高龄瘢痕子宫再妊娠孕产妇剖宫产术终止妊娠直接病因及预后影响因素分析

摘要 目的：探讨高龄瘢痕子宫再妊娠孕产妇剖宫产术终止妊娠直接病因及预后影响因素分析。方法：回顾性分析2016年1月-2020年10月在我院收治的400例高龄瘢痕子宫再妊娠孕妇。按照是否终止妊娠将400例孕妇分为终止妊娠组（200例）和未终止妊娠组（200例）。并对200例终止妊娠孕妇进行2年随访,按照2年内再妊娠情况分为再妊娠成功组（150例）和再次终止妊娠组（50例）。采用Spearman检验进行相关性分析;采用logistics回归模型进行回归分析。结果：200例终止妊娠孕妇中瘢痕妊娠60（30.00 %）例,死胎13（6.50 %）例,胎儿畸形25（12.50 %）例,子痫前期81（40.50 %）例,胎膜早破11（5.50%）例,妊娠意外事件10（5.00 %）例。高龄瘢痕子宫孕妇终止妊娠后再妊娠与教育水平、是否有固定职业、家庭月收入无关（P＞0.05）;与年龄、孕次、产次、剖宫产手术史、终止妊娠病因有关（P<0.05）;200例终止妊娠孕妇预后再妊娠与年龄、孕次、产次、剖宫产手术史、终止妊娠病因密切相关（P<0.05）;多因素分析结果显示,年龄、孕次、产次、剖宫产手术史、终止妊娠病因是独立危险因素（P<0.05）。结论：高龄瘢痕子宫孕妇终止妊娠的主要病因为瘢痕妊娠,死胎,胎儿畸形例,子痫前期,胎膜早破,妊娠意外事件。年龄、孕次、产次、剖宫产手术史、终止妊娠病因是影响高龄瘢痕子宫孕妇预后再妊娠的独立危险因素。     

早发型重度子痫前期终止妊娠对母婴预后的影响分析

目的:探讨早发型重度子痫前期终止妊娠时机对母婴预后结局的作用,为临床实践提供指导。方法:从2007年1月至2010年12月期间在我院妇产科分娩并为重度子痫前期患者中随机选取135例作为研究对象。按终止妊娠时间分为两组,A组<32周、32周≤B组≤34周。对两组均终止妊娠,比较两组间血压状况、尿蛋白、血小板、凝血、眼底状况及胎儿监护。结果:A组的胎盘早剥、子痫和肾功能损害的发生率略高于B组,然而差异均无统计学意义(P>0.05)。A组的新生儿窒息率,新生儿呼吸窘迫综合征发生率,围产儿死亡率等3个指标均明显高于B组,且卡方检验显示,两组比较差异有显著性(P<0.05)。结论:对于终止妊娠的时间、方式应根据患者的状况进行综合考虑。无论选择何时终止妊娠或治疗,都应该综合考虑母婴两方面的状况,密切进行监护,尽量获得良好的结局。     

马流产杆菌脂多糖终止小白鼠妊娠的初步研究

参照酚—水法从马流产杆菌中提取出脂多糖,其纯度达到参考标准品的要求。用它对早、中和晚期妊娠小鼠进行腹腔或尾静脉注射,每只小鼠(体重25—30克)注射剂量在5—30μg均能产生终止妊娠的效果,有效率达93—100%。每只注射剂量25和25μg以下的妊娠小鼠全部存活,无明显毒性反应,而30μg剂量的8只小鼠中有2只死亡。     

米非司酮配伍米索前列醇与利凡诺在终止妊娠中的应用比较

目的:比较米非司酮配伍米索前列醇与利凡诺在终止妊娠中临床效果与安全性。方法:选取自愿终止妊娠者86例,随机分成观察组和对照组,每组各43例。观察组使用米非司酮配伍米索前列醇;对照组予以利凡诺行羊膜腔内穿刺注射。观察两组的引产过程、引产效果及可能出现的副作用。结果:观察组用药后宫缩发动时间、产程均短于对照组(P<0.01);观察组与对照组引产成功率分别为93.02%、86.05%,无统计学差异(P>0.05);但观察组24h内引产成功率显著高于对照组,而对照组24~48 h、48 h后引产成功率显著高于观察组(P<0.01)。观察组胎膜残留、产后2h内出血量、药物热、胃肠道反应、腹痛的发生率均低于对照组(P<0.05或P<0.01)。结论:米非司酮联合米索前列醇终止中期妊娠具有方法简单、宫缩发动快、产程短、损伤小、出血少等优点,优于利凡诺羊膜腔内穿刺注射。     

川金丝猴流产和死胎的病理学观察

川金丝猴(Rhinopithecus roxellanae)在各动物园及有关饲养单位饲养过程中,怀孕母猴极易流产,造成繁殖困难,故动物园等单位饲养的金丝猴逐年减少。本文对其8胎次流产胎儿及胎盘和1 只正产胎盘作病理组织学观察比较,以提供对流产原因的分析探讨,现将结果简报如下。材料和方法     

口服米非司酮配伍米索前列醇阴道用药终止早孕临床观察

我们参照Ｅｌ－Ｒｅｆａｅｙ等［１］报道的方案,口服米非司酮配伍米索前列醇（米索）阴道用药终止早孕３９例,效果良好,现报告如下。１临床资料１．１研究对象自愿接受此药物流产方案的孕妇３９例,停经４９ｄ,平均４２．５ｄ,年龄最小１９岁,最大３２岁,平均２５...     

重复异位妊娠28例临床分析

目的 :分析重复异位妊娠的发病因素、治疗及结局。方法 :回顾性调查 1995年 1月至 2 0 0 2年12月我院 2 8例重复异位妊娠的诊治 ,分析前次异位妊娠的治疗方法 ,所见盆腔炎情况等与本次重复异位妊娠之间的关系。结果 :重复异位妊娠 2 8例占同期 5 76例异位妊娠中的 4 86 %。首次行患侧输卵管切除术者的重复异位妊娠发生对侧占 93 3% ,而保守性手术及药物保守治疗者重复异位妊娠发生在原患侧占84 6 %。两者间差异有显著意义 (P <0 0 5 )。结论 :输卵管炎症与保守治疗是重复异位妊娠的高危因素     

慢性前列腺炎病因分析及护理对策

前列腺炎是男性泌尿生殖系统常见病,约50％的男性在其一生中曾有前列腺炎的症状。其中,慢性前列腺炎（CP）更为多见,在全世界男性中的患病率为9％～14％．本病的临床表现变化多端．病因及发病机制尚未完全阐明,因此许多患者没有得到有效的治疗,严重影响息者生活质量。现对我院2003-2009年收治住院的96例慢性前列腺炎患者的资料进行总结分析如下。     

小儿气管异物的病因分析及护理

气管异物是耳鼻喉科急重症之一,多发生于1～5岁,尤其3岁以下多见.轻者可致气管、支气管和肺部损伤,重者可因窒息死亡.我院2002年11月～2007年11月收治小儿气管异物32例,经积极抢救,精心护理,全部治愈出院.现将小儿气管异物发生原因进行分析及护理总结如下.     

蛋白质合成终止的研究进展

蛋白质合成终止的研究进展于长春,程焉平,王庆华（四平师范学院生物系,四平１３６０００）（山东大学生物系,济南２５０１００）关键词蛋白质合成,释放因子,终止密码子在过去５年中,对蛋白质合成终止取得了一些新的认识。当然,多数结果是由研究Ｅ．ｃｏｌｉ取得的...     

Clinical evaluation of different applications of misoprostol and aglepristone for induction of abortion in bitches

The aim of the present study was to compare the clinical and endocrinological effects of different applications of misoprostol (MIS) and aglepristone (AGL) for the induction of abortion in bitches. For this purpose, 28 healthy pregnant bitches from different breeds, ages, body weights (Body weigt, BWs, 10–40 kg), and between Days 25 to 35 of gestation were used. Bitches were randomly assigned to four groups. In group 1 (GI, n = 7), AGL (10 mg/kg BW, s.c. on 2 consecutive days); in group 2 (GII, n = 7), AGL (as in GI), intravaginal MIS (IVag, 200 μg for bitches with ≤20 kg BW, 400 μg for bitches with >20 kg BW, daily intravaginally until completion of abortion); in group 3 (GIII, n = 7), AGL (as in GI), ICVag (as in GII), per os MIS (400 μg for bitches with ≤20 kg BW, 800 μg for bitches with >20 kg BW, daily orally, until completion of abortion); in group 4 (GIV, n = 7), AGL (as in GI), per os MIS (as GIII) were used. Clinical, vaginal, and ultrasonographic examinations were performed daily until abortion was completed. For measurement of serum progesterone, blood samples were collected in all groups immediately after the first AGL administration and every other day until completion of abortion. No statistical differences were found between groups concerning the duration until completion of abortion after treatment (nonsignificant); however, in GII, one bitch completed abortion 2 days after the start of treatment.     

The intravaginal application of misoprostol improves induction of abortion with aglepristone

The aim of the present study was to compare the clinical and endocrinological effects of four different treatments for the induction of abortion in bitches. For this purpose, 28 pregnant bitches between days 25 and 35 of gestation, were randomly assigned to four groups. In group I (n = 7), only aglepristone (AGL, 10mg/kg bw, two injections 24 h apart, s.c.) was administered. In group II (n = 7), AGL (as in group I), cabergolin (CAB, 5 μg/kg, daily p.o., until completion of abortion) and misoprostol (MIS, 200 μg for bitches with ≤ 20 kg bw, 400 μg for bitches with > 20 kg bw, daily intravaginally, until completion of abortion) were administered. In group III (n = 7), AGL (as in group I) and MIS (as in group II) were administered. In group IV (n = 7) AGL, (as in group I) and cloprostenol (CLO, 1μg/kg bw, s.c., two injections 24 h apart with the AGL injections) were combined. In all groups, bitches were examined daily, clinically and ultrasonographically to monitor resorptions/abortions. To measure serum progesterone (P4) and total estrogen (TE) concentrations, blood samples were collected in all groups immediately after the first AGL administration and every other day until completion of abortion. No statistical differences were found between groups concerning the duration until completion of abortion following treatment (n.s.); however, in Group III, 6 d after the start of treatment all pregnancies were terminated whereas in Group I, II and IV, only 57.1% (4/7), 85.7 % (6/7) and 42.8 % (3/7) of pregnancies were terminated. In the latter groups, all pregnancies were terminated between days 8 and 10 after the start of treatment. In Group IV, P4 concentrations on days two and one before the beginning of abortion and the day the abortion started was significantly lower than in the other groups (P < 0.01). No statistical differences were found between groups for TE concentrations (P > 0.05). In Groups I, II and III, no severe side effects occurred. Severe vomiting after each treatment and until the end of abortion was observed in Group IV only. In conclusion, only when a combination of AGL and MIS was used abortion was completed within 6 d in all bitches whereas the additional use of CAB did not improve the treatment.     

Induction of abortion with aglepristone significantly changed the expression of progesterone and estrogen receptors in canine endometrial stromal cells

In the present study, resorption/abortion was induced between days 25 and 45 of gestation with aglepristone (group IRA, n=10). The aim was to observe the change in the distribution of progesterone (PR) and estrogen receptors (ER), in comparison to a group of spontaneous resorptions/abortions (group SRA, n=5), and a further group of normal healthy pregnant animals, ovariohysterectomized between days 25 and 45 of gestation (controls, n=7). The receptors were assessed by means of immunohistochemistry (IHC) and RT-PCR, at the placental and interplacental sites of the uterine horn as well as in the corpus uteri. Significant differences were observed between the controls on one side and the groups of resorption/abortion on the other side. The total scores of the progesterone receptors (TPR) in the placental and interplacental part of the uterine horn, was significantly lower in the endometrial stromal cells (ESC) of the control group than in those of the SRA- and IRA-group, respectively (placenta: 5.8 vs. 6.5 and 6.7, p<0.01; interplacental sites: 5.6 vs. 6.6 and 6.6, p<0.05). In contrary, the total scores of the estrogen receptors (TER) at interplacental sites and the corpus uteri, respectively, was significantly higher in the myometrial smooth muscle cells (MSMC) and the ESC (p<0.05) of the controls. We therefore conclude, that the here observed differences between groups point to an up-regulation of TPR- and a down-regulation of TER-scores in endometrial stromal cells at different uterine sites during resorption/abortion, which indicates a special role of these cells.     

Discrimination between defects in elongation fidelity and termination efficiency provides mechanistic insights into translational readthrough

The suppression of stop codons (termed translational readthrough) can be caused by a decreased accuracy of translation elongation or a reduced efficiency of translation termination. In previous studies, the inability to determine the extent to which each of these distinct processes contributes to a readthrough phenotype has limited our ability to evaluate how defects in the translational machinery influence the overall termination process. Here, we describe the combined use of misincorporation and readthrough reporter systems to determine which of these mechanisms contributes to translational readthrough in Saccharomyces cerevisiae. The misincorporation reporter system was generated by introducing a series of near-cognate mutations into functionally important residues in the firefly luciferase gene. These constructs allowed us to monitor the incidence of elongation errors by monitoring the level of firefly luciferase activity from a mutant allele inactivated by a single missense mutation. In this system, an increase in luciferase activity should reflect an increased level of misincorporation of the wild-type amino acid that provides an estimate of the overall fidelity of translation elongation. Surprisingly, we found that growth in the presence of paromomycin stimulated luciferase activity for only a small subset of the mutant proteins examined. This suggests that the ability of this aminoglycoside to induce elongation errors is limited to a subset of near-cognate mismatches. We also found that a similar bias in near-cognate misreading could be induced by the expression of a mutant form of ribosomal protein (r-protein) S9B or by depletion of r-protein L12. We used this misincorporation reporter in conjunction with a readthrough reporter system to show that alterations at different regions of the ribosome influence elongation fidelity and termination efficiency to different extents.     

Antimicrobial resistance in bacteria from breeding dogs housed in kennels with differing neonatal mortality and use of antibiotics

This work examines the antimicrobial resistance of potentially pathogenic bacteria (Staphylococcus pseudintermedius, Streptococcus canis, Escherichia coli) found in the vaginal tract in prepartum mammary secretions and postpartum milk of bitches housed in breeding kennels (N = 20; 92 bitches). The kennels were divided into three categories: no routine antimicrobial administration around parturition (category 1); routine administration of one antibiotic around parturition (category 2); routine administration of multiple antimicrobials around parturition (category 3). Bacteriological cultures and antibiotic susceptibility tests were performed on vaginal specimens, prepartum mammary secretions, and postpartum milk. Stillbirths and neonatal deaths were recorded for each whelping and analyzed as “within-litter stillbirths” and “within-litter neonatal deaths” according to kennel category, by Pearson χ² test and the Kruskal-Wallis nonparametric test, respectively. The frequency of isolation and antimicrobial resistance of bacteria were analyzed according to kennel category by Pearson χ² test. Kennel category was not significantly associated with differing numbers of stillbirths or neonatal death events, nor was the frequency of isolation of potentially pathogenic bacteria in the three kennel categories significantly different. Kennel category 3 had a significantly higher frequency of isolation of multiresistant gram-positive bacterial strains. Our results show that intense administration of antibiotics to breeding bitches does not effectively reduce neonatal mortality; on the contrary, it induces multiresistance in potentially pathogenic bacteria. Breeders and veterinarians should be aware of the risk of selecting pathogenic bacteria by uncontrolled treatment in prepartum bitches.