足月新生儿动脉导管自然闭合情况的研究

目的 探讨足月新生儿动脉导管自然关闭的情况,以及是否进行早期人工干预的必要性.方法 将2007年3月～2007年12月间正常产检,孕期超声筛查胎儿心脏正常并在该院分娩的1 437名足月新生儿纳入研究,在新生儿出生后24～96 h内进行超声心动检查,对其中发现的单纯动脉导管开放的新生儿,在生后3月复查超声心动了解其闭合情况并电话随访其发育情况.结果 1 437例足月新生儿中发现单纯动脉导管开放的318例,生后 24 h动脉导管59.3%处于开放状态,48 h、72 h、96 h的比例分别为27.1%、15.2%、9.0%.11例失访,304例在生后3月内自然闭合,诊断PDA 3例,其发生率为1:475.男:女为1:2.结论 足月新生儿动脉导管在生后96周后仍有自然闭合的可能,如无临床症状,无须过度干预,但应注意随访,确定其闭合情况.     

子宫畸形合并妊娠母儿妊娠结局临床分析

目的探讨妊娠合并子宫畸形对于母儿妊娠结局的影响。方法选取北京大学人民医院收治的妊娠合并子宫畸形患者108例,并以372例正常子宫妊娠患者作为对照,对其临床资料进行回顾性分析。结果①在29245例分娩的病例中,妊娠合并子宫畸形共108例,发生率约为0.4%。其中以子宫纵膈最为常见,占49.1%,其次为双子宫,占21.3%;②子宫畸形合并妊娠的患者中,胎位异常发生率（46.3%）及剖宫产率（73.2%）均显著升高;③子宫畸形组的平均孕周（37.2周）,新生儿平均出生体重（2873g）显著低于对照组,而早产率（24.1%）及足月低体重儿发生率（6.5%）均显著高于对照组;④纵膈子宫、单角子宫（83.3%合并残角子宫）、双角子宫、及双子宫在终止妊娠方式上存在差异,剖宫产率在纵膈子宫为最低（64.2%）。各组在早产率、孕周、胎儿体重方面差异无统计学意义（P〉0.05）。结论子宫畸形对于妊娠结局可产生不良影响,临床医生应加强孕前及孕期管理。     

妇产科学模拟教学实验室应用现状与展望

为了提高医学生妇产科学临床综合技能培训的水平,利用模拟教学手段改善妇产科学的教学困境,必须建立和应用妇产科学模拟教学实验室.北京大学人民医院妇产科学模拟教学实验室具备多媒体和多种仿真模型教具,主要用于医学生临床见习阶段基本知识和基本技能的学习以及实习前的再培训;将来还需要增加手术操作的教具,创建妇科学微创手术实验室,以适应多层次教学的需要,并注意在模拟场景中始终贯彻医学伦理学教育.     

妊娠合并极重度血小板减少26例临床分析

Objective To investigate the etiology and perinatal outcome of pregnancies complicated with extremely severe thrombocytopenia [ at least two times of platelets count (PLT) < 10 × 109/L during pregnancy]. Methods Clinical data, including basic information, etiology, management and outcomes of pregnant women with extremely severe thrombocytopenia, admitted to Peking University People's Hospital from January 2004 to March 2009, were retrospectively collected. The management of these cases varied according to different etiology and the symptoms: (1) PLT were maitained > 20 × 109/L and hemoglobulin> 70 g/L in those women without spontaneous bleeding; (2) PLT transfusion would be required when PLT< 10 × 109/L or bleeding occur and RBC would be supplied when hematocrit <25% and hemoglobulin <70g/L; (3) Hemoglobulin should be > 70 g/L and PLT >30 × 109/L before cesarean section or delivery;(4) Predinisone and/or intravenous immunoglobulin G (IVIG) would be given in women complicated with idiopathic thrombocytopenic purpura (ITP) when PLT < (20-30) × 109/L or bleeding. PLT would be given if all the above management were failed, or PLT < 10 × 109/L, or bleeding. Women without bleeding would be closely monitored and delivery would be planned. Results (1) Twenty-six cases were identified among 9302 deliveries during the study period (0.28%), with an average of maternal age of 29. Seventeen were diagnosed before conception and 9 during pregnancy. Among the 26 women, half received regular prenatal check in our hospital and the average gestations at diagnosis was 24 weeks and the other half without regular prenatal visits and the average gestations at diagnosis was 32 weeks. Etiology was identified in 24 out of the 26 women, including 14(54%) ITP, 5 myelodysplastic syndrome (MDS), 4 chronic aplastic anaemia(CAA) and 1 systemic lupus erythematosus (SLE). (2) Management: All of the 26 women received blood products. Among the 14 ITP cases, 6 received predinisone and IVIG and 8 only took predinisone. Nine of the 26 patients (35%) had pregnant complications, among which 6 (6/9) were preeclampsia. The overall average gestation at delivery was 36 weeks. Only 2 delivered vaginally with the average blood loss of 83 ml and 23 cesarean sections were performed with the average blood loss of 410 ml. (3) Perinatal outcomes:There were 26 perinatal babies, among which 1 died intrauterine and 25 were born alive (12 preterm infants). The average birth weight was 2877 g. Neonatal severe thrombocytopenia presented in 2 newborns whose mother complicated with ITP. Conclusions The main cause of extremely severe thrombocytopenia during pregnancy is ITP, managed mainly by predinisone and IVIG, followed by CAA and MDS, which may require supportive treatment. Pregnancy complicated with extremely severe thrombocytopenia is not an indication of termination. Better maternal and fetal outcomes can be achieved through proper treatment based on the etiology, intensive care in prevention and management of complications and cesarean section.     

产妇睡眠模式的改变及护理

睡眠是生理活动所必需的过程，通过睡眠，可以使人的精力和体力得到恢复。人的一生之中大约三分之一的时间是在睡眠，睡眠对于维持人类健康，特别是促进病人的早日康复，具有十分重要的意义。     

分娩动因研究进展

早产与先兆早产是围产学中的一个相当重要的课题,目前尚无有效的治疗方法,主要是因为对分娩时子宫及宫颈的调控机制不清.本文对近年来有关分娩动因的研究进展作一回顾,以助探讨.     

残角子宫妊娠并发产前子痫一例

残角子宫的妊娠率为总妊娠的1/10万,其结局大多为子宫破裂,胎儿死亡。约10％可维持至足月。本例残角子宫妊娠32周,并发产前子痫而终止妊娠,现报道如下。 患者26岁,妊2产0。主因宫内妊娠32周,抽搐3次,阴道出血伴腹痛3天,于1992年8月19日下午4时急诊入院。既往月经规律,无痛经,如年自然流产1次。末次月经:1992年1月10日。从未行产前检查。20天前双下肢水肿,5天前感头痛、头晕、眼花。3天前阴道少量出血伴腹痛,并感胎动减少。入院前1天阴道出血增多,腹痛加重,     

产妇产程中进食与新生儿血糖

本文对156例1996年1月至4月出生的足月新生儿进行血糖监测。结果发现母亲产程中未进食的新生儿血糖较正常进食的低(t=3．9，P     

降低妇产科学临床教学中医疗纠纷风险的探讨

随着患者维权意识的增强和相关法制的健全,实习教学中的医疗纠纷风险显著增加并倍受关注.本文就妇产科学教学中容易发生医疗纠纷的原因进行了分析,并提出了相应的对策,希望能够为相关医学院校减少或避免由于临床教学带来的医疗纠纷提供一定的帮助.     

产科临床面临的挑战

降低孕产妇死亡是我们产科工作者的最终目标。为此，产科工作者付出了大量的努力，2005年我国孕产妇死亡47／10万（城市25／10万，农村53／10万），到2010年要在2000年基础上下降1／4达到39．8／10万，任务艰巨，这是一个系统工程，是我们产科质量的全面体现。