Objective To by analyzing the outcomes of thyroid function screening for pregnant women in the first trimester and tracing the screening outcomes of their neonates, we evaluate the management status of thyroid diseases during pregnancy, and find the reason of the raising positive rate of the neonatal screening. Method 1849 pregnancy women were divided into six groups according to their thyroid function in the first trimester, while their neonates were divided into three groups according to the neonatal screening outcomes. We compared the neonatal screening outcomes among six pregnancy women groups with Chi square test. Result There was no neonatal screening positive case in all the hypothyroidism pregnancy. In normal thyroid function pregnancy, neonatal screening positive rate in TSH>2.5mIU/L group is three folds of it in TSH≤2.5mIU/L group. In subclinical hypothyroid pregnancy, the percentage of neonatal heel blood TSH≥5mIU/L reached 37.9%. Conclusion We should pay more attention on thyroid function monitoring and iodine status in subclinical hypothyroid and normal thyroid function with TSH>2.5mIU/L pregnancy to improve neonatal thyroid function.

Objective To explore the curative effect of puerperal nutrition intervention in treatment of hypogalactia,effectively prevent puerperal hypogalactia and promote recovery of puerperal women.Methods From January 2016 to Janua~ 2017,122 puerperal women with hypogalactia treated in Department of Obstetrics in Fuxing Hospital were selected and randomly divided into nutrition group (61 cases) and routine group (61 cases).The puerperal women in routine group were treated by lactation instrument,and the puerperal women in nutrition group were treated by lactation instrument and nutrition intervention.The curative effects in the two groups were compared.Results The initiating time of maternal lactation in nutrition group was statistically significantly earlier than that in routine group (P＜0.05).AT 24 hours after delivery,the volume of maternal lactation in nutrition group was statistically significantly higher than that in routine group (P＜0.05).The level of serum prolactin in nutrition group was statistically significantly higher than that in routine group (P＜0.05).The incidence rate of anemia in nutrition group was statistically significantly lower than that in routine group (P＜0.05).Conclusion Based on traditional treatment,nutrition intervention can effectively improve the initiating time of maternal lactation and increase the amount of maternal lactation.

Objective:To analyze the effect of gestational diabetes anxiety on maternal blood glucose and explore the intervention effect of psychological intervention combined with biofeedback training.Methods:A total of 110 pregnant women with gestational diabetes mellitus received from January 2015 to January 2017 were collected from the obstetric ward of our hospital.The mental state of all pregnant women was assessed by the Hamilton Anxiety Scale (HAMA).According to the results of the score of which more than or equal to 14 points in 18 cases of maternal divided into study group,score of less than 14 points in 92 cases of maternal divided into control group.Two groups of pregnant women were receiving common obstetric care services,the study group received psychological intervention combined with biofeedback training on the basis of the control group.Observed the effect of anxiety on the blood glucose of pregnant women before and after the two groups,evaluated the change of HAMA score before and after the two groups,and observed the perinatal outcome of the two groups.Results:These scores of fasting blood glucose,postprandial blood glucose and glycosylated hemoglobin were significantly higher than those in the control group(t =2.0677,4.6560,2.0494;P ＜0.05).The HAMA score of the study group after intervention was significantly lower than that before intervention and that of the control group((t =16.8259,-10.1203;P ＜ 0.05);There was no significant difference in the incidence of cesarean section,postpartum hemorrhage,neonatal body weight and complication between the two groups.Conclusion:Anxiety will increase the blood glucose level of gestational diabetes mellitus,and psychological intervention combined with biofeedback training can effectively alleviate the anxiety of pregnant women to improve the perinatal outcome.

目的：探讨PBL教学法在产科住院医师规范化培训中应用效果。方法对比分析我院自2011年9月～2015年9月经产科住院医师规范化培训的60名住院医师，按照带教方法分为两组：一组实施PBL教学法，一组采用传统带教方式。结果3个月培训结束进行理论及实践考核，问卷调查，并对培训结束阶段考核通过率进行比较。PBL教学组对带教方式满意度、出科考核成绩、阶段考核通过率均高于传统教学组。结论 PBL教学法在产科住院医师规范化培训中可激发产科学习和工作兴趣，提高规范化培训效果。

Objective To analyze the glucose and metabolism and perinatal outcome in pregnant women with different extent gestational diabetes mellitus (GDM) of IADPSG diagnostic criteria,and to investigate the necessity to manage mild GDM.Methods Total 368 pregnant women at 24-28 gestational weeks were given 75 g glucose oral glucose tolerance test (OGTT).They were divided into three groups according OGTI result,single abnormal group (GDM1 group,148 cases),combination abnormal group (GDM2 group,120 cases) and normal group (100 cases).The three groups were given determinations of glycosylated hemoglobin,fasting C peptide (FCP),fasting insulin (FINS),total cholesterol (TC),triglyceride (TG),high density lipoprotein cholesterol (HDL-C),low density lipoprotein cholesterol (LDL-C),apolipoprotein (Apo) A1 and ApoB,calculated homeostasis model of assessment for insulin resistance index (HOMA-IR) and homeostasis beta cell index (HBCI).Results From normal group,GDM1 group to GDM2 group,the fasting plasma glucose,glycosylated hemoglobin,FCP,HOMA-IR,TG were gradually increased [(4.39 ± 0.38),(4.98 ± 0.49),(5.25 ± 0.59) mmol/L; (5.10 ± 0.29)％,(5.27 ± 0.36)％,(5.46 ± 0.46)％ ;(1.37 ±0.67),(1.73 ±0.73),(1.99 ±0.96) μ g/L;1.07 ±0.42,1.26 ±0.54,1.37 ±0.43; (2.77 ±0.67),(3.05 ± 0.78),(3.34 ± 0.92) mmol/L,P ＜ 0.01],while HBCI was gradually decreased (5.93 ± 0.48,5.42 ±0.45,5.29 ± 0.44,P ＜ 0.01).ApoA1 in GDM1 group and GDM2 group were significantly lower than that in normal group [(2.21 ±0.39),(2.15 ±0.35) g/L vs.(2.42 ±0.37) g/L,P ＜0.01],but there was no significant difference between GDM1 group and GDM2 group (P＞ 0.05).ApoB/ApoA1 in GDM2 group was significantly higher than that in normal group and GDM1 group (0.49 ±0.14 vs.0.42 ±0.14 and 0.45 ±0.12,P ＜ 0.01),but there was no significant difference between normal group and GDM 1 group (P ＞ 0.05).There was no significant difference in FINS,TC,HDL-C,LDL-C,ApoB,neonatal weight and the incidence rate of premature delivery among the three groups (P ＞ 0.05).The incidence rates of eclampsism,large for date infant and cesarean section in GDM1 group and GDM2 group were significantly higher than those in normal group [8.1％(12/148) and 14.2％(17/120) vs.2.0％(2/100),14.9％(22/148) and 16.7％(20/120)vs.6.0％(6/100),52.0％(77/148) and 54.2％(65/120) vs.30.0％(30/100),P＜ 0.01].Conclusions Different extent GDM of IADPSG diagnostic criteria has different extent abnormal glucose and lipid metabolism and abnormal perinatal outcome,so it is necessary to diagnose and manage GDM pregnant women even mild GDM.

Objective To investigate the glucose metabolism and lipid metabolism and their relationship in patients with different extent Gestational diabetes mellitus.Methods There were totally 384pregnant women at 24~28gestational week received antenatal care in the clinic of our hospital from 2010to 2011.Each woman underwent 75g OGTT and lipid testing.Patients were divided into normal group(NGT,n=100),and GDM group(n= 266)which including mild GDM1(n=148),moderate GDM2(n=86)and severe GDM3(n=32)with respect to the results of OGTT.Results The levels of HOMA-IR[(4.18±1.67)and(3.13±1.22)],HBCI[(5.41 ±0.44),(5.93±0.48)],TG[(3.18±0.85)and(2.77±0.67)mmol/l and ApoB/ApoA1(0.47±0.14)and(0.42±0.14)]were significantly different between GDM and NGT(P<0.05).2.The levels of HOAM-IR(5.06±1.79),LnHBCI(5.09±0.48),TG(3.78±1.12)mmol/L,Ln(TG/HDL-C)(0.25±0.14),ApoB/ ApoA1(0.56±0.17)and ApoB(1.13±0.26)g/Lin GDM3were significantly different from GDM1or GDM2(P<0.05).3.The TG level was positively correlated with the levels of FPG,FIN,HbA1cand HOMA-IR;the level of HDL-C was negatively correlated with the levels of FPG,HbA1cand HOMA-IR,but positively with the levels of HBCI and ApoA1.Conclusion The patients with different extent gestational diabetes mellitus have abnormal glucosemetabolism and lipidmetabolism.The serum lipid disorder is closely associated with pancreatic islets secretion function and insulin resistance.