高龄孕妇妊娠中期唐氏筛查在产前诊断的价值研究

目的:分析高龄孕妇妊娠中期唐氏筛查在产前诊断的必要性。方法:收集来我院进行唐氏综合征筛查的孕妇1986例,其中将年龄≥35岁的高龄孕妇1009例作为观察组,将年龄<35岁的997例孕妇作为对照组,对两组患者分别进行唐氏初筛和羊水穿刺细胞培养确诊唐氏综合征,对观察组与对照组孕妇唐氏筛查阳性率、羊水穿刺结果、唐氏初筛的检出率和随访的妊娠结局进行比较。结果:观察组孕妇唐氏初筛的阳性率(20.1%)高于对照组(9.0%),观察组唐氏儿的比率(9.9%)高于对照组(2.3%),染色体核型异常的发生率也高于对照组,唐氏初筛软件对唐氏儿的检出率观察组高于对照组(P<0.05);观察组总不良妊娠结局发生率(10.9%)高于对照组(3.5%)(P<0.05)。结论:高龄孕妇孕中期唐氏筛查在高龄孕妇唐氏综合征的预防中有较高的应用价值,且对评估高龄孕妇发生不良结局的风险有较好的作用。

275例妊娠期肝内胆汁淤积症孕妇羊水性状与妊娠结局的研究

目的:探讨妊娠期肝内胆汁淤积症(ICP)孕妇羊水性状与妊娠结局的相关性。方法:选择2005年2月至2012年2月在我院分娩的ICP患者275例为研究对象,对其临床资料进行回顾分析。对患者的羊水污染率、胎儿窘迫率、新生儿窒息率及剖宫产率等进行统计分析。结果:275例ICP患者中,无羊水污染202例(73.5%),羊水污染73例(26.5%),其中羊水Ⅱ级26例(9.4%),羊水Ⅲ级47例(17.1%)。ICP分级轻度196例,占71.3%,重度79例,占28.7%。其中,重度ICP患者中羊水Ⅱ级、Ⅲ级例数均显著高于轻度ICP患者(P<0.05)。羊水污染组的胎儿窘迫率为20.55%,明显高于无羊水污染组的9.90%(P<0.05);羊水污染组的新生儿窒息率为19.18%,明显高于无羊水污染组的3.47%(P<0.05)。且随着ICP羊水分级数的增加,胎儿窘迫率、新生儿窒息率呈上升趋势。结论:ICP孕妇的病情程度与羊水污染呈正相关性,及时检测患者的羊水情况,适时终止妊娠能够有效地降低围生儿的病死率。

Comparison of different diagnostic methods in infants with Cholestasis

AIM: To evaluate different methods in differentiating idiopathic neonatal hepatitis from biliary atresia. METHODS: Sixty-five infants with cholestatic jaundice and final diagnosis of idiopathic neonatal hepatitis and biliary atresia were studied prospectively from September 2003 to March 2006. A thorough history and physical examination were undertaken and the liver enzymes were examined. All cases underwent abdominal ultrasonography, hepatobiliary scintigraphy, and percutaneous liver biopsy. The accuracy, sensitivity, specificity and predictive values of these various methods were compared. RESULTS: There were 34 girls and 31 boys, among them 46 subjects had idiopathic neonatal hepatitis (age, 61 ± 17 d) and 19 had biliary atresia (age, 64 ± 18 d). The mean age at onset of jaundice was significantly lower in cases of biliary atresia when compared to idiopathic neonatal hepatitis cases (9 ± 13 d vs 20 ± 21 d; P = 0.032). The diagnostic accuracy of different methods was as follows: liver biopsy, 96.9%; clinical evaluation, 70.8%; ultrasonography, 69.2%; hepatobiliary scintigraphy, 58.5%; and liver enzymes, 50.8%.CONCLUSION: Our results indicate that clinical evaluation by an experienced pediatric hepatologist and a biopsy of the liver are considered as the most reliable methods to differentiate idiopathic neonatal hepatitis and biliary atresia.

Preeclampsia from a renal point of view:Insides into disease models,biomarkers and therapy

Proteinuria is a frequently detected symptom,found in 20% of pregnancies.A common reason for proteinuria in pregnancy is preeclampsia.To diagnose preeclampsia clinically and to get new insights into the pathophysiology of the disease it is at first essential to be familiar with conditions in normal pregnancy.Animal models and biomarkers can help to learn more about disease conditions and to find new treatment strategies.In this article we review the changes in kidney function during normal pregnancy and the differential diagnosis of proteinuria in pregnancy.We summarize different pathophysiological theories of preeclampsia with a special focus on the renal facets of the disease.We describe the current animal models and give a broad overview of different biomarkers that were reported to predict preeclampsia or have a prognostic value in preeclampsia cases.We end with a summary of treatment options for preeclampsia related symptoms including the use of plasmapheresis as a rescue therapy for so far refractory preeclampsia.Most of these novel biomarkers for preeclampsia are not yet implemented in clinical use.Therefore,we recommend using proteinuria(measured by UPC ratio) as a screening parameter for preeclampsia.Delivery is the only curative treatment for preeclampsia.In earlypreeclampsia the primary therapy goal is to prolong pregnancy until a state were the child has an acceptable chance of survival after delivery.

A nested case-control study of maternal-neonatal transmission of hepatitis B virus in a Chinese population

AIM:To examine the determinants of maternal-neonatal transmission of hepatitis B virus(HBV) METHODS:A nested case-control study was conducted in Changsha,Hunan,People's Republic of China from January 1,2005 to September 31,2006 To avoid potential maternal blood contamination,we collected vein blood of newborns immediately after birth and before initial hepatitis B vaccination to determine the HBV infection status of the newborn For each HBsAg-positive infant,one HBsAg-negative infant born to an HBsAg-positive mother was matched by hospital at birth(same),gender(same),and date of birth(within 1 mo) A faceto-face interview was conducted to collect clinical and epidemiological data Conditional logistic regression analysis was used to estimate the independent effects of various determinants on maternal-neonatal transmission of HBV RESULTS:A total of 141 HBsAg-positive infants and 141 individually matched HBsAg-negative infants were included in the final analysis Maternal first-degree family history of HBV infection,intrahepatic cholestasis,and premature rupture of membranes were risk factors for perinatal transmission of HBV,whereas systematic treatment and HBV immunoglobulin injections for mothers with HBV infection were protective factors for maternal-neonatal transmission of HBV,after adjustment for potential confounding factors CONCLUSION:For HBsAg-positive mothers,systematic treatment,HBV immunoglobulin administration,and controlling intrahepatic cholestasis and pregnancy complications may reduce the incidence of perinatal transmission of HBV.

Management of inflammatory bowel disease in the pregnant patient

Inflammatory bowel disease (IBD) is a chronic disorder affecting young adults in their reproductive years. Many young women with IBD express concern about the effect their disease will have on fertility, pregnancy course and fetal development. This article presents an approach to management of IBD in the pregnant patient, including counseling and investigation, and summarizes existing data on the safety of medications used to treat IBD in pregnancy and breastfeeding.

Mental health of perinatal women

Pregnancy and childbirth are major stressors for some women. They can be followed by deterioration in mental health status and cause mental illnesses during perinatal period. Undetected and untreated perinatal mental illnesses can have negative unexpected impacts on parenting skills of the women and children’s development. Mentally ill mothers may not effectively attend their children’s needs in a timely manner and may experience an unfavourable mother-child attachment affecting the child’s language, social, emotional and cognitive development. The rate of pregnancy and postnatal health complications and interventions is higher among mentally ill women with some certain risk factors. The mentally ill mothers along with their partners need comprehensive support and counselling to be able to care for their infants and establish strong parent-child bond and attachment. Mental health campaigns across the world have endeavoured to increase the knowledge and awareness of the public towards perinatal mental health illnesses. To this aim, a routine screening is recommended in order to identify the women who are at risk of mood or anxiety disorder during perinatal period. The development of knowledge on perinatal mental illnesses among public and the health professionals has resulted in timely recognition and treatment of perinatal mental illnesses. Although great volumes of research show high prevalence of perinatal mental illnesses and their impacts on parenting confdence and competence as well as child’s developmental process, there is still lack of research on various aspects of perinatal mental illnesses. To enable early prevention, diagnosis and intervention, it is crucial to identify families who are at an increased risk of perinatal mental illnesses and provide support and intervention to minimise the adverse outcomes. The children’s needs may not be met by providing treatment to parental mental illnesses alone. It is also important to understand the impact of specifc parenting behaviours on child outcomes which is modified by the quality of parenting.

Risks and guidelines for the consumption of alcohol during pregnancy

Daily average intake of alcohol during pregnancy has consistently been associated with short term adverse outcomes such as miscarriage, preterm birth and intrauterine growth restriction, a large variety of malformations, as well as long term adverse outcomes such as foetal alcohol syndrome, mental retardation and general impairment of cognitive functions including intelligence, attention, learning abilities as well as social and behavioural functions. Weekly average consumption and alcohol binge drinking （usually defined as ≥ 5 drinks on a single occasion） independently of high daily average intake has not been consistently associated with short and long term adverse outcomes. Health authorities in most countries recommend that pregnant women completely abstain from alcohol. Even so, many health professionals including doctors, midwives and nurses do not provide information to pregnant women in accordance with the offcial recommendations, although a large proportion of women of child bearing age and pregnant women drink alcohol, especially before recognition of pregnancy. The discrepancy between guidelines and the information practice of health personnel is likely to continue to exist because guidelines of abstinence are not clearly evidence-based and not in line with current focus on autonomy and informed choice for patients, and because guidelines do not consider the everyday clinical communication situation.

Laparoscopic surgery in pregnancy

Each year, roughly 2% of pregnant women will undergo non-obstetrical abdominal surgery. Appendicitis, symptomatic cholelithiasis and adnexal masses are some of the common diagnoses encountered. Pregnancy poses challenges in the diagnosis and surgical management of these conditions for several reasons. Since the 1990's, laparoscopic surgery has gained popularity and in the past few years has become the standard of care for pregnant women with surgical pathologies. The advantages of laparoscopic surgery include shorter hospital stay, lower rates of wound infection, and decreased time to bowel function. This brief review discusses key points in laparoscopic surgery during pregnancy and highlights studies comparing laparoscopic and open approaches in common surgical conditions during pregnancy.

Second-trimester maternal β-human chorionic gonadotropin level associated with subsequent development of pregnancy-induced hypertension

Objective:To determine whether maternal β-human chorionic gonadotropin(β-hCG) level in second-trimester may be associated with subsequent development of pregnancy-induced hypertension(PIH).Methods:Seven hundred and sixty-two women in mid-trimester were to have maternal urine β-hCG standardized concentrations and maternal serum β-hCG measurements.Their case histories were recorded and reviewed from mid-trimester to delivery.The relation was observed between maternal urine,serum markers and subsequent development of PIH.Results:Among 762 women,504 cases were normal pregnancies,42 cases had PIH,94 cases had premature rupture of membrane (PROM),69 cases had preterm delivery (PD),53 other cases were excluded by various reasons.The levels of maternal urine,serum β-hCG in PIH were (61.75±9.78) IU/L and (304.56±54.17) ng/mg respectively,which were higher significantly than normal pregnancy group ([20.65±7.61] IU/L and [146.34±47.81] ng/mg,P<0.05).When maternal serum,urine β-hCG levels ≥2 MOM(multiple of mean),the incidences of developing PIH were increased significantly as compared with those of β-hCG <2 MOM women.The incidence of PIH increased from 5.1% in pregnancies with urine β-hCG ≥2 MOM to 11.7% in cases with urine β-hCG ≥4 MOM.Conclusion:The elevation of maternal mid-trimester urine,serum β-hCG levels is not only an early signal for dysfunction of placenta but also a dangerous signal for development of PIH.Second-trimester maternal urine β-hCG measurement proves to be superior to serum marker in clinical prediction.

Prevalence and Characteristics of Pregnant Syphilis among Women Attending Antenatal Clinics in Shenzhen (China) in 2003

Background: The Nnewly reported cases ofcongenital syphilis have been increaseding substantiallyover the past few years. To control the epidemic, a mu-nicipal program aimed at preventing mother-to-childtransmission of syphilis was introduced in July, 2001,which was designed aimed to screen all pregnant womenfor syphilis at their first visit to antenatal clinics or atadmission to hospitals in Shenzhen.Objectives: The aim of the study is tTo determine theprevalence of syphilis among women attending antenatalclinics and other medical institutions in Shenzhen andidentifies its patterns of infection. Methods: Upon giving informed consent, w Women whoattended antenatal care centers in Shenzhen from Janu-ary to December 2003 were included in this study subjectto obtaining informed consent. A blood sample was har-vested for syphilis screened for syphilising by using rapidplasma reagent test (RPR) and confirmed by TPHA forthose who were RPR positive. The women with pregnantsyphilispositive serology were systematically interviewedto obtain . During the interview, their demographicdetailsinformation,patterns of risk behaviors andother data. Data were collected andwere analyzedretrospectively.Results: Among Of 118,235 pregnant women surveyed,555 pregnant women were confirmed to have syphilis(prevalence of 4.69%), with a incidence of 4.69‰。 123women were excluded from the analysis because of in-complete medical records. Of 432 infected subjects withcomplete medical records, the average age was 26.8, witha range of 19 to 41. 7.41% (32/432) of them suffered fromprimary syphilis, 3.24% (14 /432) were ofhad secondary syphilis, and 89.35% (386/432) had latent syphilis. with-out any conspicuous clinical signs and symptoms.Conclusions: The prevalence of syphilis among the preg-nant women in our series was high and most of them wereasymptomatic. Screening for syphilis among pregnantwomen in Shenzhen is of importantce for the preventionof mother-to-child transmission of syphilis.

Pseudoxantoma elasticum,as a repetitive upper gastrointestinal hemorrhage cause in a pregnant woman

Pseudoxantoma elasticum is a rare, hereditary, multisystemic disease affecting the skin, eye, and cardiovascular system. A twenty-eight-year-old female has presented to emergency unit with the complaint of gastrointestinal hemorrhage. This patient, who had been monitored in the gastroenterology clinic more than 10 times in the past 8 years, noted a repetitive hemorrhage during her previous pregnancy in her history. The examination of the patient revealed the following signs and symptoms： atrophy in the epithelium of the retina pigment; typical angioid streaks and peau d＇orange finding in the fundus; thinning of the retinal nerve fiber in OCT （optic coherence tomography）; bilateral and reticular papillary lesions with yellowish- color in the neck region （plucked chicken appearance）; presence of bleeding loci in fundus, and nephrocalcinosis in kidneys. In light of these symptoms, the patient was diagnosed with pseudoxantoma elasticum. Skin biopsy confirmed the pseudoxantoma elasticum diagnose. PXE is an uncommon, hereditary disease. Early diagnosis of pseudoxantoma elasticum cases, is important for minimalizing systemic complications and informing the other family members through genetic counseling.

Urgent need to change clinical practices about postpartum contraception

In the United States, maternal mortality and unintended pregnancy rates are increasing. There are growing disparities in maternal health between indigent, minority women and Caucasian women of higher socioeconomic status. Family planning has long been viewed as a solution to these problems. As reliance on permanent contraception has diminished, timely access to highly effective contraceptive methods, namely long acting reversible contraceptives, which includes the contraceptive hormonal implant and intrauterine device- has become even more important. For women in the United States and abroad, the time of delivery is the one reliable opportunity for women to receive medical care. Consistently, research has shown that providing contraception in the immediate postpartum period is safe, effective, feasible and cost effective. However, misperceptions, lack of supplies, and reimbursement issues combine to defeat attempts to provide the most effective methods of contraception during that hospitalization. We believe that it is time to tackle the problem of unintended and rapid repeat pregnancy using an evidence-based, patient-centered paradigm and to eradicate systemic barriers blocking access to contraceptive methods during hospital stay. This editorial will outline some of the more compelling evidence supporting this move and will provide insights from successful programs.

Effect of the maternal-fetal interface immunoregulation on the occurrence of intrahepatic cholestasis of pregnancy

Maternal immune tolerance of the fetus is indispensable for a healthy pregnancy. Currently, the study of the immune microenvironment of the maternal-fetal interface has been a heated topic in reproductive immunology research. More and more studies show that the immune imbalance in the maternal-fetal interface plays a very important role in the incidence of intrahepatic cholestasis of pregnancy(ICP). However, the precise etiology and mechanism of immune imbalance in the occurrence of ICP is still unknown. In order to clarify the potential immunologic mechanisms of ICP, this review summarizes the recent studies of the decidual immunology microenvironment and the potential immunologic mechanisms related to the development of ICP.

Ethnic disparities: Genetics vs(social) environment

To define "ethnicity" in the context of perinatal care is a tough job. The word makes us think: "racial, social, cultural, national…". An ethnic group is generally considered a group of people with a common history, usually(but not always) a common religion and language, sharing aspects of culture such as nutrition and traditions concerning pregnancy, childbirth, the way they care for children. As procreation occurs mostly ingroup, every ethnic group will demonstrate a higher prevalence of, more or less well-known, genes and their connected diseases. For some populations, such as Ashkenazi Jewish people, the prevalence and associated risks of these autosomal diseases are well known, as in the case of "Jewish genetic disease", and specific screening programs are available.

Cost effective evidence-based interventions to manage obesity in pregnancy

The rising tide of obesity has seen the prevalence of overweight and obese women presenting for antenatal care approach 50% in recent years. In addition, many pregnant women have gestational weight gain in excess of Institute of Medicine guidelines and develop obesity as a result of pregnancy. Both variables impact adversely upon pregnancy outcome. Individualised programs are not financially viable for cash strapped health systems. This review outlines an evidencebased, public health approach to the management of obesity in pregnancy. The interventions are affordable and in randomised and epidemiological trials, achieve benefits in pregnancy outcome.

The Comparison of Urinalysis Parameters in Pregnant and Non-pregnant Women in Berat

Routine chemical examination of urine has changed dramatically since the early days of urine testing, owing to the development of the reagent strip method for chemical analysis. Reagent strips currently provide a simple, rapid means for performing medically significant chemical analysis of urine, including pH, protein, glucose, ketones, blood, bilirubin, urobilinogen, nitrite, leukocytes, and specific gravity. The study was conducted in the Medical Hospital in Berat City. A total of 480 midstream urine specimens were collected in sterile containers from urinalysis cases of women （reproductive age group） from outdoor and indoor female patients （n = 480）. A total of 240 pregnant women and 240 non-pregnant women were evaluated. The patients included were between the ages of 15-50 years. The obtained results in this study ware： 1） The percentage of glucose in pregnant women has resulted in 6.67%, while in non-pregnant women 23.34% distributed by age group; 2） 16% of pregnant women had bilirubinuria, where the highest percentage is occupied by 1＋, while in non-pregnant women 26%, where the highest percentage is occupied by 1＋; 3） Urobilinogen in pregnant women has this distribution： 11.67% of the cases included in the amount of 0.7, 82% of the cases included in the amount of 1 and only 6.34% of the quantity 1.5. Urobilinogen in non-pregnant women： 11.67% of cases are in the amount 0.7 and 72.92% of the quantity 1, while others are scattered. The material was collected in sterile cups for urine. The collected material was processed based on evidence to beakers or microscope preparations. In 5 age groups, the highest percentage is from 26 to 30 years old in the pregnant women and for the non-pregnant women 15 to 20 years old.

Impact of Omega-3 Nutritional Protocol on the Occurrence of Preeclampsia among High Risk Pregnant Women

Purpose： to examine the impact of omega-3 nutritional protocol for risky pregnant women on the occurrence of preeclampsia. Topic： Supplementation with omega-3 has been proposed to reduce the risk of preeclampsia, but the effects of this intervention are still uncertain. Method： A RCT （randomized controlled trial） had been conducted on 400 pregnant women between 12 and 16 weeks of gestation. Women were assigned randomly to either the control group or the study group. Achievements： Of the 400 women enrolled, 195 were randomly assigned to the study group and 205 to the control group. There was a significant difference between the study and the control groups in relation to the incidence ofpreeclampsia （0.5% and 5.5% respectively, P 〈 0.05）.

Nutritional Status and Associated Factors among Pregnant Women in Wondo Genet District, Southern Ethiopia

Inadequate quality and quantity diet is one of the major reasons for high levels of malnutrition in pregnant women. A cross-sectional survey was conducted in Wondo Genet District, Southern Ethiopia. A two-stage cluster sampling technique was used to select a representative sample of 153 pregnant women aged 19-49 years from three rural villages （＂Kebeles＂）. Energy and nutrient intakes from foods were calculated from one-day weighed food records on a sub-sample （n = 77）. The result of the study showed that the intakes of most nutrients were lower than the recommended intake. The energy intake of the study participants both in 2nd and 3rd trimesters of pregnancy were 2,308 kcal and 1,420.5 kcal compared to the recommended 2,340 kcal and 2,452 kcal, respectively. Except iron, almost all micronutrient intakes were lower than the recommended intake. Vitamin A intake was 3/ag compared with the recommended 800μg, while protein intake of the study respondents in 2nd and 3rd trimester of pregnancy was 45.9 g and 31.5 g, respectively, compared with the recommended 71 g. Risk factors for undernutrition were multiple pregnancy and no consumption of cereal-based foods. This study revealed that the energy and nutrient intake of the pregnant women in study area was below the recommended intakes. Furthermore, the situation might be aggravated by high phytate content food consumption reported. Nutritional status of pregnant women in study area was not adequate to support the increased energy and nutrient requirement of the participants.

Infertility and gynaecological oncology

Infertility and gynaecological cancer are two major problems in the field of women's health, where both have serious implications on a woman's physical, social and emotional wellbeing. There are well established links between many aspects of infertility and different types of gynaecological malignancies, including etiology, pathogenesis and disease management. In this special issue there are valuable articles that highlight different aspects of the relationship between infertility and gynaecological oncology. The issue covers conditions that represent risk factors for both infertility and gynaecological neoplasia. There is emphasis on the role of the fallopian tube being a critical organ for both conditions. There is a review on the advances in cancer diagnosis and treatment with consideration of the preservation of patient fertility. The various technologies for fertility preservation are reviewed and their strengths and weaknesses discussed. One of the important fertility preservation techniques is cryopreservation of embryo oocytes or ovarian tissue. This special issue emphasises that fertility preservation is now an important consideration in oncology clinics, and the options available to patients are routinely offered. Future developments will offer women in this difficult situation more options for fertility preservation, with an individualised approach for each patient. Equally, for infertile patients it is important to assess the risk of malignancy so as to provide optimal and timely intervention.