两种产后立即放置TCu380A宫内节育器方法的比较——910例12个月随访分析

目的：比较徒手和卵圆钳两种方法对产后立即放置（ＩＰＰＩ）宫内节育器（ＩＵＤ）效果的影响。方法：将９１０例阴道分娩产妇（其中９７．７％是首次分娩）随机分成两组，于胎盘娩出后１０分钟内放置ＴＣｕ３８０ＡＩＵＤ，其中４７０例徒手放置（手放组），４４０例用卵圆钳放置（钳放组）。随访１２个月，以生命表法统计、χ２检验比较两种放置方法的脱落率、妊娠率、因症取出率等。结果：６和１２个月的随访率分别为９５．１６％和９２．６４％。９１０例中未发生子宫穿孔和感染，仅手放组有１例带器妊娠。放置后主要停用原因是脱落，手放组与钳放组１２个月的粗累积脱落率分别为１５．８６／１００妇女和１５．８８／１００妇女，因症（出血、疼痛）取出率分别为２．１１／１００妇女和１．５７／１００妇女，差异无显著性（Ｐ均＞０．０５）。结论：徒手放置或卵圆钳放置对ＩＰＰＩ的效果无明显影响；ＴＣｕ３８０ＡＩＵＤ适合中国妇女产后立即放置。     

Increased placental apoptosis in intrauterine growth restriction

OBJECTIVES: Our purpose was to investigate a possible role for apoptosis in the pathophysiologic mechanisms of intrauterine growth restriction. STUDY DESIGN: Placental samples were obtained from 43 uncomplicated third-trimester pregnancies and from 26 pregnancies complicated by intrauterine growth restriction. The definition used to identify cases of intrauterine growth restriction depended on three criteria: clinical evidence of suboptimal growth, ultrasonographic evidence of deviation from an appropriate growth percentile, and individualized birth weight ratios <10th percentile. Light microscopy was used to quantify the incidence of apoptosis. Electron microscopy and TUNEL (terminal deoxynucleotidyl transferase–mediated deoxyuridine triphosphate nick end labeling) staining were used to confirm the occurrence of apoptosis. RESULTS: Quantification of apoptosis (medians and interquartile ranges) resulted in the following values: normal third trimester (n = 43) 0.14% of cells (0.08% to 0.20%) and intrauterine growth restriction third trimester (n  = 26) 0.24% of cells (0.16% to 0.29%). The incidence of apoptosis was significantly higher in placentas from pregnancies with intrauterine growth restriction compared with normal third-trimester placentas (p < 0.01, Mann Whitney U test). CONCLUSIONS: These results suggest that apoptosis may play a role in the pathophysiologic mechanisms of intrauterine growth restriction.(Am J Obstet Gynecol 1997;177:401)     

母血、羊水中IGF水平与胎儿宫内生长受限关系的研究

目的 探讨胰岛素样生长因子-Ⅰ(IGF-1)和IGF-Ⅱ与胎儿生长发育的关系。方法 抽取15例分娩IUGR胎儿(IUGR组)及20例分娩正常Jk(对照组)产妇肘静脉血、新生儿脐静血及羊水。采用放射免疫法及免疫放射法分别测定其IGF-Ⅰ、IGF-Ⅱ水平。结果 IUGR组产妇血清IGF-Ⅰ水平低于对照组，IGF-Ⅱ水平无显著差异；IUGR组脐血及羊水中IGF-Ⅰ、IGF-Ⅱ水平较对照组显著降低。结论 检测母血及羊水中IGF-Ⅰ、IGF-Ⅱ水平可监测胎儿生长发育，早期诊断IUGR。     

孕妇血清HBV-DNA含量对预测胎儿宫内感染的临床价值

目的:探讨孕妇血清HBV-DNA含量对预测胎儿宫内感染的临床价值。方法:应用聚合酶链反应(PCR)法检 测103例乙型肝炎表面抗原(HBsAg)阳性孕妇的血清HBV-DNA含量,并对相关因素进行分析。结果:103例HBsAg阳性孕妇 的HBV-DNA检出阳性率为56%,胎儿宫内感染率为12.6％,且胎儿宫内感染率随血清HBV-DNA含量的增加而升高, HBV-DNA含量与胎儿宫内感染率呈正相关(r=0.572,P<0.01)。结论:孕妇血清HBV-DNA含量可间接预测胎儿宫内感染 的发生率。     

Intrauterine growth restriction—genetic causes and consequences

Intrauterine growth restriction is known to be associated with many medical problems for the baby, both before and after delivery. The mechanisms involved in fetal growth are not well understood, with an increasing range of metabolic diseases being implicated. Several key genes involved in normal embryonic and fetal growth and development are now known to be imprinted. Disruption of this parent-specific mono-allelic expression causes phenotypic changes, many of which are important for growth and development. Two growth disorders, Beckwith–Wiedemann syndrome and Silver–Russell syndrome, are discussed in detail as they represent well-characterized phenotypes that arise as a consequence of disrupted imprinting. These human models will allow us to elucidate key genes and mechanisms important in normal fetal growth.     

脐带穿刺致胎心减慢相关因素分析

目的 通过对脐带穿刺致胎心减慢相关因素的分析，提出预防脐带穿刺致胎心减慢的措施。方法 采用病例对照分析的方法，对1992年12月至2000年12月中山大学附属一院收治的70例脐带穿刺后胎心减慢病例与同期210例脐带穿刺后胎心正常病例的手术指征、手术相关因素及胎儿预后进行比较分析。结果 脐带穿刺后胎心减慢与脐带穿刺进针次数、手术时间、穿刺抽血量、是否穿入脐动脉、穿刺前是否进餐等密切相关。结论 穿刺前30min鼓励进餐，尽量缩短手术时间，提高穿刺的命中率，减少脐带穿刺的抽血量．避免穿入脐动脉．可预防穿刺后胎心减慢。     

应用小剂量阿斯匹林提高宫腔内授精妊娠率的临床观察

目的:本研究采用前瞻性随机双盲的方法,探讨小剂量阿斯匹林对提高宫腔内授精(IUI)妊娠率的临床效果。方法:采用CC/HMG/HCG方案促排卵,将行IUI的114例不孕妇女随机分为两组:观察组57例,于月经第1-20天连续服用阿斯匹林75mg/d;对照组57例,服用安慰剂。分别于排卵前1天和排卵后10天检测两组对象子宫动脉 血流阻力指数(RI)、子宫内膜形态、厚度及妊娠率。结果:两组妊娠率分别为24.6％和14％,子宫内膜呈三线征发生率分别为75.4％和50.8％,经比较均有显著性差异(P<0.01);与对照组比较,观察组RI显著降低(P<0.01),子宫内膜明显增厚(P<0.01)。结论:小剂量阿 斯匹林可改善子宫内膜发育,提高IUI妊娠率。     

尼尔雌醇在绝经后取宫内节育器中的应用

目的:探讨绝经后取宫内节育器前服用尼尔雌醇片的价值。方法:148例绝经后要求取出宫内节育器的妇女,随机分成两组,一组为直接取器组73例,按常规方法直接取出宫内节育器;另一组为服药组75例,顿服4 mg尼尔雌醇片1周后再取出宫内节育器,2组均在B超监测下取器。结果:直接取器组取器成功率为85%,用药组取器成功率为100%,两组有显著性差异(P<0.05)。结论:对于绝经后妇女,直接取器易造成IUD取出困难及失败,通过术前服用尼尔雌醇改善宫颈条件,可以提高取环的成功率。     

应用宫内节育器的妇女沙眼衣原体感染与子宫内膜中铜含量的关系

目的:探讨女性生殖道沙眼衣原体(CT)感染与宫内节育器(IUD)种类及内膜中铜含量的关系。方法:用聚合酶链反应检测65例置含铜IUD及97例置不锈钢单环的妇女宫颈分泌物CT;对因症取出IUD的20例妇女,取器后刮取子宫内膜,用原子吸收分光光度法测子宫内膜铜含量。结果:放置含铜IUD者CT感染率(3.1%)明显低于置不锈钢单环者(12.3%),P<0.05;放置含铜IUD的妇女子宫内膜铜含量明显高于置不锈钢单环者(P<0.05)。结论:含铜IUD对生殖道CT感染有抑制作用。含铜IUD可能通过释放的铜离子来发挥抗CT作用。     

Perforation of the bowel from intrauterine contraceptive devices: case series and discussion

The intrauterine contraceptive device is used extensively in the female population. Serious complications are rare, but they do occur. We discuss three cases of bowel perforation caused by these devices following their perforation through the uterine wall. It is important that cases of perforation be recognised swiftly and the possibility of involvement of other organs considered.