Aim:To study the clinical characteristics of pregnancy combined with epidemic hemorrhag-ic fever (EHF)and the prognosis of the mother and fetus,in order to provide data for clinical diagnosis and therapy of the disease.Methods:7 cases of EHF with pregnancy were analyzed for clinical symp-toms and characteristics.Laboratory tests were carried out for prognosis of the mother and fetus.Results:6 cases exhibited fever symptoms and 5 cases had abnormal bleeding.Laboratory tests showed that all of the 7 cases had thrombocytopenia,coagulation abnormalities,prolonged APTT and TT,elevated activities of liver enzymes,hypokalemia and positive EHF-IgM test.Prognosis:4 of the mothers had fully recov-ered,2 had renal function abnormalities and 1 was dead;2 babies were found healthy,1 premature baby suffered from congenital heart disease and necrotizing enterocolitis,3 fetus were found dead after 7,24, and 27 weeks of gestation,respectively,1 fetus lost contact after 22 weeks of gestation.Conclusion:The mortality is high for both mothers and fetus.Fever and hemorrhage were the main clinical features. Thrombocytopenia,coagulation abnormalities,elevated liver enzyme activities and hypokalemia were the clinical characters of EHF with pregnancy.EHF-IgM is the necessary test for diagnosis.

Objective To investigate the appropriate range of gestational weight gain in pregnant women in Shenzhen City.Methods 3008 term singleton pregnant women were selected as the research group who have their prenatal examination and delivered in People's Hospital of Shenzhen City from September 2011 to February 2013.All subjects were divided into 4 groups according to their body mass index(BMI) before pregnancy: low weight group(n = 679,BMI18.5 kg/m2);normal weight group(n = 2003,18.5-23.9 kg/m2);overweight group(n = 278,BMI23.9-27.9 kg/ m2);obesity group(n = 48,BMI 27.9 kg/m2).The weight gain among different groups who delivered normal birth weight infant and macrosomia were analyzed.The weight gain of pregnant women who delivered babies weighing 2900-3499 g in each group was calculated as the appropriate weight gain.Results Occurrence rate of macrosomia in overweight group and obesity group were higher than those in low weight group and normal weight group,the differences were statistically significant(P 0.05).The weight gain of pregnant women who delivered macrosomia in low weight group,normal weight group,overweight group were higher than those who delivered normal birth weight infant,the differences were statistically significant(P 0.05).The appropriate ranges of weight gain for each group were: overweight group: 12.00-18.00 kg,average(15.06 ±4.52) kg;normal weight group: 12.00-17.50 kg,average(15.05±4.20) kg;overweight group: 9.00-15.00 kg,average(12.39 ±5.17) kg;obesity group: 9.00-14.50 kg,average(12.17±5.09) kg.Conclusion In Shenzhen City,the appropriate pregnancy weight gain in low weight group and normal weight group were 15 kg,the appropriate ranges of weight gain are 12.00-18.00 kg.

Objective:To study the pharmacokinetic mechanism and clinical effect of pulmonary surfactant administrated by amniotic injection to prevent respiratory distress in preterm newborns.Methods:The pregnant rabbit fetus in 25d gestation was devided into 5 groups:0.1ml PS was injected into amniotic fluid,and the rabbit fetus was delivered by cesarean in 1h,2h,4h(group Ⅰ,Ⅱ,Ⅲ).0.1ml PS or saline was adminstrated by tracheal and observed in 1h(group Ⅳ,controls).The concentration of DPPC in the rabbit fetus lung tissues was tested.Clinical research:the preterm labor cases in 28~32 weeks gestation was devided into 3 group.In the amniotic group,2ml curosurf was injected into amniotic fluid before delivered.In tracheal group,2ml curosurg was administrated by tracheal.In the control group,no PS was administrated.Results:(1)There was no difference between the groupⅠ and groupⅢ(P>0.05),but each of the group was significantly higher than control(P<0.01).There was no difference between group Ⅱ or group Ⅲ and control(P>0.05).(2)The rate of NRDS and CPAP was no difference between amniotic group and tracheal group,each of the group was significally lower than those of the control group(P<0.05).All the infants in amniotic group and tracheal group were alive.4 deaths in control group.The in-patient time in amniotic group was 27.8±9.6d,and 26.8±11.7d in tracheal group(P>0.05),but all much shorter than the control group(P<0.05).Conclusion:PS administrated by amniotic is as effective as by tracheally to prevent NRDS of preterm neonates,but the risk is lower and much simple than the later.

目的 探讨严重妊娠高血压疾病的颅脑影像学变化及特征,分析并发脑血管病变的临床高危因素.方法 回顾性分析我院近8年来100例重度子痫前期及子痫患者的颅脑CT及临床资料.①根据入院诊断分为:子痫组,43例;重度子痫前期组,57例;②根据颅脑CT结果分为3组:出血组7例;缺血组47例;无异常组46例.结果 子痫组脑缺血率为76.8%(33/43),高于重度子痫前期组24.6%(14/57)(χ2＝26.739,P＜0.01);两组颅内出血率无明显差异(F=0.113,P＞0.05).出血组平均动脉压156.0±22.4mmHg,高于缺血组133.6±19.9mmHg(t=2.731,P＜0.01)及无异常组136.1±19.9mmHg(t＝2.416,P＜0.05).血清乳酸脱氢酶含量出血组及缺血组均明显高于无异常组(Z值分别为2.435、2.327,均P＜0.05).出血组并发弥散性血管内凝血及HELLP综合征的发生率为42.9%,明显高于缺血组的10.6%(χ2＝5.011,P＜0.05).预后:死亡2例;植物人状态1例,2例脑缺血患者遗留视力减退.结论 子痫组比重度子痫前期组患者颅脑异常的发生率高.当平均动脉压接近156mmHg左右、乳酸脱氢酶异常增高及合并HELLP综合征、弥散性血管内凝血患者应警惕颅内出血发生.严重脑缺血或颅内出血患者预后不良.

Objective To discuss the situation and feature of early pelvic function recovery after delivery.Methods One hundred and ninety-four puerperae after delivery 6-8 weeks who outpatients in department of obstetrics from 2010 october to november and inpatient delivery in department of obstetrics in Shenzhen People′s Hospital were selected,pelvic function was checked by the specialist,including conventional gynaecological check-up,pelvic floor muscle strength assessment by hand and pelvic organ prolapsed quantitative score,the urine mat experiment made for had history of urinary leakage person.Results Among the 194 puerperae,146 puerperae(75.26%) had pelvic organ prolapse,42 puerperae(21.65%) had postpartum stress urinary incontinence.All the patients who had pelvic organ prolapse suffered from anterior vaginal wall prolapse,in which 66.44%(97/146) were of grade Ⅰ,33.56%(49/146) were of grade Ⅱ.Anterior vaginal wall prolapse combined with posterior vaginal wall prolapse accounted for 4.79%(7/146),all were grade Ⅰ;Anterior vaginal prolapse combined with uterine prolapse accounted for 11.64%(17/146),all were grade Ⅰ.One puerperae(0.68%) had anterior vaginal wall prolapse combined with posterior vaginal wall prolapse and uterine prolapse,for Ⅰ degree of prolapse.Conclusion The incidence of female pelvic floor dysfunction is high on the early postpartum,especially anterior vaginal wall prolapse and stress urinary incontinence.Luckily,most of them are mild.Therefore,emphasis should be put on pelvic floor reeducation on the early postpartum,in order to improve quality of their lives.

目的探讨不同分娩方式对产后早期盆底功能的影响。方法选择2010年10至11月在我院产科门诊就诊的产后6～8周的初产妇105例,根据分娩方式分为阴道顺产组(74例)和选择性剖宫产组(31例),由专人负责行盆底功能检查,进行POP-Q评分。有漏尿史者需行尿垫实验。比较2组产后早期盆腔器官脱垂(POP)、压力性尿失禁(SUI)的发生率。结果阴道顺产组中,POP2发生率77.03%(57/74),较选择性剖宫产组38.71%(12/31)高,2组差异有统计学意义(P<0.05);阴道顺产组中,产后SUI发生率31.08%(23/74),较选择性剖宫产组3.23%(1/31)高,2组差异有统计学意义(P<0.05)。结论产后早期POP和SUI的发生与分娩方式有关,选择性剖宫产可降低产后早期盆腔脏器脱垂和压力性尿失禁的发生。

Objective To investigate the sexual problems during early postpartum period and the awareness of postpartum sexual health. Methods A questionnaire survey was carried out in 109 women who received routine postpartum check-up in our outpatient department between October and November 2010 to identify postpartum sexual problems and the awareness of postpartum sexual health. Results The first postpartum check-up was received 6 to 12 weeks after the delivery. Of 109 participants,6 (5.5%), 17(15.6%) and 46 (42.2%) resumed sexual activity within 6,6 to 8,and 12 weeks after the delivery,respectively. Postpartum sexual problems included dyspareunia (35/46,76. 09% ), vaginal dryness (29/46,63.04% ), hypoactive sexual desire (25/46,54. 35% ) and lack of orgasm ( 11/46,23.91% ). 10. 87% (5/46)took contraceptive measures,21.10% (23/109) understood the appropriate time to resume sexual activity, 12. 84% (14/109) was aware of the possible postpartum sexual problems, 13.76% (15/109) knew how to avoid pregnant,6.42% (7/109) would visit a doctor in case of the sexual disorders,and 9. 17%(10/109) hoped that their husband know about sexual health. Conclusion Postpartum sexual problems may be common and maternal awareness of postpartum sexual health could be low.

脑血管意外是妊娠期高血压疾病的严重并发症之一,几乎均发生于重度子(癎)前期(preeclampsia)及子痢(eclampsia)患者,是导致孕产妇死亡的主要原因之一[1].目前国内外关于妊娠期高血压疾病并发脑血管病的影像学研究资料较少,更鲜有系统的、大样本的临床研究资料.

【Objective】To investigate the relationship between gestational diabetes mellitus(GDM)without systemic management and pregnancy complications and perinatal prognosis.【Methods】Sixty unmanaged GDM patients from January 2007 to June 2009 were selected as the experimental group,while sixty-two managed GDM patients were served as the control group.The comparison between the two groups was made in pregnancy complications,cesarean section rate and perinatal conditions.【Results】The rates of pre-eclampsia,polyhydramnios,preterm labour,cesarean section rate,macrosomia,neonatal hyperbilirubinemia,cardiac diseases,neonatal respiratory distress syndrome(NRDS),meconium aspiration syndrome(MAS) and neonatal hypoglycemia in the experimental group were significantly higher than those in the control group(P 0.05 for all),while the rate of neonatal asphyxia was similar between the two groups(P 0.05).【Conclusion】The unmanaged GDM patients have a higher risk of pregnancy complications and worse perinatal conditions compared with the managed GDM patients.The comprehensive interventions including better management for GDM patients,health education,diet therapy,exercises,glucose monitoring with insulin supplementation will reduce the risk of maternal and perinatal complications.

[Objective]To explore the etiology,pathology,diagnosis,treatment and preventive measures of ce sarean scar pregnancy with placenta. [Methods]12 cases of cesarean scar pregnancy during the 5-year period from January 2004 to April 2009 were analyzed retrospectively and the relative literature was reviewed. [Results]Of the 1 600 cesarean scar pregnancies,placenta increta occurred in 12 cases,with an incidence rate of 0.75%. Ten out of 12 (83.33%) cases received emergency hysterectomy. Two cases were treated with uterine compression sutures and intrauterine pack with gauze for hemostasis. There were no maternal deaths. [Conclusions]Reducing cesarean sec tion rate is essential to reduce the incidence of these complications of cesarean scar pregnancy. Early prenatal diag osis of placenta accreta is the key to improve their prognosis. When placenta accreta is suspected a strategy to minimize blood loss during surgery should be discussed by a multidiseiplinary team. Emergency hysterectomy is usu ally inevitable for cases with serious hemorrhage. Management plan should be individually tailored.

Objective:To explore the changes of cerebral tissue oxygenation in asphyxiated newborns,and to direct the treatment of asphyxiated newborns.Methods:Using TSAH-100(Tsinghua near- infrared spectroscopy) non-invasive monitoring of tissue oxygenation, the cerebral regional oxygen saturation(rSo) was measured in 49 asphyxiated and 29 normal term infants, respectively at 2-8 hourand the second,third,fifth,seventh and the tenth day after birth.According to the blood gas of 12 h after birth,infants were divided to asphyxiated group with metabolic acidosis,asphyxiated group with no metabolic acidosis and control group.Results:No significant differences were detectable at 2-8 h after birth between the two asphyxiated group and control group.The rSo2 of asphyxiated group with no metabolic acidosis on the second and third day after birth were significantly different with that of control group.But no significant differences were observed between the two groups on the fifth,seventh and tenth day after birth.Significant differences were observed between asphyxiated group with metabolic acidosis and control group on the second,third,fifth,seventh and tenth day after birth.No significant differences were observed between cesarean delivery asphyxiated newborns and vaginal ones.Conclusion:Early stage cerebra has higher perfusion after hypoxia exist in asphyxiated newborns.The degree of hypoxia in asphyxiated group with no metabolic acidosis is milder and the recovery is faster as well.The rSo2 of asphyxiated group with metabolic acidosis do not recover even on the tenth day after birth,which includes that those newborns have got hypoxic-ischemic cerebral injury.And there is no directly relationship between the delivery mode of the asphyxiated newborns and the rSo2 of newborns.

目的应用组织多普勒成像(TDI)技术对糖尿病孕妇胎儿二尖瓣环的运动速度进行动态观察,并与正常胎儿比较,探讨其评价糖尿病孕妇胎儿左室舒张功能变化的可行性。方法分别在妊娠20～28周、32～38周,应用TDI技术测量31例妊娠糖尿病孕妇和45例正常孕妇胎儿二尖瓣环的运动速度。用传统多普勒技术测量舒张期胎儿二尖瓣血流速度,并与舒张期二尖瓣环的运动测值进行比较。结果无论在中孕期或晚孕期,应用TDI技术测量的糖尿病组胎儿Ea/Aa与正常对照组比较差异有统计学意义(P<0.05),而传统采用的二尖瓣血流E/A值两组之间差别无统计学意义(P>0.05)。结论糖尿病孕妇胎儿左室舒张功能在中孕期及晚孕期均已发生改变;TDI技术较传统多普勒技术更能敏感反映胎儿左室舒张功能的微小变化。

Objective To investigate the relation between fetal distress and brain tissue oxygen saturation(rSO2) of neonates,and the change of rSO2 of neonatus with hypoxia in perinatal stage combining with brain injured.Methods 135 cases of full-term newborn with fetal distress were divided into two groups according to the diagnostic criteria of hypoxic-ischemic encephalopathy(HIE),the HIE group(62 cases) and no HIE group(73 cases).full-term newborn with no fetal distress were assigned as control group.Brain tissue rSO2 was measured by Near-infrared spectroscope on postnatal 2～8 h,the 2nd,3rd,5th,7th day.Results Brain tissue rSO2 in HIE group was lower than the control group(P0.05)on postnatal 2-8 h and the 2nd,3rd,5th,7th day.Brain tissue rSO2 in no HIE group was lower than control group on postnatal 2～8 h and the 2nd,3rd day and Brain tissue rSO2 in HIE group was lower than no HIE group on 2～8 h and the 2nd,3rd day.Brain tissue rSO2 of neonates with uterine-incision delivery and fetal distress was lower than the spontaneous labor levels on the second day(P0.05).There was no obvious difference among three groups(P0.05).Conclusion Neonates with HIE are complicated with oxygenation and cell metabolic disorders because of hypoxia for long time in uterus.There is no cerebral damage due to serious hypoxia.There is no direct relationship between the way of delivery for distressed fetus and neonatal brain tissue oxygen saturation level.Skilled delivery with forceps doesn't increase the risk of fetal brain injured.

Objective To investigate the predictive value of FHR monitoring during the second stage of labor for fetal acidemia and to investigate the relationship between pathological cardiotocogram(CTG) and different types of fetal acidosis.Methods 216 parturients with satisfactory FHR tracings during the second stage of labor were enrolled in the study.Umbilical blood gases were analyzed immediately after birth,fetal outcome and neonatal morbidity were recorded.Results ①The sensitivity of normal,marginal and pathological CTG patterns during the second stage of labor for predicton of fetal acidemia was 3.57%,10.72% and 85.71%,respectively;specificity was 57.45%,61.70% and 80.85%,respectively;positive predictive value was 1.23%,4.00% and 40.00%,respectively;negative predictive value was 80.00%,82.27% and 97.44%,respectively;accuracy was 50.46%,55.09% and 81.48%,respectively.②The incidence of late deceleration(LD) and prolonged deceleration(PD) was significantly higher in the group of metabolic acidosis than that in the group of mixed acidosis and respiratory acidosis(P=0.001,P=0.027,respectively).The incidence of severe variable decelerations and severe bradycardia was significantly higher in the group of mixed acidosis than that in the metabolic and respiratory acidosis(P=0.041,P=0.004,respectively).The incidence of merging decelerations was significantly higher in the group of respiratory acidosis than that in the group of mixed and metabolic acidosis(P=0.006).No statistical differences were observed in the baseline rate of absent variability among the three groups(P=0.168).Conclusion ①FHR monitoring alone was not efficient to detect fetal acidosis in the second stage of labor;other tests are required to confirm the diagnosis and to avoid unnecessary surgical intervention.②LD and PD were associated with metabolic acidosis,severe variable decelerations and severe bradycardia were associated with mixed acidosis and merging decelerations were associated with respiratory acidosis.

Objective Purposes to investigate the characteristics of the FHR tracings and to recognize the pathological patterns of the second stage.Methods Two hundred and sixteen cases with satisfactory or comparatively satisfactory FHR tracings in the second stage were studied.Logistic regression analysis was performed respectively to select those FHR patterns associated with increased risk for cord abnormality,meconium-stained amniotic fluid,operative delivery and adverse neonatal outcome.Results ①The incidence of mild variable deceleration(VD)was 53.24%,which was the highest in the 16 FHR patterns of second stage;②When cord abnormality served as dependent variable,variables entered Logistic regression equation were mild VD,moderate VD and saltatory pattern(OR=17.26,3.46,11.85);when operative delivery as dependent variable,severe bradycardia and merging of deceleration could be entered into equation(OR=12.65,3.84);when meconium-stained amniotic fluid as dependent variable,no variables could be entered into equation;when adverse neonatal outcome as dependent variable,variables entered equation were LD,PD,severe VD,absent baseline variability,severe bradycardia and merging of deceleration(OR=2.88,2.84,4.49,6.76,7.00,3.46).Conclusion ①Mild VD was the most frequent FHR pattern in the second stage.Mild VD,moderate VD and saltatory pattern were associated with cord abnormality and severe bradycardia and merging of deceleration with operative delivery;②There was no significant correlation between meconium-stained amniotic fluid and FHR patterns of the second stage;③The FHR patterns associated with adverse neonatal outcome in the second stage included absent or minimal baseline variability,late and prolonged decelerations,merging of decelerations,severe bradycardia and severe VD.If they were detected,it should be closely monitored.

Objective:To determine the predictive value of FHR monitoring for fetal acidemia during the second stage of labor,the relationship between FHR patterns and different types of fetal acidemia and the relationship between the duration from pathological FHR patterns to delivery and low Apgar score and neonatal hypoxia-ischemic encephalopathy.Methods:216 cases with singleton,term pregnancy,without contraindications for vaginal delivery were carried out continuous electronic fetal heart rate monitoring(EFM) during the second stage of labor Umbilical blood gas was analyzed at birth,Apgar score was recorded and neonatal hypoxia-ischemic encephalopathy was followed up.Results:The positive predictive value of normal,suspicious and pathological FHR patterns for predicting fetal acidemiain the second stage was 1.23%,4.00% and 40.00%.When the FHR patterns was normal and suspicious,the type of fetal acidemia was respiratory and when pathological,the types were respiratory,mixed and metabolic one.Neonatal asphyxia was recorded in mixed and metabolic acidemia group and no asphyxia in respiratory acidemia one.The duration from pathological FHR patterns to delivery were associated with low Apgar score and neonatal hypoxia-ischemic encephalopathy.Conclusion:The pathological FHR patterns during the second stage of labor have predictive value for fetal academia and the mixed and metabolic academia have more greatly effect on neonatal outcome than the respiratory one.The duration from pathological FHR patterns to delivery are associated with neonatal hypoxia-ischemic encephalopathy.But the duration from pathological FHR patterns to delivery need more cases to study in avoiding neonatal hypoxia-ischemic encephalopathy

Objective To assess fetal left ventricular diastolic function in diabetic pregnancies by echocardiography. Methods Changes of left ventricular diastolic function in 34 fetuses of diabetic mother and 54 normal fetuses were prospectively studied by detailed fetal echocardiography for two times,respectively at fetus gestational age 20-28 weeks and 32-38 weeks. The parameters of pulmonary venous flow and mitral valve were measured and S/D, E/A were calculated. These variables were then analyzed using an unpaired 2-tailed Student t test. Results Fetal pulmonary venous flow S/D, presystolic velocity in diabetic pregnancies were different from those of control group(P(0.05)). The E/A of mitral valve had no evident difference between two groups(P(0.05)). Conclusions The fetuses of diabetic pregnancies demonstrated signs of altered left ventricular diastolic function at both medium and late periods of pregnancy. Fetal pulmonary venous flow S/D, presystolic velocity were more sensitive than mitral valve (E/A) to reflect the variation of fetal left ventricular diastolic function.

目的探讨Ⅲ度羊水胎粪污染与新生儿脑组织氧饱和度的关系及影响新生儿脑组织氧饱和度的围生因素。方法将2004年1月至2005年3月在暨南大学第二临床学院妇产科分娩的Ⅲ度羊水胎粪污染的足月新生儿,根据胎粪吸入综合征(MAS)诊断标准分为MAS组和无MAS组,羊水清的足月新生儿为对照组,在新生儿出生后2～8h,第2、3、5、7天测量脑组织氧饱和度。结果MAS组新生儿出生后2～8h,第2、3、5、7天脑组织氧饱和度与无MAS组、对照组比较明显降低,差异有极显著性意义(P<0.01),无MAS组新生儿在第2、3天脑组织氧饱和度与对照组比较明显降低,差异有极显著性意义(P<0.01)。顺产组新生儿出生后2～8h脑组织氧饱和度比剖宫产组低,差异有极显著性意义(P<0.01),在第2、3、5、7天比较差异则无显著性意义(P>0.05)。新生儿出生后脑组织氧饱和度持续异常的围生因素有:绒毛膜羊膜炎合并Ⅲ度羊水胎粪污染及Ⅲ度羊水胎粪污染伴随新生儿窒息。结论MAS组新生儿脑组织氧饱和度受到影响并发生脑损伤。Ⅲ度羊水胎粪污染应立即结束分娩。绒毛膜羊膜炎出现Ⅲ度羊水胎粪污染及Ⅲ度羊水胎粪污染伴随新生儿窒息可导致严重的围生期脑损伤。

第二产程是胎儿发生酸中毒的最危险时期[1～3],而此时由于脐带受压,宫缩加强,胎头旋转、下降及受挤压等种种原因使胎心率发生异常改变,因而胎心监护图形也会有较大的变异性.在第二产程时,很多的病例外监护表现出胎心率异常,而这种异常是否能真实地反映胎心率变化情况,目前未见有关文献报道.本文就第二产程对同一产妇同时进行胎儿头皮电极胎心内监护和多普勒超声探头胎心外监护进行对比研究.