围产期不同阶段的缺氧与新生儿缺氧缺血性脑病的关系173例分析

对1989年1月至1993年12月本院分娩的173例新生儿缺血脑病(HIE)及颅内出血(ICH)进行分析,并对其中156例进行头颅CT检查。HIE的发生率为活产儿的2.13％,病死率为7.51％,是同期活产儿围产期死亡率的14.44倍。按围产期不同阶段的缺氧将173例HIE患儿分为四组,探讨其与临床分度、预后的关系以及临床分度与CT分度关系。分析CT诊断HIE及ICH的价值,并对HIE及ICH的早期诊断和预防进行讨论。     

晚期妊娠孕妇B群链球菌定植状况及妊娠结局分析

目的探讨妊娠晚期孕妇B群链球菌（GBS）定植情况、抗菌药物敏感性及妊娠结局。方法纳入2016年1月至2018年12月在东部战区总医院和南京医科大学第一附属医院妇产科定期产检的孕妇，于孕35~37周采用标准方法采集阴道及直肠拭子进行GBS培养，并对阳性标本分离的菌株进行药物敏感性试验。按培养结果分为GBS阳性组和GBS阴性组，阳性组按照产程中是否使用了抗菌药物治疗分为用药组与未用药组，比较不同组别妊娠结局的差异。结果共13 000名孕妇入组，GBS总体定植率为3.65%（475/13 000）。GBS在阴道中定植率为2.33%（303/13 000），在直肠中定植率为1.75%（227/13 000）。通过对直肠标本的采集检测，GBS阳性检出率增加了56.77%（172/303）。GBS每月的定植率有明显波动，3月份和10月份最高（均 P < 0.05）。475份GBS阳性标本对头孢曲松、万古霉素和利奈唑胺的敏感率为100%，对氨苄西林和青霉素的敏感率分别为97.26%和93.47%，而对左氧氟沙星、克林霉素、红霉素、四环素的耐药率较高，分别为30.11%、48.00%、52.21%和88.63%。GBS阳性组胎膜早破、产后出血、产褥期感染、新生儿肺炎、败血症发生率较GBS阴性组明显增高（均 P < 0.01）。产程中预防性使用抗菌药物的GBS阳性孕妇产褥期感染、新生儿感染及新生儿重症监护室入住率明显低于未使用抗菌药物的孕妇（ P < 0.05或 P < 0.01）。 结论妊娠晚期孕妇GBS定植率较低，无明显的季节性，通过补充直肠检测能提高GBS检出率。头孢曲松、氨苄西林和青霉素是目前预防和治疗GBS相关疾病的首选药物。GBS感染会明显增加母婴并发症的发生可能，产程中抗菌药物治疗可以改善母婴的结局。     

早发性先兆子痫母儿结局的86例临床分析

目的 探讨早发性先兆子痫的母婴结局及终止妊娠的时间和方式对妊娠结局的影响.方法 对1997年1月-2007年5月我院86例早发性先兆子痫病例进行回顾性分析.结果 86例患者中利凡诺、水囊引产18例,阴道自然分娩13例,11例经过治疗后好转继续妊娠,5例因经济原因自动出院,剖宫产39例,剖宫产率45.3%,无孕产妇死亡.孕30周后终止妊娠的新生儿窒息率和围生儿病死率及母亲的并发症明显低于孕30周前终止妊娠者.结论 孕周已近34周的早发性先兆子痫患者,经促胎肺成熟治疗后即可终止妊娠.而孕30周左右的早发性先兆子痫患者,在严密监测下尽量延长孕周以增加胎儿的成熟度并不增加母亲的并发症.     

Decreased response of plasma immunoreactive erythropoietin to "available oxygen" in anemia of prematurity

Erythropoietin, hemoglobin, hematocrit, oxygen affinity (P50), and reticulocyte counts were measured weekly starting at 1 week of age in 10 very-low-birth-weight infants and on a single occasion in 15 healthy men. In the adults, "available oxygen" (derived from oxygen carrying capacity and P50) averaged 13.1 ml/dl blood and the mean erythropoietin level was 15.2 mU/ml. Erythropoietin levels in the infants were inversely related to concentration of hemoglobin, P50, and available oxygen. However, despite the much lower mean "available oxygen" of 9.3 ml/dl in the infants compared with that in adults (P less than 0.001), the mean erythropoietin value of 8.2 mU/ml in the infants was less than in adults (P less than 0.001). Furthermore, the erythropoietin response to decreased "available oxygen" was lowest in the least mature infants. VLBW infants often develop clinical evidence of hypoxia during the anemia of prematurity. The relatively low erythropoietin levels in relation to "available oxygen" are compatible with a decreased erythropoietin response to hypoxia compared with that in adults. Such a difference in response could be a contributing factor to the anemia of prematurity.     

围产期心肌病36例临床分析

目的 通过资料分析以寻切实有效的治疗。方法 采用中西医结合疗法，强心，利尿和纠正心律失常，加用中药生脉，黄芪，适时终止妊娠。结果 治愈率91．66％，死亡率8．3％，首次发病无一例死亡。再次妊娠分娩后再发率100％。结论 加强孕期检查及增加母体营养，积极治疗妊娠合并症，可取得良好效果。     

贵阳市四街道辖区妊娠高血压综合征流行病学调查

本文报告1984年至1986年在贵阳市四街道辖区内年平均人口102 729人中进行妊高征流行病学调查的结果。妊高征的发病率为6.74%,围产Ⅰ死亡率为17.37‰,无孕产妇死亡。与妊高征发病有关的因素有家族高血压和妊高征史、贫血、肥胖和双胎等。妊高征患者的手术产率、产后出血、滞产等的发生率和胎婴儿的死亡率、患病率,宫内窒息及宫内发育迟缓等的发生数均明显高于非妊高征组。     

试管婴儿的出生缺陷及围产期情况研究

目的 探讨试管婴儿发生先天畸形、围产期合并症及死亡的危险性。方法 对1994年7月至2003年10月在我院接受IVF-ET术的156例母亲所生活产婴儿211例（试管婴儿组），及同期分娩的与母亲年龄及分娩时间相当的213例正常受孕母亲所生婴儿218例（对照组）进行分析，比较两组的母亲妊娠合并症及是否多胎、胎儿窘迫和出生窒息、出生缺陷、生后合并症、转儿科住院及存活情况。结果 试管婴儿组的多胎妊娠、早产及剖宫产率均显著高于对照组，分别为37．2％和2．3％，37．2％和8．5％、97．0％和71．8％（P均〈0．01）；妊高征、早期先兆流产率显著高于对照组，分别为22．4％和10．8％（P〈0．01），4．5％和0％（P〈0．01）；对照组胎儿窘迫的发生率显著高于试管婴儿组，14．6％和4．5％。试管婴儿组心脏畸形率和畸形总数皆高于对照组，但未显示出统计学差异。结论 试管婴儿的多胎率明显增高，由此造成的相关的围产期合并症发牛率也随之增高。     

Family Management of Infants with Fetal Alcohol Syndrome or Fetal Alcohol Spectrum Disorders

We studied the effects on family life of medical, social, and/or judiciary decisions taken when 28 infants born between 1995 and 2003 to alcohol-abusing mothers and diagnosed with fetal alcohol syndrome (FAS) or fetal alcohol spectrum disorders (FASD) were discharged from a neonatology hospital unit near Paris. Medical files of these infants and their mothers’ obstetrical files (when available) were retrieved from the hospital database; data was then collected and analyzed retrospectively. Post-discharge familial settings were established using questionnaires or telephone interviews with their doctors or the staff of the institutions where they were fostered. The 28 mothers of these FAS/FASD children all came from underprivileged backgrounds, had chronic health problems and/or lived with alcohol abusers. The neonatology team has to decide, at discharge, whether the families can provide a ‘good environment’ for their babies, if not, they refer them to the courts. In any case, the mother/parents must obey certain rules (such as respecting follow-up appointments for example). These FAS/FASD infants usually came from dysfunctional families, and at hospital discharge, 18% of them were put in care, while the mothers could be given court-approved visiting rights. When the infants lived with their biological families, the mothers’ marital situation usually deteriorated within 2 years. The mothers/parents often proved unable to look after their babies properly; this was reported to the courts, and their children put in care. Based on our results, we recommend that the current management of families with FAS/FASD children should be reviewed.     

围产期异常儿童首次癫痫样大发作的预后探讨

作者对有围产期异常史的１７３例首次癫痫样大发作儿童进行了预后随访医院。结果发现首次痫样大发作后５年内，累积复发率构成比为２１．５８％。由此表明，围产期脑损后形成“产痫灶”引起癫痫发作，而窒息、产钳、吸引术及严重感染是导致脑损伤的四大危险因素。