目的 探讨与分析胰岛素治疗妊娠糖尿病的起始剂量与妊娠结局的相关性.方法 2015年5月—2018年12月选择诊治的106例妊娠糖尿病孕妇,根据随机数字表法分为低剂量组与高剂量组各53例.高剂量组:给予胰岛素1日多次给药治疗,门冬胰岛素注射液初始剂量0.5 U/(kg?d),低剂量组给予胰岛素泵持续治疗,门冬胰岛素注射液起始剂量0.2 U/(kg?d),两组疗程均为4周,记录两组妊娠结局.结果 低剂量组的胰岛素用量显著低于高剂量组(P<0.05),两组血糖达标时间对比差异无统计学意义(P>0.05).两组治疗后的FPG与2 hPG值都显著低于治疗前(P<0.05).所有孕妇都顺利完成分娩,低剂量组的羊水过多、早产、妊娠期高血压、低血糖等并发症发生率为3.8％,显著低于高剂量组的24.5％(P<0.05).低剂量组的新生儿高胆红素血症、新生儿低血糖、新生儿窒息、巨大儿等并发症发生率为3.8％,显著低于高剂量组的26.4％(P<0.05).结论 基于初始低剂量的胰岛素泵注射方式在妊娠糖尿病孕妇中的应用能减少胰岛素的应用剂量,能达到同样的降糖效果,改善孕妇与新生儿的预后.

目的:研究染色体核型分析联合CNV检测在超声结构异常胎儿中的应用价值.方法:选择本院于2019年1-12月收治的137例经超声检测显示胎儿结构异常的孕妇为观察对象.所有研究对象均应用染色体核型分析与CNV检测展开联合诊断,分析其临床应用价值.结果:在137例经超声检测结构异常胎儿中,经染色体核型分析检出22例,检出率为16.06％;CNV检测30例,检出率21.90％;联合检测检出37例,检出率为27.01％;染色体核型分析在137例经超声检测结构异常胎儿中的异常检出率较CNV检测与联合检测异常检出率更低,且CNV检测胎儿异常检出率低于联合检测异常检出率.其中联合检测与染色体核型分析的检出率比较,差异有统计学意义(P<0.05);CNV检测与染色体核型分析及联合检测的检出率比较,差异均无统计学意义(P>0.05).染色体核型结果显示正常的胎儿中,检测出有15例CNV-seq结果为异常,检出率为10.95％(15/137),其中已知致病性的CNVs有8例,其余7例为VOUS.8例致病性的CNVs中,有4例的CNV均为16号染色体短臂微缺失,其中3例是16p11.2微缺失,1例缺失是16p12.2;2例为X染色体短臂微重复;1例为19号染色体短臂微缺失;1例为X染色体单体.7例CNV-seq结果为VOUS的胎儿中,有3例为22号染色体长臂微缺失,1例为22染色体长臂微重复;1例为9号染色体短臂微重复;1例为14号染色体长臂微重复;1例为15号染色体长臂微缺失.结论:染色体核型分析联合CNV检测在超声结构异常胎儿中具有较高的临床应用价值,高危妊娠孕妇可通过染色体核型分析与CNV检测尽早筛查胎儿结构异常情况,从而提升临床控制效果,值得推广.

目的 分析高龄孕中期高风险胎儿发育畸形患者的羊水细胞染色体核型.方法 对医院妇产科2016年1月～2018年5月收治的1 60例高龄高风险胎儿发育畸形患者的临床资料进行回顾,均于孕中期行羊水穿刺,取羊水细胞做染色体核型检测,统计检测结果.所有患者均接受跟踪随访并明确胎儿发育情况.结果 本组受试者中羊水细胞染色体核型检测结果异常者构成比为28.57％,其中染色体数目异常、染色体结构异常和染色体多态性变异者构成比分别为50.00％、37.50％、12.50％,且常染色体数目异常、常染色体结构异常、性染色体数目异常、性染色体结构异常、染色体多态性变异者构成比依次为33.33％、22.92％、16.67％、14.58％、12.50％;染色体倒位、21三体综合征、性染色体数目异常、染色体多态性变异、18三体综合征、相互易位/缺失、1 3三体综合征/标记染色体/罗伯逊易位的构成比依次为27.08％、22.92％、16.67％、12.50％、6.25％、4.17％/4.17％、2.08％/2.08％/2.08％;48例羊水细胞染色体核型异常的患者中死胎/引产者构成比为87.50％,继续妊娠者中新生儿正常者构成比为33.33％;120例孕中期羊水细胞染色体核型正常的受检者中围产儿不良妊娠结局发生为13.33％.结论 高龄孕中期高风险胎儿发育畸形患者羊水细胞染色体核型异常风险高,种类多样,需根据检测结果指导选择干预方案,以降低出生缺陷的发生风险.

目的 应用经阴道三维超声评估剖宫产瘢痕与非妊娠期异常子宫出血的关系.方法 对2015年1月-2018年6月来该院检查的有剖宫产史的203例妇女进行阴道超声检查,根据瘢痕情况分为完整瘢痕组(116例)和瘢痕憩室组(87例),比较两组妇女异常子宫出血的发生率;测量瘢痕憩室组憩室的长径、深径、横径及憩室前方残存肌层厚度,并运用三维技术计算憩室容积,分析憩室相关超声参数与异常子宫出血的关系.结果 完整瘢痕组中异常子宫出血14例,发生率12.07％,瘢痕憩室组中异常子宫出血61例,发生率70.11％,两组比较差异有统计学意义(P＜0.05);憩室的长径、深径、横径和容积在异常子宫出血与月经正常妇女中比较,差异有统计学意义(P＜0.05),而残存肌层厚度在二者间比较差异无统计学意义(P＞0.05).结论 剖宫产瘢痕憩室的存在与非妊娠期异常子宫出血高度相关,经阴道三维超声不仅能在二维图像上测量憩室大小,还能通过三维处理计算憩室容积,可作为二维超声诊断的补充,为临床医生的诊治提供更多的影像信息.

目的 研究妊娠期糖尿病危险因素并分析其及对妊娠结局的影响.方法 该院2013年1月—2018年12月根据有无妊娠期糖尿病分为100例妊娠期糖尿病组(GDM组)和100例无妊娠期糖尿病组(n-GDM组),比较两组研究对象一般临床资料、早期空腹血糖、孕早期糖化血红蛋白、孕早期甘油三脂和妊娠结局的差异,采用Logistics回归分析妊娠期糖尿病危险因素.结果 GDM组和n-GDM组孕产妇在年龄、既往代谢疾病史、孕次和产次中的差异无统计学意义,在孕前BMI、孕期体重增加量、孕早期空腹血糖、孕早期糖化血红蛋白和孕早期甘油三酯中的差异有统计学意义(P<0.05).Logistics回归分析发现孕前BMI、孕期体重增加量、孕早期空腹血糖、孕早期糖化血红蛋白和孕早期甘油三酯为妊娠期糖尿病的危险因素(P<0.05).GDM组妊娠期糖尿病孕产妇产后出血、羊水异常、胎膜早破及早产发生率均显著高于n-GDM组正常孕产妇,差异有统计学意义(P<0.05).结论 产前HbA1c水平对妊娠期糖尿病孕产妇妊娠结局具有重要影响,与围产期并发症密切相关,临床上应积极干预.

目的:为了提高妊娠期糖尿病的治疗效果,分析胎盘病理与脐血流的关系.方法:选择2015年01月至2017年01月期间在佛山市禅城区中心医院(承办单位)及佛山市顺德区妇幼保健医院(合作单位)做孕前检查并分娩的孕妇,分别选取在妊娠23～28周内并分娩的被诊断为妊娠期糖尿病的孕妇随机选取50例(承办单位)和30例(合作单位)作为观察组,同期随机选取75克葡萄糖耐量试验(O G T T)正常孕妇50例(承办单位)、30例(合作单位)作为对照组,进行胎盘病理的研究分析,并在孕32～41周期间分别进行胎儿脐动脉血流频谱检测.结果:数据显示,观察组与对照组相比,观察组孕妇的胎盘重量以及新生儿体重明显增加,胎盘系数增高,统计学差异比较均有意义(P<O.05).脐血流S/D比值无随孕周增加而下降,维持高值,小于38周、大于等于38周小于39周、大于等于39周小于等于41周,其组间统计学差异比较无意义(P>0.05),但大于等于39周小于等于41周P值有显著差异性.脐血流S/D比值升高,胎盘绒毛成熟不良及间质毛细血管充盈情况较明显,两组脐血流与绒毛成熟情况显著呈正相关,相应新生儿窒息率升高.结论:妊娠期糖尿病患者脐血流S/D比值增高,和胎盘病理密切相关,临床应重视监测,降低新生儿室息率,改善母婴结局.

目的 分别于孕早、孕中与孕晚期开展专项管理对妊娠期糖尿病孕妇的血糖控制与妊娠结局影响效果的探讨.方法 本研究择取2016年1月-6月在我院产科门诊3,660例建档的孕妇中筛选出孕早期具有妊娠期糖尿病高危因素的和通过葡萄糖耐量试验诊断为妊娠期糖尿病130例孕妇为研究样本,依据其建档时孕期阶段分为三组,孕早期干预组54例、孕中期干预组49例、孕晚期干预组27例,对上述三组于不同孕期启动专项管理干预的研究样本在血糖控制率与妊娠结局的差异度进行比较分析.结果 孕早期与孕中期干预组血糖控制率显著高于孕晚期干预组,母婴并发症发生比例显著低于孕晚期干预组(P<0.05).结论 建议尽早开展对妊娠期糖尿病孕妇的专项管理干预,以便实现更为理想的血糖控制率与提升母婴安全度.

Objective To investigate the practical value of monitoring uterine hemodynamics with ultrasound during second trimester in clinical diagnosis and treatment on early-onset preeclampsia.Methods Doppler ultrasound was given to observe PI,RI and S/D of uterine arteries in 20-23+6 weeks and 24-28 weeks for all pregnant women,follow up observation was conducted to pregnant women during pregnancy and childbirth,then we compared the group uterine artery blood flow parameters of early-onset preeclampsia with normal pregnancy.Results According to pregnancy outcomes,access to 21 cases of early-onset preeclampsia and 40 cases of normal control group,patients with early-onset preeclampsia had higher uterine arterie PI,RI and S/D than the those of normal control group in 20-23+6 weeks and 24-28 weeks,the difference has statistical significance,P ＜ 0.05.Conclusion The early-onset preeclampsia compared with normal,uterine artery blood flow velocity of pregnant women is quite different,uterine artery blood flow parameters can be used as a secondary indicator to assist clinicians of screening risk populations with early-onset preeclampsia during second trimester.

Objective To evaluate the application of ultrasound-guided umbilical vessel puncture in prenatal diagnosis ,and assess the clinical risk factors of fetal chromosomal abnormalities, increased umbilical vessel puncture of fetal chromosomal abnormality detection rate. Methods 413 pregnant women were selected under the guidance of ultrasound in abdominal umbilical vessel puncture parallel chromosome examination, and karyotype analysis were done. To compare the different indications for prenatal diagnosis of chromosomal abnormalities in group of detection rate and related factors analysis. Results The success rate of puncture was 100%. Fetal umbilical vessel puncture complications were puncture site (41cases, 9.92%) and fetal heart brachycranic (8cases, 1.93%). Fetal loss (1 cases, 2.42‰). 62 chromosomal abnormalities were found and the detection rate was 15.01%. There was significant correlation between the couple's chromosomal abnormalities and the fetal′s(r=0.526 P=0.005). Conclusions Umbilical cord blood karyotype analysis for clinical diagnosis of fetal chromosomal abnormalities and provide a reliable basis, but needs to grasp the operation indication and strengthen the performer skilled degree. especially when couples have more than two kinds of indications of chromosomal abnormalities.

Objective To evaluate the effect of nitrous oxide-inhale combined with lidocaine-injection by Ciliao and Uterine points and single therapy in labor analgesia,and the impact on maternal and child.Methods 400 cases were randomly divided into four groups.Observation group:100 cases take the therapy of Nitrous oxide-inhale combined with lidocaine-injection in Ciliao and Uterine points in the time of active period.Control group 1:100 cases take the therapy of gas mixture-inhale( 50％ Nitrous oxide and 50％ Oxygen) in the time of active period.Control group 2:100 cases take the therapy of lidocaine-injection in Ciliao and Uterine points in the time of active period.Control group 3:100 cases do not take any analgesia.Analgesic effects,labor time,mode of delivery,neonatal conditions,the amount of bleeding in every group were observed.Results There was statistically significant differences between the observation group with the control group 1,2,3 on analgesic effects ( x2 =48.513,P ＜ 0.05 ) labor time( F =782.88,1120.81,1104.57,all P ＜ 0.05 ),mode of delivery ( x2 =85.715,P ＜ 0.05 ),neonatal conditions,the amount of bleeding( F =422.66,P ＜ 0.05 ).Conclusion Combination therapy was more effective than the single treatment.

Objective To study the incidence of gestational diabetes and the relationship between gestational diabetes risk factors and abnormal glucose tolerance test.Methods Blood glucose levels of 24 weeks-28 weeks pregnant women were determined after 50 g oral glucose,glucose tolerance test(OGTT) was performed on subjects whose blood sugar level was higher than 7.8 mmol/L to get diagnosis.Results The incidence of gestational diabetes mellitus(GDM) was 1.26%.The incidence of Gestational impaired glucose tolerance(GTGT) was 2.95%,the incidences of subjects with gestational diabetes risk factors such as the history of abnormal pregnancy,DM family history,pre-pregnancy obesity or excessive weight gain during pregnancy were significantly different from those with no risk factors of abnormal glucose tolerance test(P<0.01).Conclusion The misdiagnosis of gestational diabetes can reduced by blood sugar screening in all pregnant women,impaired glucose tolerance during pregnancy should be actively treated,pregnant women with the risk factors should be monitored specifically.