摘要：目的观察早孕期检测血清PAPP-A联合中孕期检测血清AFP、freeβ-HCG、uE_3对胎儿唐氏综合征(DS)和爱德华氏综合征(ES)的筛查效果。方法回顾性分析在我院行产前筛查且有随访结局的7 055例孕妇的临床资料。所有孕妇早孕期检测血清妊娠相关蛋白A(PAPP-A)和游离人绒毛膜促性腺激素β(Freeβ-h CG),中孕期检测血清甲胎蛋白(AFP)、freeβ-HCG、游离雌三醇(μE3)。设计3个DS、ES筛查方案。方案A纳入指标为早孕期PAPP-A、Freeβ-h CG,方案B案纳入指标为中孕期AFP、freeβ-HCG、μE3,方案C纳入指标为早孕期PAPP-A和中孕期AFP、freeβ-HCG、μE3。用Life Cycle 4.0软件综合患者年龄、体质量、孕周等数据计算用三种方案筛查得出的患者DS、ES风险值。DS风险值>1/270为高风险,1/1 000~1/270为临界风险;ES风险值>1/350为高风险,1/1 000~1/350为临界风险。比较三种方案的DS高风险、DS临界风险、ES高风险、ES临界风险及阳性筛查结果检出情况。胎儿出生者以胎儿是否确诊DS、ES为金标准,终止妊娠者以羊水核型分析结果为金标准,计算三种方案筛查DS、ES的检出率、假阳性率。结果方案C的DS高风险、DS临界风险、筛查结果总阳性率均低于方案A、B(P均<0.05)。羊水穿刺染色体核型分析和胎儿出生后随访共发现DS患儿9例,其中方案A筛查结果阳性7例,检出率77.8%,假阳性率3.95%;方案B筛查结果阳性6例,检出率66.7%,DS假阳性率4.24%;方案C筛查结果阳性8例,检出率88.9%,假阳性率1.80%。方案C的检出率、假阳性率均优于方案A、B。羊水穿刺染色体核型分析和胎儿出生后随访共发现ES患儿2例,其中1例在3种筛查方案都得到了检出,另1例ES患者用联合方案得出了高风险值,ES检出率联合筛查方案均高于孕早期、孕中期方案。结论早孕期检测血清PAPP-A联合中孕期检测血清AFP、freeβ-HCG、u E3对胎儿DS和ES的筛查效果优于早孕期检测血清PAPP-A、freeβ-HCG或中孕期检测血清AFP、freeβ-HCG、u E3。

摘要：目的分析早孕期剖宫产瘢痕妊娠的临床及病理特点。方法选取2016年1月至2017年6月期间本院收治的74例早孕期瘢痕妊娠患者,运用MRI检查将患者分为外生型组(32例)和内生型组(42例),分析其临床特征及病理特点。结果多数早孕期剖宫产瘢痕妊娠患者伴有下腹隐痛、阴道不规则出血及腹腔内出血问题,少数患者无明显症状表现;但外生型病理变化发生率明显高于内生型,差异有统计学意义(P<0.05),且外生型患者停经时间、人绒毛膜促性腺激素(hCG)水平、出血量及住院时间与内生型相比差异有统计学意义(P<0.05),两组患者年龄、距上次剖宫产时间及妊娠包块比较差异均无统计学意义。结论剖宫产瘢痕妊娠患者有外生型和内生型两种不同临床分型,其临床及病理特点均有差异,医者可根据不同分型结合患者病情设计个性化医疗方案,以帮助其早日恢复健康身心。

摘要：Objectives: To examine if a low level of psychosocial resources in early pregnancy is associated with the occurrence of prolonged labour. Study design: A cross sectional study of 644 women expecting their first child. Participants were asked to complete a questionnaire at their first antenatal visit, measuring psychosocial resources defined as social network and support, work-related psychosocial factors, control of daily life and health characteristics. Outcome was prolonged labour at the end of the pregnancy. Results: A low level of psychosocial resources was not associated with prolonged labour. The majority of women reported that the degree of support was high in early pregnancy. Conclusions: A perceived low level of psychosocial resources in early pregnancy did not increase the risk of prolonged labour at the subsequent delivery.

摘要：Objective: The purpose of this study was to investigate temporal correlations between maternal serum placenta growth factor levels and placental perfusion in early human pregnancies. Study design: Systolic umbilical artery Doppler blood flow velocity indices at fetal and placental insertion sites were measured between 7 and 22 weeks of gestation from normal singleton pregnancies. Maternal serum placenta growth factor levels were determined by enzyme-linked immunosorbent assay. Results: Maternal serum placenta growth factor levels showed an exponential increase at approximately 14 weeks of gestation. Placenta perfusion, as estimated by systolic Doppler blood flow indices, significantly increased with gestational age (P < .000 1). There was a close association between placenta growth factor expression levels and evidence of increased placenta perfusion (P < .033). Conclusion: The significant increase in serum placenta growth factor coincides with the increased perfusion of the maternal/fetal interface at approximately 12 to 14 weeks of gestation. Correlation of placenta growth factor expression and placental perfusion suggests that placenta growth factor may contribute to assuring adequate vascular development/function of the placenta early in gestation.

摘要：目的观察五味子提取物对妊娠期苯并[a]芘(Benzo[a]pyrene,Bap)暴露致早孕期大鼠胚胎损伤的防治作用。方法采用性周期筛选合笼法制备孕鼠模型。将50只SD雌性孕鼠按体重进行随机区组设计分为BaP模型组、五味子低、中、高剂量组和正常对照组,每组10只。BaP模型组予BaP 2 mg/(kg·d)灌胃,五味子低、中、高剂量组分别予五味子提取物40、200、1 000 mg/(kg·d)加BaP 2 mg/(kg·d)灌胃,正常对照组予相同体积的橄榄油,持续灌胃8天。观察大鼠各期体重变化,子宫连胚总质量、卵巢质量并计算脏器指数;统计黄体数、胚胎着床数、吸收胎数并计算着床率和吸收胎率;E LISA法检测大鼠血清绒毛膜促性腺激素(human chorionic gonadotrophinβ,β-HCG)及孕酮(progesterone,PROG)水平。结果与正常对照组比较,Bap模型组大鼠孕9天体重、胚胎着床数、子宫连胚总指数、卵巢指数、大鼠血清β-CG及PROG水平均下降,差异有统计学意义(P<0.05,P<0.01);与Bap模型组比较,五味子低、中及高剂量组大鼠体重、子宫连胚总指数及PROG水平增加(P<0.05,P<0.01),五味子中、高剂量组大鼠卵巢指数及血清β-HCG水平升高(P<0.05,P<0.01),五味子高剂量组大鼠胚胎着床数明显增高(P<0.01)。结论五味子提取物可以降低妊娠期苯并[a]芘暴露对大鼠胚胎及生殖造成的毒性作用。