外来孕妇与本地孕妇产前检查和妊娠结局对照分析

目的研究外省户籍孕妇与温岭户籍孕妇围产保健方面存在的差距，分析两者不良妊娠结局的差别。方法回顾分析2009年3月至11月在浙江省温岭市第一人民医院住院分娩的外省籍孕妇660例与同期分娩的温岭籍孕妇2435例，以外省籍孕妇为研究组，温岭籍孕妇为对照组。结果研究组产前检查覆盖率为90．76％，对照组为99．51％，剖宫产率研究组为36．7％，对照组为56％。两组分娩方式差异有统计学意义（P〈0．01）。对照组不良妊娠结局的发生随产检次数增加而减少，研究组产后出血并未因产检次数增加而减少。结论普及产前检查可以改善外来孕产妇的妊娠结局。     

13例妇科急腹症误诊原因分析

我院 1999年 1月— 2 0 0 1年 12月共收治妇科急腹症患者 2 10例 ,误诊 13例 ,误诊率为 6 .2 %。13例均经手术确诊 ,病理证实。现对误诊病例进行回顾性分析 ,以减少误诊。1　临床资料1 1　一般资料　患者年龄 12～ 6 4岁 ,平均 31岁 ;已婚 8例 ,未婚 5例。其中外科转入 6例 ,内科转入 2例。发病时主要症状和体征 :突发下腹剧烈疼痛 9例 ,慢性腹痛近日加重4例 ,发热 3例 ,休克 3例 ,伴恶心呕吐 6例 ,阴道出血 5例 ,腹部压痛 11例 ,反跳痛 8例 ,腹肌紧张 4例 ,移动性浊音 3例 ,行妇科检查 4例 ,下腹包块 1例。1 2　误诊疾病　见表 1。以异位妊…     

人乳头状瘤病毒与妇科其他常见病原微生物感染关系的调查

Objective To Investigate correlation between screening assay of human papillomavirus (HPV) and microbial pathogens in gynecology. Methods Cervical samples were collected to search for HPV, bacteria and yeast infections in gynecologic outpatients. HPV typing was carried out by PCR and sequencing on cervical brush specimens. Chlamydia trachomatis was identified by strand displacement amplification (SDA) and the other microorganisms were detected by conventional methods. All data were analyzed to investigate the correlation among them. Results In this cross-sectional study, among 857 enrolled outpatients, there were 266 cases with positive HPV DNA, and the rate of infection was 31.0%(266/857). HPV genotype showed that thirty-five different HPV types were identified, of which HPV16 was the most prevalent ( 14.5%, 38/262), followed by HPV58 (9.2%, 24/262), HPV53 (8.0%, 21/262)and HPV42 (6.1%, 16/262); while other genotypes were present in less than 5% of HPV positive women.According to the reclassification, the aggregated percentage (high-risk and probably high-risk) of detected HPV was 58.8% ( 154/262), 27.9% (73/262) for low-risk and 13.4% (35/262) for unknown-risk HPV types. Among HPV positive women, cervical brush specimens results showed that more than 60% cases with normal cytology, 3.8% (10/266) with high-grade squamous intraepithelial lesions (HSIL), 29. 7% (79/266) with low-grade squamous intraepithelial lesions (LSIL) and 3.0% (8/266) with atypical squamous cells of undetermined significance (ASCUS), respectively. Statistical analyses revealed there was a significant association between the infected HPV and Chlamydia trachomatis or Ureaplasma urealyticum ( >10000 CCU/ml; all P <0.01), while no correlation was found between HPV infection and bacterial vaginosis, streptococcus agalactiae, candida, Trichomonas vaginalis or Ureaplasma urealyticum ( ≤ 10000CCU/ml; all P > 0.05 ). Among the cases with bacterial vaginosis, the positive rate of HPV infected was42.6%. Chlamydia trachomatis was one of the high-risk factors for the infection of HPV ( OR = 2.82, 95%CI: 1.74 -4.57). Mycoplasma hominis was isolated only in 2 cases, no patient was infected with Neisseria gonorrhocae. Conclusions Although bacterial vaginosis was not significantly associated with HPV, it was more common among the HPV positive women. There is the significant association between HPV and Chlamydia trachomatis or Ureaplasma urealyticum which may be increase the infection of HPV. These data suggest that it may be important to screen for the simultaneous presence of different microorganisms which may have synergistic pathological effects.     

巨大儿115例回顾性分析

目的分析巨大儿的临床特点,以改善巨大儿预后.方法回顾2002年1～12月在我院住院分娩巨大儿115例与同期住院分娩胎儿出生体重2 500～3 999g单胎孕足月儿92例做对照,分析两组的孕产次、孕周、分娩方式及分娩结局.结果经产妇、孕周>40周巨大儿发生率增加,巨大儿剖宫产率显著增高,巨大儿、新生儿窒息率高于对照组,但无统计学差异.结论预防巨大儿发生,筛选巨大儿以指导产程处理及选择分娩方式是改善巨大儿预后的关键.     

胰岛素、C肽和葡萄糖与胎儿生长发育关系的研究

目的：探讨母血、脐血和羊水的胰岛素（INS）、C肽及葡萄糖（GLU）水平与胎儿生长发育的关系。方法选择妊娠期糖尿病（GDM）患者59例,同期单胎正常妊娠孕妇78例,测定母血、脐血、羊水的INS、C肽及GLU水平,并进行比较。结果（1）两组母血、脐血INS、C肽及GLU水平差异均有统计学意义（P＜0.05或0.01）。（2）两组母血、脐血的INS、C肽与新生儿体重、身长均无明显相关（均P＞0.05）;母血与脐血中C肽与INS水平明显相关（均P＜0.05）;对照组羊水INS和新生儿体重、身长均明显相关（均P＜0.05）。（3）多元回归分析显示孕妇年龄、孕前体重与新生儿出生体重密切相关（均P＜0.05）。结论可以通过测定血C肽的浓度间接反映母亲和胎儿体内的INS水平;羊水C肽水平可以作为评估胎儿宫内发育的指标;孕妇的孕前及孕期营养状况是影响胎儿宫内生长发育的主要因素之一。     

温岭地区妇女子宫颈人乳头瘤病毒感染现状调查及其与宫颈病变关系

<正>人乳头瘤病毒(HPV)感染是目前人类最常见的性传播性疾病之一,HPV感染是宫颈癌发生的主要原因。本研究对浙江温岭地区妇科门诊就诊妇女进行宫颈HPV感染的现状调查,并联合宫颈液基细胞学技术(TCT)及阴道镜检查,进行宫颈癌病变的筛查,评价HPV检测在宫颈癌筛查中的作用。1对象与方法1.1研究对象2008年1月至2009年1月期间,在浙江省温岭市第一人民医院妇科门诊就诊的妇女     

妊娠期糖尿病患者胎盘中HGF、RAGE的表达及临床意义

目的:探讨妊娠期糖尿病(GDM)患者胎盘中肝细胞生长因子(HGF)、晚期糖基化终产物受体(RAGE)的表达情况及其临床意义。方法:选择2011年1月～2012年12月该院各项资料完整的45例晚孕GDM孕妇作为观察组,另选择同期来院产前检查(产检)并分娩的正常晚孕孕妇43例作为对照组。采用免疫组织化学法检测两组患者胎盘中HGF、RAGE的表达水平及表达位点,并采用RT-PCR法测定HGF mRNA和RAGE mRNA水平。结果:观察组胎盘中HGF mRNA及表达水平明显低于对照组,差异有统计学意义(P<0.01),而RAGE mRNA及表达水平明显高于对照组,差异有统计学意义(P<0.01)。结论:GDM患者胎盘中HGF、RAGE的表达情况与正常妊娠孕妇有明显的差异,提示了两者对GDM的诊断和治疗有着重要的临床意义。     

影响剖宫产率的原因分析

近年来剖宫产率渐趋上升。笔者1997—2000年就本院产妇分娩方式变化来探讨剖宫产率上升的原因，并试图为降低剖宫产率寻找切实可行的方法。1临床资料 1．1一般资料上述时期在我院住院足月分娩病例6157例，年龄25～32岁；初产妇5408例，经产妇749例。1．2方法对上述病例进行分娩总数、难产率、剖宫产率、产钳率等所占比例的回顾性分析，统计相关的构成比和率，进一步分析影响这些变化的因素。     

人乳头状瘤病毒与妇科其他常见病原微生物感染关系的调查

Objective To Investigate correlation between screening assay of human papillomavirus (HPV) and microbial pathogens in gynecology. Methods Cervical samples were collected to search for HPV, bacteria and yeast infections in gynecologic outpatients. HPV typing was carried out by PCR and sequencing on cervical brush specimens. Chlamydia trachomatis was identified by strand displacement amplification (SDA) and the other microorganisms were detected by conventional methods. All data were analyzed to investigate the correlation among them. Results In this cross-sectional study, among 857 enrolled outpatients, there were 266 cases with positive HPV DNA, and the rate of infection was 31.0%(266/857). HPV genotype showed that thirty-five different HPV types were identified, of which HPV16 was the most prevalent ( 14.5%, 38/262), followed by HPV58 (9.2%, 24/262), HPV53 (8.0%, 21/262)and HPV42 (6.1%, 16/262); while other genotypes were present in less than 5% of HPV positive women.According to the reclassification, the aggregated percentage (high-risk and probably high-risk) of detected HPV was 58.8% ( 154/262), 27.9% (73/262) for low-risk and 13.4% (35/262) for unknown-risk HPV types. Among HPV positive women, cervical brush specimens results showed that more than 60% cases with normal cytology, 3.8% (10/266) with high-grade squamous intraepithelial lesions (HSIL), 29. 7% (79/266) with low-grade squamous intraepithelial lesions (LSIL) and 3.0% (8/266) with atypical squamous cells of undetermined significance (ASCUS), respectively. Statistical analyses revealed there was a significant association between the infected HPV and Chlamydia trachomatis or Ureaplasma urealyticum ( >10000 CCU/ml; all P <0.01), while no correlation was found between HPV infection and bacterial vaginosis, streptococcus agalactiae, candida, Trichomonas vaginalis or Ureaplasma urealyticum ( ≤ 10000CCU/ml; all P > 0.05 ). Among the cases with bacterial vaginosis, the positive rate of HPV infected was42.6%. Chlamydia trachomatis was one of the high-risk factors for the infection of HPV ( OR = 2.82, 95%CI: 1.74 -4.57). Mycoplasma hominis was isolated only in 2 cases, no patient was infected with Neisseria gonorrhocae. Conclusions Although bacterial vaginosis was not significantly associated with HPV, it was more common among the HPV positive women. There is the significant association between HPV and Chlamydia trachomatis or Ureaplasma urealyticum which may be increase the infection of HPV. These data suggest that it may be important to screen for the simultaneous presence of different microorganisms which may have synergistic pathological effects.     

多项血清因子联合检测在胎膜早破早期宫内感染预测中的意义

目的探讨血清IL-6I、L-8与TNF-a联合检测在胎膜早破早期宫内感染预测中的价值。方法采用酶联免疫吸附法对2008年6月-2010年6月医院收治的52例胎膜早破孕妇终止妊娠时血清IL-6I、L-8、TNF-a进行检测,产后取胎膜组织做病理检查;选择同期正常足月妊娠孕妇50例作为对照组;比较细胞因子水平与绒毛膜羊膜炎严重程度的关系。结果产后胎膜早破组45例胎膜病检确诊为绒毛膜羊膜炎,其血清IL-6I、L-8、TNF-a水平分别为(521.1±237.2)(、740.6±258.5)(、676.2±295.1)pg/ml,明显高于对照组的(293.3±153.7)、(560.3±185.2)(、442.4±289.6)pg/ml,并且其严重程度与IL-6I、L-8、TNF-a水平呈正相关。结论胎膜早破孕妇血清IL-6I、L-8、TNF-a水平明显增高,其含量与绒毛膜羊膜炎的严重程度密切相关,可作为预测绒毛膜羊膜炎的重要指标。