目的 分析15例腹腔妊娠患者的临床病例特点,为临床工作提供参考依据,进一步减少漏诊及误诊的情况。方法 收集我院2002年1月—2018年6月期间住院治疗的腹腔妊娠患者的临床病例资料。回顾性分析并总结患者的临床诊治特点。通过t检验,进一步比较腹腔镜与腹式手术患者围手术期情况是否存在统计学差异。结果 1例B超检查提示大网膜妊娠可能;另1例入院前外院B超提示腹腔妊娠,孕8⁺周单活胎;其余13例患者术前B超提示宫内未见孕囊,子宫旁有包块,提示异位妊娠可能,术前未能明确腹腔妊娠。14例患者行手术治疗,另1例行介入穿刺保守治疗。术中探查发现腹腔妊娠病灶种植部位：位于大网膜5例,位于盆腔9例（膀胱区右下方盆壁1例,子宫直肠窝右侧直肠表面1例,右侧宫骶韧带2例,子宫下段前壁瘢痕处右缘1例,偏左侧肠管与子宫粘连之间1例、右侧盆壁1例、子宫直肠窝1例、子宫左侧圆韧带起始端1例）,位于腹腔1例（腰3椎体前方、腹主动脉与下腔静脉之间）。结论 腹腔妊娠的异位妊娠病灶种植部位非常广泛,超声检查需进一步扩大检查范围。必要时可选择MRI或CT检查准确定位,减少漏诊及误诊的情况。

Objective To analysis and summary clinical characteristics of 15 patients who were diagnosed with abdominal pregnancy,which supply reference for clinical work. Methods 15 cases who were diagnosed with abdominal pregnancy and admitted to Guangdong Women and Children hospital between January 2002 and June 2018 were identified. Retrospective analysis was used to summarize the clinical characteristics of diagnosis and treatment in 15 patients. Test statistics used Student's t test to find if there was statistical difference between laparoscopic and abdominal surgery patients in perioperative period. Results One case was likely diagnosed with greater omentum pregnancy by type B ultrasound. Another one patient was diagnosed with abdominal pregnancy which has 8+ weeks pregnant single live fetus by type B ultrasound in other hospital prior to hospitalization.The B ultrasound tests of the other 13 patients showed there were no sac in uterus and enclosed mass beside uterus which were diagnosed with ectopic pregnancy, but not positive diagnosis with abdominal pregnancy.Surgery was performed for 14 patients.We found more different sites where gestational sacs plant in abdominal pregnancy patients in operation, 5 cases sacs planted in greater omentum, 9 cases sacs planted in pelvic cavity including 1 case sac planted in pelvic wall bottom-right bladder,1 case sac planted in rectum outside right-hand of Douglas pouch,2 cases sacs planted in right utero-sacral ligament,1 case sac planted in right-side of scar in lower uterus segment,1 case sac planted in adhesive tissue between the lift intestinal canal and uterus,1 case sac planted in right pelvic cavity,1 case sac planted in Douglas pouch,1 case sac planted in initiating terminal of the lift round ligament of uterus. The inteventional puncture with medical treatment was supply for only 1 patient,CT test showed the sac planted in abdominal: ahead of third lumbar vertebra between abdominal aorta and inferior vena cava. Conclusion There are more sites where gestational sacs can plant in abdominal pregnancy patients. Ultrasound is first choice for patient who was considered ectopic pregnancy and better to expansion the inspection range. MRI or CT may find sacs plant site who was considered abdominal pregnancy which may reduce missed diagnosis and misdiagnosis. Surgery is first performed who was diagnosed with abdominal pregnancy. Medical treatment for patients who vital signs are stable.

目的 了解孕妇妊娠期运动现状及其影响因素,为优化妊娠期运动方案提供依据。方法 采用便利抽样法,使用自编《孕妇妊娠期运动现状及影响因素调查问卷》对广州市某三级甲等妇幼保健院214名孕周＞37周的孕妇进行调查。结果 妊娠期每次运动时长集中在30min~1 h的孕妇占43.0%;91.6%的孕妇选择散步和爬楼梯,仅有8.4%的孕妇接触过孕妇体操和瑜伽等其他运动形式;妊娠合并糖尿病与无合并症孕妇运动量相比,差异无统计学意义(P>0.05);家人朋友为孕妇主要获取妊娠期运动信息来源。认为妊娠期运动不重要、缺乏安全感、家庭及社会支持为妊娠期运动的主要影响因素。结论 孕妇运动量总体处于较低水平,运动形式单一,受认知、心理、生理、社会因素影响;孕妇尤其是患有妊娠合并糖尿病的孕妇对妊娠期运动的重要性和必要性没有给予足够的重视;医护人员对于妊娠期运动的引导作用较弱。

目的 探讨孕期生殖道菌群变化特征及其与不良妊娠结局的相关性。方法 选取2015年1月—2015年9月期间在我院妇产科门诊进行常规产科检查的90例孕妇为研究对象,根据孕期分为孕早期组28例(孕周＜14周),孕中期组29例(孕周14～28周),孕晚期组33例(29～42周)。采集阴道分泌物或宫颈分泌物,对生殖道菌群进行检测。比较三组生殖道菌群分布情况。根据细菌检测结果分为阳性组与阴性组,分别为44例、46例。观察两组不良妊娠结局发生情况,分析生殖道菌群变化特征及其与不良妊娠结局的相关性。结果 90例孕妇中,细菌检测阳性44例,占48.89%,依次为解脲脲原体20例(45.45%)、假丝酵母菌属9例(20.45%)、肠杆菌属8例(18.18%)、葡萄球菌属3例(6.82%)、阴道加德纳菌属2例(4.55%)与衣原体2例(4.55%);孕早期、孕中期、孕晚期孕妇生殖道菌群分布情况相比,差异无统计学意义(P＞0.05);细菌检测阳性者胎膜早破、产褥感染、新生儿感染、早产发生率高于细菌检测阴性者,差异有统计学意义(P＜0.05);不同菌属类型者不良妊娠结局相比,差异无统计学意义(P＞0.05)。结论 孕期生殖道菌群以解脲脲原体、假丝酵母菌属、肠杆菌属为主,细菌检测阳性者不良妊娠结局发生率高,而不同菌属类型与不良妊娠结局无关。

Objective To investigate the correlation between change characteristics of pregnant genital tract flora and adverse pregnancy outcomes. Methods 90 pregnant women received routine obstetric examination in our obstetrics and gynecology of hospital from January 2015 to September 2015 were selected as research object. According to duration of pregnancy, they were divided into 28 cases of early pregnancy group (gestational weeks<14 weeks), 29 cases of middle pregnancy group (14~28 weeks) and 33 cases of late pregnancy group (29~42 weeks). The vaginal or cervical secretions were collected, and genital tract flora was detected. The genital tract flora distribution of three groups were compared. According to bacteria detection results, patients were divided into 44 cases of positive group and 46 cases of negative group. The adverse pregnancy outcomes of two groups were observed, and the correlation between change characteristics of pregnant genital tract flora and adverse pregnancy outcomes was analyzed. Results Among 90 pregnant women, there were 44 cases of positive bacteria (48.89%), which included 20 cases of ureaplasma urealyticum(45.45%), 9 cases of Candida (20.45%), 8 cases of enterobacter (18.18%), 3 cases of staphylococcus (6.82%), 2 cases of vaginal gardnerella (4.55%) and 2 cases of chlamydia (4.55%); There was no statistical difference in the genital tract flora distribution among early, middle, late pregnancy group (P>0.05); The incidence of premature rupture of membrane, puerperal infection, neonatal infection and premature birth in patients with positive bacteria was higher than that in patients with negative bacteria (P<0.05); There was no statistical difference in the adverse pregnancy outcomes in patients with different types of bacterial genus (P>0.05). Conclusion Pregnant genital tract flora are mainly ureaplasma urealyticum, candida and enterobacter, and the incidence of adverse pregnancy outcomes in patients with positive bacteria is higher, but different types of bacterial genus has no correlation with adverse pregnancy outcomes.

目的 探讨宫腔积血对于中晚期妊娠结局的影响以及影响的因素。方法 结合477例中晚期宫腔积血孕妇的临床资料分析,根据妊娠结局分为正常妊娠结局组(NP)及不良妊娠结局组(AP)。结果 AP的平均孕周(23.22±6.87周)明显大于NP(16.11±4.76周),两组有明显差异性(P<0.001)。两组首次B超宫腔积血平均体积分别为8.01(2.22~28.67)(NP),13.05(3.54~26.34)mL(AP)(P=0.001),但相邻第二次测量结果两组相差不大(P=0.230)。AP组中胎盘下血肿的比率(53.4%)明显大于NP组(24.2%),而绒毛膜下血肿比率(44.0%)明显小于NP(73.8%),两组有明显差异性(P<0.001)。宫缩也是影响因素之一,在AP组可扪及宫缩的病例(88例55.3%)明显高于NP(38例11.9%),两组有明显差异性(P<0.001)。但在阴道流血率方面两组没有明显差异(P=0.407)。结论 妊娠中晚期宫腔积血可能会导致不良妊娠结局,而首次出现的孕周,急性大量宫腔出血、宫腔积血位置以及是否伴有宫缩都是影响妊娠结局的重要因素。

Objective To study the poor pregnancy outcomes of patients with intrauterine hematoma in the second and third trimesters, and discuss the risk factors. Methods We analyzed the clinical data of 477 patients who underwent routine examination in our hospital from January 2010 to June 2016 and classified them into normal pregnancy (NP) group and adverse pregnancy (AP) group according to their pregnancy outcomes. Results Gestational age at first detection of hematoma of AP group(23.22±6.87 weeks) was more than NP group (16.11±4.76 weeks)(P<0.001). The volumes of hematoma during the first detection were significantly different between the two groups (P=0.001).The average hematoma volume were 8.01(2.22-28.67)(NP),13.05(3.54-26.34)mL(AP)respectively. However, the hematoma volumes recorded in the second B-ultrasound examination were not significantly different between the two groups (P=0.230). In the AP group, the incidence of retroplacental hematoma (53.4%) was significantly higher than in the NP group (24.2%), while the incidence of subchorionic hematoma (44.0%) was significantly lower than in the NP group (73.8%)(P<0.001). The incidence of palpable contractions in the AP group (62.8%) was significantly higher than in the NP group (12.1%), P<0.001. However, the incidence of vaginal bleeding was similar (P=0.407). Conclusion Intrauterine hematoma in the second and third trimester may lead to adverse pregnancy outcomes. Risk factors for poor pregnancy outcomes are included gestational age at first diagnosis, acute and large intrauterine bleeding, location of hematoma and accompanying contraction.

目的 探讨二孩政策后二次妊娠孕妇产前不良情绪及影响因素。方法 选取2016年2月—2017年1月我院收治二次妊娠待产孕妇93例作为研究组,选取同期收治初产妇50例作为对照组,采用汉密顿焦虑量表(HAMA)和抑郁状态采用抑郁自评量表(SDS)评估比较两组产期焦虑、抑郁情绪,同时按照HAMA、SDS评分结果将研究组患者分为A组(合并不良情绪)和B组(未合并不良情绪),采用单因素和多因素Logistic回归分析方法分析影响二次妊娠孕妇产前不良情绪危险因素。结果 研究组HAMA、SDS评分均高于对照组(P＜0.05)。妊娠合并症、不适应医院环境、未参加孕妇学校及胎儿异常均为影响二次妊娠孕妇产前不良情绪危险因素。结论 二孩政策后二次妊娠孕妇产前易合并不良情绪,影响产前不良情绪危险因素较多,产前应针对性进行预防和干预。

目的 分析妊娠期慢性乙型肝炎病毒携带者病毒载量与孕妇肝功能、妊娠并发症的相关性。方法 将本院2015年1月—12月间在本院住院并于本院分娩的携带慢性乙型肝炎病毒(HBV)的86例孕妇作为本次研究对象,于住院期间分娩前测定孕妇HBV脱氧核糖核酸(HBV-DNA)定量,依据HBV-DNA定量测定结果将全部患者分为阴性组与阳性组,分别对比2组患者的临床资料、肝功能、妊娠并发症发生率及母婴结局;分析HBV-DNA载量与孕妇妊娠期肝功能及妊娠并发症的相关性。结果 2组孕妇的年龄、BMI、孕次与产次均无差异,P>0.05;阴性组患者妊娠期肝功能指标优于阳性组,P<0.01。阴性组中羊水量异常(偏多或偏少)发生率高于阳性组,P<0.05;其他妊娠期并发症发生率2组均未见差异,P>0.05。2组母婴结局均未见统计学差异,P>0.05。HBV载量与ALT肝功能指标均呈正相关,0<r<1,说明HBV-DNA越高则ALT越高,孕妇的肝功能越差。HBV载量与并发症发生间基本不相关,|r|<0.3,P>0.05。结论 慢性乙型肝炎病毒携带者妊娠期时随着病毒载量的升高,孕妇的肝功能有所下降仍可维持在正常标准,但与妊娠并发症的发生无相关性;提示对HBV-DNA阳性的孕妇给予密切监护,通过临床常规对症治疗能够保证母婴安全。

Objective To analyze the correlation between viral load of chronic hepatitis B virus infection and liver function and pregnancy complications. Methods We selected 86 cases of pregnant women with chronic hepatitis B virus(HBV)in our hospital from January 2015 to December 2015 as the research objects, and then during the hospitalization to test the quality of the HBV deoxyribonucleic acid (HBV-DNA)for them before delivery. According to the HBV-DNA quantitative results, all patients were divided into low dosage group and high dosage group, and then the clinical data, liver function, the incidence rate of pregnancy complications and the outcomes of the two groups were compared; at last we analyzed the correlation among the HBV-DNA load, liver function of pregnant women during pregnancy and pregnancy complications. Results There was no difference between the two groups of pregnant women in the age, BMI, pregnancy and birth time, P>0.05; the low dose group was better than the high dose group in the liver function index during the pregnancy, P<0.01. The incidence of abnormal amniotic fluid volume (more or less) in the low dose group was higher than that in the high dose group, P<0.05; there was no significant difference between the two groups in the incidence of other complications, P>0.05. There was no statistical difference between the two groups in maternal and neonatal outcomes, P>0.05. The HBV load was positively correlated with the two liver function indexes ALT, 0<r<1, indicating that the higher the HBV-DNA, the higher theALT, the worse the liver function of the pregnant women. There was no correlation between HBV load and complications, |r|<0.3, P>0.05. Conclusion Chronic hepatitis B virus carriers during pregnancy with increasing viral load, liver function of pregnant women declined to maintain in normal level, but not associated with pregnancy complications; that of HBV-DNA positive pregnant women given close monitoring of disease through clinical routine treatment can ensure the safety of mother and child.

目的 分析个体化营养指导对双胎妊娠的结局影响。方法 将2014年2月—2015年12月在新疆喀什疏附县人民医院分娩的80例双胎妊娠,接受过个体化营养指导的42例为治疗组;未能或不自愿接受个体化营养指导的38例为对照组,观察比较对照组和治疗组的妊娠结局。结果 治疗组妊娠期糖尿病(GDM)、贫血、妊娠期高血压疾病、产后出血、新生儿窒息、低出生体重儿发生率小于对照组差异有统计学意义(P<0.05)。结论 利用个体化营养指导双胎妊娠孕妇饮食,可以减少并发症,取得理想的妊娠结局。

目的 探讨经阴道三维彩色能量多普勒成像在诊断子宫瘢痕妊娠(CSP)中的应用价值。方法 回顾性分析245例临床怀疑瘢痕妊娠(CSP)患者的二维彩色超声(2D-CDFI)及经阴道三维彩色能量多普勒成像的表现,与病理结果进行对比,总结分析它们对子宫瘢痕妊娠(CSP)的灵敏度、特异度及阳性检出率。结果 2D-CDFI 诊断CSP的灵敏度、特异度及阳性检出率分别为73.7%、68.75%及74.44%;经阴道三维彩色能量多普勒成像诊断CSP的灵敏度、特异度及阳性检出率分别为87.06%、73.33%及88.10%;两者在诊断CSP的准确率差异有统计学意义(P=0.0026,P<0.05)。结论 经阴道三维彩色能量多普勒成像检查能清晰显示包块与子宫的空间立体结构,也能够多角度多方面显示瘢痕妊娠与子宫肌层间的异常血管,是早期诊断CSP的首选方法之一,具有重要的临床价值。

目的 探讨妊娠期甲亢患者血清甲状腺功能和免疫含量变化及其临床应用价值。方法 分别取妊娠期与非妊娠期甲亢病例各250例,于孕15周、孕25周以及孕35周时测定两组血清甲状腺功能各项指标与免疫含量。结果 与对照组相比,观察组患者整个妊娠期T3、T4水平明显更高(P＜0.05);孕中晚期两组FT3、FT4水平差异并无统计学意义(P＞0.05)。结论 血清T3、T4在妊娠合并甲亢患者整个妊娠过程中呈高水平表达,临床应高度重视TRAb阳性率、FT3、FT4表达水平,以明确诊断。

目的 对比观察罗哌卡因及布比卡因应用于患有妊娠期高血压的产妇行剖宫产时腰麻联合硬膜外麻醉的临床效果。方法 将103例择期行剖宫产手术的妊娠期高血压患者随机分为罗哌卡因组51例及布比卡因组52例分别采用对应药物进行麻醉,研究两组阻滞效果、心血管系统变化情况及不良反应发生情况。结果 两组间麻醉镇痛效果及优良率比较,差异没有统计学意义(P>0.05)。罗哌卡因组感觉及运动阻滞起效时间较布比卡因组长,运动阻滞恢复时间较布比卡因组短(P<0.05)。心血管系统变化情况比较,麻醉5min、10min时两组收缩压及平均动脉压均降低,但布比卡因组波动更大,两组间比较差异显著(P<0.05),心率及血氧饱和度比较无差异(P>0.05)。罗哌卡因组不良反应出现时间较布比卡因组晚,同时其不良反应发生率较布比卡因组低(χ²=4.1599,P<0.05)。结论 罗哌卡因及布比卡因在阻滞时间上略有差异,麻醉镇痛效果相当,但鉴于妊高症产妇本身心血管系统存在基础问题,运用罗哌卡因对心血管系统的影响较小,安全性更高,更值得推荐使用。