小剂量左甲状腺素对早期妊娠合并亚临床甲状腺功能减退症患者的疗效及安全性分析

目的探讨小剂量左甲状腺素对早期妊娠合并亚临床甲状腺功能减退症患者疗效和安全性的影响。方法将2015年6月至2017年6月东南大学附属中大医院江北院区收治的早期妊娠合并亚临床甲状腺功能减退症患者124例作为研究对象,按照随机数字表法分为两组,每组62例。对照组给予常规治疗,观察组在此基础上给予小剂量左甲状腺素治疗。对比两组临床疗效、治疗前后甲状腺功能指标、并发症发生率和妊娠结局情况。结果观察组治疗有效率高于对照组(P0.05);观察组治疗后促甲状腺素水平低于对照组,游离三碘甲状腺原氨酸、游离甲状腺素水平高于对照组,差异有统计学意义(P0.05);观察组早产、流产、胎儿畸形、胎儿宫内窘迫、新生儿窒息、糖代谢异常、妊娠期肝内胆汁淤积症、妊娠期高血压疾病、产后出血等妊娠不良结局发生率低于对照组,差异均有统计学意义(P0.05)。结论小剂量左甲状腺素应用于早期妊娠合并亚临床甲状腺功能减退症患者可明显提高临床疗效,改善甲状腺功能和妊娠结局,降低并发症发生率,安全性较高。     

左旋甲状腺素片治疗妊娠合并亚临床甲状腺功能减退的效果

目的对于妊娠合并亚临床甲状腺功能减退孕妇开展左旋甲状腺素片进行治疗的具体方法以及对孕妇妊娠结局所产生的影响情况加以探讨。方法选取2019年1-12月接诊的妊娠合并亚临床甲状腺功能减退孕妇80例作为文章观察对象,利用随机数字表法将所选孕妇加以分组,给予其中40例妊娠合并亚临床甲状腺功能减退孕妇左旋甲状腺素片进行治疗,将其纳入研究组,剩余40例妊娠合并亚临床甲状腺功能减退孕妇接受常规干预,将其纳入对照组,对比两组妊娠合并亚临床甲状腺功能减退孕妇的妊娠结局情况。结果研究组与对照组妊娠合并亚临床甲状腺功能减退孕妇在自然流产率、早产率、宫内窘迫的差异无统计学意义(P>0.05),但研究组孕妇在妊娠贫血、胎膜早破、妊娠期糖尿病出现几率上明显较对照组降低(P<0.05)。结论临床中对于妊娠合并亚临床甲状腺功能减退孕妇,为其提供左旋甲状腺素片治疗效果明显,能够显著改善孕妇的妊娠结局。     

妊娠合并亚临床甲状腺功能减退症的早期治疗对妊娠结局的影响

目的探讨妊娠合并亚临床甲状腺功能减退症(SCH)的早期治疗对妊娠结局的影响。方法选取2013年10月-2014年11月该院产科接收的患有妊娠合并SCH的96例产妇作为观察组,并将其随机分为两组,其中48例给予左甲状腺素钠片(L-T4)早期治疗(治疗组),48例不给予药物治疗(未治疗组)。另选取同期甲状腺功能正常的48例孕妇作为对照组,比较分析3组孕妇的妊娠结局。结果观察组妊娠期高血压疾病、产后出血、早产、流产、胎儿窘迫、胎儿畸形以及新生儿低体重等不良妊娠结局的发生率均明显高于对照组,差异具有统计学意义(P0.05)。妊娠合并SCH产妇中,治疗组上述不良妊娠结局的发生率明显低于未治疗组,差异具有统计学意义(P0.05)。结论妊娠合并SCH可增加不良妊娠结局的发生率,早期治疗能够有效降低其妊娠并发症的发生率,改善妊娠结局。     

左旋甲状腺素片治疗孕早期合并亚临床甲状腺功能减退对妊娠结局的影响

目的探讨左旋甲状腺素片治疗孕早期合并亚临床甲状腺功能减退对妊娠结局的影响,为改善孕早期合并亚临床甲状腺功能减退孕妇妊娠结局的干预措施提供依据。方法回顾性分析2013-2016年在医院诊断的孕早期合并亚临床甲状腺功能减退的孕妇3 512例的临床资料,根据是否接受治疗分为治疗组2 145例与未治疗组1 367例;根据TPOAb的结果分为阳性治疗亚组1 772例,阴性治疗亚组373例,阳性未治疗亚组341例,阴性未治疗亚组1 026例。另选择正常妊娠孕妇1000例作为对照组。比较治疗组与非治疗组、TPOAb阳性治疗亚组与TPOAb阳性未治疗亚组、TPOAb阴性治疗亚组与TPOAb阴性未治疗亚组妊娠结局,比较治疗组与非治疗组治疗前、后TSH水平。结果治疗4周后,治疗组TSH水平显著下降,未治疗组无明显变化,两组治疗后比较差异有统计学意义(P0. 05);未治疗组流产、早产、妊娠期高血压、胎儿生长受限、出生低体质量儿发生率显著高于治疗组与对照组,差异有统计学意义(P0. 05);治疗组不良妊娠结局发生率与对照组比较差异无统计学意义(P0. 05)。TPOAb阳性治疗亚组流产、早产、妊娠期高血压、胎儿生长受限、出生低体质量儿发生率显著低于TPOAb阳性未治疗亚组,差异有统计学意义(P0. 05)。TPOAb阴性治疗亚组与TPOAb阴性未治疗亚组不良妊娠结局发生率比较差异无统计学意义(P0. 05)。结论左旋甲状腺素片治疗孕早期合并亚临床甲状腺功能减退能显著改善妊娠结局,尤其是TPOAb阳性的患者。     

妊娠合并甲状腺功能减退的诊断及治疗进展

甲状腺功能减退症是威胁育龄妇女健康的常见内分泌疾病,尤其在妊娠期,甲状腺处于应激状态,需分泌足量的甲状腺激素才能满足正常妊娠的需要,从而使非孕期甲状腺功能正常的孕妇处于代偿状态,导致部分妊娠妇女出现亚临床甚至明显的甲状腺功能减退情况。妊娠期甲状腺功能减退可分为妊娠期亚临床甲状腺功能减退和妊娠期临床甲状腺功能减退,也有一部分孕妇表现为妊娠期单纯低甲状腺素血症。孕妇严重的甲状腺功能减退症随访妊娠结局,但不良妊娠结局(妊娠期糖尿病、胎膜早破、妊娠期高血压疾病、早产、巨大儿)发生率高,而且还影响了胎儿神经智力发育[1]。因此,及时发现孕妇伴有甲状腺功能异常是孕期保健工作必不可少的部分,如进行早期宣传,对高危人群进行甲状腺功能筛查等。甲状腺功能低下早期发现并及时干预可以改善围产期结局,并减少对子代的不利影响。     

妊娠合并甲状腺功能减退与不良妊娠结局的研究

目的:探讨妊娠期间甲状腺功能减退与各种不良妊娠结局的相关性。方法:选择来医院进行妊娠常规检查及随访的妇女,采用微粒子酶联免疫检测法(MEIA)测定血清促甲状腺激素(TSH)、游离甲状腺素(FT4)和甲状腺过氧化物酶抗体(TPOAb),采用过氧乙酸四甲基联苯胺氧化显色法测定尿碘水平。根据检验结果分为甲功正常组和甲功减退组,甲功减退组分为临床甲减组、亚临床甲减组、低甲状腺素血症组,各组再分成治疗组与未治疗组。随访妊娠结局(胎膜早破、妊娠期糖尿病、妊娠期高血压疾病、胎儿生长受限、巨大儿、早产),比较各组不良妊娠结局的发病率。结果:甲功正常与甲减孕妇不良妊娠结局的发病率差异有统计学意义(P<0.05),不良妊娠结局中妊娠期高血压疾病、胎儿生长受限的发病率差异有统计学意义(P<0.05),甲减治疗组与甲减未治疗组间不良妊娠结局的发病率差异无统计学意义(P>0.05)。甲功正常与亚甲减孕妇不良妊娠结局的发病率差异无统计学意义(P>0.05),亚甲减孕妇治疗组与未治疗组间不良妊娠结局的发病率差异无统计学意义(P>0.05)。甲功正常与低T4血症孕妇不良妊娠结局的发病率差异有统计学意义(P<0.05),患有低T4血症孕妇治疗组与未治疗组间不良妊娠结局的发病率差异无统计学意义(P>0.05)。结论:甲减是妊娠妇女的常见病,不仅与产科并发症相关,而且还影响胎儿神经智力发育。     

早期左甲状腺素钠治疗对妊娠合并甲状腺功能减退患者甲状腺功能及妊娠结局的影响

目的研究妊娠合并甲状腺功能减退患者早期应用左甲状腺素钠治疗对其甲状腺功能及妊娠结局的影响。方法选取2017年9月-2019年9月该院收治的妊娠合并甲状腺功能减退患者122例,根据患者意愿将其划分为对照组与观察组。对照组61例,不采取药物治疗,仅给予饮食指导;观察组61例,给予左甲状腺素钠治疗。分析两组患者甲状腺功能、抗甲状腺过氧化物酶抗体(TPOAb)及抗甲状腺球蛋白抗体(TGAb)阳性率、妊娠结局、不良反应发生率。结果两组患者治疗前促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT_3)、游离总甲状腺素(FT_4)水平比较,差异无统计学意义(P0.05);治疗后,观察组TSH低于对照组,而FT_3、FT_4水平更高,差异有统计学意义(P0.05)。两组患者治疗前TPOAb、TGAb阳性率比较,差异无统计学意义(P0.05);治疗后,观察组TPOAb、TGAb阳性率均低于对照组,差异均有统计学意义(均P0.05);观察组患者胎儿窘迫、胎儿生长受限、流产及早产等不良妊娠结局的发生率均低于对照组,差异均有统计学意义(均P0.05);两组患者高血压、糖代谢异常、肝内胆汁淤积等不良反应发生率比较,差异均无统计学意义(均P0.05)。结论妊娠合并甲状腺功能减退患者早期应用左甲状腺素钠治疗可以有效纠正其甲状腺指标水平,避免不良妊娠结局发生,且其用药安全性可以保证,在临床治疗中具有实践与推广价值。     

COX-2、NF-κB在妊娠期甲状腺功能减退患者胎盘中的表达及与妊娠结局的关系

目的探讨COX-2、NF-κB在妊娠期甲状腺功能减退(甲减)患者胎盘中的表达意义及其与妊娠结局的关系,为妊娠期甲状腺功能减退症的监测和妊娠结局的评估提供临床依据。方法选取2016年11月-2017年6月期间在该院进行产检的102例妊娠期甲状腺功能减退患者为研究对象,设为观察组,分为甲减治疗组(51例)和甲减未治疗组(51例)两个亚组,与此同时,选取同期进行产检的正常孕妇55例为对照组,对3组孕妇的妊娠结局进行对比,检测3组胎盘中COX-2、NF-KB的表达,分析COX-2、NF-κB表达与妊娠结局的相关性。结果甲减未治疗组贫血、流产、早产发生率显著高于对照组和甲减治疗组,自然分娩率、新生儿Apgar评分、平均体重显著低于对照组和甲减治疗组(P0.05),而对照组和甲减治疗组的妊娠结局比较差异无统计学意义(P0.05);甲减未治疗组COX-2、NF-κB阳性表达率显著高于对照组和甲减治疗组(P0.05);甲减治疗组COX-2、NF-κB阳性表达率与对照组比较差异无统计学意义(P0.05)。结论妊娠期甲状腺功能减退会导致流产、早产、贫血等不良结局,而甲状腺功能减退孕妇胎盘中COX-2、NF-κB的表达与妊娠结局密切相关,对COX-2、NF-κB进行监测有助于监测甲状腺功能减退症状及对妊娠结局进行评估。     

左甲状腺素钠对妊娠合并甲状腺功能减退患者甲状腺功能及母婴预后的影响

目的评估左甲状腺素钠对妊娠合并甲状腺功能减退患者甲状腺功能及母婴预后的影响。方法选择2019年9月—2020年8月宁波大学医学院附属医院收治的妊娠合并甲状腺功能减退患者136例为研究对象,遵照知情同意原则并按照随机数字表法均分为观察组和对照组各68例,对照组采用甲状腺素片治疗,观察组采用左甲状腺素钠治疗。比较两组治疗后的临床效果,甲状腺功能指标血清促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT_(3))、游离总甲状腺素(FT_(4))、甲状腺过氧化物酶抗体(TPOAb)水平及孕妇/产妇结局、胎儿/新生儿结局。结果治疗3个月后,观察组显效率、总有效率分别为60.3%、97.1%,对照组分别为42.6%、91.2%,观察组显效率显著高于对照组,差异有统计学意义(P<0.05);观察组总有效率略高于对照组,差异无统计学意义(P>0.05)。治疗前两组血清TSH、FT_(3)、FT_(4)、TPOAb水平差异均无统计学意义(P>0.05),治疗后两组血清TSH、TPOAb水平显著降低,FT_(3)、FT_(4)水平显著升高,观察组改善显著优于对照组,差异均有统计学意义(P<0.05)。观察组的妊娠期肝内胆汁淤积、剖宫产、产后出血等孕妇/产妇不良结局发生率显著低于对照组,胎儿窘迫、胎儿生长受限、早产儿、新生儿窒息等胎儿/新生儿不良结局发生率显著低于对照组,差异均有统计学意义(P<0.05)。结论妊娠合并甲状腺功能减退患者左甲状腺素钠治疗干预效果满意,能够显著提高治疗显效率,改善甲状腺功能,减少不良母婴结局的发生,具有较高的临床应用价值。     

妊娠期甲状腺功能减退对母婴结局的影响

目的探讨妊娠期甲状腺功能减退(甲减)对母婴妊娠结局的影响。方法对产检的30 698例孕妇进行调查,其中临床甲减患者81例作为甲减组、临床亚甲减患者690例为亚甲减组,同期随机选取420例正常孕妇为对照组;经过治疗后比较3组孕中期、孕晚期的TSH、FT4水平及不良母婴妊娠结局。结果 30 698例孕妇中甲减发生率为2.51%(771/30 698);与亚甲减组、对照组相比,甲减组在孕中期、孕晚期的TSH水平表现为升高,而FT4水平下降,差异有统计学意义(P<0.05);与对照组相比,亚甲减组在孕中期、孕晚期的TSH水平也表现为升高,差异有统计学意义(P<0.05),但FT4水平正常。甲减组、亚甲减组的整体不良母婴妊娠结局发生率高于对照组,而甲减组的不良母婴妊娠结局发生率又高于亚甲减组,差异有统计学意义(P<0.05)。结论孕妇妊娠期有较高的甲减发生率,应早期筛查和治疗妊娠期甲减,控制孕妇甲状腺激素水平,改善母婴妊娠结局。     

孕期体操对妊娠结局的影响

目的:了解孕期运动的安全性及其对妊娠结局的影响。方法:使用队列研究的方法,选择2006年3月~2007年3月期间在该院规律做孕期体操的(实验组)与不做体操的(对照组)两组孕产妇为研究对象,随访其妊娠结局。结果:实验组孕期体重增长和剖宫产率低于对照组,且产程缩短,孕期并发症的发生率未增加。结论:适当的孕期规律运动可以促进自然分娩,缩短产程,孕期适当运动可在体检正常的孕产妇中进行推广。     

卵巢妊娠与输卵管妊娠的临床比较分析

目的 探讨卵巢妊娠的病因、临床表现及诊治特点.方法 对北京市海淀区妇幼保健院2002年1月至2011年12月诊治的26例卵巢妊娠病例进行回顾性分析,并与同期52例输卵管妊娠进行对照分析研究.结果 ①卵巢妊娠发病率占同期异位妊娠的0.52%,无逐年增加的趋势(χ2=2.398,P=0.663>0.05);输卵管妊娠占86.45%,发病率逐年下降(χ2=97.940,P=0.000<0.01);②卵巢妊娠与输卵管妊娠临床表现相似,术前确诊困难,误诊率高达96.15%.卵巢妊娠停经史占76.92%,停经时间短,平均38.65±10.57天,与输卵管妊娠(45.37±7.81天)比较,差异有显著性(t=-3.171,P=0.002<0.01);两组腹痛发生率、阴道出血发生率及休克发生率差异均有显著性(χ2值分别为5.880、10.054、8.432,均P<0.05).结论 卵巢妊娠仍以手术治疗为主,输卵管妊娠逐渐趋向药物治疗,腹腔镜手术治疗异位妊娠呈上升趋势.     

DOHaD孕期营养监测与妊娠并发症及妊娠结局的临床研究

目的通过监测孕妇孕期营养状况并给予合理的营养指导,探讨其对妊娠并发症和妊娠结局的影响。方法随机选取1500名健康孕妇分为两组,营养监测组:应用DOHaD孕期营养监测,对妊娠早期、中期和晚期营养状况进行膳食监测,并指导饮食;对照组:根据个人饮食习惯进食。结果营养监测组巨大儿、妊娠期高血压疾病、妊娠期糖尿病、早产和新生儿窒息的发生率低于对照组,差异有统计学意义(P<0.05)。营养监测组胎儿宫内生长受限发生率与对照组相比,差异无统计学意义(P=0.052)。结论合理孕期营养监测及指导,能减少和降低妊娠并发症和不良妊娠结局的发生。     

Ectopic pregnancy

This discussion of ectopic pregnancy covers mortality, definition, etiology, diagnosis and management, and contraception. In the 1979-81 "Report on Confidential Enquiries into Maternal Deaths in England and Wales," ectopic pregnancy accounted for 11.4% of all maternal deaths. Avoidable factors were found in 64% of deaths from ectopic pregnancy, the most common being delay in diagnosis and operative intervention. Ectopic pregnancy is the implantation of the conceptus outside the uterus or in an abnormal location within the uterus. Tubal gestation invariably has a multifactorial etiology and occurs owing to delay in the transport of the fertilized ovum. Table 1 lists causes. Salpingitis is the main cause of tubal pregnancy and now is considered to be due primarily to chlamydia. The consequences of tubal surgery, for whatever reason, and hormonal treatment also are major etiological factors. Every woman of reproductive age, especially if she has 1 or more etiological factors in her past history, who presents with a history of a missed period and irregular vaginal bleeding or abdominal pain, must be considered to have an ectopic pregnancy until proved otherwise. Diagnosis still is essentially a clinical one. In difficult cases use should be made of radioimmunoassay of beta hCG, ultrasonic scanning, and laparoscopy. In 25% of cases, a correct diagnosis was made only at laparotomy. Culdocentesis and endometrial biopsy are of limited use. In cases of ruptured ectopic pregnancy with circulatory collapse, immediate operative intervention is essential. In regard to contraception, the combined oral contraceptive (OC), in suppressing ovulation and thickening the cervical mucus, has a protective effect. Method failure does not increase the incidence of extrauterline pregnancy above normal. The progestagen-only pill is associated with a small increase in the risk of an initial and recurrent ectopic pregnancy. It does not suppress ovulation and may affect tubal motility, but it can be considered if the combined OC is contraindicated, as it is more advisable than an IUD if ectopic pregnancy is feared. Barrier methods will not affect the incidence of ectopic pregnancy and may protect against pelvic infection. It is still being debated whether the absolute incidence of ectopic pregnancy in IUD users is increased. A woman has a 0.3-5% risk of having a 1st ectopic pregnancy and a 15% chance of having a recurrence when given postcoital contraception. As with barrier methods, there is no effect on the incidence of extrauterine pregnancy with periodic abstinence, but in the case of periodic abstinence there is no protective effect against pelvic infection. Female sterilization does not protect against ectopic pregnancy. Of all failed sterilizations, 12% result in an ectopic pregnancy.     

Ectopic pregnancy

Reports from throughout the world consistently reveal an increasing incidence of ectopic pregnancy that appears to be linked to pelvic inflammatory disease, previous tubal surgery, and IUD use. Ectopic pregnancy generally presents with pelvic or lower abdominal pain, amenorrhea, and vaginal bleeding. Methods of establishing the diagnosis include ultrasonography and laparoscopy; before 5-6 weeks of gestation, these methods may no t be sufficiently sensitive and use of serial monitoring of the beta-chain of human chorionic gonadotropin concentrations in plasma is recommended. Salpingectomy is indicated if the ectopic pregnancy has ruptured and the tube is very swollen. Conservative surgery is a possibility when there has not been rupture and damage to the tube is minimal. A comparison of data from England's Jessop Hospital for Women shows that, while more ectopic pregnancies were treated in 1988-90 than in 1977-79 (109 and 49, respectively), this complication is being diagnosed at an earlier stage, before there is extensive damage to the fallopian tube. The mean gestation of ectopic pregnancies in 1977-79 was 8.1 + or - 2.8 weeks compared to 7.4 + or - 1.7 weeks in 1988-90. As a result, only 4% of the ectopic pregnancies in the earlier period compared to 14% in the more recent period could be treated by conservative surgery.     

Adolescent pregnancy

An unplanned adolescent pregnancy can have serious physical, psychological, and social consequences, especially in the youngest adolescent. Adolescents have not finished growing and their reserves are very low. Fetal growth and lactation increase the nutritional needs of the adolescent. Adolescent pregnancy-related risks carry over to the mother and the newborn. Adolescent growth in girls less than 16 years who have a child nearly stops, even if nutrition is good. Maternal mortality among adolescents is higher than it is among women aged 20-30. Maternal morbidity is also higher in girls aged 15-19. The main pregnancy complications are severe anemia, renal complications, eclampsia, pre-eclampsia, and labor complications (e.g., vesico-vaginal or recto-vaginal fistulas). They are most common in the youngest adolescents. Poor quality of prenatal care contributes greatly to poor pregnancy outcomes. Prematurity and low birth weight are also more common among adolescents than other age groups. The perinatal mortality rate of infants born to adolescent mothers is also greater: 104-120% greater in Sao Paulo, Brazil and 73% greater in India. The psychological and social consequences of adolescent pregnancy depend on the acceptance of the family and of society. In many cultures, the single pregnant adolescent carries feelings of shame and guilt and hides her condition from her family and society for as long as possible due to fear of a lack of understanding and of rejection. A pregnant adolescent in many countries is forced to quit school. Traditional societies in Africa and Latin America, however, consider a child a blessing and the family supports the adolescent during pregnancy and delivery. Urbanization, socioeconomic pressure, and female education have a tendency to dispel this traditional attitude. Interventions to reduce adolescent pregnancy and its consequences include accessible contraception and access to good quality prenatal care.