目的 探讨COOK双球囊导管和欣普贝生引产的优劣性。方法 选择住院分娩的孕妇388例,根据引产方式分为两组,研究组应用COOK双球囊导管,对照组应用欣普贝生。根据宫颈Bishop评分,研究组分为研究组1和研究组2,对照组分为对照组1和对照组2,研究组1和对照组1宫颈Bishop评分小于或等于3分,研究组2和对照组2宫颈Bishop评分大于3分而小于或等于6分。分别对各组促宫颈成熟及引产情况、妊娠结局进行比较。结果 各组放置COOK宫颈双球囊或欣普贝生前后,宫颈Bishop评分有差异,低宫颈Bishop评分组欣普贝生效果更好。研究组与对照组比较,阴道分娩和剖宫产病例差异无统计学意义;急产、产后出血、羊水污染病例差异有统计学意义。研究组新生儿窒息率低于对照组,体温>37.5℃发生率高于对照组,差异无统计学意义。结论 对宫颈条件较差者,建议选用欣普贝生诱导宫颈成熟;COOK双球囊导管引产,作用温和,安全性好,成功率高。
Objective To evaluate the advantage of the COOK double balloon catheter and Propess induced labor. Methods We collected 388 cases with pregnant women. The patients were divided into the research and control groups. The research group applied COOK double balloon catheter while the control group applies Propess. According to cervical Bishop rating, the research team was divided into research group 1 and research group 2. The control group was divided into control group 1 and the control group 2. The cervical Bishop score of the research group 1 and control group 1 was less than or equals 3 points. The cervical Bishop score of the research group 2 and the control group 2 was greater than 3 and less than or equal 6 points. We separately compared the pregnancy outcome for each group to promote cervical mature and induced labor situation. Results The cervical Bishop scores have significant difference before and after COOK cervical double balloon and Propess are positioned between two groups.The effect of low cervical Bishop scores group is better than the high cervical Bishop by propess. The rates of urgent production, postpartum hemorrhage and amniotic fluid pollution reduce significant in the research group. The neonatal asphyxia rate, incidence of temperature > 37.5, vaginal delivery cases and cesarean section cases have not significant differences between the research group and the control group. Conclusion We suggest that patients whose cervical condition is poor should choose Propess induced cervical mature; The COOK double balloon catheter induced labor is safe and has a high success rate.
目的 探讨影响自然周期供精人工授精妊娠的因素。方法 回顾性分析2007年4月—2013年4月期间在广东省计划生育专科医院行自然周期供精人工授精的6161个周期,其中妊娠组1454周期,对照组4707个周期。采用单因素分析及多因素Logistic回归分析女方年龄、不孕年限、子宫内膜厚度、类型及冻融复苏后前向运动精子总数与AID妊娠结局的关系。结果 年龄越大,不孕年限越长,妊娠率越低(P＜0.001); A型子宫内膜妊娠率25.94%较AB型的23.87%及B型的21.54%都高(P=0.001);妊娠组冻融复苏后前向运动精子总数均值(28.95±6.86)×106较对照组的(28.26±6.98)×106高(P=0.001);年龄(OR=1.614,P＜0.001)、不孕年限(OR=1.194,P=0.012)、子宫内膜分型(OR=1.258,P=0.001)影响妊娠率。结论 女方年龄、不孕年限、子宫内膜形态及冻融复苏后前向运动精子总数是影响自然周期供精人工授精妊娠的因素。
Objective To explore the parameters affecting the pregnancy rate from 6161 natural cycles of artificial insemination by donor(AID). Methods Consecutive cases of 6161 natural cycles of AID from April,2009 to April 2013 in Guangdong provincial family planning special hospital were analyzed retrospectively.1454 pregnant cycles were defined as observation group and the other 4707 non pregnant cycles were classified as control group.Related factors in effect of pregnancy rate of AID were analyzed by logistic regression analysis. Results The rate of pregnancy decreased with the increase of women ages and the infertility duration(P＜0.001).And the pregnancy rate of ICI among the women with type A endometrium was the highest among the three types of endometrium(25.94%vs23.87%vs21.54%,P=0.001).The sum of the forward moving sperm after freezing and thawing recovery of observation group is higher than control group(28.95±6.86)×106vs (28.26±6.98)×106.The value of OR of age,infertility duration and types of endometrium were 1.614,1.194 and 1.258,respectively. Conclusion Age of women,infertility duration,types of endometrium as well as the sum of the forward moving sperm after freezing and thawing recovery played an important role in pregnancy rate of natural cycles of AID.
目的 探讨GDM孕早、中期脂肪细胞因子Chemerin、RBP4水平的变化。方法 采用前瞻性研究,测定38例GDM及40例正常孕妇孕早、中期血清Chemerin、RBP4水平,分析其与胰岛素抵抗的相关性。结果 GDM组孕妇孕早、中期血清Chemerin、RBP4水平及HOMA-IR均较对照组升高,差异有统计学意义(P<0.05);两组孕妇孕中期血清Chemerin、RBP4水平均较孕早期升高,差异有统计学意义 (P<0.05);Chemerin、RBP4水平与IR成正相关,差异有统计学意义(P<0.05)。结论 GDM孕妇孕早、中期脂肪细胞因子Chemerin、RBP4水平升高,Chemerin、RBP4水平的升高与IR有一定相关性。
Objective To discuss the serum levels of the Adipokine Chemerin、RBP4 of Gestational Diabetes Mellitus(GDM) in early pregnancy and middle pregnancy. Methods In prospective study, pregnant women, venous blood was collected from 40 controls and 38 GDM during early pregnancy (9-12weeks)and middle pregnancy (22-26weeks). Serum insulin, Chemerin, RBP4 were measured by enzyme-linked immunosorbent assay (ELISA). Results Mean serum levelsof Chemerin and RBP4 were significantly higher among GDM cases compared with controls during early pregnancy and middle pregnancy(P<0.05). In two groups, Mean serum levels of Chemerin and RBP4 in middle pregnancy were significantly higher than those in early pregnancy (P<0.05).During early pregnancy and middle pregnancy, the Chemerin and RBP4 levels were positively related with HOMA-IR (P＜0.05). Conclusion There is evidence of a positive association elevated Chemerin and RBP4 concentration of early pregnancy and middle pregnancy with increased GDM risk.
目的 探讨高龄妊娠期糖尿病（GDM）产妇糖耐量的特点及其与妊娠结局的关系。方法 选择2020年1月1日—2024年12月31日在广州市第一人民医院规律产检并分娩的高龄产妇727例，包括高龄初产妇226例（GDM 78例）和高龄经产妇501例（GDM 131例），按照75 g OGTT血糖异常项数进行分组：一项血糖异常产妇为GDM I组（高龄初产妇38例，高龄经产妇68例）；两项血糖异常产妇为GDM Ⅱ组（高龄初产妇26例，高龄经产妇51例）；三项血糖异常产妇为GDM Ⅲ组（高龄初产妇14例，高龄经产妇12例）；75 g OGTT正常高龄产妇为对照组。收集研究对象一般资料、75g OGTT血糖及相关妊娠结局进行分析比较。结果 高龄初产妇GDM发生率（34.51%）较高龄经产妇GDM发生率（26.15%）高，差异具有统计学意义（P=0.021）；高龄初产妇GDM Ⅲ型宫内感染（28.57%）、产后出血（14.29%）发生率最高，差异具有统计学意义（P=0.037、0.039）；高龄初产妇GDM I型早产（23.68%）发生率最高，差异具有统计学意义（P=0.013）。高龄初产妇及经产妇GDM Ⅱ型的羊水过多、甲状腺功能减退、宫内感染、早产发生率均呈上升趋势。结论 高龄妊娠糖尿病产妇随OGTT血糖异常项增多出现不良妊娠结局风险升高，其中高龄初产妇的早产、宫内感染及产后出血的发生率更高，因此，针对高龄初产妇，应更加注重孕期血糖及健康管理，以减少不良妊娠结局的发生。
Objective To analyze glucose tolerance characteristics in elderly pregnant women with gestational diabetes mellitus（GDM）and relationship with pregnancy outcomes．Methods From January 1，2020，and December 31，2024，727 elderly pregnant women who underwent routine prenatal examinations and delivered in Guangzhou First People’s Hospital were recruit．Among them，226 were elderly primiparas and 501 were elderly multiparas．GDM was diagnosed in 78 elderly primiparas and 131 elderly multiparas．Based on the results of the 75 g oral glucose tolerance test（OGTT），GDM cases were classified as follows：GDM I（one abnormal glucose value；38 elderly primiparas，68 elderly multiparas），GDM II（two abnormal values；26 elderly primiparas，51 elderly multiparas），and GDM Ⅲ（three abnormal values；14 elderly primiparas，12 elderly multiparas）．Elderly pregnant women with normal OGTT results served as the control group．General clinical data and pregnancy outcomes were collected．The prevalence and characteristics of GDM in elderly primiparas and multiparas were analyzed．Results The incidence of GDM was significantly higher in elderly primiparas than in elderly multiparas（P=0.021）．The incidence of intrauterine infection and postpartum hemorrhage was highest in elderly primiparas with GDM Ⅲ（P=0.037，0.039）．The incidence of preterm birth was highest in elderly primiparas with GDM I（P=0.013）．The incidence of polyhydramnios，hypothyroidism，intrauterine infection，and preterm birth showed an increasing trend in both elderly primiparas and multiparas with GDM II．Conclusions Elderly primiparas with more severe glucose tolerance abnormalities are at a higher risk of adverse pregnancy outcomes．Enhanced blood glucose monitoring and comprehensive health management during pregnancy are crucial for reducing the incidence of adverse outcomes in this population．
目的 比较宫腔镜病灶切除术与超声监测下吸宫术治疗剖宫产瘢痕部位妊娠（CSP）的有效性。方法 回顾性分析2021年7月—2023年10月在南宁市妇幼保健院确诊为I、Ⅱ型CSP并接受治疗的129例患者，停经时间在38～83 d，中位停经时间48 d。其中42例患者接受了宫腔镜病灶切除术治疗（A组），87例患者接受超声监测下吸宫术治疗（B组），比较两组患者术后1、3、7、14 d的人绒毛膜促性腺激素水平以及手术出血量、手术时间、住院时间、住院花费。结果 两组患者在术后1 d，血清HCG水平下降，下降幅度均超过50%，且A组患者术后1 d血清HCG的下降幅度及下降速率大于B组患者（P＜0.05）；术后3、7、14 d，两组血清HCG水平仍持续下降。另外，A组患者手术出血量、手术时间、住院时间、住院花费分别为（15.35±14.53）mL、（60.73±53.05）min、（4.33±1.90）d、（6 689.23±2 216.19）元；B组患者手术出血量、手术时间、住院时间、住院费用分别为（26.09±29.24）mL、（51.59±54.46）min、（4.82±1.83）d、（6 270.34±2 547.85）元。A组患者术中出血量低于B组、住院时间短于B组（P＜0.05），手术时间及住院费用与B组比较差异无统计学意义（P均＞0.05）。结论 宫腔镜病灶切除术与超声监测下吸宫术均能有效治疗CSP，但宫腔镜病灶切除术在术后血清HCG的下降幅度及下降速率、术中出血量、住院时间等方面优于超声监测下吸宫术，而且手术时间和住院费用并没有显著增加。
Objective To compare the efficacy between hysteroscopic resection surgery and ultrasound-guided uterine aspiration in the treatment of cesarean scar pregnancy（CSP）．Methods A retrospective analysis was performed in 129 patients diagnosed with CSP（type I or Ⅱ）and treated in Nanning Maternal and Child Health Hospital from July 2021 to October 2023．Their duration of amenorrhea was between 38～83 d，with a median of 48 days．Among them，42 patients were treated with hysteroscopic resection surgery therapy（group A），87 patients were treated with ultrasound-guided uterine aspiration therapy and（group B）．Then，the levels of human chorionic gonadotropin（HCG），the amount of the intraoperative bleeding volume，surgical time，hospitalization time，and hospitalization expenses were compared between the two groups at one，three，seven and 14 days postoperativey．Results After one day of surgery，the serum HCG levels of two groups significantly decreased，with a decrease of more than 50%，and the magnitude and rate of decrease in serum HCG levels of group A were significantly larger than those of group B（P＜0.05）；After three，seven，and 14 day of surgery，serum HCG levels continued to decrease．Furthermore，the intraoperative bleeding volume，surgical time，hospitalization time，hospitalization expenses in group A were（15.35±14.53）mL，（60.73±53.05）min，（4.33±1.90）d，（6 689.23±2 216.19）yuan，respectively．That in group B were（26.09±29.24）mL，（51.59±54.46）min，（4.82±1.83）d，（6 270.34±2 547.85）yuan，respectively．Compared to group B，the intraoperative bleeding volume of group A was significantly lower（P＜0.05），and the hospitalization time is shorter，while there was no significant difference in surgical time and hospitalization expenses．Conclusions Both of hysteroscopic resection surgery and ultrasound-guided uterine aspiration can treat cesarean scar pregnancy effectively，but the former is superior to the latter in terms of the magnitude and rate of decrease in serum HCG levels after surgery，intraoperative bleeding volume，and hospitalization time，with no significant increase in surgical time and hospitalization expenses．
