孕妇情绪与产后抑郁症相关因素的研究

为了探讨孕妇抑郁、焦虑情绪、产后抑郁症的发生率，及其关系和有关影响因素，随机抽取1997年1～11月在本院分娩的部分孕妇共1052例进行情绪测定（HAD）问卷调查，其中以艾氏广后抑郁量表（EPDS）跟踪至产后7天的有866例。调查结果：EPDS阳性率为15．01％，HAD问卷中A值总分、D值总分≥11分的分别为5．13％及437％；随着A值、D值的增高，EPDS阳性率也随之升高。据此分析了影响EPDS和A值、D值的有关因素，并提出了相应措施。     

第2产程剖宫产术对母婴的影响

本文对我院近 4年来第 2产程 (以下简称 2程 )剖宫产 6 1例进行回顾性分析。资料表明 :第 2产程剖宫产术易合并羊水污染及术时并发症 ,新生儿Apgar氏评分低 ,术后并发症高于对照组 (P <0 .0 5 ) ,提示第 2产程剖宫产术比一般头位急症剖宫产术对母婴不利 ,其并发症的发生与第 2产程的延长相关 (P <0 .0 1) ,故应把握时机尽量减少宫口开全后施行剖宫产。     

两种术式治疗多囊卵巢综合征的远期疗效追踪比较

[目的]评价开腹卵巢楔形切除(OWR)和腹腔镜下双侧卵巢电灼开窗术(LOD)两种术式对多囊卵巢综合征(PCOS)的远期疗效.[方法]1981至2001年在我院诊断为PCOS并接受手术治疗的妇女共151例,其中行OWR 61例、LOD 90例,追踪分析两组妇女术后妊娠率、术后妊娠时间的分布及术前后月经模式变化.[结果]两组的临床特征具有可比性,OWR组累积妊娠率84%,LOD组累积妊娠率72%,两组间没有明显差异,绝大部分妊娠发生在术后18个月内;OWR组术后3个月、半年、1年、3年、5年及10年月经规律的妇女所占的比例分别是81.3%、81.3%、77.3%、77.6%、78.9%、85.2%,明显高于术前的31.1%(P值＜0.05);LOD组术后3个月、半年、1年、3年、5年及10年月经规律的妇女所占的比例分别是80.6%、63.5%、56.7%、58.0%、57.6%、42.9%,明显高于术前的35.6%(P值＜0.05);术后OWR组月经规律妇女占的比例明显高于LOD组(P均＜0.05).[结论]两种术式的术后妊娠率相似.OWR比LOD更好、更长远地改善PCOS妇女的月经异常.     

The effect of supplementation with fish oil during pregnancy on breast milk immunoglobulin A, soluble CD14, cytokine levels and fatty acid composition

BACKGROUND: Breast milk contains many immunomodulatory factors (soluble CD14 (sCD14), IgA and cytokines) with the potential to influence infant immune development. OBJECTIVE: To determine if changes in breast milk omega-3 polyunsaturated fatty acid (n-3 PUFA) composition as a result of maternal dietary fish oil supplementation during pregnancy can modify levels of these immunological parameters in breast milk. METHOD: In a randomized controlled trial, 83 atopic women received either 4 g fish oil capsules (containing 3.7 g n-3 PUFA) (n = 40) or 4 g olive oil capsules (n = 43) from 20 weeks gestation until delivery. Breast milk was collected 3 days post-partum and fatty acids were analysed by gas liquid chromatography and IgA, sCD14 and cytokines (IL-5, IL-6, IL-10, TNF-alpha and IFN-gamma) were quantitated by ELISA or time resolved fluorescence (TRF). RESULTS: Omega-3 docosahexaenoic acid (DHA; 22:6n-3) and eicosapentaenoic acid (EPA; 20:5n-3) levels were significantly higher (P < 0.001) in breast milk from women supplemented with fish oil (n = 33, DHA mean 1.15%, SD 0.47% and EPA mean 0.16%, SD 0.07%) than in samples from the control group (n = 40, DHA mean 0.50%, SD 0.17% and EPA mean 0.05%, SD 0.02%). Breast milk arachidonic acid (AA; 20:4n-6) levels were significantly lower (P = 0.045) in the fish oil group (mean 0.55%, SD 0.12%) compared with the control group (mean 0.61%, SD 0.14%). Breast milk IgA was positively correlated with DHA (P = 0.046) and 22:5n-3 (P = 0.003), but inversely correlated with linoleic acid (LA; 18:2n-6) (P=0.034). Levels of sCD14 were also positively correlated with 22:5n-3 (P=0.009). Cytokines involved in IgA synthesis (IL-10 and IL-6) were also significantly correlated with both IgA and n-3 PUFA levels, although there were no differences in the levels of breast milk IgA, sCD14 or cytokines between study groups. CONCLUSION: Supplementation with fish oil during pregnancy significantly alters early post-partum breast milk fatty acid composition. omega-3 PUFA levels were positively associated with IgA and sCD14 levels, suggesting a relationship between fatty acid status and mucosal immune function.     

IVF周期中性激素水平的改变与临床妊娠率的相关性

目的探讨超排卵周期中血清雌、孕激素水平的变化及其与临床妊娠率的关系。方法56例不孕患者经普通IVF-ET(包括ICSI)过程,于注射FSH或HMG(启动日)、启动后4～7天、注射HCG日测定血清雌、孕激素、FSH、LH水平,于停经后6～8周行腹部B超检查示宫腔内孕囊存在并伴HCG上升则确认为临床妊娠。将临床妊娠组(23例)及非临床妊娠组(33例)的上述3日雌、孕激素、FSH、LH水平作一回顾性的分析对比。结果雌、孕激素、FSH水平随周期天数增加而增加,LH水平随周期天数增加而减少;临床妊娠组比非临床妊娠组雌、孕激素、FSH、LH水平略低,以HCG日较为明显,但两组雌、孕激素、FSH、LH水平间没有明显差异(P>0.05)。结论在IVF周期中, 临床妊娠率可能与多种因素有关,雌,孕激素的水平对胚胎着床的影响将有待我们提高样本量进一步探讨。     

输精管绝育术复通前后血清抗精子抗体的变化与妊娠的关系

目的:比较3种术式输精管绝育术(直视钳穿输精管结扎术、输精管注射粘堵、可复性输精管注射栓堵)复通前后血清抗精子抗体情况的变化和差异,评价复孕与血清抗精子抗体及精液质量的关系。方法:对88例采用3种不同术式进行输精管绝育术术后2年复通的受试对象,分别在复通后3、6、12、24个月对精子出现、血清抗精子抗体和女方妊娠情况进行随访观察。结果:①3种术式绝育术间复通前后血清抗精子抗体的阳性率差异无显著性(P>0.05)。②复通术前后血清抗精子抗体阳性率变化差异无显著性(P>0.05)。③在接受复通手术的对象中,精子出现组和精子未出现组血清抗体阳性率间差异无显著性(P>0.05)。④血清抗精子抗体的阳性率、强度(活动精子挂珠率)和种类对妊娠无直接影响(P>0.05)。⑤复通对象中,已孕组和未孕组血清抗体阳性率间差异无显著性(P>0.05)。⑥精子密度≥20×106/m l组妊娠率明显高于精子密度<20×106/m l组(P<0.01)。结论:输精管绝育术术式对抗精子抗体无影响;复通术没有消除血清抗精子抗体或降低其阳性率;血清抗精子抗体对妊娠无直接影响;复通后的精液质量与复通后的复孕有直接关系。     

超声诊断异位妊娠249例临床分析

目的为了提高对异位妊娠的诊断技术。方法选择在我院经手术病理证实的异位妊娠249例住院患者行2DB超和CDFI的声像图特征进行分析。结果2D超声声像图特征在249例异位妊娠中内膜增厚223例，厚度为4—8mm／2；宫内假环状孕囊28例，大小为4．12mm；宫外探及孕囊178例，大小为8-48mm；盆腔混合性包块28例，大小为40．80mm：伴有黄体囊肿的123例，存活宫外孕3例，可显示原始心管搏动；CDFI声像图特征为宫外孕急性破裂的患者显示肿块及周围组织的彩色血流信号增多，动脉频谱血流速度增快，RI降低。结论超声检查对妇产科急诊有显著性作用，可直接指导临床明确诊断，选定治疗方案。     

Pregnant dreaming: Search for a typology of a proposed dream genre

Dreams during pregnancy were collected from post-partum women on the maternity ward of an Israeli hospital. Our data indicate that primipara women and women with complicated obstetrical histories were more likely to report increased dreaming during pregnancy. The collected dream corpus suggests that dreams during pregnancy can be viewed as a distinct dream genre. This paper develops a tentative typology of that genre. In addition, the authors argue that the context of disclosure was highly relevant to the sorts of manifest contents that were reported.     

Sister-Sister in vitro fertilization surrogate pregnancy with donor sperm: The case for surrogate gestational pregnancy

A case of surrogate pregnancy is described in the sister of a 40-year-old hysterectomized woman where two oocytes of the latter were fertilized in vitro with known donor sperm and transferred into the surrogate. A normal singleton pregnancy developed which was complicated after 24 weeks of gestation with recurrent antepartum hemorrhages due to grade 3 placenta praevia. A healthy female baby was delivered by elective cesarean section at 36 weeks of gestation. The legal, social, psychological, and ethical issues of surrogacy remain unsettled and are discussed in this case report.