目的:根据2018国际妇产科联盟(FIG0)剖宫产时胎盘植入性疾病(PAS)临床分级系统,评估腹主动脉球囊预置术在凶险性前置胎盘(PPP)伴不同分级PAS剖宫产术中的应用价值.方法:回顾性分析2014年1月至2020年12月在上海交通大学医学院附属国际和平妇幼保健院产科住院并剖宫产分娩的230例PPP合并PAS产妇的临床资料,剖宫产前行腹主动脉球囊预置术后为观察组(160例),未行预置术的为对照组(70例),根据2018年FIGO的PAS分级标准进一步分组,比较不同PAS分级标准的两组患者术中、术后及并发症等情况.结果:①PAS分级2级、PAS分级3级中观察组与对照组的手术时间、术中出血量、术中输血、术后血红蛋白的下降、子宫切除率比较,差异均无统计学意义(P＞0.05).而PAS分级4～5级中观察组孕妇术中出血量明显少于对照组(3533.3±2391.4 ml vs 4293.6±1235.4 ml,P＜0.05),且术中全子宫切除率低于对照组(5.0％ vs 33.3％,P ＜0.05).②两组产妇术后入住ICU时间、术后住院时间、术后抗生素使用时间、术后病率差异无统计学意义(P＞0.05).③两组新生儿出生体质量、Apgar评分＜7分、新生儿住院率比较,差异均无统计学意义(P＞0.05).结论:术前联合超声检查及MRI检查充分评估,经多学科协作,对于PAS分级4～5级及以上水平患者建议术前行腹主动脉球囊预置术,以期望减少术中出血量并降低子宫切除率.

目的·探讨妊娠早期血脂水平与子痫前期(preeclampsia,PE)发病风险的关系.方法·研究对象为2015年1月—2017年12月于上海交通大学医学院附属国际和平妇幼保健院行常规产检并住院分娩的孕妇,经筛选后纳入26230例,其中发生PE的孕妇(PE组)680例、未发生PE的孕妇(对照组)25550例.通过电子病历系统获取2组孕妇的一般临床资料和妊娠10～14周的血脂指标.采用多因素Logistic回归分析探讨妊娠早期血脂水平(四分位等级)与PE发病风险的关系.结果·与对照组相比,PE组孕妇妊娠早期的总胆固醇(total cholesterol,TC)、三酰甘油(triacylglycerol,TAG)、低密度脂蛋白(low density lipoprotein,LDL)和载脂蛋白B(apolipoprotein B,ApoB)水平均较高(均P<0.05),而高密度脂蛋白(high density lipoprotein,HDL)水平较低(P=0.000).多因素Logistic回归分析显示,TAG(>1.45 mmol/L)、LDL(>3.26 mmol/L)和ApoB(>0.86 g/L)是PE发病的独立危险因素(均P<0.05),HDL(>1.99 mmol/L)是PE发病的独立保护因素(P=0.002).在调整了潜在的混杂因素后,随着TAG、LDL和ApoB水平的升高,PE的发病风险逐渐增加,而HDL反之(均趋势P<0.05).以最低四分位组为参考,TAG、LDL、ApoB和HDL在最高四分位组的调整OR值及95％CI分别为1.90(1.47～2.45)、1.39(1.08～1.78)、1.51(1.13～2.04)和0.66(0.50～0.86).结论·妊娠早期的血脂代谢异常预示孕期PE的发病风险增加,及早进行血脂水平的检测有助于PE的早期预测.

目的 探讨助产士连续性服务模式在瘢痕子宫孕妇阴道分娩中的应用效果.方法 便利抽样法选择2016年4月至2017年3月在上海交通大学医学院附属国际和平妇幼保健院就诊的有阴道分娩意愿、符合剖宫产术后再次妊娠阴道试产(trial of labor after cesarean section,TOLAC)条件且自愿参加助产士咨询门诊的孕妇635例为研究对象,对其实施助产士连续性服务模式,对该模式开展前后瘢痕子宫孕妇剖宫产术后再次妊娠阴道分娩(vaginal birth after cesarean,VBAC)的情况及母婴结局进行比较.结果 开展助产士连续性服务模式后,635例孕妇中,最终VBAC 130例,与开展前(2013-2015年)比较,剖宫产率、VBAC产妇的会阴侧切率及新生儿窒息发生率均有所降低,差异均有统计学意义(均P＜0.05).结论 助产士连续性服务模式的应用,有利于提高瘢痕子宫孕妇TOLAC的成功率,保障母婴安全.

Objective:To investigate the effect of the music therapy combined with group psychological intervention on the anxiety and depression emotion in high-risk pregnant women during pregnancy and postpar-tum. Method:One hundred and ninety-five high-risk women with 16-20 weeks pregnancy were randomly as-signed into the intervention group(98 cases)and control group(97 cases). The intervention group were trea-ted with music therapy once when their pregnancy at 24 weeks;then asked them to listen to the music 30 min every day at home until delivery. While,they received group psychological intervention once a week when preg-nancy at 25 to 29 weeks. The control group received the usual care. All of the high-risk pregnant women were as-sessed with the hospital anxiety and depression scale(HAD)every month during the last 3 months of pregnan-cy. And 3 to 7 days,42 days and 3 months after delivery they were assessed with Edinburgh postnatal depres-sion scale(EPDS). Results:At 7 to 8 months pregnacy,the scores of HAD in the intervention group were significantly higher than those in the control group(all P ﹤ 0. 05);but before delivery the HAD score in the in-tervention group was significantly lower the the baseline and the two groups had no significant difference. Post-partum the EPDS score of each time point in the intervention group was significantly lower than those in the con-trol group(P ﹤ 0. 05 or P ﹤ 0. 01). Conclusion:Music therapy combined with group psychological interven-tion can not only reduce the anxiety and depression symptoms during pregnancy,but also reduce the postpartum depression symptoms.

目的 通过比较“二胎”政策开放前后经产妇妊娠和分娩结局,探讨如何加强生育第二胎产科质量安全管理.方法 收集2013年1月-2015年6月某院产科分娩第二胎的基本数据,进行统计分析.结果 “二胎”政策实施后,经产妇、瘢痕子宫再次妊娠比例呈上升趋势,高龄经产妇占比、妊娠期高血压疾病/糖尿病患病率、早产率、巨大儿/低体质量儿分娩率以及产后出血率显著增高.妊娠期高血压疾病经产妇中新生儿窒息、早产、低体质量儿、产后出血的发生风险增高;妊娠期糖尿病经产妇中早产、低体质量儿、巨大儿的发生风险增高.结论 现阶段生育第二胎妇女中,高龄、瘢痕子宫再次分娩、妊娠并发高血压/糖尿病者增多,不良分娩结局风险增加;需对再生育者加强孕前检查、妊娠并发症防治以及重症产科出血、子宫破裂应急管理,保证母婴安全.

目的:观察丹参滴注液治疗胎儿生长受限的临床疗效.方法:选择诊断为胎儿生长受限并接受治疗并住院分娩孕妇80例,随机分为2组:治疗组40例,对照组40例;正常孕妇40例为正常组,观察治疗前后宫高、腹围、双项径、股骨长增长幅度,脐血流指标(S/D、PI、RI)变化情况,并比较出生时Apgar评分及体重情况.结果:1)治疗后,治疗组宫高、腹围、BPD及FL治疗前后增长值明显高于对照组,有明显统计学意义(P＜0.05);2)治疗后,治疗组脐血流治疗(S/D、PI、RI)低于对照组,有明显统计学意义(P＜0.05);3)治疗组出生体重高于对照组(P＜0.05),但仍低于正常组.结论:丹参滴注液能够有效治疗胎儿宫内生长受限.

妊娠期糖尿病（GDM）是1种妊娠后首次发现或发病的糖尿病，不仅增加围产期孕妇和胎儿的风险，也增加这些孕妇远期发生2型糖尿病（T2DM）、代谢综合征及其子代肥胖的概率。目前，GDM的病因及发病机制尚未完全明确，但其与T2DM具有相似的临床特征，均存在胰岛素分泌缺陷或胰岛素抵抗，提示两者可能存在相同的遗传基础[1-2]。近年来的研究证实，褪黑素受体（MTNR）1B基因是T2DM的候选基因[3]，MTNR1B基因rs10830962位点单核苷酸多态性（SNP）与葡萄糖代谢和胰岛β细胞的功能密切相关，与T2DM的发病具有高度的相关性[4]。该基因位于染色体11q21~q22，编码高亲和力G蛋白偶联受体，与松果体分泌的激素--褪黑素（melatonin）结合而发挥生理作用。2012年，Kwak等[5]通过对韩国GDM人群的研究发现，MTNR1B基因rs10830962位点SNP与GDM的发病具有显著相关性。2013年，Li等[6]通过对中国汉族的GDM患者及正常孕妇的MTNR1B基因rs10830962位点进行研究，结果发现， rs10830962位点SNP与GDM发病无明显相关性。上述两项研究的结果不同，提示，GDM的发病在不同的人群中可能存在一定的遗传异质性。本研究采用Sanger测序技术及小测序法（SNaPshot）分型技术，探讨MTNR1B基因rs10830962位点SNP与GDM发病的关系。现将结果报道如下。

Hemophilia is a recessive X-chromosome genetic diseases with coagulation disorders, due to clotting factor Ⅷ or Ⅸ deficiency.Pregnant women with hemophilia could be at risk of bleeding throughout gestation and during delivery. This article introduced the prenatal diagnosis, obstetrical management, delivery mode, therapy and newborn treatment of hemophilia.

<正>通常体外循环手术最后步骤是将胸骨、皮下各层组织和皮肤重新缝合起来,若因某种原因(如循环不稳、呼吸功能不全、顽固性出血和凝血障碍、心律失常以及需要安置辅助循环插管等)使胸骨未能1期合拢,经24～72 h后,待循环稳定、凝血机能改善、心律紊乱

目的探讨全膝关节置换术中经关节周围软组织内注射包含大剂量布比卡因的混合镇痛药物的护理配合,以顺利完成操作,避免发生并发症。方法重视深浅组织内注射混合药物的不同配方,避免配制过程中发生错误和污染,提醒和配合医生分层分次注射,严格掌握3次注射药液的部位和注射时间,注意提醒麻醉师观察注射药麻醉深度调整和是否有注射药中毒反应。结果 2010年10月至2011年2月,对30例接受全膝关节置换术病人采用术中关节周围软组织内注射包含大剂量布比卡因的混合药物的方法进行术后镇痛治疗,结果显示无局部麻醉药不良反应发生,术后1～3 d疼痛视觉模拟评分(VAS)分别为平均1.08±0.67分、1.21±0.6分和3.67±0.89分。术后1 d时53.3%病人能够进行自主直腿抬高动作,出院时自我满意度为平均9.25±0.75分。结论掌握关节注射镇痛法的配合要点、药物性能、药理作用、配制方法等,娴熟配合骨科医生完成手术,有利于明显降低全膝关节置换术病人术后疼痛,避免并发症发生。

Objective To investigate the advantages of the standardized administrative procedures for orthopedic implants to reduce the nursing labor costs as well as indirectly improve the quality of medical services.Methods The patients undergoing total hip arthroplasty and spinal fixation from January to December 2008 served as control group to carry out temporary delivery implants and device management model.The patients undergoing the appropriate surgiries from January to December 2009 served as control group to carry out inventory-type implants and device management model.By calculating the consumption of man-hours of nursing manpower,the nursing labor costs were compared under the two management models.Results The procedure time-consumption and the total human time-consumption before and after surgery in the experimental group were significantly less than those in the control group undergoing total hip arthroplasty or spinal fixation(P0.01).Conclusion The standardized administrative procedures significantly reduces the nursing labor costs,and improves the work efficiency,thus helping to reduce operating room nursing labor costs,improving physicians' satisfaction,lowering infection rates and thus improving the quality of surgery. 【

[目的]探讨个体化参数设置下肢空气止血带充气压力的临床可行性.[方法]将219倒手术时间在2h以内使用止血带的下肢手术病人随机分为两组,常规组采用固定参数加压法,压力恒定为2倍病人上臂动脉收缩压；个体化组采用个体化加压法,将血氧饱和度感光探头夹在患肢脚趾上,边充气边观察血氧监测仪中的动脉波形,一但动脉波形消失成直线,立即停止充气,并将止血带此时的压力锁定;两组均1h放1次止血带,10min再灌注.[结果]个体化组充气压力为201.03 mmHg±21.10 mmHg,明显低于常规组的240.43 mmHg±34.78mmHg (P＜0.01)；病人术后主诉止血带压迫部位疼痛和皮肤损伤发生率个体化组明显优于常规组(P＜0.01);术后并发症的发生率个体化组低于常规组(P＜0.05)；手术时间超过1h时创面渗血个体化组较常规组严重(P＜0.01).[结论]采用血氧监测个体化设定下肢充气止血带压力可降低并发症发生,短时间手术止血效果满意,但不适合于手术时间较长的情况.

Objective To discuss the feasibility,the rate of success and clinical value in cordocentesis by ultrasound-guided free-hand puncture for prenatal diagnosis.Methods Cordocentesis by ultrasound-guided free-hand technique and guidance support system were respectively performed in 134 and 81 pregnancy women at second or third trimester for prenatal diagnosis.Clearly set down standard for puncture times.Discussed the advantage,influencing factors for one times successful puncture,and complications when cordocentesis was performed by ultrasound-guided free-hand puncture.Results The total successful rate of puncture was 96.3%,95.1% and one puncture was 64.3%,61.0%,which both have no significant difference in two methods.When one puncture was failure and the second puncture should be done again,cordocentesis by free-hand would greatly reduce the puncture times through the skin.Proficiency degree,umbilical vein diameter,anterior placenta and the length of puncture path were major factors for influencing successful puncture.The puncture times was correlative with complications.Conclusion There are many merits by ultrasound-guided free-hand puncture such as only common ultrasound probe used with one-off asepsis plastic sheath,which could reduce probe spoilage and the possibility of infection.Simultaneously,the operator independently can operate cordocentesis by strictly training which means that one cerebellum is better than two for coordination.

Objeetive Detection of cell-free fetal mRNA in maternal plasma by real-time quantitative flouorescence poly-meraae chain reaction(QFIPCR) and on the basis of it' s amount to discuss the feasibility as a new prenatal screening in-dicator of Down' S syndrome. Methods Peripheral blood samples (n = 26) were collected from pregnant women atten-ding the International Peace Maternity and Child Health Hospital,School of Medicine,Shanghai Jiaotong University from May 2007 to August 2008. Cell-free fetal mRNA in maternal plasma was isolated from 26 samples in the midtrimester ( 15 ～ 26W) pregnaney. Samples consisted of 9 women carrying trisomy 21 fetuses(group B) ,4 carrying aneuploid fetuses (group C), and 13 carrying normal fetuses (group A ). QF-PCR was used to detect HPL, β-HCG, TFPI2, DSCR4, LOC90625 gene markers of the placental origin and 18sRNA gene of the mothers and the fetuses. Results All abnormal high concentrations of cell-free fetal mRNA but TFPI2 were found in a proportion of women carrying trisomy 21 fetuses and aneuploid fetuses( P <0. 01 ). Conclusion Cell-free fetal mRNA in maternal plasma is a potential prenatal screening maker for trisomy 21.

Objective:To explore the efficacy of prenatal psychological intervention in anxiety and depression in postpartum period.Methods:A randomized controlled trial design was used in this study.A total of 800 pregnant women at 16～20 weeks gestation were selected continually from clinic.All the women were randomly divided into intervention group(n=386) or control group(n=414).The intervention consisted of six sessions(five sessions for the pregnant women+one session for the husbands).Both of the two groups attended the normal hospital education equally.All the subjects were evaluated with the Hospital Anxiety and Depression scale(HAD) once a month prenatally,and with the Edinburgh Postnatal Depression Scale(EPDS) additionally at 3 days,42 days,and 3 month postpartum.The SCID-I Chinese version 2004(Structured Clinical Interview for DSM-IV-TR Axis I Disorders,Research Version) was used for clinical diagnosis.Analysis of the mental health outcomes,by intention-to-treat,was adjusted for the correlated structure of the data.Results:(1)According to the HAD score changes,in the per-protocol sets(PP sets),the intervention could relieve the anxious emotion in postpartum period.The "anxiety" item scores of HAD in intervention group dropped from 0-2-4(quartile) at 3 days postpartum to 0-2-3 at 3 months postpartum,while that in control group dropped from 0-2-4 to 0-2-3.5.During 3 months postpartum,the rate of anxiety in intervention group was significantly lower than that in control group(3.2% vs.7.8%,P=0.045).However,the intervention had no efficacy on depressive emotion according to neither HAD or EPDS.(2) In SCID-I interview,there was no significantly difference in incidence of major depressive disorder between the two groups at each time-point postpartum.Conclusion:The prenatal psychological intervention can prevent postpartum anxious emotion to some extent.How to prevent the postpartum depression needs to be studied further.

OBJECTIVE:To find out whether there was any change in early infant temperament after mothers had received group psychological therapy on depression and anxiety during pregnancy period.METHODS:A total of 800 subjects meeting the inclusion criteria, without the exclusion criteria and willing to sign the informed consent were recruited randomly from Shanghai International Peace Maternity & Child Health Hospital in their l6th-20th weeks of pregnancy. They were randomized into the therapy group and the control group by the doll randomization table. Women in the therapy group would have a group psychological therapy for 6 times, 1.5 hours each time, while the control group not. The group psychological therapy included therapist introduction and participatory discussion. The therapy concerned the antepartum and postpartum depression, the risk factors concerned with antepartum and postpartum depression, antepartum and postpartum anxiety, psychological defense theory, reflex training and spouse lesson. Mothers reported their babies' infant temperament by filling the early infant temperament questionnaire (EITQ) within 3 months post-delivery.RESULTS:The percent of easy infant temperament type was 87.9% in the psychological therapy group and 81.7% in the hard group. And there was significant difference between two groups (chi2 = 4.530, upsilon=1, P = 0.033). And there were significant differences in the dimensions of approach-withdrawal and threshold of responsiveness in infant temperament between two groups.CONCLUSION:The maternal antepartum psychological therapy can increase the ratio of easy infant temperament. And it has effects upon the temperament dimensions of approach-withdrawal and threshold of responsiveness.

Objective:To investigate the ERβ gene susceptivity for postpartum depression. Methods: Sixty-eight cases (depressed women postpartum) and 93 control (non-depressed women postpartum) selected from the 746 continuity who had joined the preceding clinical test were genotyped by ERβ gene two SNPs (rs1256030 and rs3020444) with polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP). Case-control association and two-point haplotype association with postpartum depression were performed. Results:The genotype "T/T" according to ERβ gene rs3020444(T/C)polymorphism was found to be associated with postpartum depression. The case who had the "T/T" genotype developed postpartum depression 2.91(1.22-6.91) times the other genotypes(P<0.05). The case who had the "T" allele developed postpartum depression 2.72 (1.19-6.18)times the "C" allele(P<0.05). The haplotype "C-C" based on rs1256030(C/T)and rs3020444(T/C)polymorphisms had a protective effect on postpartum depression, OR=0.306(0.113-0.827),P=0.019.However, the rs1256030(C/T)alleles or genotypes were not associated with postpartum depression. Conclusion:ERβ gene may join in the pathogenesis of postpartum depression. But a large sample is needed to testify the finding.

Objective To study the effects of Tongxinluo(TXL)on sympathetic remodeling and ventricular fibrillation threshold(VFT) after myocardial infarction(MI) in rats. Methods MI was induced by ligation of the left anterior descending coronary arteries in the rats.The rats were then randomized to sham-operated group,MI group and TXL group(n =8).Six weeks after operation,cardiac structure and function were assessed by echocardiography,VFT was then measured,and the distribution and density of growth associated protein 43(GAP43) and tyrosine hydroxylase(TH) in ventricles were detected by immunohistochemistry. Results The distribution of nerve fibers in ventricles of sham-operated group was homogeneous,and became chaotic in MI group.The density of nerve fibers with positive immunostaining for GAP43 and TH significantly increased in MI group compared with that in sham-operated group(P0.05).VFT was significantly lower in MI group than that in sham-operated group(P0.05).The nerve fibers density in TXL group was significantly lower than those in MI group(P0.05).VFT in TXL group significantly increased compared with that in MI group(P0.05),and was similar to sham-operated group. Conclusion TXL can inhibit sympathetic remodeling,increase VFT after MI in rats,and plays a potential role in the prevention of ventricular tachyarrhythmia after MI.

[Objective] To explore the relationships between postnatal maternal depression, anxiety and early infant temperament. [Methods] 590 mothers were asked to finish the questionnaires of HAD and Edinburgh scale in the 3rd day, the 42nd day and 90th day to evaluate the degree of postnatal depression and anxiety. Infant temperament was evaluated at 3 months by maternal report using Early Infancy Temperament Questionnaire ( EITQ ). [Results] The odds of difficultinfant temperament were found more in the infants of depressive or anxious mothers. Postnatal maternal depression, anxiety was also related to the scores of phobotaxis, suitability, response intensity and attention dispersity, while no statistical relationship was found between postnatal maternal depression, anxiety and the infant temperament types. And among the infants with difficult infant temperament, more mothers were found depression or anxiety. [Conclusions] It seems that there is correlation between postnatal maternal depression, anxiety and early infant temperament.

Objective To investigate the prevalence of anxiety and depression relating socio-psychological factors,through follow up for women from pregnancy to postpartum. Methods 307 women pregnant for at least 16 weeks meeting the included and excluded criteria,were followed up to postpartum 23(rd) day,42(nd) day and 3(rd) month.At each period they had to answer the hospital anxiety and depression scale(HAD,for anxiety and depression),fill the form of related risk factors,and further use the Edingburgh postnatal depression scale(EPDS) for judgement of the postpartum depression. Results The HAD anxiety rate was 5.5% and the depression rate was 4.9% in the pregnant period.The EPDS depression rate was 7.5% on 2-3(rd) day postpartum,13.5% on 42(nd) day postpartum,and 9.8% in 3(rd) month postpartum.There had been no significant difference between HAD and EPDS on the 2-3(rd) day postpartum for the detection of depression.However,there were significant difference on 42(nd) day and 3(rd) month postpartum.The inherent coherence Kappa value between the two scales was less than 0.4 at any postpartum period.The anxiety during pregnancy was related to postpartum depression on 2-3(rd) day,and the depression of pregnancy was related to the postpartum depression on(42 nd) day.The first menstrual age and the worrying for heritable disease of baby were the major factors of pregnancy anxiety.The past history of infant death,nutrition and worrying for infant-feeding were the major factors of pregnancy depression.The postpartum salvage,diet and the prepartum preparation and clean-hobby were major factors of postpartum depression on 2-3(rd) day,the house furniture equipment was the major factor of the postpartum depression on 42(nd) day;the house environment,baby-sitter and life-events were the major factors of the postpartum depression at 3(rd) month. Conclusions The anxiety and depression in pregnancy or postpartum period are objectively present.The prevalence of depression is different in each postpartum period,and the risk factors of anxiety and depression are not the same in different periods.The morbid emotion of pregnancy can lead directly to the occurrence of postpartum depression.The primary health care work should be developed not only at postpartum,but also at prepartum.