SCD patients with different genotypes. Pregnancy in sickle cell hemoglobinopathies needs careful multidisciplinary management and cautious caring so as to decrease maternal and fetal morbidity and mortality.     

Anaesthetic management of an obstetric patient with Pompe disease

Pompe disease (Glycogen storage disease type II) leads to abnormal glycogen deposition in various vital organs resulting in multiple systemic sequelae. We present the anaesthetic management for caesarean section of a 31-year-old parturient with known Pompe disease. The parturient had symptoms and signs of respiratory dysfunction and the pregnancy was complicated by preeclampsia. She underwent urgent caesarean section under regional anaesthesia resulting in the birth of a healthy baby girl. To our knowledge, this is the first reported case of both spinal anaesthesia for caesarean section and successful live birth in a patient with Pompe disease.     

超声引导下行胚胎移植对妊娠结局的影响

目的研究超声引导下行胚胎移植对体外受精-胚胎移植结局的影响。方法回顾性分析2008年6月至2010年1月,接受体外受精-胚胎移植（包括卵母细胞内单精子注射）治疗的436个移植周期的资料,按照胚胎移植时有无B超引导分为常规胚胎移植组（常规组）和超声引导下胚胎移植组（超声组）,分别有110个周期和326个周期,比较两组患者的临床妊娠率、胚胎种植率、胚胎残留率、异位妊娠率,困难移植率及内外移植管血染率。结果常规组和超声引导组的周期临床妊娠率分别是36.4%（40/110）和40.5%（132/326）,P〈0.05;胎种植率分别是16.4%（47/286）和23.5%（207/880）,P〈0.05;困难移植率分别是7.3%（8/110）和2.1%（7/326）,P〈0.05;内外移植管出血率7.3%（8/110）和4.6%（5/326）,P〈0.05;胚胎残留率分别是3.6%（4/110）和2.6%（8/326）,P〉0.05;异位妊娠率分别是2.2%（2/110）和1.5%（5/326）,P〉0.05。结论超声引导下行胚胎移植能提高体外受精-胚胎移植的胚胎种植率,降低困难移植率及内外移植管血染率,能有助于改善临床妊娠率,是一种有效的胚胎移植方法。     

中西药结合治疗输卵管妊娠的疗效分析

目的探讨中西药结合治疗输卵管妊娠的临床效果。方法56例未破裂型输卵管妊娠患者,将其分成两组,中西药结合组40例给予甲氨喋呤(MTX)多次静脉注射,次日加四氢叶酸钙解毒,并辅以具有灭胚胎及活血化瘀作用的中药治疗。对照组16例,MTX多次静脉注射,次日加四氢叶酸钙解毒。治疗后定期检查血-βHCG及B超,注意患者的腹痛、阴道流血、腹泻、肛门坠胀感、黑色大便等及生命体征情况。结果中西药结合组38例治愈,治愈率95.00%,血-βHCG平均3.6 d开始下降,18.7 d下降为正常,47.5%呈现一过性上升;再次异位妊娠率2.5%;副反应发生率30.00%。对照组15例治愈,治愈率93.75%,血HCG平均9.9d开始下降,28.9 d下降为正常。两组相比,治愈率无显著性差异,血-βHCG下降时间和速度均有显著性差异(P<0.05)。结论符合保守治疗条件的输卵管妊娠患者采用中西药结合治疗效果良好,疗程缩短。     

妊娠期阑尾炎临床病例分析(附33例报告)

目的探讨妊娠期阑尾炎的临床表现,研究其诊治分析影响措施与母儿预后的。方法回顾性分析1990年至2005年收治的妊娠期阑尾炎33例的诊治方法。结果延误诊断3例治疗后2例流产,及时准确诊断并手术治疗30例,母儿安全,足月顺产。结论妊娠期阑尾炎影响母儿生命安全的主要原因是延误诊断或延误手术,准确诊断和及时手术,辅以积极的保胎和抗感染治疗是确保母儿生命安全的关键措施。     

男性慢性乙型肝炎患者服用阿德福韦酯期间妻子妊娠安全性的研究

如何评判男性慢性乙型肝炎患者在服用阿德福韦酯期间对孕妇及胎儿的影响,是医生和患者必须面对的问题,我们对收治的26例孕妇进行随访及对照研究,现报道如下.一、资料与方法1.研究对象:26例男性慢性乙型肝炎患者为2006年1月至2009年3月南京市第二医院门诊患者,诊断均符合2005年《慢性乙型肝炎防治指南》诊断标准[l].年龄26-34岁(中位数30岁),服药前患者HBsAg均为阳性,HBeAg为阳性或阴性,HBV DNA>104拷贝/ml.同时半年内未服过其他抗病毒药物,服用阿德福韦酯的时间为6 - 47个月(中位数26个月),入组时HBV DNA均已下降至＜500拷贝/ml、肝功能正常.26名孕妇年龄为23 - 32岁(中位数27岁).     

Ventilator Strategy for Status Asthmaticus in Pregnancy: A Case-Based Review

Asthma is a common and potentially serious condition complicating pregnancy. However, the literature available on the management of severe asthma in pregnancy is limited. We describe two episodes of respiratory failure due to asthma in pregnant women and discuss their management in the context of a review of the literature. In both patients, adequate oxygenation was maintained by using controlled hypoventilation with a permissive hypercapnia strategy. Both patients received aggressive steroid therapy, aerosolized bronchodilators, sedation, and paralysis. Aggressive asthma treatment as in a nongravid female is recommended.     

The Urban Built Environment and Associations with Women’s Psychosocial Health

The determinants that underlie a healthy or unhealthy pregnancy are complex and not well understood. We assess the relationship between the built environment and maternal psychosocial status using directly observed residential neighborhood characteristics (housing damage, property disorder, tenure status, vacancy, security measures, violent crime, and nuisances) and a wide range of psychosocial attributes (interpersonal support evaluation list, self-efficacy, John Henryism active coping, negative partner support, Perceived Stress Scale, perceived racism, Center for Epidemiologic Studies—Depression) on a pregnant cohort of women living in the urban core of Durham, NC, USA. We found some associations between built environment characteristic and psychosocial health varied by exposure categorization approach, while others (residence in environments with more rental property is associated with higher reported active coping and negative partner support) were consistent across exposure categorizations. This study outlines specific neighborhood characteristics that are modifiable risk markers and therefore important targets for increased research and public health intervention.     

肾移植术后妊娠对移植肾的影响

目的 探讨肾移植术后妊娠对移植肾的影响。方法 对1978年4月至2002年3月妊娠超过5个月的13例肾移植受者资料进行回顾性分析。结果 免疫抑制方案，4例采用环孢素A（CsA)及泼尼松（Pred)。5例为CsA，霉酚酸酯（MMF）及Pred。4例为他他克莫司（FK506），MMF及Pred。13例中，10例患者妊娠足月，生产，母，婴均存活，移植肾功能稳定；1例产后2周因并发肺部感染，心力衰竭死亡，死亡时移植肾有功能，婴儿存活；2例妊娠中期出现蛋白尿，病理证实移植肾发生慢性排斥反应，终止妊娠，但抗排斥治疗无效，切除移植肾，恢复血液透析，目前11名子女健康，无发育异常。结论 肾移植患者若情况允许，在严重监护下是可以妊娠的。