异位妊娠51例误诊分析

<正> 异位妊娠是妇产科常见急腹症。若处理不当容易造成死亡。及时正确诊断和处理,对预后极为重要。近年来,国内外报道其发病率有上升趋势。由于临床上不典型的异位妊娠易与内科、外科、妇产科其他疾病混淆,常延误诊断和治疗。1995年7月至12月我们共收治异位妊娠242例,其中门诊误诊34例,术前误诊17例。本组病例均经过手术和病理检查证实。现将病例分析如下。     

腹腔镜下诊治异位妊娠82例临床研究

目的：探讨腹腔镜诊治异位妊娠的临床意义。方法：回顾分析2004年1月~2009年1月腹腔镜手术治疗异位妊娠82例的临床资料。结果：手术均在腹腔镜下完成,手术时间平均55min（25~110min）,术中平均出血24ml（20~100ml）,住院天数平均4.2d（3~6d）。结论：腹腔镜是诊断异位妊娠的金标准。手术操作细致,尽可能清除残留滋养细胞,术中或术后给予MIX治疗,可降低持续性异位妊娠的发生。     

异位妊娠92例发病因素分析

目的 :探讨异位妊娠的发病因素 .方法 :收集 1997～ 2 0 0 0年丰城市保健院收治的异位妊娠病例临床资料 .结果 :我院收治的异位妊娠的平均发病率为 1 15 %且呈逐年升高趋势 .异位妊娠发病的前三位因素分别是输卵管结扎史 ;妇科感染 (宫内膜炎、附件炎、盆腔炎 )史 ;人流上环史 .异位妊娠农村明显高于城市 .结论 :提高输卵管结扎术、人流上环术质量 ;控制妇科炎症是减少异位妊娠发病的关键 .     

189例异位妊娠病因分析

据近年文献报导,异位妊娠的发病率有增加趋势。我院统计近几年亦有所增加。异位妊娠发病急,病情重,尤以在偏僻山区,因未能达到及时抢救而死亡者,经常发生。本文统计失血性休克48人次,占25.4％。根据我院与郭磊庄医院1982～1991年10年间回顾性异位妊娠189例,病因进行分析,以其对预防提供了依据。     

异位妊娠误诊126例分析

异位妊娠是妇科常见病.其发生率在逐年上升,虽然妇科医生对此病已有重视,但误诊误治现象仍有发生,轻则增加患者的痛苦,重则可危及生命,导致患者精神和经济的损失.我们对2001-01-2010-12在我院住院误诊的异位妊娠126例进行总结分析,现报道如下.     

休克指数在预测宫外孕破裂中的应用价值

[目的]研究异常生命体征和异位妊娠之间的关系,探讨休克指数在预测宫外孕破裂中的应用价值.[方法]用回顾性的病例对照分析研究心率(HR)收缩压(SBP)和休克指数(SI)与腹腔内出血的相关程度,探讨它们的预测价值.[结果]只有48个病例参加了研究,其中心率、收缩压、休克指数与腹腔内出血的相关系数分别为(0.52,-0.22,0.72).[结论]休克指数对异位妊娠破裂预测效果最佳.     

影响夫精宫腔内人工授精成功率的相关因素分析

通过分析影响人工授精的各种因素寻求提高临床妊娠率的方法.方法:对行IUI治疗的不孕症夫妇148例共242个周期,分析患者的年龄、促排卵方案、HCG注射日子宫内膜厚度及类型、每周期内IUI次数、IUI周期数、处理后前向运动精子总数对IUI妊娠率的影响.结果:女方年龄、助孕周期数、HCG注射日子宫内膜厚度及类型、精液处理后的前向运动精子总数与IUI妊娠率有关.结论:女方年龄、助孕周期数、HCG注射日子宫内膜厚度及类型、精液处理后的前向运动精子总数影响IUI妊娠率,一周期内双次IUI、促排卵药物使用无法提高IUI妊娠率.     

卵巢妊娠22例临床分析

卵巢妊娠是一种极少见的异位妊娠,因其症状和体征不典型,往往诊断为输卵管妊娠,经术中探查及术后病理方能确定诊断.本文对我院收治的22例卵巢妊娠的临床资料作回顾性分析,现报道如下.     

阴道超声对异位妊娠的诊断价值

目的:探讨经阴道超声(TVS)对异位妊娠的早期诊断价值,减少误漏诊.方法:对54例患者经阴道超声诊断为异位妊娠,与手术及病理结果对照.结果:54例患者中,异位妊娠 51例,黄体破裂误诊为可疑异位妊娠3例.子宫呈漂浮型9例,未破裂型13例,混合包块型(流产破裂型)29例.结论:经阴道超声诊断异位妊娠,准确性高,尤其结合病史及血BHCG,能对异位妊娠作出早期诊断,为临床提供了可靠的诊断及治疗依据.     

宫腔内节育环合并宫角妊娠二例分析

近年来国内外对宫内节育器并发异位妊娠屡有报道,但合并宫角妊娠较为罕见。本文指出,早期诊断及时手术,是治疗宫角妊娠的主要措施。     

探讨经腹部及经阴道彩色多普勒超声在异位妊娠诊断中的临床价值

目的探讨经腹部及经阴道彩色多普勒超声在异位妊娠诊断中的临床价值。方法经腹部及经阴道彩色多普勒超声检查160例异位妊娠患者。结果 160例宫外孕,经手术证实输卵管妊娠129例,宫颈妊娠8例,卵巢妊娠8例,均与超声诊断相符。5例超声诊断为腹腔妊娠,其中4例手术证实为卵巢妊娠,4例超声诊断为残角子宫妊娠,3例手术证实为输卵管间质部妊娠,子宫肌壁间妊娠1例,5例超声初次检查为阴性,再次复查诊断为异位妊娠,超声诊断符合率90.6%。结论经腹及经阴道彩色多普勒超声图像直观、方便、安全,可以多次复查而无创伤性,联合运用为超声诊断异位妊娠提供更多重要的参考信息。     

彩色多普勒超声对异位妊娠破裂的诊断及鉴别诊断

目的讨论实时彩色多普勒超声对异位妊娠破裂的诊断及鉴别诊断。方法采用PHILIPSEnVisorC彩色多普勒超声诊断仪对15例疑似异位妊娠破裂患者的声像图进行分析与鉴别诊断。结果15例妇产科疑似异位妊娠破裂患者,手术后经病理科证实12例为异位妊娠破裂,3例误诊。结论实时超声对异位妊娠破裂有很高的诊断和鉴别诊断价值。     

多途径彩色多普勒超声早期诊断异位妊娠100例临床分析

目的探讨彩色多普勒超声诊断宫外孕的特征性依据,提高宫外孕诊断的准确性。方法对临床怀疑异位妊娠患者行多途径（经阴道或腹部）彩色多普勒超声探查子宫附件区域,并与血人绒毛膜促性腺激素（HCG）检查结果比较,确诊宫外孕。结果 100例疑似宫外孕患者的超声检查中,5例因附件区未见异常包块未能确定。另95例均发现附件区包块,其中包块内实质性部分可检测到滋养血流信号57例,频谱为低阻力型;伴有不同程度的盆腹腔积液54例,双侧卵巢可同时显示85例。结论对疑似早期宫外孕的患者进行二维经阴经腹彩超检查,测量包块处滋养动脉血流频谱存在,同时测定血HCG阳性,可以早期诊断宫外孕。     

Vascular complications following prophylactic balloon occlusion of the internal iliac arteries resolved by successful interventional thrombolysis in a patient with morbidly adherent placenta

The increasing incidence of morbidly adherent placenta (MAP) is placing women at a higher risk of life-threatening massive hemorrhage. The involvement of interventional radiology to manage this complex condition by performing prophylactic iliac artery balloon occlusion has been reported recently. However, the effectiveness and safety of this technique have not been fully determined. Here we report the case of a 25-year-old woman with placenta increta with preemptive bilateral internal iliac artery balloons who had external iliac artery thrombosis detected by computed tomography angiography (CTA) 72 h post cesarean section. A digital subtraction angiogram (DSA) and intra-arterial thrombolysis were instantly performed followed by supplementary conservative treatments, leading to a desirable resolution of thrombus without sequela. This is the first report of vascular complications with successful interventional thrombolysis in this setting. Our experience suggests that prophylactic iliac artery balloon occlusion should be used cautiously in cases of MAP and consideration given to minimizing vascular complications given the hypercoagulable state of pregnancy.     

Fatal child abuse in Georgia: the epidemiology of severe physical child abuse

Decisions about the occurrence of child abuse are increasingly difficult to make because concepts of what qualifies as reportable child abuse may be broadening. We examined this question by comparing 51 fatal child abuse cases occurring in Georgia between July 1975 and December 1979 to non-fatal cases and to the Georgia population. Overall rates of fatal child abuse were higher for male perpetrators compared with female and black perpetrators compared with white. However, the latter finding varied with economic and geographic status. The highest child abuse fatality rates were found in poor, rural, white families (3.3/100,000 children) and in poor, urban, black families (2.4/100,000 children). Risk factors for fatal abuse included early childhood (RR 6:1), parental teenage childbearing (RR 4:1), and low socioeconomic status. These characteristics were similar to those of the severe child abuse cases noted in the early child abuse literature. Non-fatal cases did not clearly share these risk factors. Severe abuse, here represented by fatal cases, is a distinct subset of reported child abuse, but characteristics associated with it are frequently attributed to all reportable child abuse. Medical personnel should be aware that they cannot rely on the presence or absence of these characteristics in screening for risk of reportable child abuse. Child abuse research should use restricted, stated case definitions. When intervention and prevention programs are being organized, they should not generalize research findings to all forms of child abuse.     

孕产妇妊娠高血压综合症流行病学特点分析

探讨妊娠高血压综合症(妊高症)发生的影响因素。方法采用两组对照的描述性研究方法对妊高症组147例和非妊高症组149例从一般情况如年龄、文化层次、发生地、妊娠次数进行比较分析。结果两组发生地(农村、城市)有明显差异P<0.05,两组文化层次也有明显差异P<0.05,年龄、妊娠次数差异不明显。结论妊高症的发生与发生地、文化层次有明显关系,农村发生率高于城市,随着文化程度的减低,妊高症发生的比例呈增大趋势。     

脑裂畸形的临床及影像学表现

脑裂畸形是神经元移行异常中最完全的一种先天畸形,特点是大脑半球内出现横贯的裂隙,其壁由异位灰质组成,常合并有透明隔缺损畸形及其它神经元移行异常,CT及MRI检查均具有特征性的表现。本文报告的10例患者,多表现为难治性的癫痫发作、精神发育迟滞、运动系统受损征等。而确诊前均误诊,因此必须提高对本病的认识,以避免作出错误的诊断。     

浅探肌注MTX保守治疗宫外孕

目的：探计肌注MTX保守治疗早期宫外孕的临床效果．方法：60例未破裂型宫外孕随机分两组，第一组30人给于一次性肌注MTX 50mg/d，第二组30人给于肌注MTX20mg/d共5d．结果：两组治愈率分别为：86．6％，80．0％．一次性肌注MTX的治愈率比分次肌注MTX的治愈率明显增高，两者之间有显著性差异(P＜0．05)．结论：应用肌注MTX保守治疗早期宫外孕效果好，剂量小，毒副作用少，能保留生殖功能，易被患者所接受，是值得推广的方法．由于同一种药物，用药方法不同也会疗效不同，所以正确掌握MTX保守治疗指征及方法，可提高宫外孕的非手术治愈率．     

The impact of previous perinatal loss on subsequent pregnancy and parenting

The loss of any pregnancy through miscarriage, ectopic pregnancy, stillbirth, or neonatal death presents as a significant life crisis for any woman and has far-reaching implications into a couple's future aspirations. Planning another pregnancy after dealing with a perinatal loss is difficult and plagued by ambivalence, doubts, and insecurities. Despite this ambivalence, a majority of women do become pregnant within a year following a perinatal loss. Four recurring issues surrounding perinatal loss and subsequent pregnancy have been identified in this literature review: the effect of the grief process on the subsequent pregnancy; parental coping mechanisms during the subsequent pregnancy; replacement or vulnerable child syndrome; and parenting issues with the subsequent live-born child. Issues surrounding anxiety as a coping mechanism during a pregnancy following a perinatal loss are documented consistently in the literature; however, less is known about the impact that a loss has on parenting behaviors with subsequent children. Further research is imperative to examine these issues in more detail so that evidence-based practices can be established and updated. Health care providers are in a unique position to assist these couples in dealing with the issues that a perinatal loss may place on subsequent pregnancies. By providing a reassuring and supportive environment, women can achieve a positive pregnancy outcome with the correct tools to decrease anxiety and enhance attachment to the subsequent healthy child.