目的 探讨妊娠中晚期应用替诺福韦酯或替比夫定阻断乙型肝炎病毒(HBV)携带孕妇母婴垂直传播的疗效和安全性.方法 2016年5月～2019年5月在通辽市传染病医院孕检的慢性HBV携带孕妇77例,在妊娠的24～28周时,按照孕妇的意愿,43例接受替诺福韦酯治疗,34例接受替比夫定治疗,在分娩后停止治疗.所有新生儿在出生后6 h内接受乙型肝炎免疫球蛋白200 IU,并在出生后0、1和6个月接种酵母源重组乙肝疫苗10μg.随访母婴至婴儿出生后7个月.结果 在分娩时,两组血清HBV DNA水平均显著低于治疗前,TDF组由(7.4±1.2)lg copies/mL降低至(3.6±1.1)lg copies/mL(P<0.05),LdT组由(7.3±1.1)lg copies/mL降低至(4.1±1.2)lg copies/mL(P<0.05),但治疗后两组之间血清HBV DNA水平比较无显著性差异(P>0.05);治疗前后两组血清ALT水平的变化也无显著性差异,停药后部分产妇血清ALT轻度升高,但在3个月后大部分降至正常;在出生后7个月龄时,两组新生儿血清HBsAg均为阴性,HBsAb均转为阳性;两组新生儿体质量、身高和头围比较,无显著性差异(P>0.05);两组均无明显的不良反应.结论 在妊娠中晚期应用替诺福韦酯或替比夫定治疗HBV携带孕妇,可以成功阻断病毒母婴传播,结合出生后应用高效价乙肝免疫球蛋白和乙肝疫苗接种可保证婴幼儿免受HBV感染,值得进一步观察.

Objective To evaluate the uterine scar again full-term delivery best choice. Methods Retrospective analysis in December 2011 to December 2012 scar uterine 98 cases of puerpera childbirth again clinical data . Result In 98 cases after cesarean section delivery vaginal delivery in 25 cases, accounting for 25.5%, Trial-produce 18 cases success, success rate 72%; RCS 80 cases, cesarean delivery rate was 81.6%. RCS group of neonatal asphyxia, postpartum blood loss, postpartum complications and hospitalization days were higher than in VBAC failure group, comparing the two groups have significant difference (P < 0.05); No significant differences between the two groups of neonatal Apgar score (P > 0.05). Conclusion Scar uterine pregnancy childbirth is not absolute indications for cesarean section, Can be combined with the mode of delivery for this pregnancy choose reasonable; If no again cesarean section indications should give full of vaginal trial production, As long as the strict observation of labor, The correct treatment can reduce the cesarean section rate again and reduction of maternal and fetal damage.

Objective Testing analysis of hepatitis b virus carriers of hepatitis b virus DNA in milk loads, to explore the safety of the hepatitis b virus carriers of breastfeeding, for carrying hepatitis b virus maternal provide reference to choose the right means of feeding. Methods Application of fluorescence quantitative polymerase chain reaction technology, the second liver virus carried in our hospital obstetrics term, 90 cases of maternal serum HBV antigen positive hepatitis b virus DNA in maternal milk loads for testing.applying Results Viral load in the milk of the big 3 this world group and HBV DNA positive rate than small 3 this world, HBsAg, HBcAb positive group, P < 0.05. Small 3 this world group of milk - HBV DNA viral load and HBV DNA positive HBsAg, HBcAb positive group and P > 0.05. Conclusion Serum HBV - DNA positive maternal milk maternal HBV - DNA tests help guide hepatitis b right choice feeding way, increase the breastfeeding rate as much as possible.