人工流产术前宫颈及子宫内膜麻醉的镇痛效果探讨

目的　探讨宫颈与子宫内膜两部位联合麻醉、普鲁卡因与利多卡因两药物配合应用在人工流产术中的镇痛效果。方法　人工流产术前对麻醉组 10 6例行普鲁卡因宫颈浸润麻醉和利多卡因子宫内膜表面麻醉。术中记录受术者腹痛程度、无阻力插入宫颈内口的扩张器号、出血量、人流综合征例数等指标。按照世界卫生组织规定疼痛标准及人工流产综合征反应进行评价 ,同期选择按传统机械扩宫法 10 4例做对照。结果　麻醉组镇痛有效率95 3% ,宫口松驰有效率 95 3% ,人流综合征无 1例发生。两组比较P均 <0 0 0 1。两组出血量比较无差异 ,无利多卡因毒性反应发生。结论　人工流产术前普鲁卡因宫颈浸润麻醉和利多卡因子宫内膜表面麻醉镇痛效果显著 ,可大大降低人流综合征的发生 ,避免利多卡因的毒性反应     

药物流产不全延迟处理54例临床分析

目的　探讨药物流产不全的原因及诊治方法。方法　收集药物流产后阴道出血达 1月以上而未行治疗者 ,根据B超等协助诊断 ,予以清宫后治愈。结果　 5 4例全部行清宫术 ,刮出物病检均为机化变性绒毛组织 ,部分伴炎性反应。清宫后阴道出血停止。结论　对于药物流产后阴道出血时间过长者 ,应及早明确诊断 ,及时行清宫术。     

Mechanical dilation to remove incarcerated laminaria during a second trimester abortion

Cervical preparation with laminaria reduces complications with 2nd trimester dilation and evacuation. During a surgical abortion at 22 weeks, we could not remove laminaria manually or with ring forceps due to laminaria “dumbbelling” [1]. Without pushing laminaria into the uterus, we mechanically dilated the cervix and removed the incarcerated laminaria.     

History of pandemic H1N1-containing influenza vaccination and risk for spontaneous abortion and birth defects

BackgroundOne recent study suggested an association between receipt of pandemic H1N1 (pH1N1)-containing vaccines in consecutive influenza seasons and spontaneous abortion, but corroborating scientific evidence is limited. In the present study, we leveraged a population of vaccine-compliant pregnant military women to examine history of pH1N1-containing influenza vaccination and adverse pregnancy outcomes. Because seasonal influenza vaccination is compulsory for military service, safety concerns regarding repeat vaccination are particularly relevant in this population.MethodsPregnancies and live births from Department of Defense Birth and Infant Health Research program data were linked with military personnel immunization records to identify women vaccinated with a pH1N1-containing vaccine in pregnancy prior to 21 6/7 weeks’ gestation, October 2009–April 2015. Cox and modified Poisson regression models estimated associations between vaccination with pH1N1- versus non–pH1N1-containing influenza vaccine in the season prior to the index pregnancy, and spontaneous abortion and birth defects, respectively. Cox models were calculated for two periods of follow-up: through (1) 21 6/7 weeks’ gestation and (2) 28 days postvaccination.ResultsOf 26,264 pregnancies, 21,736 (82.8%) were among women who received a dose of pH1N1-containing vaccine in the prior influenza season and 4,528 (17.2%) were among women who received non–pH1N1-containing vaccine in the prior influenza season. Among 23,121 infants, 19,365 (83.8%) and 3,756 (16.2%) had mothers exposed and unexposed to pH1N1-containing vaccine in the prior influenza season, respectively. The adjusted hazard ratio (aHR) for spontaneous abortion approximated 1.0 across the complete follow-up period (95% confidence interval [CI]: 0.89–1.13) and was slightly elevated when censored at 28 days postvaccination, though the CI was imprecise (aHR: 1.19; 95% CI: 0.97–1.46). No associations with birth defects were observed.ConclusionThis work lends additional safety evidence and support for vaccination against pH1N1 in pregnancy, regardless of the vaccine received in the prior influenza season.     

不同特征女性人工流产时焦虑、抑郁情绪及影响因素

目的:研究不同特征女性人工流产时焦虑、抑郁情绪评估及影响因素。方法:以2019年1-7月在本院择期行人工流产者105例,其中已婚54例、未婚51例,手术流产62例、药物流产43例。采用焦虑自评量表(SAS)和抑郁自评量表(SDS)评价并比较不同特征者人工流产前焦虑及抑郁程度,多因素logistic分析可能影响因素。结果:不同婚姻状态、文化程度、孕次、产次、流产方式者发生术前焦虑及抑郁程度存在差异(P<0.05),不同年龄、流产次数者术前焦虑及抑郁程度评分未见差异(P>0.05);未婚及手术流产者术前焦虑及抑郁情况最高(P<0.05)。多因素分析,流产妇女婚姻状态、文化程度、产次、孕次以及流产方式均为产生术前焦虑情绪的独立危险因素。结论:未婚及手术流产者流产前负面情绪较高,提示临床在行人工流产中,及时开展健康教育,做好咨询工作,降低流产妇女的负面情绪,提升生殖健康质量。     

反复自然流产患者血清中封闭抗体的检测

本文根据病史将反复自然流产(RSA)分类为原发性RSA 及继发性RSA,分别以单向混合淋巴细胞反应封闭试验及补体依赖微量细胞毒试验评价封闭抗体与两类流产的关系。结果发现,原发性RSA主要因封闭抗体缺乏所致;而继发性RSA 无封闭抗体缺乏迹象。因此,尽管原发性RSA 与继发性RSA 临床表现类似,但其免疫学病因及发病机理可能不同。     

Pregnancy: The effect of dose of mifepristone and gestation on the efficacy of medical abortion with mifepristone and misoprostol

Although it has been demonstrated that a combination of mifepristoneand a prostaglandin is an effective method of inducing abortionin early pregnancy, the optimum dose of the antigestogen isunknown. Women (n = 220) requesting abortion in early pregnancy(63 days amenorrhoea) were randomized to receive a single doseof either 600 or 200 mg mifepristone followed 48 h later bya single dose of 600 µg misoprostol by mouth. The percentageof women who had a complete abortion (93.6% confidence interval90.4–95.5%) was identical in the two groups. There wasno significant difference in the number of women who passedthe fetus within 4 h of receiving the prostaglandin (64 versus74%), the days of bleeding (14.6 ± 1.1 versus 15.3 ±0.9) nor in the onset of the next period (39.7 ± 1.3versus 36.7 ± 1.3) respectively between the groups receiving200 or 600 mg mifepristone. However, the complete abortion ratewas significantly higher in women 49 days compared to women50–63 days amenorrhoea (97.5 versus 89.1% respectively;P < 0.02). There was no difference in any of the other parametersat different weeks of gestation. We conclude: (i) that the recommendeddose of mifepristone could be reduced from 600 to 200 mg withoutloss of clinical efficacy, (ii) that the combination of mifepristoneand 600 µg misoprostol is a highly effective alternativeto vacuum aspiration for inducing abortion in women < 50days amenorrhoea and (iii) at gestation >56 days, this combinationmay result in too many incomplete abortions to be clinicallyacceptable.     

未产妇药物流产对再次妊娠结局的影响

为探讨未产妇药物流产对再次妊娠结局的影响 ,采用前瞻性调查方法对本次妊娠前有药物流产史的妇女 12 8例与同期有人工流产史妇女 2 46例及无流产史的妇女 2 5 8例进行比较 ,随访妊娠分娩结局。结果表明 :因胎盘原因所产生的妊娠及分娩并发症发生率和先兆流产、早产发生率药物流产组明显低于人工流产组 (P <0 .0 1) ,与无流产组差异无显著性 (P >0 .0 5 )。产后出血发生率 ,药物流产组亦明显低于人工流产组 (P <0 .0 5 ) ,与无流产组差异无显著性 (P >0 .0 5 )。提示未产妇女药物流产后再次妊娠分娩时产科并发症的发生率与无流产者相比未见增加 ,与人工流产者相比 ,有较大的安全性     

抗心磷脂抗体与反复流产及宫内死胎关系

目的　探讨反复流产、宫内死胎、孕中、晚期孕妇与抗磷脂自身抗体的关系。方法　采用ELISA对44 2例患者进行ACA IgG、ACA IgM抗体测定。结果　表明反复流产患者血中ACA阳性检出率最高达 44 % ,宫内死胎阳性率 30 % ,正常妊娠妇女阳性率为 3.6 % ,检出阳性者多为宫内发育迟缓及轻度妊高症。结论　ACA阳性与反复流产及宫内死胎、宫内发育迟缓有密切关系。     

子宫峡部阻滞麻醉应用于人工流产术的临床观察

目的　探讨人工流产术中最佳的镇痛方法 ,方法　用带 7号针头的注射器 ,于宫颈 3点、9点距宫颈外口约 1cm处水平穿刺进针约 3cm ,回抽无血后 ,分别推注 2 %盐酸利多卡因各 3ml,2min后手术。结果　子宫峡部阻滞麻醉后 ,疼痛明显减轻或消失 ,与对照组相比有极显著性差异 (P <0 .0 1) ,人工流产综合征发生率明显低于对照组 (P <0 .0 1)。结论　子宫峡部阻滞麻醉开展无痛人流安全、简便、有效。