保守治疗后重复异位妊娠研究进展

异位妊娠是严重危害现代女性生命和健康的常见病,而近年来发病率却明显升高, 特别是希望保留生育功能而采用保守治疗方法(手术保守治疗、药物保守治疗), 使再次发生异位妊娠的风险随之上升.重复异位妊娠(recurrent ectopic pregnancy,REP)是指首次异位妊娠经手术治疗或药物治疗后,再次在子宫腔以外的卵巢、输卵管、腹腔、子宫颈或阔韧带等部位发生的妊娠[1].本文综述了关于保守治疗后重复异位妊娠病因及预防研究的最新研究成果.     

长效达菲林联合阴道超声引导下穿刺治疗卵巢子宫内膜异位囊肿及对辅助生殖技术结局的影响

目的:探讨长效达菲林联合阴道超声引导下穿刺治疗卵巢子宫内膜异位囊肿及对辅助生殖技术(ART)结局的影响.方法:回顾分析因不孕要求实施ⅣF-ET的子宫内膜异位症患者126例,比较卵巢子宫内膜异位囊肿行长效达菲林联合囊肿穿刺组(实验组)与单用长效达菲林组(对照组)囊肿大小变化、早卵泡期(基础)FSH、LH、E2水平、Gn启动日FSH、LH、E2水平、取卵日E2水平、获卵数、受精率、卵裂率、优质胚胎数及IVF-ET结局的差异.结果:实验组与对照组相比,卵巢大小、基础内分泌及启动日LH、E2、受精率、卵裂率、临床妊娠率均无统计学差异.穿刺组囊肿全部消失,未穿刺组96个囊肿31个消失.实验组启动日FSH低于对照组,取卵日E2明显高于对照组(P＜0.05),优质胚胎数、成熟卵泡数明显多于对照组(P＜0.05).结论:因子宫内膜异位症导致不孕而要求行辅助生殖技术的患者,尤其不愿手术的患者,可以先行囊肿穿刺术,同时使用超长方案ART治疗可获得更多优质胚胎数,因而可能有助于提高累积妊娠率.     

妊娠合并系统性红斑狼疮的母婴护理

系统性红斑狼疮(systemic lupus erythematosus,SLE)是一种由于体内大量自身抗体产生和免疫复合物沉积导致的多系统器官损害的疾病,多发生于青年妇女,尤其是育龄女性.该病虽不影响患者的生育能力,但可影响胎儿,出现反复流产、胎儿生长受限、胎死宫内、早产、胎儿窘迫和新生儿窒息、围产儿缺血缺氧性脑病等.据报道[1],系统性红斑狼疮的自发流产率为14%~23%,人工流产率为14%～22%,早产率为25%～40%,宫内生长迟缓发生率为9.5%～20%.系统性红斑狼疮可导致妊娠期高血压发生率增高,同时妊娠又可诱发系统性红斑狼疮的复发或恶化.     

不当妊娠损害赔偿之诉探析

所谓的不当妊娠,是指因医师过失施行绝育手术或避孕药处方开不当,造成妇女再度怀孕,而小孩或双亲提出的诉讼。对于不当受孕的情况,借鉴发达国家的经验,应承认母亲因生产或堕胎所受之身心痛苦、医疗费用,以及因此减少的薪水为损害,而请求赔偿;而不允许对于小孩抚养费用的请求。     

妊娠合并子宫肌瘤120例分析

目的 探讨妊娠合并子宫肌瘤的临床分析.方法 回顾性分析120例患者在我院分娩的妊娠合并子宫肌瘤的临床资料.结果 孕前和孕期存在子宫肌瘤35例(自然分娩20例,剖宫产15例);于剖宫产术中发现子宫肌瘤85例,其中未行肌瘤剥除术10例,原因为肌瘤生长的部位特殊.结论 妊娠合并子宫肌瘤可以根据情况予阴道试产,剖宫产术中发现子宫肌瘤,应根据肌瘤的部位、可能出血量的多少及自己的临床处理能力来决定是否同时行肌瘤剥除术.     

浅谈“前置胎盘”的预防及治疗

<正>我院自2009年～2011年三年时间共收治前置胎盘病例18例,平均年龄29岁。有2例入院时处于重症危险的抢救状态。经及时救治转危为安。其余经治疗及采取保胎措施均正常分娩。前置胎盘现象多见于妊娠晚期,是妊娠的严重并发症,妊娠28周后胎盘覆盖于子宫下段或子宫内口处,是产前出血的     

米非司酮的合理应用

米非司酮最早用于药物流产,以后用于中止妊娠和性激素依赖性疾病子宫肌瘤、子宫内膜异位症（内异症）等妇科病以及库欣综合症。本文介绍米非司酮在临床的合理使用,以期进一步探索米非司酮的治疗方案、临床疗效和副作用防治。     

子宫输卵管造影术126例观察及护理

子宫输卵管碘油造影术是治疗不孕症常见也是最有效的办法之一,而正确的护理是促进手术成功的重要方面,本文根据我院实例介绍,探讨了子宫输卵管碘油造影术的观察和护理工作。     

承德地区女性不孕325例病因分析

目的 探讨女性不孕症病因给予相应的预防和治疗.方法 分析325例不孕症类型及病因的变化.结果 输卵管导致不孕占52.92%,排卵障碍不孕占32.61%、其中多囊卵巢综合征占排卵障碍不孕的87.74%,盆腔结核占3.25%,宫须分泌物解眠支原体(UU)感染率54.77%,沙眼衣原体(CT)感染率为11.08%.结论 导致女性不孕病因主要是输卵管性因素、排卵障碍不孕,其中生殖道炎症是导致输卵管堵塞的主要原因,而流产、分娩、宫腔操作及不洁性生活也是输卵管堵塞的重要因素.     

超长方案在卵巢储备良好前次IVF/ICSI-ET失败患者中的应用分析

目的:评估超长降调节方案在卵巢储备良好前次IVF/ICSI-ET失败患者中的应用效果.方法:回顾分析246例卵巢储备功能良好前次IVF/ICSI-ET常规长方案失败再次行助孕治疗的患者,其中超长方案治疗52例为研究组,常规长方案治疗194例为对照组.结果:研究组Gn时间及获卵数均高于对照组(P＜0.01);但优质胚胎数、Gn量、注射HCG日孕酮水平、移植日子宫内膜厚度、中-重度OHSS发生率与对照组比较均无明显统计学差异(P＞0.05);研究组HCG阳性率、临床妊娠率均明显高于对照组,分别是:79.1%vs 61.1%,P=0.03;69.8%vs 54.9%,P=0.048,胚胎种植率有上升趋势(39.5%vs 31.5%,P=0.18).结论:在前次卵巢反应良好IVF/ICSI-ET失败患者中超长方案较长方案子宫内膜容受性可能更好,妊娠结局明显改善,是值得推荐的治疗方案.     

Alternative approaches to decreasing maternal anemia: identifying the need for social marketing strategies to promote iron-folic acid supplementation in the Peruvian highlands

• Anemia is the most common health condition affecting women during pregnancy, and leads to adverse health outcomes of both the mother and infant. Despite national fortification and supplementation programs in Peru, 21% of women of reproductive age are anemic. Adherence to iron-folic acid (IFA) supplements in this vulnerable population is low and influenced by side effects of the tablets, such as nausea and vomiting, caused by the generic formula of the tablets. The trust within a patient–provider relationship and the provider's competency at effective counseling increases women's adherence, whereas late entry into prenatal care and government regulations limit early initiation of IFA supplementation. It is important for partners to support women during supplementation and participate in their prenatal care. Social marketing strategies targeting the product, price, place, promotion, and policy of IFA supplements should decrease barriers to women's ability to obtain IFA tablets and adhere to the supplementation regimen and reduce iron deficiency maternal anemia. Public health practitioners implementing supplementation programs should consider different behavioral influences at the intrapersonal, interpersonal, and community levels that affect adherence.

Copyright © 2012 John Wiley & Sons, Ltd.     

树立正确六观 加强领导干部道德建设

领导干部,身处要位、手握重权,是社会各项事业的组织、领导者,他们的道德素养和人格品质,具有十分重要的示范导向作用,影响整个社会良好道德风气的形成和人们的精神状态,关系到中国特色社会主义事业的成败。广大领导干部必须大力加强道德建设,按照应遵循的道德原则、道德规范,严格要求自己,经受锤炼,耐住艰苦,顶住诱惑,管好亲属,把握尺度,做到慎独,牢固树立正确的人生观,名利观,权力观,亲情观,友情观,筑起拒腐防变的金钱观。     

Why Do Cohabiting Couples Marry? An Example of a Causal Event History Approach to Interdependent Systems

The purpose of this paper is to demonstrate a causal approach to interdependent systems based on two empirical investigations. These examples demonstrate (1) the study of two highly interdependent processes: entry into first marriage as the dependent process and the process of first birth/first pregnancy as the explaining one; (2) an interdependence occurring mainly in a very specific phase of individuals' lives (i.e. during the period of first family formation); (3) the involvement of time lags between cause and its effect (e.g. time until detection of conception); and (4) the highly dynamic character of an unfolding effect over time (i.e. the effect of first pregnancy/first birth on first marriage strongly depends on the progress of pregnancy and the time since the birth has taken place).     

African‐American Midwifery,a History and a Lament

The medicalization of fertility and infertility, pregnancy, abortion, contraception, childbirth, and postpartum care has not always worked in the interests of women. It has had particularly devastating effects on African‐American women. Their fertility has been managed for hundreds of years, first as slaves forced to have children for owners, then as objects to be experimented on without anesthetics, and finally as mothers sterilized without their consent. The relatively high rates of infant and maternal mortality, along with limited access to safe and high‐quality reproductive services, are continuing signs of such devastation. This article discusses the history and consequences of the medicalization of pregnancy, contraception, and abortion in America. Attention is drawn to the ways in which the profession of medicine took control away from midwives, the traditional birth attendants and pregnancy caregivers, and the particular consequences for African‐American women. Ultimately, we posit that greater access to midwifery care could lower infant and maternal mortality rates and improve reproductive services. The reintroduction of spirituality through midwifery would also restore the important role of “wise women” in supporting women, babies, and communities.     

Expecting the worst: circumstances surrounding pregnancy discrimination at work and progress to formal redress

This study explored the details of 318 cases of alleged workplace pregnancy discrimination reported to a community advocacy organisation in Australia. Circumstances surrounding pregnancy discrimination included derogatory comments about physical appearance, changed working conditions, denial of access to opportunities and less favourable work performance appraisals. Dismissal or constructive dismissal was often reported. The study also highlights the complexity and difficulty in navigating formal complaints processes and examines some of the outcomes for women who chose this course of action.     

Policy,planning and program development: Case study—adolescent pregnancy

The role of the Federal Government in stimulating local/regional/state action to pursue clearly identified problems is examined, with case study focused on the problem of adolescent pregnancy. Critical analysis is undertaken of the legislative framework within which health policy and programming is formulated and implemented and the directions and limitations inherent in increased volunteerism in the public sector.     

The Demand for Abortion by Unmarried Teenagers

A bstract A demand model was developed and applied to a nationally representative sample of unmarried, pregnant teenagers drawn from the National Longitudinal Surveys in order to identify the economic determinants of abortion Measures of the opportunity costs of pregnancy were found to play a major role in the individual's decision to give birth or to abort Economic variables in the analysis included predicted wages , local area unemployment rates, other family income, poverty status, and school enrollment status Other factors found to be significant were age, ethnicity , and religiosity In general, young women in favorable economic circumstances were substantially more likely than others to abort a pregnancy     

A new quantile treatment effect model for studying smoking effect on birth weight during Mother's pregnancy

This paper proposes a new quantile regression model to characterize the heterogeneity for distributional effects of maternal smoking during pregnancy on infant birth weight across different the mother's age. By imposing a parametric restriction on the quantile functions of the potential outcome distributions conditional on the mother's age, we estimate the quantile treatment effects of maternal smoking during pregnancy on her baby's birth weight across different age groups of mothers. The results show strongly that the quantile effects of maternal smoking on low infant birth weight are negative and substantially heterogenous across different ages.     

Law commentary–Pregnancy and sex discrimination: the recent judgement of the European Court of Justice

This comment examines the issues related to pregnancy and sex discrimination in the light of the recent decision of the European Court of Justice in Webb and EMO Air Cargo (UK) Ltd.     

The demand for season of birth

We study the determinants of season of birth for married women aged 20–45 in the USA, using birth certificate and Census data. We also elicit the willingness to pay for season of birth through discrete‐choice experiments implemented on the Amazon Mechanical Turk platform. We document that the probability of a spring first birth is significantly related to mother's age, education, race, ethnicity, smoking status during pregnancy, receiving WIC (Women, Infants & Children) food benefits during pregnancy, prepregnancy obesity, and the mother working in “education, training, and library” occupations; whereas among unmarried women without a father acknowledged on their child's birth certificate, all our findings are muted. A summer first birth does not depend on socioeconomic characteristics, although it is the most common birth season in the USA. Among married women aged 20–45, we estimate the average marginal willingness to pay (WTP) for a spring birth to be 877 USD. This implies a willingness to trade‐off 560 grams of birth weight in the normal range to achieve a spring birth. Finally, we estimate that an increase of 1,000 USD in the predicted marginal WTP for a spring birth is associated with a 15 pp (percentage points) increase in the probability of obtaining an actual spring birth.