双胎妊娠一胎宫内死亡的临床分析

目的:探讨双胎妊娠一胎宫内死亡的原因及处理方法。方法:对本院2013年1月～2017年6月住院分娩的双胎妊娠一胎宫内死亡的病例进行回顾性分析。结果:双胎妊娠一胎宫内死亡28例,占同期双胎分娩的1.63%,占同期双胎胎盘送检的4.33%。6例孕28周,14例孕28～34周,8例孕周34周。全部孕产妇均无出血倾向或发生凝血功能障碍。产妇年龄23～45周岁,平均31.3周岁;初产妇23人,经产妇5人。应用辅助生殖技术受孕5例,自然受孕23例;剖宫产7例,顺产21例;确诊一胎儿死亡时间为孕12周余～34周余。主要致死原因为脐带因素13例次(46.43%),胎盘因素12例次(42.86%),双胎输血综合征及纸样胎共5例次(17.86%),胎儿畸形4例次(18.18%)。结论:孕中晚期双胎之一胎儿宫内死亡妊娠不足34周,应在密切监护母胎情况下行期待治疗,单绒毛膜囊双胎34周后可以分娩,双绒毛膜囊双胎可妊娠至36周。     

外周血Toll样受体2与早产的关系

目的:探讨早产产妇外周血Toll样受体2(toll-like receptor2,TLR2)mRNA的表达水平及与亚临床绒毛膜羊膜炎的关系.方法:选择早产自然分娩组15例,足月妊娠自然分娩组20例,足月要求剖宫产10例.RT.PCR检测母血中TLR2 mRNA的表达及与胎盘亚临床绒毛膜羊膜炎的关系.结果:①早产自然分娩组产妇TLR2高表达,明显高于足月自然分娩组,差异有统计学意义(P<0.05).②妊娠合并亚临床绒毛膜羊膜炎组TLR2较无亚临床绒毛膜羊膜炎组高,有统计学意义(P<0.05).结论:孕妇外周血表达TLR2,与分娩方式及感染情况有关;可能参与了分娩发动,尤其是早产分娩发动.     

妊娠晚期胎羊宫内外科手术的实验研究

目的　以妊娠晚期孕羊为研究对象 ,探讨宫内外科手术的可行性 ,为开展胎儿外科研究建立动物实验模型。方法　通过对妊娠 12 0d左右的 4只双胎孕羊进行宫腔手术 ,切除双胎中 1只胎羊的脚趾或唇部皮肤 ,观察妊娠结果。并取分娩后羔羊脑组织及手术切除部位皮肤作组织形态学观察和评价。结果　妊娠羊经阴道足月分娩后羔羊均成活 ,脚趾及唇部切除处未见疤痕形成 ,皮肤组织形态学观察对照组与实验组未见明显差异 ;脑组织形态学检查仅有 1例实验组羔羊有轻度病理学变化 ,与对照羔羊有差异 ,其余 3例实验羔羊与对照羔羊脑组织结构均正常 ,未见有明显的病理学改变。结论　妊娠羊经宫内胎羊外科手术后能够持续妊娠状态并经阴道自然分娩 ,产出羔羊的精神状态及病理组织学观察结果表明 ,利用妊娠晚期孕羊进行胎儿外科动物实验研究是可行的 ,为进一步开展人类先天性畸形胎儿的早期治疗奠定了动物实验基础     

病毒的母子感染

<正> 本文主要叙述在妊娠中和分娩前后,母体的病毒感染对胎儿或新生儿的影响。 1.母体的感染时期:母体在妊娠早期初次感染风疹,将引起胎儿先天性风疹综合征。在分娩时感染单纯性疱疹病毒(HSV),能引起新生儿全身性疱疹。母体在妊娠中感染风疹、巨细胞病毒(CMV)、人乳头状瘤病毒(HPV);在分娩时感染HSV、乙     

人体胚胎发育概况与新进展(三)——胎膜、胎盘的构成及其功能

所谓胎膜,就是指绒毛膜、羊膜、卵黄囊、尿囊及脐带这五者而言。胎膜虽是由受精卵衍化而来,但并不组成胚胎本身的任何成份。胎盘则是由母体子宫的基蜕膜和胎儿的丛密绒毛膜两者合起来组成。胎膜与胎盘是对胚胎起作保护、营养、呼吸和排泄等作用的附属结构,有的还有一定的内分泌功能。胎儿娩出后,胎膜、胎盘和子宫蜕膜一并排出,总称为衣胞。     

44例不同孕周脐带脱垂患者的临床资料分析

目的:探讨不同孕周脐带脱垂患者相关因素的差异。方法:回顾性比较分析2012年01月至2017年12月我院收治的44例脐带脱垂患者的临床资料。将患者按照脐带脱垂发生的孕周分为足月组、早产组及流产组,使用SPSS18.0统计软件处理数据。结果:我院近六年脐带脱垂总的发病率为1.829/1000。44例患者中,足月组7人,占15.91%;早产组22人,占50%;流产组15人,占34.09%。三组患者的年龄、产次及孕次均无显著统计学差异(P0.05)。足月组新生儿apgar评分最高,与其它两组相比均有统计学差异(P0.05),早产组apgar评分显著高于流产组(P0.05);足月组剖宫产率为100%,早产组为63.64%,流产组则为13.13%,三组患者剖宫产率比较存在统计学差异(P=0.000),足月组剖宫产率与早产组比较无统计学差异(P=0.075),足月组剖宫产率与流产组比较有统计学差异(P=0.000),早产组剖宫产率与流产组比较有统计学差异(P=0.003)。足月组异常胎方位的发生率显著低于早产组(P=0.038)。早产组胎儿数(单胎、双胎)与足月组及流产组相比均有统计学差异(P0.05),而足月组与流产组胎儿数则无统计学差异(P0.05)。早产组双胎妊娠占比例更高。三组患者发生脐带脱垂的地点比较无统计学差异(P=0.256)。结论:不同孕周是否发生脐带脱垂与患者的年龄、产次、孕次及地点无关。脐带脱垂较多发生于早产者,且早产患者中双胎、异常胎方位发生率更高。一旦发生脐带脱垂,尤其是有机会存活的胎儿,应以最快的方式娩出胎儿,提高新生儿存活几率。     

法安明联合维生素E对胎儿生长受限高危患者早期干预的临床研究

目的:探讨法安明联合维生素E对胎儿生长受限高危患者进行早期干预的临床疗效。方法:选择存在胎儿生长受限高危因素的孕妇共156例,研究组86例,每天皮下注射一次法安明5000U,同时给予天然维生素胶丸E0.1g,每天口服3次,可根据D-二聚体结果调整法安明用量直至降至正常,孕中期开始补钙。对照组70例,孕早期不干预,孕中期开始补钙。比较两组妊娠结局。结果:研究组分娩孕周、新生儿出生体重明显高于对照组,胎儿生长受限、羊水过少、妊娠期高血压疾病、新生儿窒息的发生率明显低于对照组,两组比较差异有统计学意义(P0.05);两组宫内死胎、围产儿死亡的发生率无差异(P0.05)。结论:法安明联合维生素E对胎儿生长受限高危患者进行早期干预,可减少胎儿生长受限、羊水过少、妊娠期高血压疾病及新生儿窒息等的发生,改善妊娠结局及围生儿预后。     

孕中期双胎妊娠与单胎妊娠孕妇血清AFP与F-β-Hcg水平的比较

目的：检测双胎妊娠孕中期孕妇血清甲胎蛋白（AFP）和人绒毛膜促性腺激素游离B亚基（F-β-hCG）的水平,探索双胎妊娠时孕妇血清学筛查用于Down＇s胎儿高风险评估的AFP、F-β-hCG界定值。方法：收集双胎妊娠129例,孕中期（15～2l周）采集孕妇静脉血,用时间分辨荧光免疫分析技术测定血清AFP和F-β-hCG的浓度,并于分娩后随访,确定胎儿有无异常。另选2603例胎儿无异常的单胎妊娠作对照组。结果：129例双胎妊娠孕妇血清AFP浓度的中位教为98.98ng／ml,F-β-hCG浓度的中位数为32.20ng／mt;2603例单胎妊娠孕妇血清AFP和F-β-hCG浓度的中位数分别为52.15ng／ml和13.00ng／mt。双胎妊娠孕妇血清AFP和F-β-hCG的水平均明显高于对照组（P均〈0.01）。结论：鉴于双胎妊娠孕妇血清AFP和F-β-hCG水平明显升高,双胎妊娠的产前唐氏筛查风险评估时应引入正常双胎妊娠的AFP、F-β-hCG值。     

胎膜早破导致胎膜绒毛膜羊膜炎的细菌培养及药敏结果分析

目的:分析胎膜早破(premature rupture of memberane,PROM)所致孕妇绒毛膜羊膜炎的细菌培养及药敏结果,探讨胎膜早破引起的绒毛膜羊膜炎主要致病菌的病原学特征,为围产期感染用药提供科学依据。方法:对2011年6月至2013年9月在我院分娩的597例破膜时间大于24小时的PROM孕妇的胎膜进行细菌培养及药敏试验。结果:597例破膜时间大于24小时的PROM孕妇的胎膜细菌培养中,86例培养阳性,阳性率为14.41%;培养阳性病例中革兰氏阴性杆菌占73.26%(63/86),革兰氏阳性菌球菌占34.88%(30/86),培养最多的菌种是大肠埃希菌,占60.47%(52/86)。革兰氏阴性杆菌对亚胺培南、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、庆大霉素、头孢西丁、左氧氟沙星敏感;革兰氏阳性球菌对亚胺培南、丁胺卡那、哌拉西林/他唑巴坦、替考拉宁、万古霉素、利奈唑胺、庆大霉素、头孢西丁、左氧氟沙星敏感。结论:革兰氏阴性杆菌是PROM相关的绒毛膜羊膜炎的主要致病菌,应根据病原学特征合理应用抗生素。     

乳酸菌阴道胶囊辅助治疗对未足月胎膜早破的疗效及对其阴道微生态的影响

目的观察乳酸菌阴道胶囊辅助治疗对未足月胎膜早破的治疗效果,并探讨其对阴道微生态的影响。方法 86例未足月胎膜早破患者采用随机数表分为常规组与研究组,各43例。常规组予以常规治疗,研究组予以乳酸菌阴道胶囊联合常规治疗。比较治疗后两组阴道微生态、胎儿宫内感染率和分娩方式、母体和胎儿不良妊娠结局发生情况。结果治疗后研究组Chao1指数和Shannon指数均高于常规组(均P0.05),治疗后研究组阴道乳杆菌属、双歧杆菌属、优杆菌属相对丰度均高于常规组,表皮葡萄球菌属、假单胞菌属、奈瑟氏菌属、支原体属、加德纳菌属、肠球菌属相对丰度均低于常规组,差异均有统计学意义(均P0.05);研究组胎儿宫内感染率、剖宫产率均低于常规组(均P0.05),研究组自然分娩率高于常规组(P0.05);研究组母体早产、产褥期感染及不良妊娠结局发生率均低于常规组(均P0.05);研究组宫内窘迫及围产儿不良妊娠结局发生率均低于常规组(均P0.05)。结论乳酸菌阴道胶囊辅助治疗未足月胎膜早破相较于常规治疗可改善阴道微生态,还可降低胎儿宫内感染率、剖宫产率,减少母体和围产儿不良妊娠结局的发生。     

The outcome of twin pregnancies complicated by single fetal death after 20 weeks of gestation.

A retrospective study involving 972 twin births was conducted to evaluate the maternal and fetal outcomes of twin pregnancies complicated by single fetal death. The incidence of single fetal death in twin pregnancies after 20 weeks was 3.3%. Preterm birth rates for 37 and 32 gestational weeks were 81.3% and 41.6% respectively. The median interval between the diagnosis of fetal death and the delivery was 11 days (range 1-27 days). Eighteen (56%) infants were delivered by cesarean and 14 (43%) vaginally. Twin-twin transfusion syndrome (TTTS) was the cause of single fetal death in 8 of 32 twin pregnancies (25%). Ten of the surviving co-twins were lost in the neonatal period (31.3%) and half of those neonatal deaths were due to TTTS. TTTS is the major contributor for perinatal mortality in same-sex twins complicated by single fetal death. The death of one twin in utero should not be the only indication for preterm delivery, and in case of severe prematurity with a stable intrauterine environment; expectant management may be advisable until fetal lung maturation ensues.     

Placental efficiency and intrauterine resource allocation strategies in the common marmoset pregnancy

Mothers and fetuses are expected to be in some degree of conflict over the allocation of maternal resources to fetal growth in the intrauterine environment. Variation in placental structure and function may be one way a fetus can communicate need and quality to its mother, potentially manipulating maternal investment in its favor. Whereas common marmosets typically produce twin litters, they regularly give birth to triplet litters in captivity. The addition of another fetus is a potential drain on maternal resource availability and thus a source of elevated conflict over resource allocation. Marmoset littermates share a single placental mass, so that differences in the ratio of fetal to placental weight across litter categories suggest the presence of differential intrauterine strategies of resource allocation. The fetal/placental weight ratio was calculated for 26 marmoset pregnancies, representing both twin and triplet litters, to test the hypothesis that triplet fetuses respond to intrauterine conflict by soliciting placental overgrowth as a means of accessing maternal resources. In fact, relative to fetal mass, the triplet marmoset placenta is significantly undergrown, with individual triplets associated with less placental mass than their twin counterparts, suggesting that the triplet placenta is relatively more efficient in its support of fetal growth. There still may be an important role for maternal-fetal conflict in the programming of placental structure and function. Placental adaptations that solicit potential increases of maternal investment may occur at the microscopic or metabolic level, and thus may not be reflected in the size of the placenta as a whole.     

Trisomy 16 confined to chorionic villi and unfavourable outcome of pregnancy.

Two cases of trisomy 16 confined to placental tissue associated with an unfavourable outcome of the pregnancy are reported. In the first case, after a diagnosis of an apparent non-mosaic trisomy 16 at chorionic villi sample (CVS), an intrauterine fetal death occurred at the 22nd week. In the second case a mosaic with trisomy 16 was found in chorionic villi and the fetus was still-born at 38 weeks. From a comparison of their cases with those of the literature, the authors conclude that a trisomy 16 confined to placental tissue has a negative effect on fetal growth and pregnancy outcome.     

Insights into viral transmission at the uterine-placental interface

During human gestation, viruses can cause intrauterine infections associated with pregnancy complications and fetal abnormalities. The ability of viruses to spread from the infected mother to the fetus arises from the architecture of the placenta, which anchors the fetus to the uterus. Placental cytotrophoblasts differentiate, assume an endothelial phenotype, breach uterine blood vessels and form a hybrid vasculature that amplifies the maternal blood supply for fetal development. Human cytomegalovirus - the major cause of congenital disease - infects the uterine wall and the adjacent placenta, suggesting adaptation for pathogen survival in this microenvironment. Infection of villus explants and differentiating and/or invading cytotrophoblasts offers an in vitro model for studying viruses associated with prenatal infections.     

Hipertiroidismo y embarazo

Association of hyperthyroidism and pregnancy is not an unusual event, and has an impact on both the mother and fetus. After delivery, it may also affect the newborn and the nursing mother. Clinical management of this situation is quite different from that required by non-pregnant hyperthyroid women and poses significant diagnostic and therapeutic challenges.This review addresses aspects related to the unique characteristics of biochemical assessment of thyroid function in pregnancy, the potential causes of hyperthyroidism in pregnancy, and the clinical and therapeutic approach in each case. Special attention is paid to pregnancy complicated with Graves’ disease and its different the maternal, fetal, neonatal, and postnatal consequences.     

ITP in pregnancy and the newborn: introduction

Idiopathic thrombocytopenic purpura (ITP) occurs more commonly in young women and is one of the commonest immune mediated disorders in pregnancy. It may exist as an incidental finding in an otherwise healthy pregnant woman or may be associated with symptomatic reduction in the platelet count and varying degrees of clinical hemorrhage. The condition termed incidental thrombocytopenia of pregnancy is invariably associated with a platelet count of greater than 100 x 10(9)/L and a very low incidence of fetal thrombocytopenia. Symptomatic thrombocytopenia is more commonly associated with low platelet counts in the fetus (estimated between 20%-40%). It has recently been suggested that the incidence of fetal thrombocytopenia is substantially lower than this figure. The management of ITP in pregnancy is complicated by the fact that fetal thrombocytopenia is difficult to diagnose and carries substantial risks during the delivery process with rare cases of fetal hemorrhage occurring spontaneously in utero. Unfortunately there are no laboratory studies that can be performed precisely in the mother that may predict the occurrence of fetal thrombocytopenia. Maternal management is usually directed towards treatment of maternal symptoms. Maternal treatment or response to treatment is inconsistently associated with predictable changes in the fetal platelet count. Obstetric management is aimed at reducing the risks of life threatening fetal hemorrhage occurring at the time of delivery, and fetal management is directed towards the obtaining of fetal platelet samples in order to plan an appropriate strategy for obstetrical delivery. Fetal blood samples are obtained either by a scalp vein puncture at the time of delivery or earlier in gestation by the use of the newer technique termed percutaneous umbilical blood sampling. Fetuses with platelet counts of less then 50 x 10(9)/L are generally delivered by cesarean section whereas those with counts greater than 50 x 10(9)/L are allowed to proceed with vaginal delivery assuming no obstetrical contraindications exist. The use of IVIgG therapy during pregnancy has theoretical implications on improving platelet counts in the mother in situations of severe hemorrhage, however cannot be considered to be appropriate treatment for the prevention of fetal thrombocytopenia, since the exogenous transport of IVIgG across the placenta appears to be inconsistent and unpredictable.(ABSTRACT TRUNCATED AT 400 WORDS)     

Fetal complications of obstetric cholestasis.

Among 56 pregnancies complicated by obstetric cholestasis five intrauterine deaths and one neonatal death occurred between 33 and 39 weeks, and a further six infants required urgent delivery for intrapartum asphyxia. Eighteen spontaneous premature deliveries occurred. Five mothers required specific treatment for unexplained postpartum haemorrhage. Cholestasis of pregnancy is therefore not a condition benign to the fetus, and it may contribute to increased maternal morbidity.     

Delivering hydrocephalic fetuses

Detection of fetal hydrocephalus with head enlargement in the third trimester raises questions concerning the extent of the physician's obligations to the fetus and to the mother. Here Strong develops and defends an approach to these questions that he discussed in an earlier essay ("Ethical conflicts between mother and fetus in obstetrics," Clinics in Perinatology 1987 Jun; 14(2): 313-328), dividing the ethical issues involved into two main topics. He first explores under what circumstances a physician is ethically justified in draining fluid from the fetal cranium to reduce head size. This procedure, which usually causes fetal death, facilitates vaginal delivery. A cesarean section, which is less stressful for the fetus, exposes the woman to the risks of surgery. Secondly, Strong applies this discussion to the issue of how the physician should counsel the woman, and what recommendations, if any, the physician should make concerning the method of delivery.     

Liver function disorders and blood coagulation disorders in the course of EPH gestosis]

Three cases of EPH-gestosis complicated with liver function and blood coagulation disorders (HELLP syndrome) are presented. The most frequent diagnostic errors and subsequent risk for both mother and fetus have also been discussed. Basing on the available literature, the safest management of pregnancy and delivery is critically assessed.