The Activity of Plasma Platelet-activating Factor Derived from Pregnant Women before and after Delivery and lts Relation to Pregnancy-induced Hypertension

The activity of plasma platelet-activating factor(PAF) from pregnant women before and after delivery was determined. Plasma samples were taken from 74 pregnant women, among whom 24 were normotensive controls, 30 mild and moderate hypertensive and 20 severe hypertensive. Of the two hypertensive groups(pregnancy-induced hypertension, PIH), PAF activity measured by a bioassay was significantly higher than that of normotensive control at 38 weeks in gestation , indicating a possible role of this potent lipid mediator in the pathophysiological mechanism of PIH. After delivery, PAF activity was obviously increased in all three groups , showing the regulation of placenta in PAF metabolism.

Significance of highly phosphorylated insulin-like growth factor binding protein-1 and cervical length for prediction of preterm delivery in twin pregnancies

BACKGROUND A twin pregnancy can carry greater risks than singleton pregnancies.About 60 in 100 twin pregnancies result in spontaneous birth before 37 wk,which is associated with several complications in the premature babies.Clinical detection of biomarkers may help to predict the possibility of premature birth so that corresponding interventions can be given to the pregnant women in a timely manner,in order to reduce the risk of preterm birth and improve the outcomes of the newborn infants.AIM To explore the clinical value of transvaginal ultrasound measurement of cervical length combined with insulin-like growth factor binding protein-1(IGFBP-1)hyperphosphorylation in cervical secretions as predictors of preterm delivery in twin pregnancies.METHODS A total of 254 pregnant women with twin pregnancies,who were admitted to Hainan General Hospital and underwent maternity examination,were selected as the study subjects from January 2015 to December 2018.All participants received transvaginal ultrasound measurement of cervical length and phosphorylated IGFBP-1(phIGFBP-1)test between 24 and 34 wk gestation.The pregnancy outcomes were analyzed.RESULTS Of the women with a positive phIGFBP-1 test result,preterm birth rate was higher in those with a cervical length≤25 mm than those with a cervical length>25 mm(all P<0.05).Similarly,in women with a negative phIGFBP-1 test result,preterm birth rate was higher in those with a cervical length≤25 mm than those with a cervical length>25 mm(all P<0.05).The sensitivity,specificity,and positive and negative predictive values of the phIGFBP-1 test combined with the cervical length test were 95.71%,91.21%,95.12%and 92.22%,respectively,for the prediction of preterm birth.CONCLUSION Cervical length combined with phIGFBP-1 tests is of value for the prediction of outcomes of preterm delivery in twin pregnancies.

Predictors of Adverse Pregnancy Outcomes Following Traumatic Injuries

Objective After traumatic injury in pregnant women,providing timely and appropriate management for high-risk patients is crucial for both pregnant women and fetuses.This study aimed to identify risk factors that predict adverse pregnancy outcomes after traumatic injury.Methods A retrospective cohort study including 317 pregnant patients who experienced trauma was conducted.The collected data included general demographics,injury mechanisms and adverse pregnancy outcomes.Patients were divided into two subgroups based on the absence or presence of trauma-related adverse pregnancy outcomes.Univariate and multivariate logistic regressions were conducted to estimate the associations between clinical variables and adverse pregnancy outcomes.Results A total of 41(12.93%)patients experienced adverse pregnancy outcomes within the first 24 h post-trauma.This study revealed that age>35 years(OR=14.995,95%CI:5.024–44.755,P<0.001),third trimester trauma(OR=3.878,95%CI:1.343–11.204,P=0.012),abdominal pain(OR=3.032,95%CI:1.221–7.527,P=0.017),vaginal bleeding(OR=3.226,95%CI:1.093–9.523,P=0.034),positive scan in focused assessment with sonography for trauma(FAST)positive(OR=8.496,95%CI:2.825–25.555,P<0.001),9≤injury severity score(ISS)<16(OR=3.039,95%CI:1.046–8.835,P=0.041)and ISS≥16(OR=5.553,95%CI:1.387–22.225,P=0.015)increased the probability of posttraumatic adverse pregnancy outcomes.Maternal age,gestational age at delivery,vaginal bleeding and positive FAST results were risk factors for abnormal delivery.Conclusion Advanced maternal age,third trimester,and positive FAST results should alert multidisciplinary trauma teams to closely monitor patients to prevent adverse pregnancy outcomes.

Clinical feature and predictive factor analysis for spontaneous regression of retinopathy of prematurity in a Chinese population

AIM:To investigate the ratio of spontaneous regression of retinopathy of prematurity(ROP)and to explore the possible relevant predictive factors.METHODS:A retrospective review of 405 infants who were diagnosed with ROP and mother during pregnancy were collected.Stage,zone,and duration of ROP were recorded.Statistical analysis was performed on 51 possible predictive factors.RESULTS:Totally 356 infants showed spontaneous regression.The incidence was 100%,95.3%,and 22.7%in stage 1,2,and 3,respectively.The 13.4%of the ROP with plus disease eventually resolved spontaneously.All affected eyes of aggressive posterior retinopathy of prematurity(APROP)failed to spontaneously regress.The mean duration of ROP was 7.2wk in patients with spontaneous resolution of ROP.Days of mechanical ventilation(OR=0.981,95%CI,0.965-0.997,P=0.021),retinal hemorrhage(OR=0.173,95%CI,0.064-0.470,P=0.001),delivery pattern(OR=2.750,95%CI,1.132-6.681,P=0.025),maternal anemia in pregnancy(OR=0.142,95%CI,0.036-0.563,P=0.005),the stages(at initial diagnosis OR=0.183,95%CI,0.041-0.816,P=0.026;at final diagnosis OR=0.031,95%CI,0.006-0.167,P<0.001),and with plus disease or not(OR=0.005,95%CI,0.001-0.031,P<0.001)were independent predictive factors of the spontaneous regression of ROP.CONCLUSION:Most mild ROP can spontaneously resolve.Active treatment is still recommended for stage 3 ROP,zone I ROP,AP-ROP,and ROP with plus disease.Prolonged mechanical ventilation and concurrent retinal hemorrhage reduce the likelihood of spontaneous ROP resolution.The pattern of delivery and the mother's anemia during pregnancy can also affect the prognosis of ROP.

Risk Factors and Pregnancy Outcome in Women with a History of Cesarean Section Complicated by Placenta Accreta

Objective:To explore the risk factors and pregnancy outcomes in women with a history of cesarean section complicated by placenta accreta(PA).Methods:This case-control study included clinical data from singleton mothers with a history of cesarean section in 11 public tertiary hospitals in seven provinces of China between January 2017 and December 2017.According to the intraoperative findings after delivery,the study population was divided into PA and non-PA groups.We compared the pregnancy outcomes between the two groups,used multivariate logistic regression to analyze the risk factors for placental accreta.Results:For this study we included 11,074 pregnant women with a history of cesarean section;and of these,869 cases were in the PA group and 10,205 cases were in the non-PA group.Compared with the non-PA group,the probability of postpartum hemorrhage(236/10,205,2.31%vs.283/869,32.57%),severe postpartum hemorrhage(89/10,205,0.87%vs.186/869,21.75%),diffuse intravascular coagulation(3/10,205,0.03%vs.4/869,0.46%),puerperal infection(33/10,205,0.32%vs.12/869,1.38%),intraoperative bladder injury(1/10,205,0.01%vs.16/869,1.84%),hysterectomy(130/10,205,1.27%vs.59/869,6.79%),and blood transfusion(328/10,205,3.21%vs.231/869,26.58%)was significantly increased in the PA group(P<0.05).At the same time,the neonatal birth weight 3250.00(2950.00–3520.00)g vs.2920.00(2530.00–3250.00)g),the probability of neonatal comorbidities(245/10,205,2.40%vs.61/869,7.02%),and the rate of neonatal intensive care unit admission(817/10,205,8.01%vs.210/869,24.17%)also increased significantly(P<0.05).Weight(odds ratio)(OR)=1.03,95%confidence interval(CI):1.01–1.05)),parity(OR=1.18,95%CI:1.03–1.34),number of miscarriages(OR=1.31,95%CI:1.17–1.47),number of previous cesarean sections(OR=2.57,95%CI:2.02–3.26),history of premature rupture of membrane(OR=1.61,95%CI:1.32–1.96),previous cesarean-section transverse incisions(OR=1.38,95%CI:1.12–1.69),history of placenta previa(OR=2.44,95%CI:1.50–3.96),and the combination of prenatal hemorrhage(OR=9.95,95%CI:8.42–11.75)and placenta previa(OR=91.74,95%CI:74.11–113.56)were all independent risk factors for PA.Conclusion:There was an increased risk of adverse outcomes in pregnancies complicated by PA in women with a history of cesarean section,and this required close clinical attention.Weight before pregnancy,parity,number of miscarriages,number of previous cesarean sections,history of premature rupture of membranes,past transverse incisions in cesarean sections,a history of placenta previa,prenatal hemorrhage,and placenta previa were independent risk factors for pregnancies complicated with PA in women with a history of cesarean section.These independent risk factors showed a high value in predicting the risk for placentab accreta in pregnancies of women with a history of cesarean section.

Systematic development of ionizable lipid nanoparticles for placental mRNA delivery using a design of experiments approach

Ionizable lipid nanoparticles(LNPs)have gained attention as mRNA delivery platforms for vaccination against COVID-19 and for protein replacement therapies.LNPs enhance mRNA stability,circulation time,cellular uptake,and preferential delivery to specific tissues compared to mRNA with no carrier platform.However,LNPs are only in the beginning stages of development for safe and effective mRNA delivery to the placenta to treat placental dysfunction.Here,we develop LNPs that enable high levels of mRNA delivery to trophoblasts in vitro and to the placenta in vivo with no toxicity.We conducted a Design of Experiments to explore how LNP composition,including the type and molar ratio of each lipid component,drives trophoblast and placental delivery.Our data revealed that utilizing C12-200 as the ionizable lipid and 1,2-dioleoyl-sn-glycero-3-phosphoethanolamine(DOPE)as the phospholipid in the LNP design yields high transfection efficiency in vitro.Analysis of lipid molar composition as a design parameter in LNPs displayed a strong correlation between apparent pKa and poly(ethylene)glycol(PEG)content,as a reduction in PEG molar amount increases apparent pKa.Further,we present one LNP platform that exhibits the highest delivery of placental growth factor mRNA to the placenta in pregnant mice,resulting in synthesis and secretion of a potentially therapeutic protein.Lastly,our high-performing LNPs have no toxicity to both the pregnant mice and fetuses.Our results demonstrate the feasibility of LNPs as a platform for mRNA delivery to the placenta,and our top LNP formulations may provide a therapeutic platform to treat diseases that originate from placental dysfunction during pregnancy.

剖宫产术后再次妊娠经阴道分娩的相关影响因素

目的探讨剖宫产术后再次妊娠时经阴道分娩的影响因素。方法选取本院80例剖宫产后再次妊娠孕妇为研究对象,根据分娩方式不同划分为经阴道分娩组与剖宫产组,各40例。回顾性分析两组的基础资料,包含年龄、产次、孕前体质量指数、上次剖宫产间隔时间等,总结分析剖宫产术后再次妊娠经阴道分娩的影响因素。结果多因素分析结果显示,年龄≤30岁、孕前体质量指数≤25kg/m²、上次剖宫产间隔时间>2年、子宫下段厚度>2mm、分娩前子宫颈Bishop评分>5分、有不良妊娠结局史是剖宫产术后再次妊娠经阴道分娩的影响因素(P<0.05)。结论年龄、孕前体质量指数、上次剖宫产间隔时间、子宫下段厚度、分娩前子宫颈Bishop评分、不良妊娠结局史是剖宫产术后再次妊娠经阴道分娩的影响因素,临床需要在分娩前高度重视,提前做好相关准备,以尽可能提高经阴道分娩成功率,改善母婴结局,提升分娩质量。

自贡地区4059例不孕不育及不良孕产史患者外周血染色体核型分析

目的 分析自贡地区不良孕产史及不孕不育患者外周血染色体异常核型,探讨其分布特点,为临床咨询提供依据。方法 选取2014年1月至2022年12月于该院遗传生殖医学中心进行遗传咨询的不孕不育及不良孕产史患者4 059例作为研究对象,制备外周血染色体标本后应用G显带技术分析染色体核型。结果 异常染色体核型检出率为14.54%(590/4 059);异常染色体核型中,染色体数目异常44例(7.46%),染色体结构异常546例(92.54%,包含多态性),其中非罗氏平衡易位32例(5.42%)、罗氏易位18例(3.05%)、倒位56例(9.49%)、缺失/重复3例(0.51%)、社会性别不符3例(0.51%)、多态性432例(73.22%)。自贡地区2021年以前遗传咨询患者人数比较均衡,2022年咨询人数陡增,染色体异常检出例数与前期比较增加不明显,染色体多态性检出数与染色体总异常数走势一致,染色体数目异常和结构异常近几年检出数较均衡。结论 自贡地区不良孕产史及不孕不育患者异常染色体核型检出率高于其他地区,对重点人群进行遗传分析有助于查明病因,指导生育,提高人口质量,为该地区遗传咨询及染色体核型分析提供参考。

孕期甲状腺功能减退孕妇阴道分娩后精神状态及产后抑郁发生危险因素

目的:分析妊娠期甲状腺功能减退(甲减)孕妇阴道分娩后精神状态及产后抑郁发生危险因素。方法:选取2021年4月-2022年4月本院治疗的妊娠期甲减孕妇87例,评估其分娩前3d及分娩后3d时的精神状况、产后抑郁评分,随访分析妊娠期甲减患者阴道分娩后6个月内产后抑郁发生危险因素。结果:产妇分娩后焦虑自评量表(50.36±4.48分)、抑郁自评量表(51.77±4.23分)、贝克抑郁自评问卷(30.36±4.27分)、爱丁堡产后抑郁量表评分(25.02±2.33分)均高于分娩前(40.36±2.11分、37.25±2.32分、21.36±3.04分、21.25±2.01分)(P<0.05)。随访产后6个月内共发生产后抑郁22例(25.3%),单因素分析显示产后抑郁的发生与年龄、产次、意外妊娠、泌乳量、喂养方式、家庭平均月收入、产后疼痛、睡眠质量有关;多因素logistics回归分析,年龄<25岁、初产、意外妊娠、泌乳量少、母乳喂养、家庭平均月收入≤5000元、产后疼痛、睡眠质量较差是患者产后抑郁发生危险因素(均P<0.05)。结论:年龄<25岁、初产、意外妊娠、泌乳量少、母乳喂养、家庭平均月收入≤5000元、产后疼痛、睡眠质量较差是妊娠期甲减患者产后抑郁发生危险因素,临床应加以关注并采取干预措施,减少产后抑郁的发生。

Risk Factors for Gestational Diabetes Mellitus(GDM)in Subsequent Pregnancy Among Women Without GDM History in China:A Multicenter Retrospective Study

Objective:This study aimed to determine the likelihood of gestational diabetes mellitus(GDM)in subsequent pregnancy among women without GDM history and to identify risk factors for GDM in subsequent pregnancy.Methods:This retrospective cohort study involved participants who delivered twice in same hospital of 18 research centers when delivered the second baby from January 2018 to December 2018.Finally 6204 women were enrolled and 5180 women without GDM history were analyzed further.Women were categorized as non-GDM or GDM based on the blood glucose values of the subsequent pregnancy,and the characteristics and GDM risk of these groups were compared.A univariate analysis of potential risk factors was performed using the Chi-squared test and/ort-test for qualitative or quantitative variables,respectively.Associations withP values<0.1 were chosen to be included in the multivariate binary logistic regression model.Results:In primary analysis of 6204 women,the incidence of GDM in subsequent pregnancy is 48.9%(490/1002)in women with GDM history and 16.1%(835/5202)in women without GDM history.In a further analysis for 5180 women without GDM at index pregnancy,compared with the non-GDM group,the GDM group had a significantly higher age,prepregnancy body mass index,and blood glucose value at each oral glucose tolerance test(OGTT)timepoint(fasting,1 h and 2 h)during the index and subsequent pregnancies,as well as higher weight retention during the interval between the two pregnancies(P<0.001).Age above 35 years in subsequent pregnancy(odds ratio(OR)=1.540,95%confidence interval(CI)=1.257-1.886,P<0.001),macrosomia in index pregnancy(OR=1.749,95%CI=1.277-2.395,P=0.001),OGTT blood glucose values in index pregnancy(fasting,OR=2.487,95%CI=1.883-3.285,P<0.001;1 h,OR=1.142,95%CI=1.051-1.241,P=0.002;2 h,OR=1.290,95%CI=1.162-1.432,P<0.001)and weight retention(OR=1.052,95%CI=1.035-1.068,P<0.001)were independent risk factors for GDM in subsequent pregnancy.Conclusion:For women without GDM history,GDM risk factors including age,macrosomia history,OGTT value,and weight retention,these can be evaluated before a subsequent pregnancy.Early warning and interventions are needed for women at high risk.

初产妇分娩后负性情绪发生现状及相关影响因素分析

目的:分析初产妇分娩后负性情绪发生情况及其相关影响因素。方法:回顾性分析2020年1月至2022年12月于本院分娩的103例初产妇的临床资料,统计其分娩后负性情绪发生情况;另收集初产妇的年龄分娩方式、文化程度、家庭月收入、既往流产史、妊娠期并发症、丈夫陪伴、分娩过程等资料,以多因素Logistic回归分析模型分析其负性情绪发生的相关影响因素。结果:103例初产妇中,分娩后负性情绪发生的有28例,发生率为27.18%(28/103)。单因素分析显示:年龄、分娩方式、文化程度、既往流产史与初产妇分娩后负性情绪的发生无关,差异无统计学意义(P>0.05);而家庭月收入、妊娠期并发症、丈夫陪伴、分娩过程与初产妇分娩后负性情绪的发生有关,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示:家庭月收入<8000元(β=1.974,OR=7.200,95%CI=2.762~18.766)、有妊娠期并发症(β=2.671,OR=14.455,95%CI=4.489~46.545)、无丈夫陪伴(β=0.921,OR=2.513,95%CI=1.035~6.099)、分娩过程不顺利(β=1.155,OR=3.173,95%CI=1.288~7.820)为初产妇分娩后负性情绪发生的主要影响因素(P<0.05)。结论:初产妇分娩后负性情绪发生率较高,而其负性情绪发生的因素较为多样,如家庭月收入<8000元、有妊娠期并发症、无丈夫陪伴、分娩过程不顺利等,临床需对上述高危人群给予高度关注。

双胎妊娠阴道试产脐动脉血气差异分析及相关因素

目的:探讨双胎妊娠阴道试产时两胎脐动脉血气的差异及相关因素。方法:回顾性分析2021年12月-2024年1月在本院进行阴道试产的双胎妊娠孕妇36例临床资料,分析临床特性、脐动脉血气结果及新生儿结局,探讨两胎脐动脉血气指标差异的相关因素。结果:脐动脉血气分析,第2胎脐动脉血气PH(7.22±0.10)、碱剩余(-4.48±3.29 mmol/L)均低于第1胎(7.29±0.06、-3.10±3.27 mmol/L),乳酸(3.68±1.52 mmol/L)高于第1胎(3.00±1.15 mmol/L)。两胎血气指标差异与产妇年龄、分娩前胎位、绒毛膜性、分娩孕周、发动方式、引产方式、产程中缩宫素使用、产程中胎心监测、分娩结局、分娩胎位等均不相关,与新生儿是否住院、住院时长不相关;双胎血气PH差异与是否为初产妇及BMI值存在中度相关,与新生儿出生后1min Apgar评分、5min Apgar评分存在中度相关。结论:本研究提示双胎阴道试产中,第2胎具有相对较差脐动脉血气状态,第二胎发生急性产时缺氧风险升高,但合适的病例在规范产程管理情况下,并不增加新生儿不良结局。

足月妊娠初产妇阴道试产失败中转剖宫产的影响因素

目的:分析足月妊娠初产妇阴道试产失败中转剖宫产的影响因素。方法:回顾性分析2019年3月至2022年3月在该院进行阴道试产的158例初产妇的临床资料。统计158例初产妇中转剖宫产发生情况,根据分娩结局不同将初产妇分为中转剖宫产组和阴道分娩组,对初产妇阴道试产失败中转剖宫产的相关因素进行单因素和多因素Logistic回归分析。结果:158例初产妇中阴道分娩135例(85.44%),中转剖宫产23例(14.56%)。两组胎膜早破、分娩镇痛占比及羊水污染程度比较,差异均无统计学意义(P>0.05);两组年龄、身高、孕前体质量指数(BMI)、孕期增重、新生儿体质量、妊娠时长、引产情况比较,差异均有统计学意义(P<0.05)。Logistic回归分析结果显示,年龄、孕前BMI、孕期增重、妊娠时长、引产均为足月妊娠初产妇阴道试产失败中转剖宫产的危险因素(OR>1,P<0.05),而身高则是足月妊娠初产妇阴道试产失败中转剖宫产的保护因素(OR<1,P<0.05)。结论:年龄、孕前BMI、孕期增重、妊娠时长、引产均为足月妊娠初产妇阴道试产失败中转剖宫产的危险因素,身高是足月妊娠初产妇阴道试产失败中转剖宫产的保护因素,临床可针对上述影响因素制订预防措施,或提前调整分娩方式。

剖宫产切口瘢痕妊娠的超声表现及影响因素分析

目的:总结剖宫产切口瘢痕妊娠超声图像特征,分析诊断准确性影响因素。方法:选择接受超声检查且经手术病理证实为剖宫产切口妊娠的44例患者,收集所有患者的临床资料与影像学资料,分析剖宫产切口瘢痕妊娠的超声特点及影响因素。结果:本组44例患者,经阴道超声检出剖宫产切口瘢痕37例,符合率为84.09%,误诊7例,占15.91%。分为单纯孕囊型与不均质包块型,其中单纯孕囊型27例,检出20例,检出率为74.07%;不均质包块型17例,全部检出;阴道超声共误诊7例,均为单纯孕囊型,患者无特异性症状,4例误诊为宫内早孕,2例误诊为难免流产,1例误诊为宫颈妊娠。超声显示孕囊距剖宫产切口瘢痕超过2.5 mm,认为孕囊距剖宫产切口瘢痕距离可能为影响超声诊断准确率的相关因素。结论:采用经阴道超声诊断剖宫产切口瘢痕妊娠,操作简单,无创,诊断准确率高,而孕囊距剖宫产切口瘢痕距离则为影响超声诊断准确性的相关因素。

剖宫产术后再次妊娠分娩方式的探讨

目的:探讨剖宫产术后再次妊娠合理的分娩方式,以期降低再次剖宫产率。方法:收集我院产科2007～2010年收治的342例剖宫产术后再次妊娠孕妇的临床资料进行回顾性分析,根据妊娠合并的高危因素(胎盘位置异常或子宫切口异常等),分为"高危"瘢痕子宫妊娠组和"普通"瘢痕子宫妊娠组,同时将"普通"瘢痕子宫妊娠组孕妇按照分娩方式分为经阴道分娩组(VBAC组)和再次剖宫产组(RCS组),并对两组的分娩结局、母婴并发症及医疗费用等进行分析。结果:342例孕妇中,"高危"瘢痕子宫妊娠组86例,"普通"瘢痕子宫妊娠组256例,其中VBAC组12例,RCS组244例。RCS组中因社会因素手术者117例,占47.95%;VBAC组孕妇平均出血量、住院时间和住院费用均低于RCS组(P<0.05)。RCS组新生儿因RDS转NICU的发生率、NICU住院时间和平均住院费用均高于VBAC组(P<0.05)。结论:对剖宫产术后再次妊娠者孕期应行详尽检查,筛选出胎盘位置异常或子宫切口异常等"高危"瘢痕子宫妊娠孕妇;其余应合理选择阴道试产,降低因社会因素导致的再次剖宫产率。

剖宫产术后再次妊娠孕妇阴道试产风险决策的调查研究

目的探讨剖宫产术后再次妊娠孕妇阴道试产风险决策现状及其影响因素。方法采用简单随机抽样法抽取贵阳市3所三级甲等医院,再通过便利抽样法从该3所医院抽取剖宫产术后再次妊娠的432例孕妇为研究对象,采用自行设计的《剖宫产术后再次妊娠孕妇阴道试产风险决策现状调查问卷》对其进行调查。结果剖宫产术后再次妊娠孕妇对本次妊娠分娩方式的决策倾向得分为(3.79±1.17)分,年龄、居住地、家庭人均月收入、既往阴道分娩史及医生对分娩方式的建议是剖宫产术后再次妊娠孕妇决策阴道试产的影响因素(均P<0.05);相关性分析显示,阴道试产感知风险、风险倾向与分娩方式决策间存在不同程度的相关性(均P<0.01);Bootstrap检验显示,风险倾向对分娩方式决策的中介效应值为0.108(P<0.05),95%CI(0.062,0.162),中介效应与总效应之比比值为0.13。结论年龄越小、居住地为乡镇和农村、家庭人均月收入越低、有阴道分娩史、医生没建议分娩方式和医生建议阴道分娩的孕妇更倾向于决策阴道试产;阴道试产感知风险越低和风险倾向越高的孕妇更倾向选择阴道试产,且风险倾向在阴道试产感知风险和分娩方式决策之间具有部分中介作用。

产科因素对产后早期盆底功能障碍性疾病发生的影响

目的探讨不同产科因素对产后早期盆底功能障碍性疾病(PFD)发生的影响,旨在为其预防和治疗提供理论依据。方法对2008年1月至2009年12月406例单胎初产妇产前及产后6～8周进行问卷调查,同时行POPQ评分,分析产科相关因素与PFD发生的相关性。结果孕期压力性尿失禁(SUI)的发生率为28.33%(115/406);产后SUI的发生率为18.47%(75/406),其中58例孕妇SUI症状由分娩前持续至分娩后,占产后SUI的77.33%(58/75);产后盆腔器官脱垂(POP)发生率为49.51%(201/406)。其中选择性剖宫产组SUI和POP的发生率为7.49%(27/227)和37.89%(86/227),阴道分娩组为32.40%(58/179)和64.25%(115/179),剖宫产组与阴道分娩组比较,差异有统计学意义(P<0.05)。Logistic回归分析显示,产后SUI的发生与妊娠期SUI、年龄、第二产程时间、会阴撕裂、产钳助产、新生儿出生体重和分娩前BMI有关(P<0.05)。结论孕期SUI的发病率高于产后;选择性剖宫产可能对盆底功能具有保护作用,与产后早期PFD的发生降低有关;产时及其他相关因素可使产后早期PFD发生的风险增加。

不同类型早产相关因素对比分析

目的探讨不同类型早产发生率、相关因素及妊娠结局。方法收集首都医科大学宣武医院妇产科2009年1月—2013年12月不同类型早产孕妇和新生儿的临床资料,对不同组别孕产妇(未足月胎膜早破组301例、未足月分娩组234例、医源性早产组193例)并发症发生情况、分娩方式、新生儿资料进行比较。结果 2009—2013年早产率逐年增加,但差异无统计学意义(P>0.05)。医源性早产组产妇年龄、剖宫产率、Apgar评分异常率及并发症明显高于未足月分娩组、未足月胎膜早破组(P<0.05),而孕周、胎儿出生体质量低于未足月分娩组、未足月胎膜早破组(P<0.05);3组早产中经产妇和未进行过产前检查者明显高于初产妇和接受过产检者(P<0.01),医源性早产组经产妇和未进行过产前检查的早产发生率高于未足月胎膜早破组和未足月分娩组(P<0.05)。医源性早产中妊娠期高血压疾病患者高占67.36%(130/193),胎盘因素占15.54%(30/193),胎儿因素占7.77%(15/193),其他占9.33%(18/193)。结论早产率逐年增加,其中医源性早产、未足月胎膜早破是早产发生率增高的重要因素,而减少医源性早产对降低早产的发生率至关重要。

单胎臀位妊娠行外转胎位术的影响因素及妊娠结局分析

目的分析单胎臀位行外转胎位术的影响因素及妊娠结局。方法收集产检单胎臀位妊娠的102例患者临床资料,比较胎头外倒转成功者(成功组)与胎头外倒转失败者(失败组)产妇的年龄、外倒转孕周、孕前BMI、孕期BMI增加、产次、羊水深度、胎盘位置、脐带绕颈等危险因素,以及外转胎位术后妊娠结局(包括分娩的间隔、孕周、方式和新生儿pH值、黄疸、转儿科ICU、早产等差异。结果 102例中,成功63例(61.8%),失败39例(38.2%),成功组与失败组患者的年龄、实施外转胎位术的孕周、孕前BMI、孕期BMI增加、产次、羊水深度、胎盘位置、脐带绕颈及新生儿体质量比较差异均无统计学意义(P均>0.05)。与失败组比较,成功组患者的分娩间隔和分娩孕周均较长、阴道顺产率较高(P均<0.05)。2组新生儿的pH值、黄疸和转科率比较差异均无统计学意义(P均>0.05)。结论对单胎臀位妊娠实施外转胎位术,可增加阴道顺产率,降低剖宫产率。

双胎妊娠并发子痫前期的发病趋势、特征及危险因素分析

【目的】探讨双胎妊娠并发子痫前期的发病趋势、特征及危险因素。【方法】回顾性分析2011年1月至2019年12月在中山大学附属第一医院住院分娩的1542例双胎妊娠孕妇子痫前期的发病趋势。最终1384例双胎妊娠孕妇纳入后续发病特征及危险因素分析,根据绒毛膜性将其分为单绒毛膜性(monochorionic,MC)组和双绒毛模性(dichorionic,DC)组,MC共有403例,其中子痫前期(preeclampsia,PE)组55例,非PE组348例;DC共有981例,其中PE组105例,非PE组876例;分别比较不同绒毛膜性孕妇PE组和非PE组的基本资料和分娩结局,采用单因素分析和多因素Logistic回归分析不同绒毛膜性双胎妊娠发生子痫前期的危险因素。【结果】双胎妊娠PE的总发病率为10.4%,2011-2019年各年PE的发病率在7.8%~11.8%之间波动。无论MC与DC双胎妊娠,PE组孕妇贫血(MC为58.2%和39.7%,P=0.010;DC为59%和38%,P=0.000)、低蛋白血症(MC为7.3%和1.7%,P=0.035;DC为10.5%和0.7%,P=0.000)、早产(MC为94.5%和70.1%,P=0.000;DC为89.5%和54.8%,P=0.000)、产后出血(MC为21.8%和10.6%,P=0.018;DC为20.9%和13.4%,P=0.035)、新生儿转新生儿重症监护室(MC为49.1%和28.6%,P=0.000;DC为26.7%和15.6%,P=0.000)的发生率均较非PE组高,组间差异有统计学意义;DC双胎妊娠PE组小胎出生体质量和大胎出生体质量均较非PE组轻,组间差异有统计学意义(P=0.000;P=0.017)。孕期增重过多、辅助生殖技术受孕是MC双胎PE的独立危险因素;孕前BMI≥24 kg/m^2、孕期增重过多、双胎体质量差过大是DC双胎妊娠PE的独立危险因素。【结论】双胎妊娠PE的发病率波动于7.8%~11.8%;不同绒毛膜性双胎妊娠PE的危险因素和分娩结局略有差异;孕期增重过多、辅助生殖技术受孕、孕前BMI≥24 kg/m2、双胎体质量差过大是双胎妊娠PE的危险因素,提示孕期体质量管理尤为重要。