超声对宫角妊娠的诊断及治疗意义

目的 探讨对误诊率高，危害大的罕见特殊部位宫角妊娠的诊断和治疗。方法 对我院1991-2001年收治的宫角妊娠临床资料进行回顾性分析。结果 宫角妊娠17例中误诊宫内妊娠行人流失败4例。13例行腹部手术，3例行B超监视下人流术，1例行子宫动脉栓塞术。结论 宫角妊娠临床诊断困难，误诊率高，破裂后造成迅猛的腹腔内出血，应提高对少见部位宫角妊娠的认识，减少孕妇死亡。     

小水囊在小月份中期妊娠引产中的应用价值

目的探讨两种引产方法在小月份中期妊娠中的应用。方法40例年龄18．35岁，停经12．17wk，要求引产的病例随机分为两组各20例，分别用米非司酮配伍米索前列醇引产，米非司酮配伍米索加用小水囊联合引产终止妊娠。结果两种引产方法对比分析，从引产至临产时间、总产程、出血量及失败率、住院时间比较，差异有显著性，从清宫率和感染率方面比较，两组无显著差异。结论双米加用小水囊应用于小月份中孕引产是一种高效、安全、经济的引产手段，值得临床推广。     

Selective drop-out in successive in-vitro fertilization attempts: the pendulum danger.

Success rates from in-vitro fertilization (IVF) in the long term are dependent on selection procedures with regard to continuation into further IVF episodes. Publications on success rates in successive episodes will give incentives to adapt selection criteria, but if these publications do not deal explicitly with patient selection, the adaptations might change their direction every time: the pendulum danger.     

Insulin binding to trophoblast plasma membranes and placental glycogen content in well-controlled gestational diabetic women treated with diet or insulin,in well-controlled overt diabetic patients and in healthy control subjects

Summary Insulin binding to trophoblast plasma membranes and the placental glycogen content were measured in twelve healthy women, in eleven well-controlled gestational diabetic women who were treated either with diet alone (n=4) or with insulin (n=7) and in 18 women with well-controlled overt diabetes mellitus (six White B; four White C; eight White D). The competitive binding assay was carried out with 22 concentrations of unlabelled insulin. Binding data were analysed by a non-linear direct model fitting procedure assuming one non-cooperative binding site. Maximum specific binding was unchanged in the total collective of gestational diabetic women, but was decreased by 30% in those treated with diet (6.2±2.2%) and increased by 90% in insulin-treated women (16.4±10.2%) as compared to the control subjects (8.7±2.5%). The diet-treated women had only 40% as many and those treated with insulin had more than twice as many receptors compared to control subjects on a per mg protein basis and if expressed per total placenta. In patients with overt diabetes mellitus maximum specific binding (18.5±10.6 %) was higher (p<0.05) due to more receptors compared to control subjects but was similar to the insulin-treated gestational diabetic patients. Maximum specific binding and receptor concentrations did not correlate linearly with maternal plasma insulin levels. Receptor affinities were virtually similar in all groups (1.8·10⁹ l/mol). The placental glycogen content was reduced (p<0.05) to about 80% of that of control subjects in the diet-treated collective, whereas it was unchanged compared to control subjects in the insulin-treated gestational diabetic women despite a 40% increase (p<0.001) of the maternal-to-cord serum glucose ratio. In overt diabetic patients the maternal-to-cord serum glucose ratio and the placental glycogen content were higher (p<0.05) than in the control subjects. We conclude that trophoblast plasma membranes from gestational diabetic women treated with diet alone express less and those from women treated with insulin express more insulin receptors than those from a healthy control group in vitro. These differences could not have been disclosed without consideration of the mode of treatment. Trophoblast plasma membranes from overt diabetic women have more insulin receptors than those from healthy control subjects.     

Postpartum acute myocardial infarction

We report a postpartum acute myocardial infarction that occurred during the first week after cesarean section delivery. We also calculated the rate of postpartum myocardial infarction as related to all women with myocardial infarctions seen in our hospital.(Am J Obstet Gynecol 1997;177:1553-5.)     

Air Embolism Death of a Pregnant Woman Secondary to Orogenital Sex

Air embolism produced by vaginal insufflation is an unusual but potentially lethal consequence of sexual activity, especially in the pregnant patient. Reported here is the case of a young pregnant woman who presented to the ED in full cardiac arrest, with little history to explain her condition. Despite aggressive resuscitative measures, the patient died, but her infant son was delivered via perimortem cesarean section and survived. A high level of suspicion for air embolism should be maintained for young women who unexpectedly develop cardiac arrest, particularly during sexual activity. Air embolism patients may require vigorous medical resuscitation, hyperbaric oxygen therapy, or surgical intervention to survive. The emergency physician should be familiar with the indications for perimortem cesarean delivery in the third-trimester patient presenting to the ED with cardiac arrest.     

Burns during pregnancy: a gloomy outcome

The effect of burns on fetal and maternal survival is known to be detrimental. This prospective study describes the performance of pregnant burned patients who were managed and followed up for fetal and maternal outcomes at Ain Shams University's burn unit and Maternity Hospital during the period from October 1995 to September 1996. During the 12-month period, 27 pregnant burned patients were managed. Fetal and maternal mortality correlated with the total body surface area (TBSA) burned, the mortality rate being 63 per cent for both mothers and fetuses in the 25–50 per cent TBSA group. A fetal loss of 56 per cent with no maternal loss were recorded in the 15–25 per cent TBSA group. Experience in dealing with pregnant burned patients proves that early surgical excision and skin grafting, with timely termination of pregnancy are the best lines of treatment. Prevention or minimizing the effects of the burns may be achieved by proper education and guidance of the pregnant woman.     

孕晚期妇女维生素B_1、B_2、C及能量需要量的研究

以武汉市纺织系统值车工孕晚期妇女43名为研究对象,采用饱和试验法对其维生素B_1,B_2和C需要量进行了初步研究,并对其能量消耗量和摄入量进行了调查。结果表明,维生素B_1最低需要量为1.65mg/d、适宜需要量为1.90mg/d,维生素B_2的最低需要量为1.45mg/d,适宜需要量为1.70mg/d;维生素C的最低需要量为46mg/d,适宜需要量为146mg/d。孕晚期值车工一日能量总消耗为9.5144MJ(2274kcal),一日能量摄入量为10.6566MJ(2547kcaI),能量摄入高于能量消耗1.1422MJ(273kcal)。再次表明,孕晚期妇女能量供给在未孕基础上增加0.8MJ(200kcal/d)是适宜的。     

Recall of medication during pregnancy: Validity and accuracy of an adjusted questionnaire

Objective — To study the validity and accuracy of an adjusted questionnaire on medical drug use during pregnancy eight years after the pregnancy. Methods — The ability of a questionnaire on medication during pregnancy to detect actual use (= sensitivity) was tested against information collected 8 years previously (in 1983–1984) from 473 women with high-risk pregnancies who delivered at the University Hospital Nijmegen, the Netherlands. Results — For separate drug groups, the sensitivity varied between 5% and 91%. The timing of use was recalled moderately well. Although specific questions on drug groups did improve the sensitivity as compared to an earlier questionnaire, the improvement was not enough to make the questionnaire valid. High maternal education, low birth weight, low gestational age and a low 5-min Apgar score were related to better recall. The sensitivity of the questionnaire depended on the behavioural score of the child, implying recall bias. Conclusion — Questionnaire data on drug use during pregnancy obtained eight years after delivery are not a valid source of information.     

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。