目的 了解国内妊娠期抗菌药物的应用现状。 方法 通过检索1994年－2012年国内医学文献，筛选出妊娠期间使用抗菌药物的原始病例报道，对收集的病例按照用药原因、抗菌药物品种、妊娠安全性分级进行统计分析。其中妊娠安全性分级是根据美国药物和食品管理局（FDA）颁布的药物危害等级标准，分为A、B、C、D、X级。 结果 妊娠期使用抗菌药物的常见原因为泌尿系统感染，选用的抗菌药物以头孢菌素和青霉素类为主（B类），但仍有部分病例选用C类、D类药物及超说明书用药。 结论 存在妊娠期抗菌药物不合理应用现象，妊娠合并感染性疾病需用抗菌药物时，医生应权衡抗菌药物对胎儿的可能危害及对母体的治疗作用，最大限度地避免用药对胎儿造成不良影响。
ObjectiveTo systematically review the clinical efficacy and effects on pregnancy outcomes of S-adenosy-L-methionine combined with ursodesoxycholic acid in the treatment of intrahepatic cholestasis of pregnancy. MethodsDatabases such as PubMed, The Cochrane Library, CNKI, VIP, WanFang Data were searched for the studies about the clinical efficacy and effects on pregnancy outcomes of S-adenosy-L-methionine combined with ursodesoxycholic acid in the treatment of intrahepatic cholestasis of pregnancy up to December 31st, 2013. Two reviewers independently screened literature, extracted data and evaluated methodological quality. Then meta-analysis was conducted using RevMan 5.0.24 software. ResultsA total of 11 RCTs involving 776 patients were included. The results of meta-analysis showed that, combined medication reduced blood biochemical indexes inlcuding ALT (MD=3.63, 95%CI 0.63 to 6.64, P=0.02), TB (MD=3.70, 95%CI 1.45 to 5.96, P=0.001), and AST (MD=7.61, 95%CI 2.47 to 12.75, P=0.004). Combined therapy significantly decreased the rates of amniotic fluid contamination (OR=0.29, 95%CI 0.19 to 0.45, P=0.000 01), cesarean section (OR=0.53, 95%CI 0.36 to 0.79, P=0.002), postpartum hemorrhage (OR=0.32, 95%CI 0.12 to 0.90, P=0.03), preterm birth (OR=0.36, 95%CI 0.24 to 0.55, P < 0.000 01), fetal distress (OR=0.33, 95%CI 0.19 to 0.58, P=0.000 1) and neonates asphyxia (OR=0.30, 95%CI 0.19 to 0.47, P < 0.000 01). Combined therapy was also beneficial to improving pruritus symptoms (MD=0.20, 95%CI 0.08 to 0.31, P=0.000 08) and benefiting fetus growth (MD=0.45, 95%CI 0.23 to 0.66, P < 0.000 1). ConclusionThe combination of S-adenosy-L-methionine and ursodesoxycholic acid is superior to ursodesoxycholic acid alone in improving clinical symptoms and pregnant outcomes of patients with intrahepatic cholestasis of pregnancy.
ObjectiveTo investigate the diagnostic value of serum cystatin-C (Cys-C) detection in hypertensive disorder complicating pregnancy patients. MethodsA hundred patients with pregnancy induced hypertension (PIH) were chosen as the research object from February 2012 to March 2013, and they were divided into mild group, moderate group and severe group according to the severity of the disease. The other 40 healthy pregnant women were selected as the controls (the control group). We compared the four groups in terms of Cys-C, serum urea nitrogen (BUN) and creatinine level, as well as the positive rate of Cys-C, BUN, and creatinine. ResultsCys-C, BUN, and creatinine in the PIH group were significantly higher than those in the control group (P<0.05). Cys-C and creatinine in preeclampsia mild group were significantly higher than those in the control group (P<0.05), but BUN level between the two was not statistically significant (P>0.05). Cys-C, BUN, and creatinine in the PIH moderate and severe groups were significantly higher than those in the control group (P<0.05). The abnormal rate of Cys-C in the PIH mild group was significantly higher than that of Cys-C and creatinine (P<0.05). ConclusionCys-C, BUN and creatinine can all show renal damage in PIH patients, but the Cys-C value in early diagnosis is better than that of BUN and creatinine. It can be used as a monitoring index of pregnancy-induced hypertension prevention and early treatment.
Objective To systematically review the association between periodontal disease during pregnancy and the risk of gestational diabetes mellitus (GDM). Methods PubMed, Web of Science, CBM and CNKI databases were electronically searched to collect studies on periodontal disease and GDM from inception to October 23, 2021. Two researchers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software. Results A total of 11 studies were included, involving 2 910 pregnant women. The results of meta-analysis showed that pregnant women with periodontal disease during pregnancy reported more GDM than normal pregnant women (OR=1.81, 95%CI 1.31 to 2.50, P=0.000 3). Conclusion The current evidence suggests that there is a positive association between periodontal disease during pregnancy and the risk of GDM. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
ObjectiveTo systematically review the diagnosis value of glycosylated hemoglobin (HbA1c) in diagnosis of gestational diabetes mellitus (GDM).MethodsThe diagnostic studies concerning glycosylated hemoglobin in gestational diabetes were electronically searched in EMbase, PubMed, The Cochrane Library, CNKI, WanFang Data and VIP from inception to October, 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies by QUADAS-2 standard. Meta-analysis was performed by RevMan 5.3 and Meta-Disc 1.4 software.ResultsA total of 33 studies involving 16 622 persons were included. The results of meta-analysis showed that the pooled sensitivity, specificity, positive predictive value, negative predictive value, the pooled DOR of HbA1c were 0.75 (95%CI 0.74 to 0.77), 0.91 (95%CI 0.90 to 0.91), 8.21 (95%CI 5.41 to 12.46), 0.18 (95%CI 0.11 to 0.28), 45.10 (95%CI 29.70 to 68.48), respectively. The AUC of SROC was 0.933 5. Subgroup analysis by different HbA1c measurements indicated that little variations between different measurements in sensitivity and specificity.ConclusionHbA1c in GDM diagnosis has high sensitivity and specificity. Due to the limited quality and quantity of included studies, the above results should be validated by more studies.
目的 探讨不典型胎盘早剥的临床特点。 方法 对2008年5月－2009年5月收治的55例胎盘早剥患者的临床资料进行回顾性分析。其中产前漏诊30例，疑诊15例，确诊10例。胎盘早剥的产前确诊率为18.2%，漏诊率为54.5%。所有患者均经产后证实。 结果 重度子痫前期（25.5%）、胎膜早破（12.7%）是胎盘早剥的主要发病诱因；阴道流血（52.7%）、腰腹痛（47.3%）及胎心异常（36.4%）是其常见的临床表现。胎盘早剥者，剖宫产率、胎儿窘迫及早产率均增加。 结论 不典型胎盘早剥病情隐匿。后壁胎盘、早剥面积小及B型超声检查阴性是漏诊的主要原因。对此患者应提高认识，动态监测，及时处理，以改善母婴结局。
ObjectivesTo systematically review the correlation between maternal serum selenium levels during pregnancy and premature birth.MethodsDatabases including PubMed, The Cochrane Library, EMbase, Web of Science, CNKI and CBM were searched to collect studies on correlation between maternal serum selenium levels during pregnancy with preterm birth in the offspring from inception to January, 2020. Two reviewers independently screened literature, extracted data and evaluated risk of bias of the included literature. Then, meta-analysis was conducted by using RevMan 5.3 software.ResultsA total of 12 studies involving 2 484 patients were included. The results of meta-analysis showed that compared with control group, the preterm group had lower serum selenium levels in pregnant females (SMD=−0.89, 95%CI −1.56 to −0.22, P=0.01). The results of the subgroup analysis showed that heterogeneity among subjects was still large when grouped accorcding to the continent to which a country belongs, the time of blood sample collection and test method in pregnant females.ConclusionsLow maternal serum selenium levels during pregnancy may increase the risk of preterm birth. Due to the limitation of the quantity and quality of the included studies, the above conclusions are required to be verified by more high quality studies.