The Effect of Intrinsic Factor in Pernicious Tape-Worm Anemia

Plasma renin substrate concentration, renin activity, serum sex hormone binding globulin and total protein concentration were measured sequentially in 10 women after elective caesarean section. Plasma renin substrate concentration decreased from 5406 ± 999 μg AI/1 (mean ± SD) at term to 2369 ± 726 μg AI/1 6 days post partum. Plasma renin activity decreased from 6.2 ± 3.3 μg AI/1/h at term to 4.2 ± 4.0 μ AI/1/h 6 days after delivery. Serum sex hormone binding globulin decreased more slowly than plasma renin substrate concentration. Clearance of plasma renin substrate based on plasma renin activity was calculated. This consumption by renin could explain only 12% of the decrement in plasma renin substrate concentration at the steepest part of the plasma renin substrate disappearance curve. It is concluded that metabolic clearance of plasma renin substrate may be much greater than that calculated from plasma renin activity.     

孕产期因素对早产儿青春期智力水平的影响

目的: 探索孕产期因素对早产儿青春期智力发育的影响。方法: 运用病例对照研究的方法,对99名11~16岁的早产儿病例组和99名足月产对照组(按同性别、同年级、年龄相差不超过0.5岁、家庭环境相似等配对),采用中国韦氏儿童智力量表(C-WISC)进行智力测试,并分析孕产期因素对早产儿青春期智力水平的影响。结果: 影响早产儿青春期智力水平的因素有母亲孕早期阴道出血、孕中晚期阴道出血、胎膜早破与分娩方式;孕产期因素对足月产儿青春期智力发育无影响。结论: 预防妊娠期阴道出血、胎膜早破以及采取剖宫产的分娩方式有利于早产儿的智力发育。     

Bacterial flora in the uterine endometrial cavity of healthy subjects on the first and fifth days of the puerperium

This study was designed to investigate bacterial flora of the endometrial cavity in healthy puerperae. Thirty puerperae who underwent an uneventful course in pregnancy, delivery or postpartum were subjects for this study. Intrauterine contents were collected on the first and fifth days of the puerperium and submitted for microbiologic examination. On the puerperal first day, a total of 76 strains (53 strains of aerobic bacteria, 21 strains of anaerobic bacteria, and 2 strains of fungi) were detected in the uteri of the 30 subjects. More than 2 strains were detected in 97% (29/30 subjects). The incidence of aerobic gram-positive cocci, aerobic gram-negative bacilli, and anaerobic bacteria was 51%, 16%, and 28% of 76 strains, respectively. On the puerperal fifth day, a total of 102 strains (68 strains of aerobic bacteria, 30 strains of anaerobic bacteria, and 4 strains of fungi) were detected in the uteri of the 30 subjects. More than 2 strains were detected in 97% (29/30 subjects). The incidence of aerobic gram-positive cocci, aerobic gram-negative bacilli, and anaerobic bacteria was 46.1%, 18.6%, and 29.4% of the 102 strains, respectively. The population of the former seemed to decrease, and that of the latter 2 seemed to increase during the postpartum course. However, the number of strains detected for these 3 classifications of bacteria increased from the first to fifth postpartum day. There is no significance between bacterial strains and frequency detected, using the 2×39 chi-square test (P=0.571). There is no significance between classification of bacteria and frequency detected, using the 2×7 chi-square test.     

Anti-Müllerian hormone concentrations in maternal serum during pregnancy

BACKGROUND: In females, anti-Müllerian hormone (AMH) is expressed only by the ovary. AMH is secreted by the granulosa cells of ovarian follicles and appears to regulate early follicle development. AMH is detected in serum from women of reproductive age and its levels vary slightly with the menstrual cycle, reaching the peak value in the late follicular phase. This study investigated serum AMH levels throughout gestation and after delivery in healthy pregnant women. METHODS: This cross-sectional study recruited pregnant women and healthy non-pregnant women, 84 in total. AMH, FSH and E2 were measured in the follicular phase, in the three trimesters of pregnancy and in early puerperium. RESULTS: Estradiol and FSH levels followed the expected patterns during gestation. During the follicular phase of the menstrual cycle AMH levels were 1.9 +/- 0.5 ng/ml. In the three trimesters of pregnancy and in early puerperium AMH levels were: 2.1 +/- 0.56, 2.4 +/- 0.64, 1.95 +/- 0.6 and 2.05 +/- 0.55 ng/ml respectively. No significant modifications were found in AMH levels during pregnancy and in the early puerperium. CONCLUSIONS: This study has obtained information on AMH and on the possible relationship with FSH. We hypothesize that the profile of the new marker of ovarian activity AMH may indicate that initial non-cyclic ovarian follicular activity during pregnancy is not abolished. Moreover FSH, does not seem to play a direct role on AMH synthesis and secretion.     

家庭探访对初产妇产褥期生活质量的影响

目的探讨家庭探访对初产妇产褥期生活质量的影响。方法将110例单胎出院进行家庭探访的初产妇设为家访组,将过去未做家庭探访,只做电话随访的110例单胎初产妇设为对照组。比较两组产后4周时生理问题和生活质量。结果产后4周家访组发生产褥期常见生理问题的例数较对照组明显减少（P〈0.05）。家访组生活质量明显优于对照组,差异有统计学意义（P〈0.01或P〈0.05）。结论家庭探访对促进初产妇产褥期生理机能恢复和维护心理健康具有明显作用,可有效提高初产妇的生活质量。     

Narcolepsy and pregnancy: a retrospective European evaluation of 249 pregnancies

In a retrospective cohort study undertaken in 12 European countries, 249 female narcoleptic patients with cataplexy (n = 216) and without cataplexy (n = 33) completed a self‐administrated questionnaire regarding pregnancy and childbirth. The cohort was divided further into patients whose symptoms of narcolepsy started before or during pregnancy (308 pregnancies) and those in whom the first symptoms of narcolepsy appeared after delivery (106 pregnancies). Patients with narcolepsy during pregnancy were older during their first pregnancy (P < 0.001) and had a higher body mass index (BMI) prior to pregnancy (P < 0.01). Weight gain during pregnancy was higher in narcoleptic patients with cataplexy (P < 0.01). More patients with narcolepsy–cataplexy during pregnancy had impaired glucose metabolism and anaemia. Three patients experienced cataplexy during delivery. The rate of caesarean sections was higher in the narcolepsy–cataplexy group compared to the narcolepsy group (P < 0.05). The mean birth weight and gestational age of neonates were within the normal range and did not differ across groups. Neonatal care was affected adversely by symptoms of narcolepsy in 60.1% of those with narcolepsy during pregnancy. This study reports more obstetric complications in patients with narcolepsy–cataplexy during pregnancy; however, these were not severe. This group also had a higher BMI and higher incidence of impaired glucose metabolism during pregnancy. Caesarian section was conducted more frequently in narcolepsy–cataplexy patients, despite cataplexy being a rare event during delivery. Furthermore, symptoms of narcolepsy may render care of the infant more difficult.     

产后妇女漏尿症状及影响因素分析

目的 调查产后妇女发生漏尿症状的现状并分析其影响因素,为预防和积极干预提供参考。方法 采用便利抽样法,收集717例产后42~60 d复查的妇女的一般资料,测量产后盆底功能及评估产后漏尿情况。结果 717例产后妇女中,出现漏尿症状130例,发生率为18.13%。单因素分析结果显示,年龄、阴道分娩次数、分娩方式、妊娠期漏尿、生殖裂孔长度、Ⅰ类肌力、Ⅱ类肌力以及POP-Q分期与妇女产后出现漏尿症状有关（P＜0.05,P<0.01）;Logistic回归分析显示,年龄、顺产、产钳助产、Ⅰ类肌力和妊娠期漏尿是产后妇女发生漏尿症状的影响因素（P<0.05,P<0.01）。结论 产后42~60 d妇女的漏尿患病率处于较高水平,年龄增大、顺产及产钳助产、I类肌力减弱和妊娠期漏尿可增加产后出现漏尿症状的概率,临床医护人员应早期给予积极干预,以降低产后漏尿的发生率。     

Assessment of pregnancy-associated,within-woman change in uterine length

Abstract

Objective: To evaluate how absolute uterine length changes as a result of pregnancy.

Methods: Longitudinal repeated-measures study of all women presenting to a university-affiliated clinic for uterine sounding prior to in vitro fertilization (IVF) who went on to deliver at term and return for repeat measurement from 2002 to 2012. Change in uterine length was assessed by the Wilcoxon signed-rank test.

Results: Among 495 women, mean pregnancy-associated change in uterine length was 0.0?cm (SD?±?0.7, p?=?0.84), with 31% of women experiencing no change and 75% of women experiencing a change ≤0.5?cm. Mean uterine lengths at pre-cycle and repeat measurement were 7.2?cm (SD?±?0.7) and 7.2?cm (SD?±?0.7) with medians of 7.0?cm (IQR 7.0–7.5) and 7.0?cm (IQR 6.8–7.8), respectively. Change in uterine length did not vary by gestational number or within time interval between measurements (all p?>?0.5).

Conclusions: There was no difference in uterine length before and after term pregnancy. The finding of minimal variation in uterine length both across and within women suggests uterine length may be relatively stable such that patients undergoing IVF after term IVF pregnancy may not require repeat measurement. Future studies might assess pregnancy-associated sonographic changes in uterine volume and the relationship between uterine length and IVF outcomes.     

孕产妇脑静脉窦及静脉血栓形成的早期诊断及误诊分析

脑静脉窦及静脉血栓形成(cerebral venous and sinus thrombosis,CVST)是缺血性脑血管病的特殊类型,好发于妊娠期和产褥期的孕产妇。发病率低,起病隐匿,临床表现错综复杂,易于误诊、漏诊,死亡率、致残率高,但早期诊断和干预则预后良好。本文重点就孕产妇CVST的早期诊断及误诊相关研究做一综述,以促进临床医师及早识别危险预警,避免误诊,早期诊断,及时干预。     

Reversible Cerebral Vasoconstriction Syndrome after Administering Etanercept during Puerperium

Our objective is to clarify relationship between reversible cerebral vasoconstriction syndrome and administrating etanercept during puerperium. Several lines of evidence have suggested tumor necrosis factor (TNF) as a mediator of vascular dysfunction associated with estrogen deficiency. A 32-year-old woman resumed etanercept (25 mg/week), a TNF inhibitor, which had been discontinued during pregnancy, because of the deterioration of rheumatoid arthritis. She was admitted to our hospital with upper right quadrant blindness and mild right hemiparesis accompanied by pulsating left occipital pain, which had appeared 4 hours after restarting etanercept (25 mg/week). Magnetic resonance imaging and angiography revealed acute left hippocampal infarction with multiple segmental stenoses of the main intracranial arteries. Reversible cerebral vasoconstriction syndrome was diagnosed based on improvement of the multiple stenoses on magnetic resonance angiography on hospital day 17. A causal relationship was considered to exist between TNF inhibition by etanercept and multiple cerebral vasoconstrictions with brain infarct in this puerperant.