阴道微生态与早产

早产的影响因素很多,其中环境因素(包括微生物群)的影响最显著,且目前研究证实,阴道微生物组成对特定人种的早产风险有显著影响。2019年6月Nature Medicine 发表了一项以非洲裔人群为主(78%)的病例对照研究,以45例孕23?36周分娩的单胎妊娠孕妇为早产组,以90例足月妊娠(≧39周)的单胎孕妇为对照组,于早、中、晚孕期及分娩后采用拭子擦拭阴道和肛门进行取样。     

妇产科学研究及临床应用热点专家研讨会--会议纪要

2001年3月31日,《当代医学》杂志社邀请国内妇产科学界部分专家召开了妇产科学研究与临床应用热点专家研讨会,以增进交流,加强各医院的协作和新技术的应用,从而推动妇产科学事业的发展.出席本次学术研讨会的代表来自中国医学科学院肿瘤医院,北京协和医院,北京大学各个临床医学院,国家计划生育委员会,中日友好医院,卫生部北京医院,北京市妇产医院等北京市各医疗单位,共50余名.中华医学会副会长曹泽毅教授担任本次会议的主席并主持了研讨会.     

阴道分泌物胎儿纤维连接蛋白与宫颈长度联合预测早产的多中心前瞻性研究

Objective To discuss the clinical value of fetal fibronectin (fFN) and cervical length in predicting preterm birth. Methods Totally, 511 pregnant women at 22-35 weeks of gestations were enrolled from Dec. 2006 to Dec. 2007 at 4 tertiary hospitals in Beijing, and all with either symptoms or high risk factors of preterm birth, but without preterm premature rupture of membrane or vaginal bleeding. Cervical fFN were determined and cervical length of each subjects were measured by ultrasound. The pregnancy outcomes were compared. Results The sensitivity, specificity and negative predictive value (NPV) of fFN in predicting preterm birth within 7 d were 77.4%, 69.4% and 97. 9%, respectively; and 70.5%, 70.0% and 96.2% for deliveries within 34 weeks. The above figures changed to 54.8%, 66.3%, 95.8% for deliveries within 7 d and 59.1%, 67.2%, 94.6% for those within 34 weeks, respectively, when cervical length ≤3 cm was applied to predict preterm birth. When fFN and cervical length were combined, the sensitivity, specificity and NPV were 51.6%, 87.1%, 96.5% for deliveries within 7 d, and 45.5%, 87.60/00, 94.5% for those within 34 weeks, respectively. Conclusions FFN has higher NPV and specificity than cervical length in predicting preterm birth within 7 d and 34 weeks, and the positive predictive value and specificity can be improved when combined with cervical length.     

妊娠合并艾森曼格综合征的诊断与治疗

目的 探讨妊娠合并艾森曼格综合征的临床表现、诊断、妊娠结局与治疗方法。方法回顾分析2例妊娠合并艾森曼格综合征患者的临床资料。结果 第1例患者孕34^ 4周临产入院，阴道分娩后即刻出现烦躁、呼吸急促、呼吸困难而死亡，临床考虑为肺栓塞。第2例患者因发现胎儿生长受限入院，口唇及甲床紫绀加重，于孕35^ 4周剖宫产，产后2周平安出院。结论 妊娠合并艾森曼格综合征母儿的结局不良，该患者不宜妊娠，婚后应采取避孕措施。一旦妊娠应在早期终止。如果患者拒绝终止妊娠，应加强监护，尽最大努力保护母儿的生命安全。     

超声诊断胎儿畸形的处理及预后分析

目的 探讨产前超声诊断的不同种类胎儿畸形的处理和预后分析.方法 总结124例产前超声检查时诊断的畸形胎儿的处理和追踪结果 .结果 (1)124例畸形胎儿中76例选择引产,其中有7例为染色体异常(2例13-三体,1例21-三体,1例45 XO,3例18-三体).(2)48例非致死性畸形在知情同意前提下选择继续妊娠.1例12指肠闭锁胎儿发生胎死宫内,1例重度膈疝胎儿生后当天死亡.18例胎儿生后手术治疗,16例健康存活,2例术后死亡.28例生后动态观察追踪,8例泌尿系统异常恢复正常;6例尚在观察中;3例卵巢囊肿生后2个月消失且健康存活;5例轻度脑室扩张者2例生后追踪未见异常,2例发展为少见的异常综合征,1例尚在追踪观察中;5例先心病患儿3例新生儿期死亡,2例等待手术;1例胸腹腔积液胎儿生后追踪至2年完全健康.结论 非致死性胎儿畸形和异常在知情同意的前提下与儿科合作,针对异常情况可以通过手术或密切观察得到良好的结局.     

B族溶血性链球菌围产期感染的预防和处理策略

B族溶血性链球菌(Group B Streptococcus,GBS)是引起羊膜腔内感染的主要致病菌之一,也是引起早期新生儿肺炎、败血症的主要致病菌.由于围产儿感染死亡率高,危害大,自20世纪70年代以来西方国家对围产期GBS感染的预防和处理给与了高度重视.     

促宫颈成熟和引产：2023年加拿大妇产科医师协会指南解读

2023年加拿大妇产科医师协会(Society of Obstetricians and Gynaecologists of Canada, SOGC)根据最新的研究结果及循证证据发布了促宫颈成熟和引产指南, 该指南分为引产总则、促宫颈成熟和引产三部分, 详述了促宫颈成熟和引产的指征和方法。本文就该指南中主要的更新点进行重点解读。该指南重点强调了引产的个体化, 更强调了尊重患者选择的人文关怀;建议孕8～12周应用超声核对孕周, 提出40岁及以上孕妇≥39周引产的合理性, 不建议无指征的意愿选择性引产;在促宫颈成熟方面, 球囊和前列腺素制剂同样有效, 球囊可用于瘢痕子宫要求阴道分娩者, 球囊及前列腺素E2栓剂可用于门诊促宫颈成熟;米索前列醇和前列腺素E2制剂既可用于促宫颈成熟又可用于宫缩诱导剂引产。小剂量米索前列醇口服安全有效, 米索前列醇溶液更易于精准给药。若促宫颈成熟时间较长, 在母胎安全的情况下, 促宫颈成熟过程可以中断休息后再开始。     

阴道分泌物胎儿纤维连接蛋白与宫颈长度联合预测早产的多中心前瞻性研究

Objective To discuss the clinical value of fetal fibronectin (fFN) and cervical length in predicting preterm birth. Methods Totally, 511 pregnant women at 22-35 weeks of gestations were enrolled from Dec. 2006 to Dec. 2007 at 4 tertiary hospitals in Beijing, and all with either symptoms or high risk factors of preterm birth, but without preterm premature rupture of membrane or vaginal bleeding. Cervical fFN were determined and cervical length of each subjects were measured by ultrasound. The pregnancy outcomes were compared. Results The sensitivity, specificity and negative predictive value (NPV) of fFN in predicting preterm birth within 7 d were 77.4%, 69.4% and 97. 9%, respectively; and 70.5%, 70.0% and 96.2% for deliveries within 34 weeks. The above figures changed to 54.8%, 66.3%, 95.8% for deliveries within 7 d and 59.1%, 67.2%, 94.6% for those within 34 weeks, respectively, when cervical length ≤3 cm was applied to predict preterm birth. When fFN and cervical length were combined, the sensitivity, specificity and NPV were 51.6%, 87.1%, 96.5% for deliveries within 7 d, and 45.5%, 87.60/00, 94.5% for those within 34 weeks, respectively. Conclusions FFN has higher NPV and specificity than cervical length in predicting preterm birth within 7 d and 34 weeks, and the positive predictive value and specificity can be improved when combined with cervical length.     

妊娠合并甲状腺功能亢进的诊治

甲状腺功能亢进简称甲亢 ,好发于生育年龄的妇女 ,因此妊娠合并甲亢并不少见 ,发病率可达 0 8%。一方面甲亢可以加重妊娠反应 ,造成妊娠剧吐 ,妊娠晚期妊娠高血压综合征 (妊高征 )发生率增加 ,诊治不及时诱发甲亢危象 ,则直接威胁母儿的生命 ;另一方面 ,妊娠合并甲亢流产 ,胎死宫内 ,胎儿宫内发育受限 ,胎儿窘迫和早产等并发症也将升高。据文献报道 ,妊娠合并甲亢流产率高达 2 5 7% ,死产和胎死宫内为2 5% ,另有 4 5 8%发生早产 ,未经治疗的甲亢孕妇其新生儿平均出生体重为 2 1 4 1± 1 64ｇ。胎儿畸形率亦明显高于非甲亢孕妇 ,主要胎儿畸…     

第二次全国产科热点问题学术会议暨第一届全国产科主任论坛在成都召开

由中华医学会妇产科学分会产科学组主办的第二次全国产科热点问题学术会议暨第一届全国产科主任论坛于9月25日至29日在美丽蓉城——成都召开。来自全国妇产科学界、特别是产科学界的专家、主任和学术骨干近200人参加了本次学术会议。在开幕式上，中华医学会副会长、妇产科学分会主任委员曹泽毅教授热情洋溢的讲话，给予广大热心产科事业的专家和医生极大鼓励。