血清P、β-HCG联合检测预测和治疗先兆流产的临床研究

目的：探讨血清孕酮与B-HCG联合检测在预测早期先兆流产预后及其治疗的临床价值。方法：对340例早期先兆流产患者血清P与B-HCG进行检测,并与追踪到的妊娠结局进行分析。结集：血清P值〉25ng／ml、血β-HCG〉50mIU／ml患者66例占19．4％,经绝对卧床休息,未用药治疗,均胚胎发育正常;血清P值在15．94-25ng／ml、血β-HCG10-50mlU／ml患者170例占50％,经口服黄体酮与HCG针保胎治疗后均胚胎发育正常;血清P值〈15．94ng／ml、血β-HCG〈10mIU／ml患者78例占22．9％,终止妊娠者均可见清除宫内组织物中几乎不见新鲜绒毛并伴有不同程度的陈旧性出血;血清孕酮与β-HCG上升不同步患者26例占7．6%,均最终难免流产。结论：联合检测血清孕酮与β-HCG可以预测先兆流产患者妊娠结局,对于指导治疗具有重要的临床价值,既避免不必要的药物干预及经济负担,又能起到提高保胎治疗的成功率。绒毛膜促性腺激素配伍口服天然黄体酮治疗由黄体功能不全引发的早期先兆流产,均能改善先兆流产患者的预后,且对母儿无不良影响,安全有效。     

孕酮，CA125及TNF-alpha水平与先兆流产的关系

目的：探讨孕酮，CA125 及TNF-alpha水平与先兆流产发生的关系。方法：选择2014 年2 月-2015 年2 月在我院诊断并接受治 疗的先兆流产患者60 例，根据妊娠结局不同，将患者分为完成妊娠组和终止妊娠组。另选取同期顺利分娩的产妇作为对照组。比 较三组研究对象血清孕酮，CA125 及TNF-琢水平。结果：先兆流产患者血清孕酮水平低于对照组，而CA125 及TNF-alpha水平高于 对照组，差异具有统计学意义（P<0.05）；先兆流产终止妊娠组血清孕酮水平低于完成妊娠组，而CA125 及TNF-alpha水平高于完成 妊娠组，差异具有统计学意义（P<0.05）。孕酮，CA125 及TNF-alpha水平是先兆流产发生的影响因素（P<0.05）。结论：孕酮水平低， CA125 及TNF-alpha水平高是先兆流产发生的危险因素。临床应给予高度重视，积极采取有效的保胎治疗，避免不良妊娠结局。     

Medical and socio-demographic implications of abortion at Felix Bulnes Hospital in Santiago (author's transl)]

602 patients were admitted for treatment of incomplete abortion (including inevitable or threatened abortion) from May 1 to October 31, 1974, at Felix Bulnes Hospital in Santiago Chile. Routine treatment included dilation and curettage in 88.7% of the cases, with a mean hospitalization time of 2.5 nights. Complications in 14.6% included fever, pelvic infection, and blood loss requiring transfusion. 78.4% had used no form of contraception in the month previous to conception, but 68.9% of those who returned for a follow-up (only 37.7%) were using effective contraceptives. The study indicates: 1) the cost of abortion is high in terms of risk of complications and hospital time; 2) infection associated with abortions outside the hospital is high; and 3) acceptance of contraception after abortion is not high enough to deter repetition of abortion.     

凝结芽孢杆菌活菌片预防先兆流产保胎妇女胃肠功能紊乱的临床观察

目的观察凝结芽孢杆菌活菌片（商品名：爽舒宝）预防先兆流产保胎妇女胃肠功能紊乱的临床疗效。方法将60例先兆流产保胎妇女随机分为爽舒宝预防组和对照组,预防组30例,对照组30例,两组均给予常规服用保胎药物,出现顽固性便秘后用开塞露通便,其中预防组在此基础上同时口服凝结芽孢杆菌活菌片首次2. 1 g,以后1.05 g/次,3次/d,温水送服,疗程2-4周。观察保胎期间孕妇胃肠功能紊乱情况和使用开塞露的通便次数。结果预防组患者胃肠功能紊乱的发生率显著低于对照组,差异有统计学意义（P〈0.05 ）。结论凝结芽孢杆菌活菌片预防先兆流产保胎妇女胃肠功能紊乱疗效显著,值得临床推广。     

滋肾育胎丸对早期先兆流产患者血清孕酮、β-HCG水平及血液流变学的影响

目的:探讨滋肾育胎丸对早期先兆流产患者血清孕酮、β-人绒毛膜促性腺激素(β-HCG)水平及血液流变学的影响。方法:选取2018年1月-2020年1月我院收治的早期先兆流产患者100例,按随机数字表法分为对照组和观察组各50例。对照组给予常规西医治疗,观察组在对照组基础上给予滋肾育胎丸治疗,治疗2周后观察两组治疗前后血清孕酮、β-HCG水平、高切全血黏度、纤维蛋白原以及红细胞比容,并比较两组临床疗效及不良反应。结果:治疗2周后,两组患者血清孕酮、β-HCG水平均高于治疗前,且观察组高于对照组(P<0.05)。观察组总有效率为92.00%(46/50),明显高于对照组的74.00%(37/50),差异有统计学意义(P<0.05)。两组患者治疗2周后高切全血黏度、纤维蛋白原均较治疗前降低,且观察组低于对照组(P<0.05);两组患者治疗前后、两组组间红细胞比容比较差异无统计学意义(P>0.05)。两组不良反应发生率比较差异无统计学意义(P>0.05)。结论:滋肾育胎丸治疗早期先兆流产患者疗效确切,能够提高血清孕酮、β-HCG水平,改善患者血液流变学,且安全性较好,值得临床推广。     

Aspirin and indomethacin: Effect on instillation/abortion time of mid-trimester hypertonic saline induced abortion

Two acidic non steroid anti-inflammatory drugs, aspirin (acetylsalicyclic acid) and indomethacin were administered to patients undergoing mid-trimester saline induced abortion, to test their analgesic properties and to observe their effect on the instillation/abortion time interval. Both drugs when administered to patients undergoing mid-trimester saline abortion prolong significantly the instillation/abortion interval. These observations on human mid-trimester saline induced abortion treated with aspirin and indomethacin correspond with experimental data recently published relative to the antiprostaglandin activity of acidic non steroid drugs. The analgesic properties of both aspirin and indomethacin are difficult to assess accurately because of the highly emotional state of the patients studied; indomethacin, however, appears to be more effective for the prodromal abortion type of pain experienced by the patient but is still inadequate for sedation for the pain resulting from strong uterine contractions.     

血清妊娠相关血浆蛋白A在诊断异常妊娠中的临床意义

目的:探讨血清妊娠相关血浆蛋白A(PAPP-A)在诊断异常妊娠中的临床意义,分析其与异常妊振的关系。方法:选取299例5~13周的正常早孕妇为正常早孕组,同期选取稽留流产86例,先兆流产54例,异位妊娠76例为异常妊娠组,用酶联免疫吸附试验(ELASA)测定两组受试者的血清PAPP-A水平,分析两组受试者各个孕周内的血清PAPP-A水平的差异。结果:稽留流产孕妇在各个孕周内(9~13周)的血清PAPP-A水平显著低于同孕周内正常早孕孕妇(t值分别为9.500,8.113,3.511,9.538,8.504,P值均0.05);稽留流产孕妇总的平均血清PAPP-A水平亦低于常早孕孕妇(t=3.651,P值均0.05);异位妊娠孕妇在各个孕周内(9~13周)的血清PAPP-A水平显著低于同孕周内正常早孕孕妇(t值分别为7.976,9.030,9.941,11.625,14.079,12.569,P值均0.05),异位妊娠孕妇总的平均血清PAPP-A水平亦低于常早孕孕妇(t=28.168,P值均0.05);先兆流产孕妇(除孕8周)与正常早孕妊娠血清PAPP-A水平比较无显著统计学意义。结论:血清PAPP-A水平在异常妊娠如异位妊娠、稽留流产中显著降低,可作为诊断异位妊娠、稽留流产及先兆流产辅助诊断的生物学指标。     

Alpha-fetoprotein in Abortion

The clinical value of maternal serum alpha-fetoprotein (AFP) as a guide to the outcome of threatened abortion was assessed. After the thirteenth week of gestation, abortion occurred more frequently (10/12) in women with abnormal serum AFP levels than in those (2/12) whose AFP concentrations were within the normal range. Low levels were present in women with blighted ovum and high concentrations were associated with intrauterine fetal death. In legal first and second trimester abortions, the circulating maternal AFP levels in postabortion samples were often higher than before abortion, irrespective of whether abortion was performed instrumentally or induced with prostaglandins. Maternal serum AFP levels provide a new means for prediction of the outcome of threatened abortion.     

Dydrogesterone in threatened abortion: pregnancy outcome

OBJECTIVE: To determine whether therapy with dydrogesterone in threatened abortion during the first trimester of pregnancy will improve pregnancy outcome. DESIGN: Prospective open study. SUBJECTS: Pregnant women presenting to the obstetric and gynaecology clinic admitting center with vaginal bleeding before 13 weeks gestation were evaluated for entry into the study. Women were excluded if they had a history of recurrent miscarriage. METHOD: Eligible subjects were randomized to receive either dydrogesterone 40 mg stat dose followed by 10 mg twice a day for one week or conservative therapy. RESULTS: One hundred and 54 women were recruited. There was no statistically significant differences between the two groups with regard to pre-treatment status. The continuing pregnancy success rate was significantly (p=0.037) higher in women treated with dydrogesterone (95.9%) compared with women who received conservative treatment (86.3%). The odds ratio of the success rate between dydrogesterone treatment and non-treatment was 3.773 (95% confidence interval: 1.009-14.108). CONCLUSION: Corpus luteal support with dydrogesterone has been shown to reduce the incidence of pregnancy loss in threatened abortion during the first trimester in women without a history of recurrent abortion.     

Properties of chromatin of peripheral blood lymphocytes in women with threatened abortion

The authors studied the properties of peripheral blood lymphocyte chromatin from donors (non-pregnant women), from women with normal pregnancy and during threatened abortion. Using three independent cytochemical methods that characterize the DNA accessibility for acridine orange and 3H-actinomycin D and the presence in histones of free amino groups, it has been established that lymphocyte chromatin from women during threatened abortion is repressed to a greater degree than in those with normal pregnancy. The data presented demonstrate the prospectiveness of the use of the cytochemical tests for chromatin properties with a purpose of diagnosing whether the pregnancy will be full-term and treatment control.     

Induced abortion--a historical outline

An historical review of the use of induced abortion is presented, beginning with early eras. The Chinese were the 1st to record the practice of induced abortion, with this operation being administered to royal concubines recorded at 500-515 B.C. Induced abortion was not used in ancient Greece, either for criminal or ethical reason. However, the ancient Greeks did utilize compulsory abortion for serious economic indications, as a means of controlling natural growth. Greek medical, gyneoclogigcal instruments for adminsitering abortions were described by Hippocrates. The Greek moral attitudes on abortion were largely adopted by the Romans, which were later altered by the appearance of Christianity and new ethical ideas. These ideas dominated European attitudes, along with the Church of Rome, limiting induced abortion to cases where the life of the mother was threatened. This attitude has existed until the present century, when these moral ideas are being challanged seriously for the 1st time in modern history.     

How to stimulate the placental function (author's transl)]

Imminent abortion, habitual abortion and threatened premature labor, all constitute difficult clinical problems. Those cases require on every occasion a diagnosis as acurate as possible, and unfortunately our present methods of biochemical determinations only represent a means to evaluate placental function. On those cases where a faulty placental function is detected thru the tests presently available, the authors recommend the utilization of a placentotropic substance, Gestanon, that is capable to stimulate and normalize the placental function, a is demostrated by the statistical results published in the international medical bibliography.     

Prostaglandins and post-abortion luteolysis in early pregnancy.

This study was undertaken to determine if post-abortion luteolysis in early pregnancy could be accelerated by the administration of 15(S)15-methyl-PGF2alpha(15-me-PGF2alpha) or delayed following pretreatment with indomethacin. Thirty-nine women were divided into four groups: 7 women were given 400mug 15-me-PGF2alpha extra-amniotically one hour prior to vacuum aspiration; 14 were pretreated with oral indomethacin (50 mg X4) over 24 hours; 7 were given indomethacin (50mg X 6) over 36 hours and 11 served as controls. Plasma progesterone and estradiol were measured at fixed intervals before and after abortion. There was a rapid drop in the plasma progesterone within the first hour after abortion followed by an exponential decline over the next 23 hours. The plasma estradiol fell rapidly duriing the same period. Under the experimental conditions of this study neither 15-me-PGF2alpha nor indomethacin exerted a significant effect on the decline in luteal function. These results are interpreted as suggesting that factors other than prostaglandins have a more significant role in post-abortion luteolysis.     

Plasma copper concentrations in pathological pregnancies.

Copper is an essential element required for the formation of many enzymes with important roles in the human body. During pregnancy, the maternal serum copper concentration is increased due to the higher levels of ceruloplasmin that are the result of elevated oestrogen levels. The aim of this work was to investigate maternal plasma copper concentrations in relation to various pathological conditions during pregnancy. A total of 319 maternal plasma samples were analysed: 103 taken from women in the first trimester, 73 in the second trimester, 99 in the third trimester of pregnancy and 44 at delivery. The plasma concentration of copper during each trimester of normal pregnancy was taken as a reference value. Group comparisons performed by analysis of variance (ANOVA) followed by Dunnett test indicated substantially lower plasma concentrations of copper in pathological conditions diagnosed during the first trimester of pregnancy (spontaneous abortion, threatened abortion, missed abortion and blighted ovum). No significant differences in maternal plasma blood copper concentrations were found in pathological conditions (threatened abortion, threatened preterm delivery and pyelonephritis) diagnosed in the second trimester of pregnancy. Significant differences in plasma copper concentrations were found in the third trimester, for which finding the Dunnett test indicated the cholestasis group to be responsible. Except for twin pregnancy, a tendency to higher plasma copper concentrations, however not statistically significant, was observed in other pathological conditions during the third trimester (gestosis, intrauterine growth retardation, preterm labour).     

Prostaglandins and post-abortion luteolysis in early pregnancy

This study was undertaken to determine if post-abortion luteolysis in early pregnancy could be accelerated by the administration of 15(S)15-methyl-PGF₂ (15-me-PGF₂) or delayed following pretreatment with indomethacin. Thirty-nine women were divided into four groups: 7 women were given 400g 15-me-PGF₂ extra-amniotically one hour prior to vacuum aspiration; 14 were pretreated with oral indomethacin (50 mg X4) over 24 hours; 7 were given indomethacin (50mg X 6) over 36 hours and 11 served as controls. Plasma progesterone and estradiol were measured at fixed intervals before and after abortion. There was a rapid drop in the plasma progesterone within the first hour after abortion followed by an exponential decline over the next 23 hours. The plasma estradiol fell rapidly during the same period. Under the experimental conditions of this study, neither 15-me-PGF₂ nor indomethacin exerted a significant effect on the decline in luteal function. These results are interpreted as suggesting that factors other than prostaglandins have a more significant role in post-abortion luteolysis.     

Prostaglandins and post-abortion luteolysis in early pregnancy

This study was undertaken to determine if post-abortion luteolysis in early pregnancy could be accelerated by the administration of 15(S)15-methyl-PGF_2α (15-me-PGF_2α) or delayed following pretreatment with indomethacin. Thirty-nine women were divided into four groups: 7 women were given 400μg 15-me-PGF_2α extra-amniotically one hour prior to vacuum aspiration; 14 were pretreated with oral indomethacin (50 mg X4) over 24 hours; 7 were given indomethacin (50mg X 6) over 36 hours and 11 served as controls. Plasma progesterone and estradiol were measured at fixed intervals before and after abortion. There was a rapid drop in the plasma progesterone within the first hour after abortion followed by an exponential decline over the next 23 hours. The plasma estradiol fell rapidly during the same period. Under the experimental conditions of this study, neither 15-me-PGF_2α nor indomethacin exerted a significant effect on the decline in luteal function. These results are interpreted as suggesting that factors other than prostaglandins have a more significant role in post-abortion luteolysis.     

地屈孕酮联合口服黄体酮胶丸对黄体功能不全先兆流产患者血清抑制素A、性激素的影响

摘要 目的：探讨地屈孕酮联合口服黄体酮胶丸对黄体功能不全先兆流产患者血清抑制素A、性激素的影响。方法：选择2018年9月到2020年9月在我院接受治疗的125例黄体功能不全先兆流产患者,采用随机数表法分为试验组（n=63）和对照组（n=62）。对照组给予黄体酮胶丸治疗,试验组在对照组的基础上给予地屈孕酮治疗。比较两组临床疗效、抑制素A、雌二醇（E₂）、孕酮（P）、人绒毛膜促性腺激素（HCG）、临床症状改善情况、妊娠结局及不良反应发生情况。结果：治疗后,两组总有效率比较差异显著（P<0.05）;治疗前,试验组和对照组血清抑制素A、E2、P、HCG比较无显著差异;治疗后试验组和对照组血清抑制素A、E₂、P、HCG随着时间的推移而升高,且试验组均高于对照组,差异显著（P<0.05）;试验组止血时间、腹痛改善时间及腰痛改善时间均显著低于对照组,差异显著（P<0.05）;试验组保胎成功率、新生儿体质量及新生儿Apgar评分均显著高于对照组,差异显著（P<0.05）;两组不良反应总发生率分别为7.94%、9.68%（P>0.05）。结论：在黄体功能不全先兆流产患者中应用地屈孕酮联合口服黄体酮胶丸效果显著,可能与其可有效改善血清抑制素A、性激素水平有关,且不增加不良反应。     

Letter to the editor: Non steroid anti-inflammatory drugs and pregnancy

A review of relevant clinical research literature leads to the conclusion that any known nonsteroid anti-inflammatory drug (NSAID) should be contraindicated for use during pregnancy. This conclusion is reached as a result of the potentially profound effects of NSAIDs noted on platelet functions and their inhibition of specific tissue prostaglandin(PG) synthetases. Study results have shown that administration of Naproxen to midtrimester abortion patients prolonged the instillation-abortion interval from 33.4 hours +or- 2.9 hours (in a placebo treated group) to 64.7 hours +or- 6.4 hours. Treatment with aspirin prolonged induction-abortion time by about 9 hours and treatment with indomethacin by 30 hours. 2 recent clinical papers have shown that use of acetylsalicylic acid, a relatively weak inhibitor of PG synthetase when compared to Naproxen, by pregnant women at or near term increased their length of gestation, their mean duration of labor, the frequency of postmaturity among them, and the incidence of pre- and postpartum hemorrhage. A small dose of aspirin given to mothers at or near term results in platelet dysfunction in both the mother and the newborn infant. NSAID most frequently disrupts normal hemostatic homeostasis mechanisms. In addition, studies have shown that use of NSAIDs increases the incidence of chromosomal abnormalities in spontaneous abortuses. Such drugs should not be used to prevent threatened abortions.     

Application of Ureteroscope in Emergency Treatment with Persistent Renal Colic Patients during Pregnancy

Background

Although the application of ureteroscopy in the treatment of ureteral calculi during pregnancy has been on the rise, for persistent renal colic patients without ultrasound-detected ureteral calculi, it may represent a clinical dilemma due to the potential risks for both mother and fetus.

Objective

The aim of the present study is to present our experience with the application of the ureteroscope in the emergency treatment of persistent renal colic patients during pregnancy.

Methods

From March 2009 to September 2014, a total of 117 pregnant women who received ureteroscopy for persistent renal colic were retrospectively analyzed. Patients were divided into three groups according to duration of the persistent renal colic: Group A (within 12 hours; 24 cases); Group B (12 to 24 hours; 76 cases); and Group C (more than 24 hours; 17 cases). The stone-free rate, complications, and other qualitative data were analyzed.

Results

Of the 117 patients, 31 patients who were found not to have renal or ureteral calculi received ureteroscopic double-J (DJ) stent insertion, whereas 86 patients who were found with ureteral calculi received ureteroscopic lithotripsy (URSL) and DJ stent insertion. Among them, 24 patients (27.9%) were found with ureteral calculi by ureteroscopy rather than ultrasound. In addition, 73 patients (84.9%) had complete fragmentation of calculi; 12 patients (10.3%) had a threatened abortion (the rates of threatened abortion in Groups A, B and C were 8.3% vs. 6.5% vs. 29.4%; Group C compared with Groups A and B, p<0.05), and one patient (1.2%) had urosepsis (in Group C). However, these complications were cured with conservative treatment, without postpartum infant and maternal complications.

Conclusion

For pregnant patients with persistent renal colic/ureteral calculi and hydronephrosis, ureteroscopic DJ stent insertion and URSL are effective and safe options when conservative treatment fails, even if no urinary calculi were found by ultrasound. At the same time, for patients with persistent renal colic during pregnancy, early application of ureteroscopy may reduce the risk of preterm birth.     

Premature labor and indomethacin.

Women in the 29th - 32nd week of gestation were admitted to hospital following the onset of premature labor contractions. After treatment with bed rest and beta-stimulating drugs, those patients with persistent uterine contractions were treated with oral indomethacin (25 mg every 6 hours for 5 days). The effect of indomethacin therapy was monitored by serial external tocometry recordings. This treatment schedule with indomethacin was repeated on several occasions at intervals of 5 to 10 days. Using a standardized technique, uterine contractility was monitored every second or third day throughout the entire treatment period. In this way, the frequency of contractions was evaluated in the presence or absence of indomethacin therapy. Following indomethacin treatment, there was a significant decrease in the frequency of contractions in all cases and a complete arrest of contractions occurred in some women. An increased frequency of contractions was observed during those times that the patient did not receive indomethacin. The plasms concentration of 15-keto-13, 14-dihydro-PGF2alpha, the major serum metabolite of PGF2alpha, was determined by the gas chromatography - mass spectrometry method before and after indomethacin in a limited number of cases. At the doses given for the duration of therapy used, no untoward effects could be detected in either the mother or the infant. These results indicate that indomethacin is a potent and useful drug in the treatment of premature labor.