目的 探讨妊娠新发系统性红斑狼疮(SLE)患者的临床特征及SLE对母儿结局的影响.方法 选取2011年1月至2021年12月嘉兴市妇幼保健院收治的单胎妊娠合并SLE患者88例.按照SLE发病时间分为孕期新发组(16例)和孕前诊断组(72例),比较两组患者临床表现、SLE病情活动指数(SLEPDAI)、妊娠并发症、母儿结局、妊娠期用药情况.结果 妊娠新发组SLEPDAI高于孕前诊断组[5.5(3,7.75)比4(2,5),P＜0.05].妊娠新发组子痫前期、早产发生率均高于孕前诊断组(40.00％比11.59％、46.67％比20.29％,均P＜0.05].两组患者分娩孕周,狼疮性肾炎、胎盘早剥、胎膜早破、血小板减少症、胎儿生长受限、羊水过少、胎儿窘迫、产后出血发生率,剖宫产分娩占比比较差异均无统计学意义(均P＞0.05).妊娠新发组患者新生儿出生体重低于孕前诊断组[(2 466.67±618.65)g比(2 838.28±529.44)g,P＜0.05],未足月低出生体重儿、入住NICU占比均高于孕前诊断组(40.00％比15.94％、53.33％比21.74％,均P＜0.05).两组患儿足月低体重儿占比比较差异无统计学意义(P＞0.05).妊娠新发组患者使用羟氯喹占比高于孕前诊断组(93.75％比66.67％,P＜0.05),而两组患者使用＞15 mg/d的糖皮质激素、免疫抑制剂、抗凝药(阿司匹林或低分子肝素)的占比比较差异均无统计意义(均P＞0.05).结论 与孕前诊断为SLE的患者相比,妊娠新发SLE的患者子痫前期、早产、未足月低体重儿及新生儿入住NICU的发生风险更高,应重视孕期SLE的筛查和多学科治疗,规范产检和有效干预以改善妊娠结局.

目的 比较双侧髂内动脉球囊预置术和腹主动脉球囊预置术在凶险性前置胎盘合并胎盘植入患者剖宫产术中的应用价值.方法 选取2015年3月至2019年3月嘉兴市妇幼保健院收治的凶险性前置胎盘合并胎盘植入的单胎妊娠患者131例,其中2015年3月至2017年10月在剖宫产术前行双侧髂内动脉球囊预置术的63例患者作为对照组,2017年11月至2019年3月在剖宫产术前行腹主动脉球囊预置术的68例患者作为研究组.比较两组患者胎儿接受的辐射剂量、胎儿介入透视时间、术中子宫切除率、球囊首次充盈阻断血流后子宫创面渗血开始增多所需时间等.结果 研究组患者在行球囊预置术过程中,胎儿接受的辐射剂量及胎儿介入透视时间均少于对照组,术中子宫切除率低于对照组,球囊首次充盈阻断血流后子宫创面渗血开始增多所需时间多于对照组,差异均有统计学意义(均P<0.05).结论 两种球囊预置术在凶险性前置胎盘合并胎盘植入的术中具有一定的有效性及安全性.相较于双侧髂内动脉球囊预置术,腹主动脉球囊预置术在介入透视时间及胎儿接受的辐射剂量方面更具有优势.

OBJECTIVE:Fetal growth restriction (FGR) refers to impaired and insufficient intrauterine growth potential caused by a variety of adverse factors and is a serious perinatal complication that leads to fetal or neonatal mortality and morbidity. FGR has numerous causes, and its pathogenesis has not been fully understood. Recently, increasing numbers of researchers have begun to focus on the placenta, the only link between the fetus and the mother. The placenta is a vital organ that plays key roles in fetal development. PLAC1 is a trophoblast-specific gene located on the X chromosome and is important for placental development. However, the biological role of PLAC1 in fetal growth restriction is not well understood. In this study, we investigated the changes in the expression of placental-specific protein 1(PLAC1) in the placentas of pregnant women with FGR and in the placentas of normal pregnancies. We also explored the regulation of PLAC1 in the growth of trophoblast cells.METHODS:Western blotting was used to detect the expression of PLAC1 in FGR and in normal placenta tissues. Cell counting kit 8 (CCK-8), wound healing, and transwell assays were used to detect the effects of PLAC1 knockdown on trophoblast cell proliferation, migration, and invasion. Western blotting was used to detect the expression of PLAC1 under hypoxic conditions, and the cell viability and apoptosis of trophoblast cells in a low oxygen concentration after overexpression of PLAC1 were detected by CCK-8 and flow cytometry assay.RESULTS:Compared with the placentas in the control group of normal pregnancies, the expression of PLAC1 in the placentas of the FGR group was significantly down-regulated (p<0.05). Knocking down PLAC1 by siRNA significantly inhibited the proliferation, migration, and invasion of trophoblast cells. After treatment with alow oxygen concentration, the expression of PLAC1 protein was significantly reduced (p<0.05). The overexpression of PLAC1 can reverse the cell viability of trophoblast cells (p<0.05) and inhibit apoptosis of trophoblast cells (p<0.05) in low oxygen concentration.CONCLUSION:The expression of PLAC1 was reduced in fetal growth restriction and did not protect trophoblast cells from hypoxic damage, suggesting that PLAC1 may be an important regulator in the occurrence of fetal growth restriction.

Background Metastatic choriocarcinoma in the third trimester of pregnancy is extremely rare. Case presentation A 25-year-old Chinese woman (gravida 3, para 0) who was 28 weeks pregnant was admitted for sudden convulsion, aconuresis, and unconsciousness. The decision was made to perform an emergency cesarean delivery and craniotomy, hematoma clearance, and decompression. Pathological examination confirmed choriocarcinoma with brain metastasis. The patient underwent chemotherapy with the etoposide, cisplatin (EP) and etoposide, methotrexate and dactinomycin alternating with cyclophosphamide and vincristine (EMACO) regimens. A satisfactory result was achieved. Conclusions When encountering intracranial mass or bilateral pulmonary nodules in a pregnant woman, especially one in the third trimester, metastatic choriocarcinoma should be considered.

探究线粒体融合蛋白 2 (Mfn2) 调控的内质网应激在子痫前期发生中的作用机制, 为临床子痫前期的诊断和治疗提供参考. 本论文着眼于滋养层细胞的内质网应激在子痫前期中具有重要作用这一研究热点, 通过对临床样本的检测和细胞水平的研究, 阐明了 Mfn2 调控的内质网应激在子痫前期发生中的重要作用, 初步确定该基因可能作为子痫前期的诊断和治疗靶点. 该研究具有针对性强、 创新高以及满足现实发展需求的意义. 采用蛋白质免疫印迹法检测子痫前期和正常胎盘组织中 Mfn2 的表达差异; 活细胞计数 (CCK8) 法、 细胞划痕、 Transwell、 流式细胞术等实验方法分别用于检测 Mfn2 敲低对滋养层细胞 JEG-3 增殖、 迁移、 侵袭和凋亡的影响. 蛋白质免疫印迹法检测内质网应激条件下滋养层细胞中 Mfn2 的表达, 并通过 CCK8、 流式细胞术和超氧化物歧化酶 (SOD) 的测定检测 Mfn2 过表达后对内质网应激条件下滋养层细胞的细胞活力和氧化应激的改善情况. Mfn2 在子痫前期胎盘组织中低表达, 下调 Mfn2 可显著抑制滋养层细胞的增殖、 迁移和侵袭. 子痫前期下内质网应激将抑制 Mfn2 的表达, Mfn2 的稳定表达可以通过调节内质网应激抑制子痫前期发生和发展.

目的 探讨胎盘特异性蛋白-1(PLAC-1)在胎儿生长受限中的表达,以及PLAC-1表达下调后对人胎盘滋养层JEG-3细胞生物学行为的影响,明确PLAC-1在胎儿生长受限中的生物学作用.方法 收集20例胎儿生长受限和20例正常对照胎盘组织,免疫印迹法检测PLAC-1在对照组和胎儿生长受限组间表达差异;针对PLAC-1的靶序列合成3条反向互补的寡聚核苷酸序列,采用瞬时转染的方法转染人胎盘滋养层JEG-3细胞,48h后收取细胞,提取总蛋白,免疫印迹法验证siRNA干扰效果.选择敲低效果最佳的siRNA进行细胞表型实验,采用CCK-8、Transwell和细胞划痕等实验方法分别检测细胞增殖、迁移和侵袭情况.结果 (1)与对照组胎盘相比,胎儿生长受限组胎盘中PLAC-1蛋白的表达水平明显下调,两组比较,差异有统计学意义(P<0.01).(2)siRNA的敲低效果:3条siRNA均具有PLAC-1的敲低效果,其中siPLAC1-1敲低效果最佳达到90％以上,选择siPLAC1-1进行后续的细胞表型实验.(3)CCK-8检测细胞增殖能力:分别在24、48、72h检测siCtrl和siPLAC-1两组细胞活性,在24h两者差异显著(P<0.05),48h和72h两者间差异极显著(P<0.01).(4)Transwell检测细胞迁移和侵袭能力:在迁移实验中,siPLAC-1组的穿膜细胞数为(67±3)个,明显少于siCtrl组(157±4)个(P<0.01);侵袭实验中,siPLAC-1组的穿膜细胞数为(25±5)个,明显少于siCtrl组(84±6)个(P<0.01).(5)细胞划痕实验检测细胞迁移:在72h时,siPLAC-1敲低组细胞迁移率为(18.1±2.4)％,对照组为(26.1±3.7)％,细胞迁移差异明显(P<0.05).结论 PLAC- 1在胎儿生长受限胎盘组织明显下调,通过RNAi在JEG- 3细胞中干扰PLAC- 1表达后,抑制细胞增殖、迁移和侵袭能力,进而影响胎盘发育异常导致胎儿生长受限的发生.

妊娠合并肠套叠临床罕见,因其临床症状不典型,易出现误诊误治,错过最佳手术时机,导致母儿不良结局.现将我院妊娠晚期合并肠套叠1例报道如下. 1 病例介绍 患者,女,26岁,孕2产1,2015年足月平产一活婴.主诉:停经34+6周,上腹部疼痛不适10 h余,于2018年4月26日16:09收入院,疼痛发作时伴有恶心呕吐,呕吐物为胃内容物,有黄色胆汁,味苦.入院查体:体温37.2℃,脉搏86次,急性病容,右上腹压痛(+),反跳痛(+),肌卫(-),未及明显包块,移动性浊音阴性,肠鸣音无亢,结肠充气试验(-);闭孔内肌试验(-);腰大肌试验(-),双肾区叩痛阴性.

目的 分析阴道试产中转剖宫产手术术后产褥感染的影响因素、病原微生物及其耐药性,探讨预防及治疗方法.方法 回顾分析经阴道试产失败中转行剖宫产手术终止妊娠的718例产妇及术后发生产褥期感染的31例产妇的临床资料.对产褥期感染患者均行支原体、衣原体、宫颈分泌物培养,高热寒颤者同时行血培养,对呼吸道感染症状者行咽拭子、痰液培养,对尿路感染症状者行尿液培养,对细菌培养结果及病原微生物耐药性进行分析.结果 产褥感染与妊娠并发症、低蛋白血症、贫血、阴道炎、胎膜早破、产后出血、阴道试产时间、中转剖宫产时宫口扩张程度以及是否围术期抗炎用药相关.产褥感染的微生物主要来源于阴道及肠道,阴道微生物以支原体为主,均对原始霉素、交沙霉素、强力霉素、四环素敏感.肠道细菌为大肠杆菌及粪肠球菌,均对哌拉西林他唑巴坦敏感.结论 加强孕期保健、治疗妊娠合并症、提高产科质量、加强院感管理和严格围术期用药可降低产褥感染的发生.对阴道试产中转剖宫产产妇发生产褥感染者,抗生素应首选哌拉西林他唑巴坦,合并支原体感染者同时口服交沙霉素或强力霉素.

RATIONALE:Postpartum hemorrhage is a common complication and difficult problem in obstetrics. Radiofrequency-induced endometrial ablation (RFIEA) widely used in abnormal uterine bleeding and achieved good effects. This article will investigate the effect of RFIEA for treatment of postpartum hemorrhage. PATIENTS CONCERNS:A 26-year-old healthy full-term parturient woman presented with postpartum hemorrhage after vaginal delivery for 11 hours, who was ready to emergency surgery (hysterectomy) 7 hours after inserting an intrauterine balloon into uterine cavity. DIAGNOSES:Blood loss after vaginal delivery was more than 500 mL during 11 hours in the full-term parturient woman. INTERVENTION:We applied RFIEA to treatment of postpartum hemorrhage. With the patient in dorsal lithotomy position, we advanced the disposable device according to the instruction and operated the Novasure system in semi-automatic mode. OUTCOMES:There was no obvious endometrial bleeding found with hysteroscopy at the end of surgery. No complications (such as thermal injury to adjacent tissue, uterine perforation, bowel perforation) were observed. LESSONS:It is safe and effective to treat postpartum hemorrhage after vaginal delivery using RFIEA.

目的:通过对老年痴呆患者各种高危行为的影响因素进行分析,探讨预防管理措施,减少此类事件的发生,保证患者安全.方法:以金华市中心医院2014年3月～2015年3月期间收治的150例老年痴呆患者作为研究对象,分析哪些相关因素会造成老年痴呆患者出现高危行为,并对每种相关因素所造成的高危行为的发生率进行分析和统计.分析其间存在的关系,制定相应的预防管理措施.结果:老年痴呆患者高危行为的发生主要与患者所患其他疾病及其应用的相关药物有关,而与性别,病程等因素相关性不大.结论:老年痴呆患者在日常生活及治疗过程中要注意避免上述各类危险因素,并积极按照高危行为的相关预防管理措施及医嘱进行治疗,以保证患者安全.

目的 探讨急性脑梗死患者脑微出血的发病情况及其危险因素.方法 选择急性脑梗死患者75例,男51例,女24例,年龄42 ～ 83(64.9±10.8)岁.行头颅CT、磁敏感成像(SWI)检查,依据脑微出血检出的结果分成阳性组(23例)与阴性组(52例),比较两组的一般资料,探讨脑微出血发病的危险因素.结果 SWI检查的检出率比CT检出率高(x 2=27.17,P＜ 0.05).阳性组年龄、高血压病、糖尿病患病率均较阴性组高,差异均有统计学意义(均P＜0.05);两组性别、血脂异常、心房颤动、冠心病、吸烟、饮酒情况比较,差异均无统计学意义(均P ＞0.05).logistic回归分析显示年龄增长、高血压病是脑微出血的独立危险因素(P＜0.05).结论 急性脑梗死患者合并存在脑微出血的比例高,SWI检查是检测脑微出血的敏感方法,年龄大、高血压病与脑微出血的发生密切相关.

目的：探讨纤维连接蛋白（fFN）与C反应蛋白（CRP）联合会阴超声监测宫颈长度缩短率在早产型胎膜早破中的应用价值。方法选取2013年1月至2014年4月89例伴有早产症状的孕妇为观察对象，将其分别进行CRP、fFN及宫颈长度缩短率的检测，然后将不同检测方法的早产型胎膜早破发生率进行统计，并统计三种指标联合应用的发生率，同时对其特异性、敏感性、阳性预测值及阴性预测值进行统计及比较。结果 CRP、fFN联合宫颈长度缩短率对早产型胎膜的预测率明显高于单用每种方法的预测率，且其特异性、敏感性、阳性预测值及阴性预测值也均高于单用每种方法，差异均有统计学意义（P<0.05）。结论 CRP、fFN联合会阴超声监测宫颈长度缩短率在早产型胎膜早破中的应用价值较高，有助于早产型胎膜早破的预测，为干预措施的制定提供依据。

目的:对丙戊酸钠在癫痫中的治疗情况进行分析.方法:随机将研究的80例患者分成两组,各40例.患者均于2015年1月份到2015年12月份在我院于因癫痫而接受治疗.对照组实施苯妥英钠治疗,实验组实施丙戊酸钠治疗.比较两组患者的临床疗效.结果:实验组的总有效率高于对照组,P＜0.05,有统计学意义;实验组的并发症发生率低于对照组,P＜0.05,有统计学意义.结论:癫痫患者在临床上应用丙戊酸钠进行治疗,安全性以及治疗效果均为理想,可推荐使用.

Objective To investigate the protective effect of incision dilation and protection device on incision in cesarean section.Methods Chose 754 cases of pregnant women who taken vaginal delivery transit cesarean section,and they were divided into observation group and control group according to the random number table method, 377 cases in each group.The observation group used extend the incision protector incision,the control group did not use incision dilation and protection device.All the women in the operation began to cut the skin before surgery and suture the skin before the end,subcutaneous tissue fluid was dipped to carry out bacterial culture,observed whether there was colony growth.The one year postoperative follow up was conducted to observe the wound infection and surgical site intrauterine membrane endometriosis incidence.Results The incision contamination rate of the observation group was lower than that of the control group(0.00% vs.13.79%),the incision infection rate was lower than that of the control group(1.33% vs.9.02%),the differences were statistically significant(χ2 =55.852,22.740,all P <0.05). In the observation group,0 case of endometriosis and 2 cases in the control group were observed,the incidence of endometriosis in the observation group was lower than that in the control group,but the difference was not statistically significant(χ2 =1.989,P =0.252).Conclusion Incision dilation and protection device using in cesarean section can significantly reduce the incision contamination rate,incision infection rate,prevent the occurrence of endometriosis.

目的:调查剖宫产产妇产后性生活质量状态,并探究其影响因素.方法:选取2014年2月至2015年12月于本院进行剖宫产的106例剖宫产产妇为观察组,并选取同时期的106例阴道分娩产妇为对照组,然后将两组产妇采用女性性生活质量问卷进行评估,然后比较对照组和观察组、观察组中不同年龄、文化程度、社会支持程度、剖宫产相关知识认知度、产次及是否存在疾病者的评估结果,并以Logistic分析上述因素与剖宫产产妇产后性生活质量的关系.结果:观察组的女性性生活质量问卷评分均低于对照组,而观察组中不同年龄、文化程度、社会支持程度、剖宫产相关知识认知度、产次及是否存在疾病者的女性性生活质量问卷评分也存在明显差异,经Logistic分析显示,上述因素均与剖宫产产妇产后性生活质量有密切的关系,P均＜0.05结论:剖宫产产妇产后性生活质量状态相对较差,且其影响因素较多,应根据其影响因素进行针对性干预.

目的：采用生物物理、血液生化相结合的方法对提高胎儿窘迫早期识别准确率的分析，并探讨其处理措施。方法回顾性分析2009年6月至2013年6月2589例新生儿的临床资料，总结诊断要点、相关指标及相应的处理方法。结果胎儿窘迫的诊断指标主要为观察胎心、羊水胎粪污染情况、胎儿头皮下组织液pH和羊水乳酸浓度。处理措施主要根据病情而定，常用处理措施包括间断给氧、左侧卧位、宫内复苏用药、剖宫产等。结论胎儿窘迫严重影响母婴的生命和健康，应尽早诊断并及时恰当地进行干预，降低新生儿窒息的发生率。

目的 评估宫腔Bakri球囊压迫止血联合欣母沛针于胎盘附着部位多点注射在前置胎盘剖宫产术中止血的有效性.方法 分析嘉兴市妇幼保健院2011年4月-2013年4月收治的前置胎盘剖宫产术中出血量500 ml以上的患者46例,胎儿娩出后立即预防采用欣母沛针250 μg用生理盐水稀释后,于子宫下段出血部位局部多点注射,如仍有活动性出血则联合宫腔填塞Bakri球囊以压迫子宫下段出血部位达到快速止血目的.结果 研究组术中术后2h、24h出血量均明显少于对照组,差异有统计学意义(P＜0.05),研究组输血患者比例为8.7％ (4/46),明显少于对照组的26.1％(12/46),差异有统计学意义(P＜0.05),2组产妇术中和术后不良反应总发生率比较差异无统计学意义(P＞0.05).结论 前置胎盘剖宫产术中出血时应用欣母沛多点注射配合宫腔填塞球囊能有效迅速控制出血,方法简便,易于掌握,值得临床推广应用.

Objective To evaluate and compare the advantages and disadvantages and the clinical application between transvaginal abdominal hysterectomy(TAH)and laparoscopically assisted vaginal hysterectomy(LAVH)on the benign lesions of non-prolapsed uterus.Methods 400 patients with benign lesions of non-prolapsed uterus were divided into two groups,TAH group(202 cases)and LAVH group(198 cases).The effects of clinical treatment of the two groups were compared.Results There were significant differentces between the two groups in operation time,the blood loss,passage of gas by anus,return to normal activities,and overall cost of treatment.However,after 1to 3 months follow-up,all patients were good in terms of outcome.Conclusion Different surgical patterns of hysterectomy had their distinctive advantages.The key point of a successful operation Was to avoid complications of the operation.

<正>正常胎盘附着于子宫体部的后壁、前壁或侧壁,若妊娠28周后胎盘附着于子宫下段,甚至胎盘下缘达到或覆盖宫颈内口处,其位置低于胎儿先露部,称为前置胎盘。根据胎盘和子宫内口的关系

胎盘植入是导致产后出血的严重并发症之一[1],以往以子宫切除为主,但有生育要求的年轻患者难以接受.我院对45例胎盘植入患者采用宫颈部位注射天花粉蛋白注射液联合口服米非司酮保守治疗,取得良好效果,现报告如下. 1 资料与方法