围产期B族链球菌感染对妊娠结局的影响

目的:调查妊娠35~37周孕妇B族链球菌(GBS)带菌情况,探讨GBS感染与不良妊娠结局的关系。方法:收集妊娠35~37周孕妇265例,取阴道下段1/3分泌物和直肠分泌物,采用实时荧光定量PCR法进行GBS检测,观察其妊娠结局。结果:265例孕妇中GBS阳性者42例,阴性者223例,带菌率约为15.84%;GBS阳性孕妇的宫内感染、胎儿窘迫和新生儿肺炎发生率高于GBS阴性组(P0.05)。结论:围产期妇女GBS感染会导致宫内感染、胎儿窘迫及新生儿肺炎的发生率升高,对妊娠结局会产生不良影响。     

下生殖道病原微生物感染对孕妇妊娠结局的影响

目的了解本地区孕妇孕中期下生殖道病原微生物感染与不良妊娠结局的关系。方法真菌、滴虫、各种细菌、厌氧菌、支原体采用体外培养和生化反应的方法进行培养和鉴定,加德纳菌采用化学反应的方法检测唾液酸酶,沙眼衣原体采用金标法检测其抗原。结果有病原微生物感染所造成的不良妊娠结局明显高于无感染者（P〈0．01、P〈0．05）,其中多种病原微生物感染所造成的危害大于单一病原微生物感染。结论孕妇孕中期病原微生物感染会增加不良妊娠结局的发生率。     

HPV感染对患者阴道菌群及妊娠结局的影响

目的研究HPV感染对患者阴道菌群以及妊娠结局的影响。方法选择2017年9月至2018年9月在本院定期产检的孕妇,根据妊娠结局将孕妇分为正常妊娠组和不良妊娠组。收集两组患者一般资料及其阴道样本进行微生物检测及分析。结果不良妊娠组患者中HPV阳性患者比例明显高于正常妊娠组,正常妊娠组中HPV阴性和HPV阳性患者及不良妊娠组中HPV阴性患者阴道中乳杆菌(Lactobacillus)丰度最高,其次是加德纳菌(Gardnerella),普氏菌(Prevotella)和纤毛球菌(Sneathia)。不良妊娠组中HPV阳性患者阴道中乳杆菌(Lactobacillus)丰度最高,其次是加德纳菌(Gardnerella),芽孢杆菌(Bacillus),巨球菌(Megasphaera)和链球菌(Streptococcus)。不良妊娠组HPV阳性患者阴道中链球菌、巨球菌和芽孢杆菌丰度明显高于HPV阴性患者,乳杆菌和奇异菌(Atopobium)丰度明显低于HPV阴性患者。结论 HPV感染女性更易产生不良妊娠结局,其机制可能是HPV降低了阴道中乳杆菌丰度,增加阴道微生物群多样性和丰富度。     

孕妇不良情绪、生活事件与妊娠结局以及分娩方式的关系研究

目的:探讨孕妇不良情绪、生活事件对妊娠结局以及分娩方式的影响。方法:选择2017年3月至2018年7月在海南省三亚市人民医院进行分娩的孕妇232例,搜集孕妇的基本资料,调查孕妇的生活事件及抑郁、焦虑状态,并记录孕妇的妊娠结局以及分娩方式,分析孕妇不良情绪、生活事件与妊娠结局以及分娩方式之间的关系。结果:在232例孕妇中,焦虑情绪孕妇有24例,占10.34%;抑郁孕妇有86例,占37.07%;发生生活事件的孕妇有69例,占29.74%。受到生活事件刺激、存在抑郁及焦虑的孕妇出现不良妊娠结局的概率均高于正常孕妇(P0.05)。剖宫产孕妇负性生活事件发生次数高于自然分娩的孕妇,而正性生活事件发生次数低于自然分娩的孕妇(P0.05)。剖宫产孕妇焦虑、抑郁的发生率均高于自然分娩的孕妇(P0.05)。结论:孕妇的不良情绪及生活事件普遍存在,可导致不良妊娠结局的发生并且对分娩方式产生一定的影响,应引起家庭及社会的重视。     

妊娠中晚期孕妇阴道菌群紊乱的改变对不良妊娠结局的影响

目的探讨妊娠中晚期孕妇阴道菌群紊乱的改变对不良妊娠结局的影响。方法选取产科门诊就诊的妊娠28-34周的患者150例。根据检查结果将其分为菌群正常组48例和菌群失常组102例。观察并对比两组患者的不良妊娠结局。结果 102例菌群失常患者中滴虫6例,假丝酵母菌67例,衣原体17例,淋菌2例,细菌性阴道病10例。假丝酵母菌感染率明显高于其他致病菌(P0.05)。菌群失常组患者早产、胎膜早破、剖宫产、产褥感染发生率分别为15.69%、22.55%、35.29%和18.63%,均明显高于菌群正常组的4.17%、8.33%、18.75%和6.25%(P0.05)。菌群失常组患者新生儿黄疽、新生儿感染和低出生体重儿发生率分别为24.51%、21.57%、16.67%,均明显高于菌群正常组的10.42%、8.33%、4.17%(P0.05),在胎儿窘迫的发生率方面两组比较差异无统计学意义(P0.05)。结论妊娠中晚期阴道菌群紊乱中以假丝酵母菌感染发生率最多,与不良妊娠结局密切相关,增加了早产、胎膜早破、剖宫产、产褥感染、新生儿黄疸、新生儿感染和低出生体重儿等与不良妊娠结局的发生率。     

线上孕妇学校在产前健康教育中的效果研究

目的探讨使用线上孕妇学校进行产前健康教育对孕期保健及妊娠结局的影响。方法随机选择门诊早孕建卡的孕妇1000例,分为对照组和研究组各500例。对照组进行传统孕妇学校健康教育干预,研究组进行线上孕妇学校健康教育干预,比较两组孕妇母婴健康素养水平和按时产检率、产前筛查率以及不良妊娠结局发生率。结果研究组孕妇母婴健康素养水平、按时产检率、产前筛查率均高于对照组(P0.05),不良妊娠结局发生率低于对照组(P0.05)。结论线上孕妇学校健康教育效果优于传统孕妇学校健康教育,可提高母婴健康素养水平及按时产检率、产前筛查率,降低不良妊娠结局发生率,保障母婴安全,提高人口出生素质。     

先兆流产孕妇宫颈分泌物的细菌菌种分布、耐药性及对妊娠结局的影响

目的探讨先兆流产孕妇宫颈分泌物的细菌菌种分布、耐药性及对妊娠结局的影响。方法对200例在我院就诊的先兆流产孕妇的宫颈分泌物培养细菌菌种分布及耐药性进行回顾性分析。根据检查结果分为检测出致病菌孕妇与未检测出致病菌孕妇,将检测出致病菌的孕妇归为观察组,未检测出致病菌的孕妇归为对照组,并追踪孕妇的妊娠结局,比较两组妊娠结局的差别。结果 200例先兆流产孕妇中,82例培养出致病菌共97株,感染率达41.00%(82/200),其中细菌52株、真菌45株;最常见的细菌为大肠埃希菌、金黄色葡萄球菌、阴沟肠杆菌、表皮葡萄球菌及屎肠球菌,最常见的真菌为白假丝酵母菌、光滑假丝酵母菌与克柔假丝酵母菌;细菌对万古霉素、阿米卡星与亚胺培南的耐药率较低,真菌对两性霉素B与5-氟胞嘧啶的耐药率较低;观察组不良妊娠结局发生率明显少于对照组(χ2=5.35,P0.05)。结论先兆流产孕妇宫颈分泌物致病菌感染率较高,感染的致病菌对多种常用抗生素耐药率较高,一旦感染会增加不良妊娠结局的发生率,因此应对先兆流产孕妇宫颈分泌物进行致病菌培养及耐药性分析,合理选择抗生素治疗。     

妊娠合并乙肝病毒感染患者血清DNMT1、TIM-3与HBV-DNA病毒载量和妊娠结局的关系分析

摘要 目的：探讨妊娠合并乙肝病毒（HBV）感染患者血清脱氧核糖核酸甲基转移酶1（DNMT1）、T细胞免疫球蛋白粘蛋白-3（TIM-3）与乙型肝炎病毒-脱氧核糖核酸（HBV-DNA）病毒载量和妊娠结局的关系。方法：选取2021年1月～2022年1月南京医科大学第一附属医院收治的186例妊娠合并HBV感染患者为HBV感染组,根据HBV-DNA病毒载量分为阳性组56例和阴性组130例,根据妊娠结局分为结局不良组和结局良好组,另选取同期于南京医科大学第一附属医院进行孕检的150名健康孕妇为对照组。采用酶联免疫吸附法检测血清DNMT1、TIM-3水平。比较HBV感染组与对照组、阳性组与阴性组血清DNMT1、TIM-3水平。采用单因素及多因素Logistic回归分析妊娠合并HBV感染患者妊娠结局不良的影响因素,受试者工作特征（ROC）曲线分析血清DNMT1、TIM-3水平对妊娠合并HBV感染患者妊娠结局不良的预测价值。结果：与对照组比较,HBV感染组血清DNMT1、TIM-3水平升高（P＜0.05）。与阴性组比较,阳性组血清DNMT1、TIM-3水平升高（P＜0.05）。186例妊娠合并HBV感染患者妊娠结局不良发生率为55.38%（103/186）。单因素分析显示,妊娠结局不良与HBV感染孕周、HBV-DNA病毒载量、谷草转氨酶（AST）、谷丙转氨酶（ALT）、DNMT1、TIM-3有关（P＜0.05）。多因素Logistic回归分析显示,HBV-DNA病毒载量阳性和DNMT1＞34.94 ng/mL、TIM-3＞18.96 pg/mL为妊娠合并HBV感染患者妊娠结局不良的独立危险因素（P＜0.05）。ROC曲线分析显示,血清DNMT1、TIM-3水平单独和联合检测预测妊娠合并HBV感染患者妊娠结局不良的曲线下面积分别为0.798、0.791、0.870。结论：妊娠合并HBV感染患者血清DNMT1、TIM-3水平升高与HBV-DNA病毒载量阳性和妊娠结局不良密切相关,血清DNMT1、TIM-3水平联合对妊娠合并HBV感染患者妊娠结局预测价值良好。     

妊娠合并乙型肝炎患者血脂及雌激素水平检测的临床意义

目的:探讨妊娠合并乙型肝炎患者血脂及雌激素水平检测的临床意义。方法:选择2014年8月到2017年4月我院收治的妊娠合并乙型肝炎孕妇80例作为观察组,同期选择无乙型肝炎的80例孕妇作为对照组,比较两组的血清HDL-C、TC、TG、LDL-C及雌激素水平,对比两组不同妊娠结局血脂和血清雌激素水平,并以妊娠不良结局作为因变量,以收集的资料、血脂及雌激素水平作为自变量,分析妊娠合并乙型肝炎患者妊娠不良结局的危险因素。结果:与对照组相比,观察组血清LDL-C、TC、TG含量均显著升高,而HDL-C含量明显降低(P0.05)。观察组与对照组的血清雌激素含量分别为154.20±10.82 pmol/L和88.14±8.98pmol/L,观察组明显高于对照组(P0.05)。与对照组相比,观察组剖宫产、产后出血、新生儿窒息、胎儿窘迫、妊娠期高血压疾病的发生率均显著增高(P0.05)。观察组和对照组中妊娠不良结局患者的血清TC、TG和LDL-C含量都明显高于妊娠正常结局患者,而HDL-C含量明显低于妊娠正常结局患者。LDL-C、雌激素、年龄、乙肝发病年限为导致妊娠合并乙型肝炎患者妊娠不良结局的危险因素(P0.05)。结论:妊娠合并乙型肝炎患者妊娠不良结局的发生率较高,且伴随有血脂异常与雌激素高表达,二者与妊娠合并乙型肝炎的不良预后相关。     

365例妊娠期妇女TORCH感染的血清学检测及妊娠结局分析

目的了解本地妊娠期妇女TORCH[刚地弓形虫(TOX)、风疹病毒(RV)、巨细胞病毒(CMV)和单纯性疱疹病毒(HSV)]感染检出情况和妊娠结局,为加强孕妇保健、促进优生优育工作提供参考依据。方法选择青田县妇幼保健所2013年1月至2014年12月产科接收的365例孕妇为研究对象,回顾性分析其血清标本中TORCH(TOX、RV、CMV和HSV)的特异性IgM、IgG检测结果,并总结妊娠结局。结果妊娠期妇女TOX、RV、CMV和HSV-IgM阳性率分别为0.82%、1.34%、3.01%和4.38%;IgG阳性率分别为2.74%、57.26%、85.48%和81.64%。TORCH-IgM阳性孕妇出现不良妊娠结局的概率为31.43%,显著高于TORCH-IgM阴性孕妇的1.81%(P0.01)。结论妊娠期妇女TORCH感染是不良妊娠结局的重要危险因素,应加强临床宣传工作和产前筛查,达到优生优育的目的。     

Early pregnancy azathioprine use and pregnancy outcomes

BACKGROUND: Azathioprine (AZA) is used during pregnancy by women with inflammatory bowel disease (IBD), other autoimmune disorders, malignancy, and organ transplantation. Previous studies have demonstrated potential risks. METHODS: The Swedish Medical Birth Register was used to identify 476 women who reported the use of AZA in early pregnancy. The effect of AZA exposure on pregnancy outcomes was studied after adjustment for maternal characteristics that could act as confounders. RESULTS: The most common indication for AZA use was IBD. The rate of congenital malformations was 6.2% in the AZA group and 4.7% among all infants born (adjusted OR: 1.41, 95% CI: 0.98–2.04). An association between early pregnancy AZA exposure and ventricular/atrial septal defects was found (adjusted OR: 3.18, 95% CI: 1.45–6.04). Exposed infants were also more likely to be preterm, to weigh <2500 gm, and to be small for gestational age compared to all infants born. This effect remained for preterm birth and low birth weight when infants of women with IBD but without AZA exposure were used as a comparison group. A trend toward an increased risk of congenital malformations was found among infants of women with IBD using AZA compared to women with IBD not using AZA (adjusted OR: 1.42, 95% CI: 0.93–2.18). CONCLUSIONS: Infants exposed to AZA in early pregnancy may be at a moderately increased risk of congenital malformations, specifically ventricular/atrial septal defects. There is also an increased risk of growth restriction and preterm delivery. These associations may be confounded by the severity of maternal illness. Birth Defects Research (Part A), 2009. © 2009 Wiley‐Liss, Inc.     

Oxidative stress early in pregnancy and pregnancy outcome

The objectives of this study were to determine whether oxidative stress early in pregnancy influenced pregnancy outcome. A combination of assays were used for exogenous and endogenous anti-oxidants together with two well accepted biomarkers for oxidative stress, the urinary excretion of 8-iso-PGF_2α (a biomarker marker for lipid oxidation, n=508) and 8-oxo-7,8 dihydro-2 deoxyguanosine (8-OHdG, a biomarker for DNA oxidation, n=487). The two biomarkers tracked different pregnancy outcomes. Isoprostanes were associated with an increased risk of pre-eclampsia and a decreased proportion of female births. In contrast, 8-OHdG tracked lower infant birthweight and shortened gestation duration. Birth defects were associated with low levels of 8-OHdG.     

Oxidative stress early in pregnancy and pregnancy outcome

The objectives of this study were to determine whether oxidative stress early in pregnancy influenced pregnancy outcome. A combination of assays were used for exogenous and endogenous anti-oxidants together with two well accepted biomarkers for oxidative stress, the urinary excretion of 8-iso-PGF(2alpha) (a biomarker marker for lipid oxidation, n=508) and 8-oxo-7,8 dihydro-2 deoxyguanosine (8-OHdG, a biomarker for DNA oxidation, n=487). The two biomarkers tracked different pregnancy outcomes. Isoprostanes were associated with an increased risk of pre-eclampsia and a decreased proportion of female births. In contrast, 8-OHdG tracked lower infant birthweight and shortened gestation duration. Birth defects were associated with low levels of 8-OHdG.     

Sleep and pregnancy

Sleep disturbances are frequent during pregnancy and are currently regarded as one of the most important factors determining pregnancy outcome. Detailed research of sleep features during pregnancy is obviously essential. In the present review recent data concerning changes in sleep structure and regulation in pregnant women and rats - main subjects of experimental sleep research, are given, including surmised mechanisms underlying such changes. The importance of women's sleep integrity preservation during pregnancy for the viability and normal development of the fetus is emphasized and possible ways of pathological influence of sleep disorders during this period are discussed.     

Thrombophilia and pregnancy

Pregnancy is hypercoagulable state. The field of thrombophilia; the tendency to thrombosis, has been developed rapidly and has been linked to many aspects of pregnancy. It is recently that severe pregnancy complications such as severe preeclampsia intrauterine growth retardation abruptio placentae and stillbirth has been shown to be associated with thrombophilia. Recurrent miscarriage and has also been associated with thrombophilia. Finally, thromboembolism in pregnancy as in the non-pregnant state is linked to thrombophilia. In this review all aspects of thrombophilia in pregnancy are discussed, and also all prophylactic and therapeutic implications.     

Schistosomiasis and pregnancy

Currently, schistosomes infect approximately 40 million women of child-bearing age, yet little is known about schistosome-associated morbidity in pregnant women and their offspring. Animal models indicate a deleterious effect of schistosome infection on maternal, fetal and neonatal outcomes. Case reports have documented maternal infection in association with poor birth outcomes, and two observational studies indicate that maternal schistosome infection might be associated with decreased birth weight. Rigorously identifying and quantifying the impact of schistosome infection on pregnancy outcomes with well-designed observational and treatment studies are crucial for improving birth outcomes in schistosome-endemic areas. In addition, studies that address the safety of praziquantel during pregnancy could lead to further adoption of the recent informal recommendation by the World Health Organization to treat schistosome-infected pregnant and lactating women.     

Radiation and pregnancy

Irradiation during pregnancy may occur either as the result of radioactive pollution of the environment, or during a medical procedure using x-rays or radionuclides. While the former is usually unforeseeable, the latter is known and accepted by both physician and patient.Recent statistics estimate that about one quarter of pregnant women have had a radiographic experience during the pregnancy, either for obstetrical reasons or in the course of medical and dental examinations. The amount of radiation delivered to the fetus is in the range of one rad or less. Radionuclidic procedures may result in fetal radiocontamination, chiefly after placental transfer and fetal uptake. Radioiodine, radioactive calcium and selenomethionine are dangerous for the fetus, since they cross the placenta freely and are taken up by fetal tissues. The labelled proteins, radiocolloids and some mercury compounds remain in the maternal compartment and therefore can affect the fetus only through their gamma radiation at some distance from the fetus.The teratogenic effect, the leukemogenic threshold and the lowered resistance to neonatal infections have been demonstrated after irradiation with doses far higher than those encountered during diagnostic applications of ionizing radiation. Statistical data suggest an increase of susceptibility to leukemia in infancy after intra-uterine irradiation at a diagnostic level. Cytogenic analysis may.... offer valuable data for the establishment of the extent of radiation damage.