妊娠期口服葡萄糖负荷试验合理血糖界值的探讨

目的 探讨目前适合我国卫生经济条件的妊娠期葡萄糖负荷试验(GCT)的筛查界值.方法 资料来源于2006年4月1日至2006年9月30日在全国18个城市25家医院保健并进行首次50 g GCT的16 286例孕妇,对其GCT结果进行统计和分析.结果 以NDDG标准诊断妊娠期糖尿病(GDM),50 g GCT的界值选取7.2 mmol/L时的敏感度和特异度分别为98.2%和59.0%,选取7.8 mmol/L时分别为96.0%和73.0%,选取8.3 mmol/L时分别为90.2%和81.5%;以ADA标准诊断GDM,选取GCT界值为7.2 mmol/L时敏感度为97.9%,特异度为60.4%;选取7.8 mmol/L时分别为96.2%和74.7%;而选取8.3 mmol/L则分别为87.0%和83.1%.以NDDG标准诊断妊娠期糖代谢异常(包括GDM及妊娠期糖耐量受损),选取7.2 mmol/L时敏感度和特异度分别为97.7%和61.4%,选取7.8 mmol/L时分别为95.4%和75.8%,选取8.3 mmol/L时分别为84.9%和84.1%.结论 据我国目前的卫生经济情况,以7.8 mmol/L作为50 g GCT的界值是合理的.     

妊娠期肝内胆汁淤积症发生死胎的临床因素分析

Objective To investigate the clinical features,critical laboratory parameters,and fetal monitoring methods in intrahepatic cholestasis of pregnancy(ICP).Methods A retrospective analysis of 21 cases of ICP suffered with fetal death in Women's hospital.School of Medicine.Zhejiang University from January 1999 to December 2010 were discussed.Results(1)The average age of ICP patients suffered with fetal death were(30.2±4.6)years old.Among them,4 cases were older than 35 years,six cases were multipara.oneo of them suffered stillbirth 2 year before.Twenty cases were singleton pregnancies and 1 cage was twin pregnancy.(2)All 21 cases of fetal death occurred in the third trimester,12 cases occurred before 37 weeks,9 cases after 37 weeks.Nine cases were diagnosed by ultrasound in outpatient clinics,fetal heart beat disappeared in 9 patients after admission because of ICP, two disappeared after labor, one during anesthesia before emergent surgery. Perinatal mortality rate of ICP was 0. 148% (21/14 184), and fetal death occurred from 29 to 41 weeks with an average gestational age of ( 33.8 ± 4. 2 ) weeks, ( 3 ) Puritus occurred in all 21 cases while 11 of them had pruritus all over the body. Ten pregnant women felt the fetal movement decreased or disappeared before diagnosis of fetal death. The glycocholic acid levels increased in all of the 21 cases. Among them, glycocholic acid levels in 11 cases were (21.49 -64. 48) μmol/L, while in 10 cases were ≥64. 48 μmol/L Serum bile acid levels elevated in 16 cases which had been analyzed ( the other 5 cases had not been checked ), and the highest level reached 270 μmol/L Serum alanine aminotransferase and aspartate aminotransferase were increased in 14 cases. Seven cases had their total bilirubin ＞21 μmoL/L, and 12 cases had their direct bilirubin levels significantly elevated. Among the 21 cases of ICP, 15 cases were in severe status, while the other 6 cases were mild. (4) Nine patients had no antepartum surveillance since fetal death were diagnosed before admission. The results of antepartum surveillance were as follows: 2 cases had nonreassuring nonstress test (NST), one had mild "V" type deceleration. Absence of diastolic flow in umbilical artery were found in 3 cases, and low fetal biophysical score was got in one case. ( 5 ) All 21 patients had vaginal delivery. Six of them delivered after natural contraction, and the remaining 14 cases delivered after oral intake of mifepristone and amniotic injection of ethacridine, or oxytocin induced labor within 48 hours, only one case delivered after additional dinoprostone suppositories. The appearance of fetus, placentas and membranes were normal, the lengths of umbilical cord were average. Four cases were found with cords binding the necks or the bodies. Eighteen cases had grade Ⅲ amniotic fluid with meconium-stained, and 2 cases complicated by oligohydramnios. Ten cases had their fetuses and placentas examined by pathologist. Among them, one case had multiple malformations, no more obvious pathological abnormalities were found in other fetuses. Pathologic examination showed that fibrin deposited around chorion and deciduas basalis, large vessels accompanied by calcification, degeneration,hemorrhagic infarction, and increased focal syncytial nodules could be seen in all of the ten placentas. Conclusions Fetal death in pregnant women with ICP of ten occurs after the contractions, Severe ICP may be a key factor that involved in the occurrence of fetal death. Up to now, there is no valid indicators in fetal monitoring, which can predict fetal death. Extensive assessment of the severity and careful antepartum surveillance should be achieved before timely termination of pregnancy.     

重度子痫前期并发胸腹腔积液15例临床分析

目的:探讨重度子痫前期并发胸腹腔积液的临床特点和救治方法.方法:回顾性分析我院2005年1月至2006年11月重度子痫前期并发胸腹腔积液患者15例的临床病例资料.结果:15例患者均有不同程度的高血压、低蛋白血症的表现,合并胸腔积液多表现为胸闷、呼吸困难和血氧饱和度下降;2例压迫症状严重的患者入院后及时剖宫产结束分娩,另13例经治疗后平均延长孕周4.5±1.5天;15例患者经治疗后,胸腹腔积液于术后5～12天内逐渐消失,术后12天左右出院.15例共分娩16例新生儿,死亡1例,其余近期预后好.结论:重度子痫前期并发胸腹腔积液患者病情极其严重,应及早发现并进行解痉、纠正低蛋白血症、降压和支持等综合治疗,适时终止妊娠是唯一有效控制病情的方法.     

臀位剖宫产——新生儿骨折的预防

臀位为产科常见的异常胎位,单胎足月臀位发生率为3%～5%。臀位围产儿发病率和死亡率高于头位,且臀位阴道分娩围产儿发病率和死亡率亦显著高于剖宫产者。尽管普遍报道臀位剖宫产安全,但仍有一定比例的新生儿产伤,尤其是臀位新生儿骨折。文章重点阐述臀位剖宫产新生儿产伤焦点问题及可对应采取的预防措施及处理,以达到尽可能降低新生儿损伤的目的。     

UPLC-MS背景扣除法联合代谢组学技术分析柴胡-白芍药对配伍前后化学成分变化

目的探究柴胡-白芍药对配伍前后化学成分的整体变化情况。方法 UPLC-MS背景扣除法联合代谢组学技术对柴胡-白芍配伍前后的化学成分进行整体分析,采用UPLC-MS分析柴胡、白芍及柴胡-白芍药对各8批提取物的化学成分,并用质谱背景扣除法将柴胡-白芍药对合提物的质谱数据分别扣除白芍、柴胡单提物的质谱数据得配伍后柴胡、白芍的单提物的质谱数据,将柴胡、白芍配伍后的化学成分分别与配伍前各自的化学成分进行主成分分析(PCA)、正交偏最小二乘法判别分析(OPLS-DA),分析柴胡-白芍药对组成药味柴胡、白芍配伍前后整体化学成分的变化情况。结果 UPLC-MS检测柴胡-白芍药对共提物、柴胡及白芍单提物化学成分共57个,结合文献报道指认出其中32个。多元统计结果显示,柴胡-白芍药对配伍前后柴胡中含量发生显著变化的成分有6个,鉴定其中3个成分;白芍中含量发生显著变化的成分有3个,鉴定其中2个成分。分别为柴胡中柴胡皂苷a、3″-O-乙酰化柴胡皂苷a、4″-O-乙酰化柴胡皂苷a配伍后含量降低;白芍中芍药苷、没食子酰基芍药苷或其异构体配伍后含量升高。结论从整体化学组成上比较了柴胡-白芍药对配伍前后的差异,为其配伍机制的阐释奠定了基础。     

胎儿胆管扩张症产前诊断及出生后评估

目的:探讨胎儿先天性胆管扩张症(CBD)的产前超声特点及临床转归。方法:回顾分析2009年9月~2015年11月经产前超声筛查疑诊CBD病例的临床资料,记录孕妇年龄、首次诊断囊肿时孕周、囊肿位置及形态、囊肿大小变化、生后诊断、治疗时机及随访情况。结果:产前疑诊CBD 60例。产前发现囊肿位于肝内11例,右上腹37例,中上腹12例;囊肿形态近圆形7例,椭圆形53例;产前发现囊肿与胆囊相通10例(10/60),出生后均证实为Ⅰ型(CBD)。产前疑诊CBD的60例中,出生后失访11例,获得完全随访49例,其中选择引产15例。余34例中,8例出生前囊肿自行消退,26例囊肿未消退至出生后,其中2例囊肿自行消退,误诊3例(回肠闭锁1例,胆道闭锁2例)。确诊CBD者21例,其中15例在未出现胆道感染症状下行囊肿切除肝肠Roux-en-Y吻合术治疗。全部病例术后恢复良好,无吻合口狭窄、反复胆管炎发作、黄疸、肠梗阻等并发症;余6例生后囊肿无变化或呈缩小趋势且临床无症状,家属拒绝手术,一直门诊随访。结论:CBD多于孕中晚期发现,当超声发现囊肿与胆囊相通,诊断准确率较高。胎儿时期诊断可有效改善预后。     

凶险性前置胎盘术中及术后并发症

<正>凶险性前置胎盘(pernicious placenta previa,PPP)是产科最具有挑战性的疾病之一。针对PPP的手术治疗,国内外尚无统一的流程或术式。了解PPP手术相关并发症,减少或防止严重并发症的发生,一旦发生采取积极有效的处理措施,对于降低孕产妇死亡率,改善远期预后有重要意义。1术中并发症1.1产后出血子宫收缩乏力和胎盘因素是引发产后出血最常见的两种原因,PPP兼有上述二大因素。     

26卷11期疑难病案

患者34岁,G2P0,因停经38周,胎动减少2+小时,于2009年4月13日11时急诊入院.平素月经规则,曾行人工流产1次,末次月经2008年7月20日,预产期2009年4月27日.     

早发型子痫前期终止妊娠的时机及分娩方式

早发型子痫前期对孕妇和胎儿的安全产生威胁,目前尚无确切有效的预防和治疗措施,唯一能够治愈的方法是终止妊娠.     

影像学技术在子宫瘢痕处妊娠诊治中的应用价值

对于有剖宫产史的子宫瘢痕处妊娠早孕病例,建议行经阴道彩色超声检查以了解胚胎的着床部位。三维超声、能量多普勒三维成像技术等的应用也提高了子宫瘢痕处妊娠的诊断率。而磁共振对于中晚孕的病例有较高的诊断价值,特别是对于怀疑有胎盘植入情况时。数字减影血管造影技术可以显示子宫动脉的分支,甚至子宫峡部血管分支出血的情况,对寻找病灶出血点,局部注射化疗药物、栓塞剂有切实的帮助。