maternal diseases and fetal outcome
2011年ATA妊娠和产后甲状腺疾病诊疗指南(中英文对照版)
Guidelines of the American Thyroid Associationfor the Diagnosis and Management of Thyroid DiseaseDuring Pregnancy and Postpartum美国甲状腺协会妊娠期和产后甲状腺疾病的诊断和治疗指南The American Thyroid Association Taskforce on Thyroid Disease During Pregnancyand Postpartum美国甲状腺协会妊娠期和产后甲状腺疾病特别工作组Translated by Wang Xinjun Binzhou people’s hospital,Binzhou Medical College王新军译滨州医学院附属滨州市人民医院INTRODUCTION前言Pregnancy has a profound impact on the thyroid glandand thyroid function. The gland increases 10% in size during pregnancy in iodine-replete countries and by 20%–40% in areas of iodine deficiency. Production of thyroxine(T4) and triiodothyronine (T3) increases by 50%, along with a 50% increase in the daily iodine requirement. These physiological changes may result in hypothyroidism in the later stages of pregnancy in iodine-deficient women who were euthyroid in the first trimester.妊娠对甲状腺和甲状腺功能具有明显影响。
非侵入性产前检测对胎儿罕见染色体三体的检测价值
罕见的染色体三体（RATs ）是指除21、18、13号染色体之外的常染色体三体，其嵌合体的发生机制可能是早期着床前胚胎配子减数分裂发生错误后三体/单体自救的结果，或有丝分裂阶段染色体不分离导致［1-3］。
罕见的染色体三体的真性嵌合在胎儿期并不多见，但随着产前检测技术的发展，已有越来越多的罕见染色体三体嵌合体被检出。
近几年，非侵入性产前检测技术（NIPT ）的检测范围由传统的常见染色体非整倍体逐渐拓展为全基因组检测，由此检测出更多的其他染色体异常，包括RATs ，给后续的遗传咨询和处理带来很多困难。
2022年美国ACMG 关于NIPT 的指南认为尚没有足够的证据支持NIPT 常规用于RATs 的筛查［4］，但也有研究发现NIPT 检测到的RATs 与不良妊娠结局有关，认为NIPT 是否有益于RATs 的检出，NIPT 检测到哪种RATs 与不良妊娠结局有关，以及嵌合体的百分比是否有助于妊娠Value of non-invasive prenatal testing for rare autosomal trisomies in fetusesXIE Xiaoxiao 1,ZHAO Qingdong 1,HU Lingyun 1,JIANG Shufang 1,WANG Xiaoping 1,ZHANG Wenling 2,LI Zhen 1,YOU Yanqin 1,LU Yanping 11Department of Gynecology and Obstetrics,2Department of Clinical Laboratory,First Medical Center of Chinese PLA General Hospital,Beijing 100853,China摘要：目的探讨非侵入性产前检测对罕见的染色体三体的检测价值。
方法收集2019年1月~2023年4月本院通过非侵入性产前检测检出罕见染色体三体高风险的病例，临床咨询后进行侵入性产前诊断，使用染色体核型分析、染色体微阵列分析、染色体拷贝数变异测序、间期荧光原位杂交等技术进行检测，分析结果并随访妊娠结局，以评价非侵入性产前检测对罕见染色体三体的检测价值。
(妇产科学课件)8.3(参考翻译)Placenta Previa
Manifestation 表现
Symptom 症状:
Sudden , recurrently painless vaginal bleeding in third trimester. 位于妊娠晚期的突然的、反复发作的 无痛性阴道流血
CHARACTER of bleeding
Painless
Manifestation 表现
useless and dangerous
Diagnosis 诊断
Check the placenta 胎盘 and membrane 胎膜 after delivery:
The distance from edge of placenta to the rupture 破裂 of the fetal membranes 胎膜 is less than 7cm.
diagnoses method—simplest 最简单, precise 精确, safest 最安全
Diagnosis 诊断
Clinical symptoms and signs Sonography: the most important diagnoses
method—simplest, precise, safest
2. Placental abnormality 胎盘功能不全
1)Large placenta 巨大胎盘 (multiple pregnancy 多胎妊娠) 2)succenturiate lobe （副胎盘）
3. Delayed development of trophoblast cell 滋养层细胞发育迟缓
General Consideration 概论
Placenta previa state（胎盘前置状态）
PPT演讲：欣普贝生产品篇
显著的临床有效性 ——提高阴道分娩率
循证医学证实，撤药后根据需要配合使用少量缩宫素， 应用欣普贝生®阴道分娩率可达80％
试验
发表时间
应用欣普贝生®后剖宫产(n/N)
Chyu Green Hunter Miller Ottinger S-Ramos Smith Wieland Wing
1997 1998 1998 1991 1998 1998 1994 1999 1997
显著的临床有效性 ——提高24小时临产率，缩短产程时间
采用多中心、前瞻性研究方法
选择具备引产指征的100例足月胎膜早破、180例 胎膜完整产妇放置欣普贝生®
24小时内临产率90.7%
组别
24小时临产数 临产率 平均放药-取药时间
平均产程时间
胎膜早破组
97
97.0%
7.6
5.9
胎膜完整组
针刺疗法
（基本不用）
＊曹泽毅、董悦等，《中华妇产科学》第二版：956
药物性方法 缩宫素小剂量低浓度静点（常规用）
PGE2凝胶宫颈管内给药（少用）
PGE2控释阴道栓剂欣普贝生® （常用）
米索前列醇
(不常规用)
卡孕栓
(基本不用)
硫酸脱氢表雄酮 (已不用)
蓖麻油
(基本不用)
前列腺素PGE2作用机理
提高胶原 蛋白酶活性
试验
发表时间
应用欣普贝生®(n/N)
Ottinger S-Ramos Wing
Total
1998 1998 1997
21 / 32 70 / 115 45 / 98
136 / 245
Edward G. Hughes et al, Dinoprostone vaginal insert for cervical ripening and labor induction: A meta-analysis. Obstetrics & Gynecology 2001;97(5): 847－855
胎膜水肿临床意义研究
胎膜水肿临床意义研究目的：探讨胎膜水肿与产妇疾病、母儿妊娠结局之间的关系。
方法：回顾性分析同济医院围产医学科2012年1月-2014年1月17例发生胎膜水肿的产妇的临床资料，选取同期未发生胎膜水肿的30例产妇为对照组，分析两组产妇并发症发生情况及新生儿状况。
结果：两组绒毛膜羊膜炎、胎膜早破、重度子痫前期及慢性盆腔炎发生率比较差异均有统计学意义（P＜0.05）；两组新生儿1 min Apger评分、5 min Apger评分、体重、身长及新生儿肺炎发生率比较差异均无统计学意义（P>0.05）。
结论：胎膜水肿与多种疾病相关，炎症过程的水肿可能造成胎膜受损至胎膜早破，但其本身可能是机体损伤后修复的一部分。
胎膜水肿产妇及时行剖宫产，对新生儿出生状况无显著不良影响。
[Abstract] Objective：To study the relationship between fetal membranes edema and maternal disease，pregnancy outcome.Method：The clinical data of 17 cases of fetal membranes edema puerperas in perinatology department of Tongji Hospital from January 2012 to January 2014 were retrospectively analyzed.30 normal puerperas without fetal membranes edema were selected as the control group. The occurrence of complications and the neonatal condition of the two groups were analyzed.Result：The differences in the incidence rates of chorioamnionitis，premature rupture of fetal membranes，severe preeclampsia and chronic pelvic inflammatory disease were statistically significant（P＜0.05）.The differences in the Apger scores of 1 and 5 minutes，weight，height and incidence rate of pneumonia of newborn were not statistically significant（P>0.05）.Conclusion：Fetal membranes edema is related to a variety of diseases.Inflammatory process of edema may cause fetal membrane damage to premature rupture of membranes，but itself is likely to be part of the body damage after repair.Timely cesarean section of fetal membranes edema puerpera has no harmful effects on neonates.[Key words] Fetal membranes edema；Premature rupture of fetal membranes；Chorioamnionitis胎膜是胎儿附属物之一，由绒毛膜和羊膜组成，受母体及胎儿面环境双重影响，生理状态下对胎儿提供营养与支持，维持胎儿生长环境的稳定[1]。
子痫前期及子痫并发HELLP综合征相关因素及妊娠结局的分析
关于论文使用授权的说明
本人完全了解学校关于保留、使用学位论文的各项规定， （选择“同意／不同意”）以下事项： １．学校有权保留本论文的复印件和磁盘，允许论文被查阅和借阅， 可以采用影印、缩印或扫描等复制手段保存、汇编学位论文； ２．学校有权将本人的学位论文提交至清华大学“中国学术期刊（光 盘版）电子杂志社”用于出版和编入 ＣＮＫＩ《中国知识资源总库》或其他 同类数据库，传播本学位论文的全部或部分内容。
丙氨酸转氨酶
ANOVA
analysis of variance
方差分析
论文独创性说明
本人申明所呈交的学位论文是在我个人在导师的指导下进行的研 究工作及取得的研究成果。尽我所知，除了文中特别加以标注和致谢的 地方外，论文中不包含其他人已经发表或撰写过的研究成果。与我一同 工作的同志对本研究所做的任何贡献均已在论文中作了明确的说明并 表示了谢意。
PPH
postpartum hemorrhage
产后出血
FGR
fetus growth restriction
胎儿生长受限
UN
urea nitrogen
尿素氮
Cr
creatinine
肌酐
AST
aspartate aminotransferaseBiblioteka 天门冬氨酸转氨酶ALT
alanine aminotransferase
—2—
Ａｂｓｔｒａｃｔ
antenatal care and examine laboratory data such as complete blood count, hepatic function, renal function, and blood clotting function of PE patients are useful to prevent and discover HELLP syndrome earlily and reduce the incidence of complications and mortality of patients and fetuses. Key words : Preeclampsia；Eclampsia ；HELLP Syndrome
妊娠合并甲状腺功能减退症的研究新进展_秦珂
娠早期由于雌激素水平增高，雌激素刺激肝脏合成 别高出了 3 倍、3． 5 倍、1． 5 倍； Abalovich 等［18］发现
甲状腺激素结合球蛋白（ TBG） 并延长其半衰期，导 无论孕前甲状腺功能如何，对妊娠期合并临床和亚
致血中 TBG 浓度翻倍，可增加至 740 mmol / L，同时 临床甲减孕68·
Proceeding of Clinical Medicine，Oct． 2016，Vol 25 No． 10
个指标，以降低亚临床甲减、低 T4 血症、隐性自身免
疫甲状腺炎的漏诊率。
7结 语
综上所述，甲状腺功能异常是威胁孕妇健康和
胎儿发育的高危因素，因此，应加强孕前或孕早期甲
状腺疾病的筛查，对于患有甲减的孕妇应当尽早进 行干预治疗［30］，并在整个妊娠期密切监测甲状腺功 能及孕妇和胎儿的情况。最终获得与健康孕妇接近
2012 年 TES 指南及 2014 年 ETA 发布的《关于 孕妇与儿童亚临床甲状腺功能减退指南》指出，对于 甲状腺过氧化物酶抗体（ TPOAb） 阴性的亚临床甲减 患者，建议进一步行甲状腺球蛋白抗体 （ TGAb） 检 查［25 － 27］。推荐对 TPOAb 阳性或 TGAb 阳性的亚临 床甲减患者，给予 L － T4 治疗［25 － 27］。其用法、用量、 监测频率等均与临床甲减相同。 5． 3 妊娠合并低甲状腺素血症
实验室检查的诊断标准［24 － 25］如下。第一，妊娠 合并临床甲减： 血清 TSH 升高，大于妊娠期参考值 上限（ 97． 5th） ，而血清 FT4 降低，小于妊娠期参考值 下限（ 2． 5th） ； 但如果 TSH ＞ 10 mU / L，无论 FT4 是否 降低，均 考 虑 甲 减。第 二，妊 娠 合 并 亚 临 床 甲 减： TSH 升高，大于妊娠期参考值上限（ 97． 5th ） ，而 FT4 正常，处于妊娠期参考值范围（ 2． 5th ～ 97． 5th ） 之间。 第三，妊娠合并低甲状腺素血症： TSH 正常，FT4 低于 妊娠期特异 参 考 值 的 第 10 （ P10） 或 第 5 百 分 位 点 （ P5） 。对于妊娠期甲状腺功能参考值的确定，目前尚 有争议。美国甲状腺学会（ ATA） 和中国《妊娠和产后 甲状腺疾病诊治指南》均建议，本单位或本地区应建 立妊娠早期（ T1 期） 、中期（ T2 期） 和晚期（ T3 期） 特 异 TSH 和 FT4 参考值，即 T1 期 0． 1 ～ 2． 5 mU / L，T2 期 0． 2 ～ 3． 0 mU / L，T3 期 0． 3 ～ 3． 0 mU / L。该诊断标 准合理，漏诊率低，但难于普及。根据目前的流行病 学资料，一些学者又提出，可以把 TSH ＞ 2． 5 mU / L 作 为妊娠合并甲减的诊断标准，此参考值较非妊娠人群 的诊断标准（ 4． 8 mU / L） 降低了 48% 。 ［26］ 5治 疗 5． 1 妊娠合并临床甲减的治疗
加卫苗说明书
妊娠期皮肤病(英文版)
Nail changes 甲改变
• Transverse grooving • Brittleness • Distal onycholysis
Increased eccrine gland activity 内分泌腺活性增加
• Miliaria • Dyshidrotic eczema • Hyperhidrosis
Systemic sclerosis Polymyositis/Dermatomyositis Pemphigus
Cutaneous tumors affected by pregnancy
• Pyogenic granuloma • Hemangioma • Hemangioendothelioma • Glomus tumor • Dermatofibroma • Leiomyoma • Keloid • Neurofibroma • Nevi • Melanoma
Intrahepatic cholestasis of pregnancy 妊娠期肝脏内胆汁郁积
• Increased incidence • Presents in third trimester with severe intractable pruritus • Clinical : Often only excoriations; clinical jaundice rare; mal-absorption of fat
Infections 感染性皮肤病
• Viral (herpes simplex, varicella zoster) • Bacterial (impetigo, trichomoniasis,
三病阳性孕产妇转诊制度及流程
三病阳性孕产妇转诊制度及流程英文回答：Referral system and process for pregnant women with three positive diseases.As a pregnant woman with three positive diseases, it is important to understand the referral system and process in place to ensure the best possible care for both the mother and the baby. The referral system is designed to facilitate the transfer of patients from one healthcare provider to another, usually from a primary care provider to a specialist or a higher level of care. This is particularly important in cases where additional expertise or resources are required to manage the specific conditions.In the case of a pregnant woman with three positive diseases, the referral process is crucial to ensure that she receives appropriate and timely care. The process typically begins with the primary care provider identifyingthe need for a referral based on the complexity of the conditions or the need for specialized care. The primary care provider then initiates the referral by providing relevant medical information and contacting the appropriate specialist or healthcare facility.Once the referral is initiated, the specialist or healthcare facility reviews the referral request and assesses the urgency and appropriateness of the referral. This may involve reviewing the medical records, conducting additional tests or consultations, and evaluating thepatient's condition. Based on this assessment, thespecialist or healthcare facility determines the next steps, which may include accepting the referral, providing further recommendations, or suggesting an alternative course of action.If the referral is accepted, the pregnant woman will be scheduled for an appointment with the specialist or at the healthcare facility. During this appointment, thespecialist will evaluate the patient's condition, provide a diagnosis, and develop a treatment plan in collaborationwith the primary care provider. This may involve additional tests, medications, therapies, or procedures to manage the three positive diseases and ensure the well-being of both the mother and the baby.Throughout the referral process, effective communication and coordination between the primary care provider, specialist, and healthcare facility are essential. This includes sharing relevant medical information, discussing treatment options, and ensuring continuity of care. Regular follow-up appointments and consultations may be scheduled to monitor the progress of the treatment plan and make any necessary adjustments.In conclusion, the referral system and process for pregnant women with three positive diseases play a crucial role in ensuring appropriate and timely care. Byfacilitating the transfer of patients from primary care providers to specialists or higher levels of care, the referral system helps manage the complexity of these conditions and provides the necessary expertise and resources for optimal maternal and fetal health outcomes.中文回答：作为一名患有三种阳性疾病的孕妇，了解转诊制度和流程对于确保母婴得到最佳护理至关重要。
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∙1Department of Gynecology and Obstetrics, University Hospital Münster, Münster, Germany. ∙2Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany.
Abstract
INTRODUCTION:
We investigated the reliability of fetal thymus measurement during first-trimester
screening, and associated fetalthymus size with crown-rump length, maternal diseases and fetal outcome.
MATERIAL AND METHODS:
In a retrospective cohort of 971 normal singleton first-trimester fetuses, we measured the anterior-posterior diameter of the thymus in a midsagittal plane in 767 fetuses. The
intra-observer and inter-observer reliabilities were tested by intra-class correlation
coefficient. We correlated thymus size with fetal crown-rump length, and investigated its association with maternal diseases (diabetes mellitus, rheumatic disorders, hypertension and coagulation disorders) and fetal outcome (small for gestational age, preterm birth and umbilical artery pH) using regression analyses.
RESULTS:
The intra-observer and inter-observer reliabilities of fetal thymus measurement were excellent (intra-class correlation coefficient 0.926, 95% CI 0.745-0.981 and 0.945, 95% CI
0.886-0.993, respectively). A linear relationship was found between crown-rump length
and thymus size (β = 0.023, p = 0.001). Pregnancies affected by maternal diabetes had a decreased fetal thymus size (β = -0.209, p = 0.001), whereas in pregnancies affected by maternal rheumatic disease the thymus size was increased (β = 0.285, p <
0.001). Fetal thymus size was not associated with maternal hypertension or maternal
coagulation disorders. There was a positive association between preterm birth
and fetal thymus size (p < 0.001).
CONCLUSION:
Measurement of first-trimester thymus size is reliable. Fetal thymus size has a linear correlation with crown-rump length. Maternal diabetes, rheumatic disease and preterm birth appear to have an association with fetal thymus size.。