米索前列醇的临床应用

米索前列醇（misoprostol,米索）是人工合成的前列腺素E_1的衍生物,有多方面临床用途。80年代早期米索最先开始用于治疗消化性溃疡,尤其是对非甾体类抗炎药引起的胃十二指肠溃疡有明显疗效,对急性应激性溃疡也有预防作用。米索可引起腹泻,但因此也可治疗严重便秘的患者。随后发现米索对肝、肾有保护作用,还具明显抗炎、抗过敏作用;与其它抗早孕药合用,米索可使完全流产率大大提高;对人工流产术前的病人用米索可软化并扩张宫颈,从而减轻扩宫时病人的痛苦,使手术顺利进行。对米索的毒副作用研究发现其毒性主要表现在消化系统和雄性生殖系统,但一般比较轻微,无明显其它不良反应。故米索可谓一种高效、低毒的药物,值得临床推广。但男性患者在长期大量应用该药时需注意其对生殖系统的影响,孕妇应禁用。     

依沙吖啶引产失败后用卡前列甲酯栓的疗效

目的：观察３５例中期妊娠用依沙吖啶１次羊膜腔注射引产失败后，再用卡前列甲酯栓的效果。方法：卡前列甲酯栓１ｍｇ，放置于阴道后穹窿，若３ｈ后无宫缩，再放１次。结果：３５例孕妇引产成功率１００％。引产后２４ｈ内阴道流血量２００±２０ｍＬ。出现腹泻，恶心等不良反应各１例。结论：卡前列７甲酯栓用于对依沙吖啶中期引产失败后效果满意。     

Density distribution of erythrocytes in class A2 (insulin requiring) gestational diabetes

We evaluated the age distribution of erythrocytes in pregnancy complicated by gestational diabetes class A2 by the density distribution of cells (DDC) method. The values for normal pregnancy and nonpregnant women were obtained from recently published studies. The cumulative density distribution of cells (DDC) of women with gestational diabetes resembled that of normal pregnancy.     

正常孕妇孕期中血清铁蛋白,叶酸,VitB12的动态观察

对首钢职工中２９０例正常初产在妊娠早，中，晚三期进行血清铁蛋白（ＳＦ），血清叶酸（ＦＡ），ＶｉｔＢ１２，Ｈｂ和ＲＢＣ五项指标追踪观察，结果：孕妇妊娠期ＳＦ，ＦＡ，Ｈｂ，ＲＢＣ均随孕期的增加而下降，而ＶｉｔＢ１２变化较小，并缺少上述规律性。     

Spontaneous ovarian hyperstimulation mimicking an ovarian tumour

Ovarian hyperstimulation syndrome in a spontaneous singletonpregnancy is exceedingly rare. We report a case of ovarian hyperstimulationpresenting as bilateral ovarian masses in association with spontaneouspregnancy, occurring in a woman with disturbed liver function.A possible mechanism is discussed.     

EFFECTS OF LOSARTAN ON THE CARDIOVASCULAR SYSTEM, RENAL HAEMODYNAMICS AND FUNCTION AND LUNG LIQUID FLOW IN FETAL SHEEP

1. The angiotensin type 1 (AT₁) receptor antagonist, losartan (10 mg/kg) was infused intravenously into nine chronically catheterized fetal sheep (125–132 days gestation). Losartan reduced the fetal systolic (P < 0.01) and diastolic (P < 0.01) pressor response to 5 μg angiotensin II (AngII) i.v. from 27.4 ± 1.5 to 7.4 ± 0.9 and from 17.5 ± 1.3 to 5.4 ± 0.6 mmHg, respectively, after 1h and to 6.1 ± 0.5 and 4.4 ± 0.5 mmHg, respectively, after 2h. Maternal pressor responses to 5 μg AngII i.v. were unchanged. Fetal mean arterial pressure decreased (P < 0.05) after losartan administration, but fetal heart rate did not change. 2. Fetal haematocrit increased (P < 0.05), fetal PO₂ decreased (P < 0.01), PCO₂ did not change and pH decreased (P < 0.01), as did plasma bicarbonate levels (P < 0.01) following administration of losartan. Thus, losartan induced a fetal metabolic acidosis. 3. Fetal placental blood flow did not change following administration of losartan. In the fetal kidney, losartan caused a decrease in vascular resistance (P < 0.01) and an increase in blood flow (P < 0.05). Glomerular filtration rate decreased (P < 0.05); thus, filtration fraction decreased (P < 0.01). There was no change in the fractional reabsorption of sodium and glomerulotubular balance was maintained. Free water clearance decreased (P < 0.01) and became negative. Urine flow decreased (P < 0.01), the excretion rates of sodium, potassium and chloride did not change, but the urinary sodium:potassium ratio decreased (P < 0.05). There was a decrease in lung liquid flow (P < 0.05) following losartan. 4. It is concluded that the fetal renin-angiotensin system (RAS) is important in the maintenance of fetal arterial pressure, the regulation of fetal renal blood flow and is essential in the maintenance of fetal glomerular function. Further, these actions of AngII are mediated via functional AT₁ receptors. These effects of losartan on the fetal cardiovascular system, renal blood flow and function are similar to those observed following captopril administration. Thus, the effects of angiotensin converting enzyme (ACE) inhibition in the foetus are due to the blockade of the fetal RAS and are independent of any direct effects on bradykinin or prostaglandin levels.     

A prospective study of psychosocial background factors associated with congenital malformations

Women's life situation and experiences during pregnancy were prospectively studied in relationship to the development of congenital malformations (CMs) in their offspring, within samples of 84 offspring of pregnant index women with a history of nonorganic psychosis and 100 offspring of pregnant control women. Within both samples, offspring CMs were related to more problematic maternal life situations during pregnancy, the common denominator in these problems across samples being difficulties associated with the husband. Little relationship was found between CMs and the woman's own attitude toward the pregnancy or her mental condition during pregnancy. In both groups, total life situational problems and distress were more strongly related to the development of very minor CMs (termed "variants") than to the major, classical CMs.     

不同孕期阶段孕妇凝血四项及FDP和D-二聚体的变化及临床意义

目的:研究不同孕期阶段(早、中、晚)孕妇凝血四项、血浆纤维蛋白(原)降解产物[plasma fibrin/fibrinogen degradation products, FDP]、D-二聚体的变化及临床意义,为临床诊疗提供理论支持。方法:回顾性分析2021年1月至2021年12月200例孕妇就诊资料中的凝血四项,纤维蛋白原(fibrinogen, FIB)、凝血酶原时间(prothrombin time, PT)、凝血酶时间(thrombin time, TT)、活化部分凝血活酶时间(activated partial thromboplastin time, APTT)。并对FDP与D-二聚体的检测结果进行统计分析,比较孕早期、中期、晚期三个阶段凝血四项、FDP和D-二聚体水平的变化。结果:孕早期、孕中期与孕晚期PT水平比较,差异有统计学意义(P<0.05);孕早期、孕中期与孕晚期三个阶段的TT相比,差异无统计学意义(P>0.05);孕早期的APTT明显长于中期、晚期孕妇,差异有统计学意义(P<0.05);孕早期、中期、晚期孕妇,随着孕周的增加,FIB水平逐渐升高...     

美国2021版《妊娠期肾结石诊治-单中心多学科指南》解读——提高临床诊断能力，加强多学科协作管理

妊娠期肾结石是妊娠期患者非产科因素住院的常见病因,容易出现疼痛、恶心、呕吐、肾功能下降、泌尿道感染等并发症,处理不当会导致流产、早产等不良妊娠结局。美国医学中心多学科联合发布《妊娠期肾结石诊治-单中心多学科指南》,以规范妊娠期肾结石的诊治。本指南共形成10个指南推荐意见,其中4个用于指导诊断和影像学检查,6个用于指导临床治疗。值得关注的是,与国内指南相比,该指南提供了循证依据,证实了妊娠期使用低剂量CT平扫的安全性、有效性,并可以在患者病情变化且诊断不明确时优先使用,本文就以上内容对该指南展开深度解读。