Serum insulin and plasma glucagon in human pregnancy — On the pathogenesis of gestational diabetes. A review

Summary The possibility that the deterioration of glucose tolerance during pregnancy might be due to a change in the functional condition of the endocrine pancreas has been examined in normal pregnant women and in non-obese gestational diabetics. Three test-situations were applied to elucidate the problem: 1) an overnight fast; 2) a glucose tolerance test (OGTT); and 3) a protein-rich meal. After the overnight fast, hyperinsulinemia and hyperglucagonemia were found in late pregnancy in both groups. However, on a molar basis, basal insulin increased more than basal glucagon and the molar insulin: glucagon ratio was therefore increased. After oral administration of glucose, the insulin response was enhanced in the late stages of pregnancy both in normal women and in those with gestational diabetes while the depression of glucagon below fasting levels was exaggerated and sustained in both groups. In response to a protein-rich meal in normal late pregnancy, the glucagon response was significantly lower than post partum in the same subjects, whereas that of insulin was unchanged. Finally, in both groups the diminished glucose tolerance in pregnancy was not associated with an abnormally elevated proportion of total insulin immunoreactivity represented by the biologically almost inactive proinsulin. Based upon these findings and those reported in the literature, it is concluded that there is no evidence in support of the idea that the diabetogenicity of pregnancy can be explained by changes in the function of the endocrine pancreas in these patients.     

Blood pressure measurement in special populations and circumstances

According to the established validation protocols, a typical validation study of a blood pressure (BP) monitor includes general population adults with normal or elevated BP. It is recognized, however, that the automated (oscillometric) BP monitors may have different accuracy or uses in some special populations compared with adults in the general population. Thus, an automated BP monitor with proven accuracy in a general population of adults may not be accurate in a special population, and therefore separate validation is needed. Recognized special populations deserving separate validation are those for which there is theoretical, and also clinical evidence, that the accuracy of BP monitors in these groups differs from that in the general population. Young children, pregnant women (including those with preeclampsia), individuals with arm circumference >42 cm, and patients with atrial fibrillation are regarded as special populations. Adolescents, individuals older than 80 years, and patients with end‐stage renal disease or diabetes mellitus have also been considered as possible special groups, but there is still inadequate evidence of altered accuracy of BP monitors in these subjects. Validation studies should be performed in special populations and evaluated separately after the BP‐measuring device has successfully undergone a validation study in a general population (unless the test device is intended only for a special population). This article discusses issues relating to the measurement of BP and the diagnosis of hypertension in selected special populations, as well as in low‐resource settings, where a simplified yet efficient evaluation strategy is necessary.     

互动式孕晚期护理干预对产妇产时认知能力及分娩结局的影响

目的:探讨互动式孕晚期护理干预对产妇产时认知能力及分娩结局的影响。方法:将126例于我院建卡并定期产检的单胎头位初产妇随机分为研究组和对照组各63例。两组产妇均行常规定期产检,孕晚期体检均予孕前指导,对照组产妇行常规孕晚期护理干预,研究组产妇行互动式护理干预。比较两组产妇分娩认知、围产期指标与分娩结局。结果:研究组产妇干预后分娩知识、分娩态度、产时应对行为评分分别为(18.29±2.15)分、(45.31±2.75)分、(31.05±3.12)分,明显高于对照组(12.31±6.24)分、(30.48±5.32)分、(21.58±2.98)分,差异有统计学意义(P0.01);研究组产妇干预后汉密顿焦虑、抑郁量表(HAMA、HAMD)评分、剖宫产率均明显低于对照组,差异均有统计学意义(P0.01);研究组总产程时间、产后出血量明显少于对照组(P0.05)。结论:互动式孕晚期护理干预可改善产妇产时认知能力,并对分娩结局产生积极影响。     

腹腔镜手术治疗妊娠期卵巢良性肿瘤16例临床分析

目的探讨腹腔镜手术治疗妊娠期卵巢良性肿瘤的临床价值。方法回顾性分析该院2003年11月-2013年10月16例妊娠期卵巢良性肿瘤的临床资料。患者均为单胎妊娠,平均年龄(28.0±5.1)岁,手术孕周为7~23周,其中,孕早期5例,孕中期11例,4例患者合并蒂扭转,其余12例均为产检时超声发现,卵巢肿瘤均为单侧,平均直径为(121.5±59.6)mm。结果所有患者均成功施行腹腔镜手术,无1例中转开腹及发生围术期并发症。6例行腹腔镜患侧附件切除术;10例行腹腔镜卵巢肿瘤剥除术,其中1例同时行卵巢肿瘤蒂扭转复位,2例同时行盆腔粘连松解术,术后病理均证实为良性。手术时间30~165 min,术中出血(32.1±5.6)ml,术后排气时间(19.6±3.2)h,术后住院(5.3±1.7)d。术后2例患者孕早期放弃妊娠,2例继续围产期保健,其余12例均已足月分娩,新生儿出生后Apgar评分均为9~10分,出生体重2 650~3 700 g。经电话随访,已分娩者后代的运动和智力发育均无明显异常,年龄最大者为6岁。结论腹腔镜手术诊治妊娠期卵巢良性肿瘤是安全有效的,不影响妊娠结局。     

Urinary tract infections in pregnancy: old and new unresolved diagnostic and therapeutic problems

Urinary tract infections (UTIs) are common in pregnant women and pose a great therapeutic challenge, since the risk of serious complications in both the mother and her child is high. Pregnancy is a state associated with physiological, structural and functional urinary tract changes which promote ascending infections from the urethra. Unlike the general population, all pregnant women should be screened for bacteriuria with urine culture, and asymptomatic bacteriuria must be treated in every case that is diagnosed, as it is an important risk factor for pyelonephritis in this population. The antibiotic chosen should have a good maternal and fetal safety profile. In this paper, current principles of diagnosis and management of UTI in pregnancy are reviewed, and the main problems and controversies are identified and discussed.     

使用自制模拟宫内妊娠模型练习产科超声检查技术

目的探讨使用自制模拟宫内妊娠模型练习产科超声检查技术的价值。方法应用自制模拟宫内妊娠模型进行产科超声检查练习并与临床相同孕周产科超声检查进行对比,评价其效果。结果自制模拟宫内妊娠模型虽然内部胎儿虽无胎动,且无法显示循环系统的彩色血流信号,但胎儿结构显示清晰,可以达到练习产科超声检查技术的目的。结论自制模拟宫内妊娠模型可广泛用于练习产科超声检查技术。