孕母间断补铁对预防婴儿缺铁性贫血的作用观察

[目的]观察孕母间断补铁预防新生儿及婴儿缺铁性贫血（iron deficiency anemia,IDA）的作用.[方法]对预防组109例孕妇从孕20周开始进行两周一次的间断补铁,每次补充元素铁105mg,共8次,对照组109例不补铁剂.实验前后对两组孕妇血以及脐血检测血红蛋白质（Hb）、血清铁蛋白（SF）、红细胞锌原卟啉（ZPP）等指标.对两组婴儿随访6～12月,评估婴儿IDA的患病情况.[结果]实验前两组孕妇间Hb、SF、ZPP差异无显著性（P＞0.05）;实验结束后对照组各项指标均低于预防组,差异有非常显著性（P＜0.01）;预防组新生儿脐血SF值和出生体重高于对照组（P＜0.05）;预防组婴儿6月龄时Hb均数高于对照组（P＜0.05）.[结论]孕期间断补铁可明显改善孕妇及胎儿或新生儿铁营养状况,有利于减少婴儿IDA的发生.     

Pre and postnatal diagnosis of fetus‐in‐fetu

Differentiation of abdominal masses detected on prenatal ultrasound is difficult and requires careful characterization of the mass and precise localization. Differentiation is required in order to distinguish benign from potentially malignant conditions. We describe a case of fetus‐in‐fetu with pre and postnatal imaging.     

妊娠期糖尿病对母子的影响

目的:探讨妊娠期糖尿病(GDM)引发的妊娠并发症和对围产儿的影响。方法:2005年6月~2007年6月对住院诊断为GDM的患者,与同期正常孕妇进行对照,回顾性分析其临床经过和母子影响。结果:GDM组妊娠期母子并发症发生率:先兆子痫40%、羊水过多32%、早产20%、剖宫产80%、产后出血16%,巨大儿36%、胎儿窘迫44%、新生儿窒息12%,较对照组均有显著差异。结论:妊娠期糖尿病的母子并发症明显增加,应加强对GDM的管理,改善母子结局。     

产儿科住院医师整合培养模式探讨

随着医学教学模式的更新,整合医学教育及围产医学理念的不断强化,产科与儿科的人才培养模式有了新的定位。临床案例中多学科合作抢救的模式的频频成功,产科与儿科的合作交流促进有了新的需求。分析产科与儿科目前住院医师规范化培训的特点,总结阐述整合培养不仅可以增强产儿科医师的自信力和职业归属感,提升围产保健的质量和救治力,而且可以培养出“高精尖”的产儿科储备人才以及缓和产儿科特殊的医患关系。从实际出发,针对具体的整合培训时长,可优化的带教形式,模拟训练的模式,反馈及奖惩制度等各方面进行探讨研究,以使整合培养的模式能落到实处,真正实现“高精尖”人才的培养,最终更好的服务于孕产妇及新生儿,提高我国围产医学领域的影响力。     

针灸治疗胎位不正的古代文献分析

目的:对针灸治疗胎位不正的古代文献进行文献计量学分析,分析古代针灸处方的特征。方法:以难产、横生逆产、横产、逆产等为文本词,检索《中华大典.医学分典.针灸推拿总部》中的相关文献并进行文献计量学分析。结果:共44条文献记录,涉及14个穴位和8条经脉,共86频次;采用针刺15条,灸法13条,其余未标明。结论:腧穴经脉的选取体现了胎位不正的病机特点,多选三阴交、至阴、合谷,经脉以脾经、大肠经、膀胱经为多;针刺与灸法并用,至阴多直接灸,其余穴位多针刺。     

内倒转术在剖宫产胎头高浮的应用观察

目的探讨剖宫产术因胎头高浮所发生胎头娩出困难的娩胎方式。方法对68例胎头高浮产妇行剖宫术,预测有胎头娩出困难者采用内倒转术取足牵引娩出胎儿。并与其他方法娩出胎儿的45例作对照。结果采用内倒转术娩出胎儿者可缩短从切皮至胎儿娩出时间,新生儿Apgar评分高于对照组,平均出血量减少。经统计学t检验,差异有显著性意义。结论剖宫产术遇到胎头高浮致胎儿娩出困难时,采用内倒转取足牵引娩出胎儿有省时、简单、安全的优点。     

Exposure to PM2.5 causes genetic changes in fetal rat cerebral cortex and hippocampus

PM_2.5 travels along the respiratory tract and enters systemic blood circulation. Studies have shown that PM_2.5 increases the incidence of various diseases not only in adults but also in newborn infants. It causes chronic inflammation in pregnant women and retards fetal development. In this study, pregnant rats were exposed to PM_2.5 for extended periods of time and it was found that PM_2.5 exposure increased immune cells in mother rats. In addition, cytokines and free radicals rapidly accumulated in the amniotic fluid and indirectly affected the fetuses. The authors collected cerebral cortex and hippocampus samples at E18 and analyzed changes of miRNA levels. Expression levels of cortical miR‐6315, miR‐3588, and miR‐466b‐5p were upregulated, and positively correlated with the genes Pkn2 (astrocyte migration), Gorab (neuritogenesis), and Mobp (allergic encephalomyelitis). In contrast, PM_2.5 decreased expression of miR‐338‐5p and let‐7e‐5p, both related to mental development. Further, PM_2.5 exposure increased miR‐3560 and let‐7b‐5p in the hippocampus, two proteins that regulate genes Oxct1 and Lin28b that control ketogenesis and glycosylation, and neural cell differentiation, respectively. miR‐99b‐5p, miR‐92b‐5p, and miR‐99a‐5p were decreased, leading to reduced expression of Kbtbd8 and Adam11 which reduced cell mitosis, migration, and differentiation, and inhibited learning abilities and motor coordination of the fetus. © 2016 Wiley Periodicals, Inc. Environ Toxicol 32: 1412–1425, 2017.     

胎儿肝脏分型及其影像诊断学意义

关于肝脏分型已有文献报道。但是,随着临床诊断技术的进步,尤其是随着影像诊断技术(如CT、B型超声、核素扫描等)的出现和普及,不断提出新的解剖学要求;另一方面有关胎儿肝脏分型的资料尚不十分充足,因此仍有对这一问题进行深入观察研究的必要。 1 材料和方法 6～10mo新鲜胎尸100具,4～5％甲醛溶液悬浮固定后,进行观察测量分型。     

Analysis of etiology,chromosome and prognosis for small left heart system development in 69 fetuses

Objective: To provide a basis for evaluating the prognosis of small left heart system development in fetuses, we analyzed its related factors.

Methods: The fetal echocardiogram was performed in 3859 pregnant women, and then small left heart system development was identified in 69 fetuses. The data of prenatal and postnatal echocardiograms, postnatal cardiac surgical treatment, chromosome and autopsy after induced labor were analyzed in the 69 fetuses.

Results: Except 1320 cases losing follow-up, 2539 cases had complete data. Among the 2539 cases, small left heart system development was identified in 69 fetuses. Of the 69 fetuses, 12 had hypoplastic left heart syndrome, 20 premature closure of foramen ovale, 13 total anomalous pulmonary venous drainage, 2 common pulmonary vein lumen atresia, 21 aortic coarctation or interruption and 1 right pulmonary hypoplasia. Among the 69 fetuses, chromosome abnormality was found in 7.

Conclusion: There are many etiological factors causing small left heart system development. The prognosis is poor in the fetuses with hypoplastic left heart syndrome, common pulmonary vein lumen atresia, pulmonary hypoplasia, other malformations or/and chromosome abnormality. Fetal echocardiography combined with chromosome examination can provide important bases for making diagnosis and evaluating the prognosis regarding small left heart system development.     

Massive cystic lymphangiomas of a fetus

We present a fetus with progressive massive subcutaneous lymphangiomas leading to intrauterine death. A 28-year-old woman was referred to our hospital because of a precordial cystic mass of the fetus. An ultrasound revealed lymphangiomas extending from bilateral axillae to the anterior chest wall. At 18 weeks' gestation, amniocentesis was performed and the karyotype of the fetus was found to be normal 46, XY. Thereafter the lesions increased in size gradually and spread over the body. Amniotic fluid decreased, pericardial, and pleural effusion appeared, and cardiomegaly became evident. The fetus died in utero at 25 weeks' gestation. Postmortem examination revealed a male fetus surrounded with multicystic soft masses spreading over the body, and syndactyly (left third and fourth fingers) was present. Histologically, a number of irregularly dilated lymphatics extended through subcutaneous tissues to the skeletal muscles. No communications between the cysts and the thoracic or abdominal cavity existed, and no lymphatic dilations in the viscera were confirmed. As far as we know, such conditions have rarely been reported. Considering that in previous literature, a favorable prognosis of a fetus with an atypically located (lateral cervical or non-cervical) lymphangioma with a normal karyotype has been reported, our case may be included in a distinct pathological entity. When we find a lymphangioma in a fetus, careful follow-up by ultrasound is mandatory.