妊娠期急性脂肪肝38例临床分析

目的 探讨妊娠期急性脂肪肝(AFLP)的临床特点.方法 对北京佑安医院2008年5月至2013年11月收治的38例AFLP患者的临床资料进行回顾性分析,包括临床特征、实验室检查和治疗、转归情况.结果 38例患者在发病前1～2周均出现不同程度乏力、不适症状,38例均有肝功能障碍,18例肝肾功能衰竭,死亡4例(10.5％),围产儿死亡3例(7.3％).结论 妊娠期急性脂肪肝起病急、病情凶险,应早期诊断治疗、及时终止妊娠,AFLP患者发生产后出血和多脏器功能不全的比例较高,应严密监测及调节凝血功能、肝肾功能,血浆置换治疗可有效降低母体病死率.     

Awareness about postpartum insertion of intrauterine device among antenatal cases

Background

In spite of many available contraceptives numerous unwanted and unplanned pregnancies occur. Though the couples desire contraception but are not able to accept it due to their ignorance and misconceptions. Intrauterine Contraceptive Device (IUCD); an effective contraceptive is usually inserted six weeks after delivery. It can be inserted within 48 h of delivery called postpartum insertion for which government has started the program in many states. The study was undertaken to find out the choices about contraception after delivery and awareness about postpartum insertion.

Methods

The present observational study was conducted in one of the zonal service hospitals. 500 antenatal cases were included in the study. Their choice of contraception after delivery and awareness was determined through a questionnaire. Reasons for refusal of postpartum insertion were recorded. A small sample of staff also was included in the study.

Results

500 cases were included in the study, a large number had decided about contraception; mainly breast feeding supplemented by barrier contraceptive. 94 of 500 were willing for insertion of contraceptive device but not immediately after delivery due to apprehension in general and fear of side effects. Staff''s awareness about postpartum insertion was poor.

Conclusion

Knowledge and acceptance of postpartum insertion is very low among antenatal women; probably because the concept is new in the community. There is a strong need to increase the knowledge and awareness about this by health education and counseling.     

Preliminary trial in treatment of postpartum endometritis with intrauterine application of hyperimmune serum in dairy cows

ObjectiveTo evaluate the efficacy of hyperimmune serum (HS) in treatment of postpartum endometritis.MethodsIn a field trial, cows with vaginal discharge, 25–35 d in milk were randomly assigned to three treatment groups. In group 1 (n=42), cows received an intrauterine treatment with 50 mL HS. HS was produced against Arcanobacterium pyogenes and Escherichia coli that had already been isolated from the Iranian dairy farms. In group 2 (n=39), cows were treated with one intrauterine infusion of 5 g oxytetracycline (OTC). In group 3 (n=65), cows affected with endometritis were treated with 0.5 mg cloprostenol (PG). Group 4 (n=89) included clinically healthy cows as control (HC) group without any treatment in groups HS, OTC and PG; all cows were re-examined 39–49 d in milk.ReultsCure rate after treatment defined as the absence of vaginal discharge at the re-examination, was 64.3%, 61.5% and 72.3% in HS, OTC and PG groups, respectively (P>0.05). Cows categorized as E1 and E2 showed higher cure rate and reproductive performance measures than E3 cows in both treatment groups but their differences were not significant. Conception rate to all services for cows with endometritis (category E1, E2 and E3) was 52.9% in HS group, 57.1% in OTC and in PG 62.1% compared to 66.7% in HC (P>0.05). The difference in the conception rate between the HS and HC group was not significant.ConclusionsWe suggest that HS could be the no antibiotic alternative treatment choice for postpartum endometritis in dairy cattle.     

经会阴盆底超声在产后女性前盆腔功能评估中的应用价值

目的 探讨经会阴盆底超声在产后女性前盆腔功能评估中的应用价值。方法 随机选取2017年1月～2018年12月在我院就诊的未孕未育育龄期正常妇女100名,设为正常组,选取初产妇产后42 d妇女100名,设为产后组,分别获取两组女性静息状态及最大Valsalva状态下前盆腔的超声图像及各项盆底相关超声指标,比较两组间的差异。结果 所有入选患者均能较好的完成Valsalva动作并取得两种不同状态下二维、三维超声图像及各种指标。正常组膀胱残余尿为(16.13±2.09)mL、静息状态下逼尿肌厚度为(2.75±0.45)mm、膀胱颈位置为(26.12±2.56)mm,产后组膀胱残余尿为(16.30±1.12)mL、静息状态下逼尿肌厚度为(2.72±0.36)mm、膀胱颈位置为(25.59±2.61)mm,两组比较差异无统计学意义(P0.05);静息状态下盆隔裂孔面积正常组为(14.92±1.03)cm~2,产后组为(19.89±1.99)cm~2,两组差异有统计学意义(P0.05);最大Valsalva动作下正常组膀胱颈移动度为(13.92±2.73)mm、膀胱尿道后角(104.67±8.57)°、尿道旋转角(39.95±4.24)°、尿道漏斗形成率为5.00%、盆隔裂孔面积(18.83±2.53)cm~2,产后组膀胱颈移动度为(29.19±4.63)mm、膀胱尿道后角(139.26±15.86)°、尿道旋转角(53.84±9.30)°、尿道漏斗形成率为25.00%、盆隔裂孔面积(23.59±1.86)cm~2,两组差异有统计学意义(P0.05)。结论 经会阴二维、三维超声联合使用能定量评估前盆腔结构和功能状态,为产后早期发现FPFD提供临床依据,并为临床诊治提供更加全面翔实的信息。     

产后盆底康复时间选择对尿失禁及盆底肌的影响

目的 分析产妇产后尿失禁及盆底肌是否会受到盆底康复时间选择的影响。方法 选取2016年2月～2018年12月期间我院收治的90例产妇,经电脑随机法将其分为观察组和对照组两组,每组45例。观察组产妇在产后48 h进行产后盆底康复训练,产后42 d进行盆底康复治疗,对照组产妇在产后42 d进行产后盆底康复治疗,比较两组产妇的治疗效果。结果 观察组的尿失禁发生率(2.22%)明显低于对照组的22.22%,轻度、中度发生率也低于对照组,差异有统计学意义(P0.05);观察组Ⅰ类、Ⅱ类肌纤维肌力最大值与平均值均高于对照组,差异有统计学意义(P0.05)。观察组的治疗有效率为95.56%,对照组的治疗有效率为82.22%,组间比较差异有统计学意义(P0.05)。结论 产妇产后越早进行盆底康复训练,越有利于修复盆底肌,降低尿失禁的发生率,缓解盆底功能受损情况,提升治疗总有效率,加快疾病恢复,有临床实践意义。     

南昌地区产妇产后抑郁症筛查及影响因素分析

目的 了解南昌地区产妇产后抑郁情况及其相关影响因素。方法 采用爱丁堡产后抑郁量表(中文版)和自编调查问卷对2018年7～12月在江西省妇幼保健院产后门诊就诊的400例产妇进行筛查。结果 (1)共筛查出79名产妇有产后抑郁症风险,筛查阳性率为19.75%;(2)对产后抑郁症风险的相关影响因素进行单因素分析:年龄、孕期并发症、与家人关系是主要影响因素。(3)对产后抑郁症风险的相关影响因素行多因素Logistic分析:孕期并发症、与家人关系是主要影响因素。结论 运用工具早期筛查出有产后抑郁症风险的产妇至关重要,有孕期并发症、与家人关系不和谐是产妇产后抑郁症风险增加的主要影响因素。医务人员和产妇家属应该对有产后抑郁症倾向的产妇充分关注,提前进行干预,减少产后抑郁症的发生。     

Prognosis of postpartum psychiatric disorders in a Turkish sample

Objective

The postpartum period represents a time of increased risk for psychiatric disorders. Postpartum depression is especially very common. Many aetiological risk factors have been reported for postpartum psychiatric disorders. The purpose of this study was to evaluate the postpartum psychiatric disorders in a Turkish sample and discuss their course.

Methods

The files of 6000 inpatients who were admitted to Gazi University School of Medicine Psychiatry Department were evaluated retrospectively, and 67 patients were chosen whose psychiatric illness had began puerperally. These patients were grouped according to age of onset of the illness, number of episodes and the type of these episodes, their postpartum psychiatric diagnoses and illness prognosis.

Results

Of 6000 patients, 67 (1.11%) were diagnosed as having a postpartum psychiatric disorder: 56.7% (n=38) were diagnosed as having a postpartum psychotic disorder, while 35.8% (n=24) as having an affective disorder. Forty-seven patients (70.1%) received a diagnosis of major psychiatric disorder during their follow-up.

Conclusion

These results show that postpartum diagnoses may show a chronic course and cause a life-time psychiatric illness and therefore patients should be monitored carefully for psychotic symptoms even after the acute period is over.     

An individual scoring system for the prediction of postpartum anaemia

Background

Postpartum anaemia (PPA) is a common postpartum complication. The goal of this study was to prospectively construct a predictive score for individual risk of PPA.

Patients et method

We prospectively analyzed factors associated with PPA (< 10 g dL⁻¹ at 48 hours postpartum). Parameters analyzed were demographic data, pregnancy characteristics, delivery and postpartum characteristics. Univariate analysis was performed using Anova or X²; the Cox model was used for multivariate analysis. The scoring system was validated using ROC curve.

Results

Analysis was performed in 475 patients and validation was carried using an additional 95 patients. Multivariate analysis found four factors independently associated with PPA: anaemia during the third trimester of the pregnancy, Southeast Asian ethnic origin, episiotomy and severe postpartum haemorrhage (PPH) identified by the use of sulprostone. According to the score derived from the Cox model, patients were classified as low (22%, score = 0), medium (55%, score = 2 or 3) and high (86%, score > 3) probability of PPA. Using the AUC of the ROC curve for both the first and the validation cohorts (performed on 95 further patients), we recorded AUCs of 72% and 70% respectively.

Conclusions

This study allowed the derivation and validation of a predictive score of PPA. This score might be useful in targeting prophylactic strategies for PPA. Such strategies could include a more active treatment of iron deficiency (increasing oral iron treatment observance or intravenous iron therapy) especially in exposed population, improvement in the prevention and treatment of postpartum haemorrhage and decreasing the use of episiotomy. Future studies must focus on the external validation and generalisation of this scoring system.     

Insomnia treatment in the third trimester of pregnancy reduces postpartum depression symptoms: A randomized clinical trial

Mental health is an important medical issue in perinatal care, and there is increasing evidence that insomnia during pregnancy is associated with postpartum depression (PPD). Therefore, the present study evaluated the effect of insomnia treatment during the third trimester of pregnancy on PPD symptoms. Fifty-four pregnant women with insomnia were randomly assigned to trazodone, diphenhydramine, or placebo treatment. Sleep quality was measured by actigraphy at baseline, and after 2 and 6 weeks of treatment. In addition, depression was assessed 2 and 6 weeks after delivery. Trazodone and diphenhydramine improved sleep profile compared to placebo after 6 weeks of treatment. Further, depressive symptoms were reduced 2 and 6 weeks after delivery in trazodone and diphenhydramine groups compared to placebo. No differences in depressive symptoms were observed between the trazodone and diphenhydramine groups. These findings indicate that insomnia treatment with trazodone or diphenhydramine during the third trimester of pregnancy may prevent PPD.