26例前置胎盘分娩方式临床分析

[目的 ]探讨前置胎盘分娩方式的选择及分娩过程中减少出血的方法。 [方法 ]对 2 6例前置胎盘病例的发病率、诊断方法、胎盘分型、分娩方式、出血情况及剖宫产术子宫切口方式与出血的关系几个方面进行回顾性分析。[结果 ]2 6例中手术率为 96 .1 5 % ,阴道分娩率为 3.85 % ,1例阴道分娩出血量为 6 0 0mL ,剖宫产术平均出血量为 6 74 .5 5mL ;剖宫产术中切口方式选择推开胎盘与避开胎盘出血量比较 ,差异无显著性 (P >0 .0 5 ) ,切开胎盘与推开胎盘出血量比较及切开胎盘与避开胎盘的出血量比较 ,差异均有显著性 (P均 <0 .0 1 )。[结论 ]剖宫产术可成为前置胎盘终止妊娠的主要方法 ,同时原则上应避开胎盘选择切口     

Immunolocalization of the Inducible Nitric Oxide Synthase Isoform in Human Fetal Membranes

PROBLEM: Nitric oxide (NO) synthesized by fetal membranes may protect the fetus from maternal infection or immune challenge or have a tocolytic effect on myometrium. The sites of synthesis and enzymes responsible for NO production in human fetal membranes remain unidentified. METHOD OF STUDY: Fetal membranes were obtained from four groups of patients: term (>37 weeks gestation) or preterm (<37 weeks gestation), both either in labor or not in labor. Frozen sections of membrane rolls were immunostained for inducible (iNOS) and endothelial (eNOS) nitric oxide synthase isoforms and the monocyte/macrophage marker CD14. RESULTS: Positive iNOS immunostaining was found in fibroblasts of amnionic and chorionic mesenchyme and in decidual macrophages identified by CD14 from all four groups of tissues. No iNOS immunostaining was seen in amnion epithelium or chorion trophoblast. Very intense iNOS staining was seen with evidence of monocyte/macrophage invasion of membranes. eNOS immunostaining was only found in decidual vascular endothelium. CONCLUSIONS: Constitutive expression of iNOS in decidual macrophages and fetal membrane fibroblasts may form an immune barrier against maternal insult. In chorioamnionitis, macrophage recruitment and NO expression may be part of the maternal immune response.     

安桃乐气体吸入在分娩镇痛中对母婴影响的观察分析

目的:探讨安桃乐(ENTONOX)气体吸入对分娩镇痛及母婴结局的影响。方法:将181名无产科或内科合并症的住院产妇随机分成两组,一组由家属全程陪护,另一组由家属全程陪护+安桃乐气体吸入,观察两组产妇的镇痛效果、产程进展、分娩方式、新生儿Apgar评分情况、产后出血量。结果:ENTONOX吸入对分娩镇痛有效率达98.2％,显效率达80.7％,对产程进展有促进作用,对分娩方式、围产儿结局、产后出血量无显著性差异。结论:ENTONOX吸入镇痛是一种安全、有效的辅助分娩技术,作用迅速、费用低廉,是产妇乐意接受的镇痛方法。     

Regulation of Interleukin (IL)-6 and IL-8 Production in an Amnion-derived Cell Line by Cytokines,Growth Factors,Glucocorticoids, and Phorbol Esters

PROBLEM: To determine whether amnion cells produce interleukin (IL)?6 and ?8 and thus may contribute to the high concentrations of these cytokines in amniotic fluid at term. METHOD OF STUDY: Amnion-derived WISH cells were treated in culture with stimuli over 16 hr, and IL-6 and IL-8 concentrations in the conditioned media were measured by enzyme-linked immunosorbent assay or bioassay (IL-6 only). RESULTS: IL-8 production was ?5-fold higher than that of IL-6 under basal and stimulated conditions. Significant (by Dunnett's test after analysis of variance) stimulation of production of both cytokines was achieved by IL-1β (>0.2 ng/ml), TNFα (>10 ng/ml), and the phorbol ester, phorbol 12-myristate 13-acetate (>2 nM), over a 16-hr culture period. Epidermal growth factor at 10 ng/ml induced a small increase in production of IL-8, but not of IL-6, whereas bacterial lipopolysaccharide had minimal effects on production of either cytokine. Basal and cytokine-stimulated IL-6 and IL-8 production was inhibited by dexamethasone at concentrations equal to or greater than 1 nM. CONCLUSION: These findings suggest that amnion may be a significant contributor to the IL-6 and IL-8 content of amniotic fluid, and that WISH cells may be a suitable model for the study of cytokine production by amnion epithelial cells.     

妇女妊娠期及分娩前后宫颈的超微结构研究

透射电镜观察证明,分娩前后人宫颈组织内出现以胶原纤维溶解和重建为主要特征的适应性改建过程.平滑肌细胞,成纤维细胞,巨噬细胞,中性白细胞及肥大细胞等多种细胞成分参与这一改建过程.它们既参与胶原纤维的溶解和吸收,又参与重新形成.文内还讨论了这些细胞之间的相互作用及调控它们形态与功能状态的因素.     

Bacteria-induced or bacterial product-induced preterm parturition in mice and rabbits is preceded by a significant fall in serum progesterone concentrations

Bacterial products are thought to induce labor by stimulating the production of pro-inflammatory cytokines and prostaglandins in gestational tissues, leading to the onset of preterm parturition. Progesterone withdrawal is a prerequisite of parturition in many species. Yet a role for progesterone in the mechanisms responsible for preterm parturition, in the setting of infection, is unclear. The current studies were conducted to determine if a fall in serum progesterone concentrations occurs before the onset of bacterial product-induced preterm parturition in animals.

Accordingly, pregnant mice at day 15 (70% gestation) were injected i.p. with Escherichia coli lipopolysaccharide (LPS; 50 μg/mouse) and timed-pregnant rabbits were inoculated transcervically with a suspension of E. coli to cause an ascending intrauterine infection. Control animals in both groups received equal volumes of sterile phosphate-buffered saline (PBS) solution. Blood specimens were collected at regular intervals and serum progesterone levels were determined by RIA. Within 14 h of LPS administration, mice delivered their pups. The median concentrations of serum progesterone were significantly lower at 1 h, 4 h, 10 h, and at the onset of preterm parturition (11–12 h) after LPS injection, compared to that in animals given PBS. Similarly, E. coli-inoculated rabbits delivered 1–2 days posttranscervical inoculation and demonstrated 60% decrease in serum progesterone within 12–24 h of inoculation compared to those given PBS. Parturition in both control groups occurred at term, following typical progesterone withdrawal. It is concluded that LPS administration to pregnant mice and ascending intrauterine infection in pregnant rabbits is associated with a dramatic fall in serum progesterone concentrations prior to the onset of parturition.     

2031例女性孕前检查甲状腺功能检测结果分析研究

目的探讨甲状腺功能异常与不良孕产史发生的相关性以及孕前甲状腺功能筛查的意义。方法选取2011年10月-2012年10月在我院进行孕前检查的女性2031名,采用固相化学发光酶免疫分析法检测sTSH,对于sTSH在正常范围外的人群,检测FT4、FT3.结果甲状腺功能异常的发生率为9．85％,有不良孕产史女性的甲状腺功能异常所占比例明显高于正常妊娠组,差别有统计学意义;体重指数高的人群甲功异常的发生率高于体重指数低的人群。结论甲状腺功能异常与不良孕产史有明显相关性;进行孕前期甲状腺功能筛查很有必要。     

A compact fiber-optic SHG scanning endomicroscope and its application to visualize cervical remodeling during pregnancy

We report the development of an all-fiber-optic scanning endomicroscope capable of high-resolution second harmonic generation (SHG) imaging of biological tissues and demonstrate its utility for monitoring the remodeling of cervical collagen during gestation in mice. The endomicroscope has an overall 2.0 mm diameter and consists of a single customized double-clad fiber, a compact rapid two-dimensional beam scanner, and a miniature compound objective lens for excitation beam delivery, scanning, focusing, and efficient SHG signal collection. Endomicroscopic SHG images of murine cervical tissue sections at different stages of normal pregnancy reveal progressive, quantifiable changes in cervical collagen morphology with resolution similar to that of bench-top SHG microscopy. SHG endomicroscopic imaging of ex vivo murine and human cervical tissues through intact epithelium has also been performed. Our findings demonstrate the feasibility of SHG endomicroscopy technology for staging normal pregnancy, and suggest its potential application as a minimally invasive tool for clinical assessment of abnormal cervical remodeling associated with preterm birth.