观察受体鼠妊娠和胚胎着床情况,并检测胚胎移植时小鼠子宫内膜中白血病抑制因子(Lif)表达水平,探讨超排卵对小鼠胚胎着床潜能的影响。方法:建立超排周期胚胎和自然周期胚胎移植小鼠模型,比较妊娠率、胚胎着床率的差异及其与Lif蛋白的表达水平之间的关系。结果:超排卵周期受体组的妊娠率(20.00%)和胚胎着床率(8.33%)显著低于自然周期组的妊娠率(55.00%)和胚胎着床率(35.00%)(P＜0.05)。自然周期胚胎和超排周期胚胎受体组内膜中Lif蛋白的表达水平相似(P＞0.05),妊娠受体组Lif蛋白的表达水平显著高于未孕受体组(P＜0.05),但单胎妊娠和多胎妊娠受体组内膜中Lif蛋白的表达水平相似(P＞0.05)。结论:超排卵可能降低胚胎的着床潜能,Lif蛋白的表达水平与胚胎着床有关,但与着床胚胎的数目无比例关系。
ObjectiveTo investigate the effectiveness of the tubal reconstruction after laparoscopic tubal pregnancy operation by comparing with simple laparoscopic tubal pregnancy operation. MethodsBetween May 2007 and May 2010, 63 patients with tubal pregnancy underwent laparoscopic tubal pregnancy operation and tubal reconstruction in 30 cases (trial group) or simple laparoscopic tubal pregnancy operation in 33 cases (control group). There was no significant difference in age, pregnancy time, and position between 2 groups (P gt; 0.05). The tube patency test and hysterosalpingography (HSG) were carried out to evaluate the efficacy. ResultsThe operation was successfully completed in 29 cases of trial group; 1 case had too severe adhesion to receive re-anastomosis and was excluded. The tube patency test showed that the tube was patency in 26 cases of trial group and in 2 cases of control group during operation, showing significant difference (Z=5.86, P=0.00); it was patency in 25 cases of trial group and in 26 cases of control group at 1 month after operation, showing no significant difference (Z=0.48, P=0.63). HSG examination showed tube was patency in 25 cases of trial group and in 2 cases of control group at 2 months after operation, showing significant difference (Z=5.35, P=0.00). After 24 months, intrauterine pregnancy of trial group (n=25, 86.20%) was significantly higher than that of control group (n=19, 57.58%) (χ2=7.72, P=0.01). ConclusionThe reconstruction after laparoscopic tubal pregnancy operation can significantly increase the intrauterine pregnancy rate, and it is better than simple laparoscopic tubal pregnancy operation.
Objective To assess the efficacy and safety of S-adenosyl-l-methionine (SAMe) for outcome improvement of intrahepatic cholestasis of pregnancy. Methods Randomized controlled trials (RCT) and quasi-randomized controlled trials were identified from MEDLINE (1983 to 2003), The Cochrane Library (Issue 4,2003), EMBASE (1980 to 2003), China Hospital Digital Library (CHDL) and Wanfang data (1994 to 2003). We also handsearched the relative references. Two researchers evaluated the quality of the trials and extracted the data independently. RevMan software 4.2 was used for meta-analysis. Results Eight studies involving 424 pregnant women were included. The following data were the results of meta-analysis of SAMe for improvements: ① Reducing cesarean-section ratio: no significant difference was seen between SAMe and placebo groups with OR 1.00, 95%CI 0.23 to 4.33 and P= 1.00; significant differences were seen SAMe versus dexamethasone and SAMe versus Dianglining with OR 0.44, 95%CI 0.23 to 0.85 and P=0.01; OR 0.28 95%CI 0.10 to 0.75 and P=0.01 respectively。② Prolonging the period of pregnancy: SAMe had no significant difference compared with placebo groups with WMD=0.70, 95%CI －0.69 to 2.10, P=0.32. SAMe was more effective than dexamethasone, Ganyinling and Qianglining on prolonging the period of pregnancy with WMD=1.10，95%CI 0.46 to 1.74, P=0.000 07; WMD=2.50，95%CI 1.86 to 3.14, P≤0.000 01; WMD=2.20，95%CI 1.61 to 2.79, P≤0.000 01 respectively；③ Increasing the weight of the newborn: meta-analysis showed that SAMe group had not significant difference compared with placebo group on increasing the weight of the newborn with WMD=-26.27，95%CI -338.35 to 285.82, P=0.87. Significant differences were seen between SAMe and dexamethasone, SAMe and Ganyiling, SAMe and Qiangling with WMD=386.86，95%CI 134.41 to 603.31, P=0.002; WMD=410.00,95%CI 321.10 to 498.90, P≤0.000 01 respectively. ④ Fetal distress: There was no significant difference compared with dexamethasone and Kuhuang groups on decreasing the fetal distress with OR=0.47, 95%CI 0.14 to 1.16, P=0.23; OR=0.44, 95%CI 0.10 to 1.97, P=0.29 respectively; ⑤ Decreasing pollution of amniotic fluid: no significant differences were seen in SAMe versus dexamethasone, SAMe versus ursoddeoxycholic and SAMe versus Kuhuang with OR=0.46, 95%CI 0.21 to 1.02, P=0.06; OR=0.68, 95%CI 0.20 to 2.31, P=0.53; OR=0.82 95%CI 0.24 to 2.81,P=0.75 recpectively. ⑥ Newborn stifile: SAMe group had no significant difference compared with dexamethasone and Kuhuang groups on decreasing the Newborn stifile with OR=0.19, 95%CI 0.01 to 4.06, P=0.29; OR=0.31, 95%CI 0.08 to 1.13, P=0.08 respectively. Compared with Qianglining group, SAMe group had better effect on reducing ratio of newborn stifile with OR=0.09, 95%CI 0.02 to 0.42, P=0.002. ⑦ Improving Apgar scores: no significant differences were seen between SAMe and placebo, dexamethasone and ursoddeoxycholic with OR=0.25, 95%CI 0.02 to 3.04, P=0.28; OR=2.09, 95%CI 0.70 to 6.27, P=0.19; OR=1.22, 95%CI 0.35 to 4.19, P=0.75 respectively. Six RCTs mentioned the side effects of S-adenosy-l-methionine, only one RCT reported mild gastrointestinal irritation. Conclusions SAMe is partly effective on improving the pregnancy outcomes of intrahepatic choletasis of pregnancy, such as reducting cesarean-section ratio, prolonging the period of pregnancy and increasing the weight of the newborn. The specified efficacy and safety of SAMe require rigorously designed, randomized, double-blind and placebo-controlled trials to offer evidence.
目的:探讨妊娠合并哮喘的临床表现及治疗方法。方法:对32 例妊娠合并支气管哮喘患者的临床资料进行回顾性分析。结果:经过适当的治疗,32例支气管哮喘合并妊娠患者症状缓解,随访至产后1 个月,婴儿和母亲均正常。结论:支气管哮喘合并妊娠时,妊娠早期可选用对胎儿无影响的药物如头孢菌素类抗生素、β2 受体激动剂、糖皮质激素(吸入布地奈德,强的松口服,短期甲强龙静滴),妊娠中晚期还可选用茶碱类药物及全身使用糖皮质激素等药物。
【摘要】目的探讨瘢痕子宫不全破裂的早期诊断、处理及预防。方法2006年1月2009年1月发生瘢痕子宫不全破裂13例,术前临床症状加B超检查确诊,手术从原切口进入宫腔,取出胎儿,修剪原切口周围瘢痕组织,10可吸收线连续缝合浆肌层,再间断包埋缝合切口,术后常规预防感染,加强宫缩治疗;胎盘植入2例尽量取出胎盘,修整切口,活动性出血明显者用10可吸收线“8”字缝扎止血,术后加服米非司酮150 mg/d共3 d。结果母婴均痊愈出院。42 d后来院复查,B超探查8例子宫下段处有线状较强回声,肌层回声均匀,余未发现异常;胎盘植入2例，随防3个月血绒毛膜促性腺激素呈阴性。结论早期B超检查能提高瘢痕子宫不全破裂确诊率,确诊后急诊剖宫产,胎盘部分植入者加服米非司酮并预防感染。
ObjectiveTo explore the nursing method for patients with urerine incision pregnancy. MethodsBetween July 2012 and April 2013, 82 patients with uterine incision pregnancy were selected, including 6 with massive haemorrhage after dilatation and evacuation in other hospitals before received in our department. All of the patients underwent arterial chemotherapy infusion and embolization; dilatation and evacuation was performed under the monitoring of B-scan ultrasound; and the patients received intensive care. ResultsAll of the 82 patients with uterine incision pregnancy were cured via proper treatment and care. ConclusionUterine artery embolization is an effective treatment method for pregnancy incision, which has advantages like minimally invasion, quick effect, and uterus preservation. Strengthen psychological care and close observation of the disease, as well as health guidance are important for the success of incision pregnancy treatment.
Objective To study the clinical value and surgical procedure of laparoscopic operation for interstitial tubal pregnancy. Methods Clinical data of 36 patients of interstitial tubal pregnancy treated by laparoscopic operation were retrospectively analyzed. Results All 36 patients were operated successfully, without conversions to laparotomy and intra- or post- operative complications. The operation time was 28-85 min(mean, 41min), and the length of stay in hospital postoperative was 3-6 d (mean, 4-5 d). Conclusion Laparoscopic operation for interstitial tubal pregnancy is safe and feasible.
Objective To discuss how is the perinatal infant’s prognosis influenced by different cardiac function and types of heart disease in pregnant women with heart disease, and to check the importance of antenatal examination. Method Retrospective analyses were conducted on the clinical records of 102 pregnant women hospitalized due to heart disease from February 2002 to February 2011 in the First Affiliated Hospital of Xinjiang Medical University. According to the level of cardiac function, 61 patients were divided into the Level I-II group and the other 41 patients were in the Level III-IV group. Results Of all cases, 38 were congenital heart disease (37.25%), followed by 22 arrhythmia (21.57%), 17 rheumatic heart disease (16.67%), 15 perinatal cardiomyopathy (14.71%), 7 hypertensive heart disease and 3 other types of heart disease. The average gestational weeks were shorter and the neonate’s weight was lower in the Level III-IV group than the Level I-II group, with a significant difference (Plt;0.05); the incidence of premature delivery, low birth weight infant at normal gestational age, neonatal asphyxia and perinatal mortality was higher in the Level III-IV group than the Level I-II group, with a significant difference (Plt;0.05); the rate of regular antenatal examination was higher in the Level III-IV group than the Level I-II group, with a significant difference (P=0.008); and there were significant differences between the regular and irregular examination groups in the incidence of premature delivery and low birth weight infant at normal gestational age (Plt;0.05), but no significant differences were found in the incidence of asphyxia and perinatal mortality (Pgt;0.05). Conclusions Congenital heart disease is the most commonly-seen type in the pregnant women with heart disease. The maternal cardiac function directly impact the prognosis of perinatal infant, and the regular antenatal examination, timely diagnosis and treatment can improve pregnancy outcome.