Intrauterine Growth Retardation of Unknown Etiology. I. Serum Complement and Circulating Immune Complexes in Mothers and Infants

ABSTRACT: Complement (C) and circulating immune complexes (CIC) levels were measured in 22 full-term pregnant women and 15 of their small-for-gestational-age (SGA) offspring in order to seek evidence supporting an immunological etiology for placental lesions related to idiopathic intrauterine growth retardation. We used 19 normal full-term pregnant women and 18 of their infants with birthweight above the 25th centile of the ponderal curve as a control population for this study. C levels were significantly lower in mothers of SGA infants than in controls (146.6 ± 46.6 and 183.6 ± 36.6 respectively, p < 0.01). CIC were present in the sera of 5 out of 22 mothers of the SGA group and in 3 out of the 15 infants sera. No CIC were found in the sera of mothers or infants from the control group. Placental lesions were observed in 14 out of the 22 (64%) cases studied in the SGA group and in 1 of 11 (9%) of the controls. Two placentas from SGA infants showed acute atherosis, and deposits of IgM and C₃ were found in their vessel walls. These data are in favor of an immunological mechanism for intrauterine growth retardation of unknown etiology.     

宫腔内人工授精97个周期临床分析

目的 选择84对患者97个周期的宫腔内人工授精(IUI)进行临床疗效分析。方法 按自然周期、克罗米芬(CC) 补佳乐 HCG、克罗米芬(CC) HMG HCG分为三组进行围排卵期IUI技术比较。结果 84对患者进行97含属期IUI，自然周期11个，有1例妊娠，妊娠率0．09％；克罗米芬(CC) 补佳乐 HCG组57个周期，有8例妊娠，妊娠率14．04％：克罗米芬(CC) HMG HCG组29个周期，有6例妊娠，妊娠率20．69％。结论 使用促排卵药物，尤其克罗米芬(CC) HMG HCG组，诱发排卵数目多，子宫内膜厚。妊娠率高。     

Hypotensive brain stem necrosis in a stillborn

Summary Hypotensive brain stem necrosis is reported in a stillborn. Additional postmortem findings included evidence of intrauterine distress, shock, and a pure blood culture of group B -hemolytic streptococci. These findings suggest group B -hemolytic streptococcal sepsis in utero, with a subsequent episode of transitory circulatory failure prior to intrauterine demise.     

宫腔镜下宫腔粘连电切术后宫腔放置子宫球囊支架或宫内节育器预防宫腔粘连的临床研究

目的对比宫腔镜下宫腔粘连电切术后宫腔放置子宫球囊支架或宫内节育器预防宫腔粘连的效果。方法选取行宫腔镜下宫腔粘连电切术的60例患者,随机分为两组各30例。观察组术后置入COOK球囊型子宫支架,对照组术后置入宫内节育器。比较两组的术后出血情况以及临床疗效。结果观察组术后48 h的中度、重度出血发生率显著低于对照组,出血量显著少于对照组(P <0.05)。观察组的总有效率为96.67%,显著高于对照组的80.00%(P <0.05)。结论宫腔镜下宫腔粘连电切术后宫腔放置子宫球囊支架能够减轻术后出血症状,有效预防粘连复发,效果优于置入宫内节育器。     

雌孕激素序贯用药治疗流产术后宫腔残留患者的临床价值分析

目的分析雌孕激素序贯用药治疗流产术后宫腔残留患者的临床价值。方法选取2017年1月至2019年12月我站收治的人工流产患者60例,按治疗方式不同分为对照组(28例)和观察组(32例)。对照组采用刮宫治疗,观察组于人工流产术后第7 d行B超检查,观察宫腔残留情况后采用药物治疗。比较两组的临床疗效、并发症。结果两组的总有效率比较无统计学差异(P>0.05)。观察组的腹痛发生率低于对照组,出血时间短于对照组(P <0.05)。结论雌孕激素序贯用药治疗能够有效清除宫腔残留,缩短出血时间,减轻腹痛,有利于重新建立正常的月经周期,促进子宫功能修复,避免再次刮宫对子宫内膜的损伤及手术对患者造成的不良身心应激,具有较高的临床推广价值。     

富血小板血浆在妇科疾病治疗中应用及其研究现状

富血小板血浆(PRP)是人自体全血经离心后获得的血小板浓缩物,含有大量生长因子及蛋白质。PRP因其有助于组织再生、伤口愈合、瘢痕修复等作用,在骨科、皮肤科、口腔颌面外科、整形美容科等领域应用广泛,而在妇科领域应用迄今相对较少。最新研究结果显示,PRP具有促进子宫内膜和卵泡生长作用,在治疗薄型子宫内膜(TE)、改善子宫内膜容受性(ER)、恢复卵巢功能等方面取得较大进展,并为多种妇科疾病治疗提供新的研究方向和手段。笔者拟就PRP的制备及分类、在妇科疾病治疗中的应用及其前景展望等最新研究现状进行阐述。     

IVF-ET术后宫内妊娠合并输卵管妊娠的诊治及妊娠结局分析

目的分析体外受精-胚胎移植(IVF-ET)术后宫内妊娠合并输卵管妊娠的诊治及妊娠结局。方法回顾性分析2014年3月至2019年6月于我院诊治的IVF-ET周期宫内妊娠合并输卵管妊娠患者50例的临床资料。分析其临床特征、超声表现、治疗方式及妊娠结局等。结果(1)本研究50例患者中10例(20.0%)无明显症状,16例(32.0%)表现阴道流血,13例(26.0%)出现下腹痛或腹胀,11例(22.0%)出现阴道流血伴下腹痛或腹胀。(2)治疗探查发现宫内妊娠合并输卵管间质部妊娠12例,宫内妊娠合并输卵管壶腹部妊娠34例,宫内妊娠合并输卵管峡部妊娠4例。(3)50例患者均通过阴道超声初步诊断,异位妊娠超声表现包括1例妊娠囊、5例卵黄囊、6例胚芽、16例心管搏动、22例附件区混合性包块。(4)39例腹腔镜手术中31例宫内妊娠存活,随访妊娠结局为2例早产,24例足月活产,5例继续妊娠;8例终止妊娠(7例流产、1例畸形引产)。7例开腹手术中3例宫内妊娠足月活产,4例流产。4例介入治疗后宫内妊娠1例早产、2例足月活产、1例流产。治疗后宫内妊娠总存活率为74.0%(37/50)。随访足月及早产婴儿健康状况良好,未发现先天畸形。(5)比较不同输卵管部位(间质部组、壶腹部组、峡部组)异位妊娠治疗后的宫内妊娠结局,3组间宫内妊娠存活率、早产率、终止妊娠孕周、新生儿出生体重、新生儿1分钟Apgar评分及并发症发生率均无显著性差异(P>0.05)。(6)除1例因胎儿畸形引产外,将剩余患者根据治疗后是否流产分为流产组(n=12)与宫内妊娠存活组(n=37),分析两组妊娠结局与临床特征的关系。结果显示,超声表现、治疗时孕周与妊娠结局有统计学相关(P<0.05),而患者年龄、体重指数(BMI)、孕次、产次、盆腔病变史、输卵管手术史、移植胚胎类型、临床症状、宫外包块平均直径、异位妊娠部位及治疗方式并不显著影响妊娠结局(P>0.05)。结论阴道超声对宫内妊娠合并输卵管妊娠的诊断有重要意义;孕早期尽早检查可以排除合并的异位妊娠对宫内妊娠的影响,早期诊断及治疗有助于获得良好的妊娠结局。     

Conception rates in women desiring pregnancy after levonorgestrel 52 mg intrauterine system (Liletta®) discontinuation

ObjectiveEvaluate reproductive function in nulligravid and gravid women after levonorgestrel 52 mg intrauterine system (IUS) discontinuation based on time to pregnancy.Study designWe evaluated women participating in the ACCESS IUS multicenter, Phase 3, open-label clinical trial of the Liletta(®) levonorgestrel 52 mg IUS who discontinued the IUS within 60 months of use and desired pregnancy. Study staff contacted participants every three months after IUS discontinuation for up to 12 months to determine whether pregnancy occurred. We excluded women who opted to stop attempting to conceive before 12 months. We evaluated 12-month conception rates in participants 16–35 years at IUS placement, comparing dichotomous outcomes using Fisher’s exact test. We performed a multivariable analysis to assess the association of baseline characteristics, age at discontinuation, duration of IUS use, and positive sexually transmitted infection testing during IUS use with conception.ResultsAmong 165 women who attempted to conceive, 142 (86.1%) did so within 12 months with a median time to conception of 92 days. The 12-month conception rates did not differ between nulligravid (66/76 [86.8%]) and gravid (76/89 [85.4%]) women (p = 0.83) and nulliparous (78/90 [86.7%]) and parous (64/75 [85.3%]) women (p = 0.83). In multivariable analysis, only obesity (aOR 0.3 [95% CI 0.1–0.8]) was associated with ability to conceive.ConclusionsAfter levonorgestrel 52 mg IUS discontinuation, women have rapid return of fertility in the year post-removal. Fertility rates after IUS removal do not vary based on gravidity, parity, age at discontinuation, or duration of IUS use.ImplicationsThis contemporary IUS study included a large population of nulligravid and nulliparous women. IUS use over many years does not effect spontaneous fertility after IUS discontinuation, regardless of gravidity or parity. Providers and patients should have no concern about the impact of IUS use on future fertility.     

经阴道超声在早孕期流产后宫腔残留物诊断中的应用价值

目的探讨经阴道超声在早孕期流产后宫腔残留物诊断中的应用价值。方法选取2018年1月至2020年1月医院收治的早孕期人工流产、自然流产及药物流产后行宫腔残留物诊断的患者80例,均采用经阴道超声检查,以病理结果为金标准,分析经阴道超声的诊断效能。结果以病理结果为金标准,经阴道超声对早孕期流产后宫腔残留物的诊断灵敏度为97.22%,特异度为62.50%,准确度为93.75%。结论经阴道超声应用于早孕期流产后宫腔残留物诊断中,具有较高的诊断灵敏度、准确度,可为临床治疗提供依据。     

早孕妇女中沙眼衣原体感染及产前诊断的研究

用PCR法对100例早孕妇女的子宫颈标本和绒毛组织进行沙眼衣原体(CT)检测,结果发现:孕妇宫颈感染率为11％(11/100),绒毛感染率为7％(7/100),在11例宫颈CT阳性的孕妇中,发现有5例绒毛CT为阳性(45.5％)。同时显示无业、个体经商者、多次妊娠(>3次)、宫颈糜烂分别是孕期感染CT的高危人群和重要因素。结论:在孕期保健中,应开展CT筛查,尤其对具有高危因素的孕妇进行检查,以利于早期发现衣原体感染,及时治疗,从而提高人口素质。