Ischaemic Heart Disease in Young Women

The mortality rate from ischaemic heart disease (I.H.D.) has increased in young women by about 50% in 12 years, and it is now possible to report the findings in 150 women who developed symptoms and signs of I.H.D. under the age of 45. Data obtained from 145 of these women form the basis of this report: 81 presented with myocardial infarction and 64 with angina. In the remaining five there was a definite nonatherosclerotic cause for the premature onset of I.H.D.Hypercholesterolaemia, hypertension, or excessive cigarette smoking each occurred in a large minority, and more than one of these major risk factors was present in most patients. Hypercholesterolaemia was the commonest factor. In women in whom lipoprotein typing was undertaken the type II pattern was more frequent than type IV. The prevalence of hypercholesterolaemia and hypertension was the same in those with myocardial infarction and in those with angina.Excessive cigarette smoking was more common in women with myocardial infarction than in those with angina. The latter did not differ in their cigarette smoking habits from the normal population.A premature menopause had occurred in 20% of these women, but there was no relation between the early onset of I.H.D. with age at menarche, parity, or the incidence of abortion. Oral contraceptives did not increase the risk of myocardial infarction unless one of the major risk factors was also present.Altogether 75% of patients with angina or myocardial infarction survived 12 years. Coexisting hypertension worsened the prognosis. The prognosis after myocardial infarction was similar in these women to that previously described for men under the age of 40.     

Association of Plasma Resistin Levels with Coronary Heart Disease in Women

Objective: To examine the association between plasma resistin levels and the presence of coronary heart disease (CHD) in women. Research Methods and Procedures: Plasma resistin levels were measured in a case‐control study including 185 women with angiographically confirmed CHD and 227 population‐based female controls from the Coronary Risk Factors for Atherosclerosis in Women (CORA) study. Results: After adjustment for age, smoking, family history of myocardial infarction, retirement, education, physical activity, menopausal status, hormone replacement use, BMI, hypertension, diabetes, and dyslipidemia, the odds ratio for CHD for women in the highest compared with lowest quintile of plasma resistin levels was 3.19 (95% confidence interval, 1.44 to 7.10; p log trend, 0.001). After additional adjustment for plasma C‐reactive protein levels, this association was substantially attenuated and no longer significant (odds ratio, 1.80; 95% confidence interval, 0.69 ti 4.69; p trend = 0.23). Discussion: These results suggest that plasma resistin levels are significantly associated with the presence of CHD in women; however, this association can largely be explained by concomitant inflammatory processes. Further studies are needed to determine the causal role of resistin in the development of CHD in humans.     

妊娠合并心脏病812例临床分析

目的:探讨妊娠合并不同种类心脏病患者的母儿预后.方法:对我院2002年3月至2012年5月间收治的812例妊娠合并心脏病患者的有关临床资料进行回顾分析.结果:1).研究的470例妊娠合并先心病患者平均年龄为30.0±4.7岁,101例妊娠合并风心病患者平均年龄为30.1+ 4.8岁,241例妊娠合并其它心脏病患者平均年龄为29.1+ 4.5岁.470例妊娠合并先心病患者初产妇为425例,101例妊娠合并风心病患者初产妇为74例,241例妊娠合并其它心脏病患者初产妇为200例.三组患者的心脏病史相比较,差异有统计学意义;三组并发症相比较,差异无统计学意义.2).妊娠合并先心病和风心病从2002年到2012年每年的发病均呈递增的趋势;妊娠合并其它心脏病的发病高峰在2007年至2010年.3).妊娠合并先心病组同妊娠合并风心痛组及妊娠合并其它心脏病组的新生儿不良结局的比较结果中,新生儿死亡及早产比较,差异有统计学意义.窒息、低体重儿、脐绕颈、胎儿窘迫的比较,差异无统计学意义.4).在母亲妊娠结局方面,三组的剖宫产、胎盘残留、产褥病率及脐带异常相比较,差异均无统计学意义.心律失常及其它并发症比较,P＜0.001,差异有统计学意义.结论:对于妊娠合并不同心脏病患者的母儿预后的影响有待更多研究,加强孕前心脏病史的管理可以显著改善母儿预后,临床上应重视合并心脏病孕妇的孕前咨询、产前检查和孕期保健,强调对其妊娠期、分娩期、产褥期进行多学科、规范化管理,割宫产是较为安全的分娩方式.     

产前超声在中孕期胎儿严重先天性心脏病筛查中的应用

目的:探究产前超声检查在中孕期胎儿严重先天性心脏病(CHD)筛查中的应用。方法:选择2012年1月至2014年1月在我院妇产科进行产前常规超声检查的孕妇12076例,年龄22-41岁,平均(28.6±8.3)岁,孕周20-36周,平均(25.2±6.7)周。将符合纳入排除标准的孕妇8953例作为研究对象,其中初产妇6023例,经产妇2930例。对纳入研究的孕妇行彩色多普勒超声检查,并对妊娠结局进行追踪,将确诊情况与筛查结果进行比较分析。结果:产前彩色多普勒超声诊断出胎儿CHD38例,经尸检或新生儿彩色多普勒超声检查均确诊为CHD,对胎儿期未筛查出CHD的孕妇进行新生儿彩色多普勒超声检查,确诊4例,产前超声检查胎儿CHD检出率为90.48%(38/42),检出准确率100%(38/38)。结论:彩色多普勒超声筛查孕中期胎儿CHD,灵敏度和特异性高,安全无创伤,操作简便快速,值得推广为产前筛查的首选方法。     

Blood Cadmium Concentrations in Women with Ectopic Pregnancy

The purpose of this study is to investigate the relationship between the blood level of cadmium and the occurrence of ectopic pregnancy. Forty-one (41) case patients with ectopic pregnancy and 41 uncomplicated intrauterine pregnant patients as controls were recruited. The concentrations of cadmium (Cd) were measured from blood samples using atomic absorption spectrometry. The cases and controls were similar in age, body mass index, and smoking habits. The median blood level of Cd was 0.32 μg/l (interquartile range [IQR] 0.00–0.71) in the women with ectopic pregnancies and 0.34 μg/l (IQR 0.09–0.59) in the controls. There was no significant association between blood cadmium levels and ectopic pregnancy.     

EEG Features in Women with a Complicated Pregnancy

Clinical and EEG spectral analysis was carried out in 14 pregnant women (five women at risk of preterm labor and four with miscarriage). It was shown that the baseline EEG pattern of women with the persistent threat of preterm labor was characterized by the high spectral power of the -rhythm and its predisposition to hypersynchronization. In the miscarriage group, virtually a complete absence of the -rhythm and the predominance of generalized both high-frequency and slow low-amplitude rhythms are noted in most pregnant women. The data obtained allow a risk group characterized by either a hypersynchronous unstable -rhythm or its absence to be identified among pregnant women.     

Resting Heart Rate Variability and the Effects of Biofeedback Intervention in Women with Low-Risk Pregnancy and Prenatal Childbirth Fear

Anxiety about labor in women at the end of pregnancy sometimes reaches levels that are clinically concerning. We investigated whether low-risk pregnant women with childbirth fear during the last trimester demonstrate specific findings with regard to resting heart rate variability (HRV) and examined whether HRV biofeedback can reduce this fear and alter resting HRV. We measured the levels of childbirth fear (Wijma delivery expectancy/experience questionnaire, W-DEQ) and resting HRV indexes in 97 low-risk pregnant women in their 32nd–34th week of gestation and advised women with W-DEQ scores of ≥?66 (n?=?40) to practice HRV biofeedback (StressEraser) at home. We then reassessed these measures 3–4 weeks later in the 36th–37th week of gestation regardless of whether the women practiced the method. We found that childbirth fear had no significant effect on resting HRV indexes when the W-DEQ cutoff was conventionally set at ≥?66. However, women with W-DEQ scores of ≥?90 (n?=?5) had a significantly lower high-frequency power than their counterparts (p?=?0.028). The W-DEQ scores reduced significantly in women who performed HRV biofeedback (n?=?18, p?<?0.001), but there was no change in those who did not perform the method (n?=?20). These findings suggested that very high W-DEQ scores (≥?90), but not the conventional criteria (W-DEQ score?≥?66), of the fear of childbirth were associated with low parasympathetic activity among low-risk pregnant women and that HRV biofeedback intervention can effectively decrease the fear of childbirth in these women.