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期刊信息/Journal information
中华围产医学杂志
北京大学第一医院
中华围产医学杂志

北京大学第一医院

杨慧霞

月刊

1007-9408

zhwc@yahoo.cn

010-66513519

100034

北京市西安门大街1号北京大学第一医院

中华围产医学杂志/Journal Chinese Journal of Perinatal MedicineCSCD北大核心CSTPCD
查看更多>>1998年5月创刊，中国科学技术协会主管，中华医学会主办，北京大学第一医院承办。本刊是围产医学是产科和新生儿科密切合作共同研究的一个新学科，本刊以“提高出生人口素质、保障母婴安全与健康”为办刊宗旨，反映基础、临床与预防医学、遗传学和社会学等相关学科中有关围产医学的新理论、新技术、新进展，旨在为我国广大围产医学工作者提供一个学术交流、信息传递和了解国内外围产医学发展动态的窗口与平台。本刊主要栏目：述评、专家笔谈、论著、实验研究、循证园地、综述、讲座、短篇论著、技术交流、病例报告、临床思维、国外医学动态、指南解读等。
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    多囊卵巢综合征和子痫前期的风险：一项基于全国注册的队列研究

    李晔张馨月
    225页
    查看更多>>摘要：为探讨多囊卵巢综合征（polycystic ovary syndrome，PCOS）与子痫前期的关系是否依赖于需治疗的临床高雄激素血症，以及PCOS是否与不同亚型的子痫前期相关，Valdimarsdottir等［1］基于瑞典全国注册数据库进行了一项队列研究。该研究2023年12月11日在线发表于《英国妇产科杂志》。
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    病例02（2024）：冠状动脉夹层致妊娠期急性ST段抬高型心肌梗死1例

    孔令英贺鹏康李建平王东信...
    226-232页
    查看更多>>摘要：本文报道1例冠状动脉夹层导致孕妇急性ST段抬高型心肌梗死的病例。孕妇41岁，1岁时曾行心脏瓣膜手术，无高血压、糖尿病、吸烟、饮酒及冠状动脉性心脏病家族史等危险因素。2021年6月1日孕31周+1突发胸痛4 h，急诊转至北京大学第一医院。心电图提示Ⅰ、aVL、V2～V6导联ST段抬高；血生化检查示高敏心肌肌钙蛋白I、肌酸激酶-MB升高；超声心动图提示节段性室壁运动不良（心尖部），左心室功能减低，诊断为急性前壁ST段抬高型心肌梗死。急诊行冠状动脉造影和经皮冠状动脉介入术，确诊冠状动脉夹层，术后予抗血小板、抗凝及支持治疗。孕34周+3急性前壁ST段抬高型心肌梗死病情相对稳定，行剖宫产顺利分娩。产后定期心内科随诊，出院2年随访心功能基本正常。 This article presents a case of acute ST-segment elevation myocardial infarction (STEMI) in a pregnant woman caused by coronary artery dissection. The 41-year-old patient had undergone cardiac valve surgery at the age of 1 and had no risk factors such as hypertension, diabetes, smoking, alcohol use, or a family history of coronary artery disease. At 31+1 weeks of gestation, she experienced sudden chest pain for 4 hours and was emergently referred to Peking University First Hospital on June 1, 2021. Electrocardiogram revealed ST-segment elevation in leads I, aVL, and V2 to V6. Biochemical assays showed elevated levels of high-sensitivity cardiac troponin I and creatine kinase-MB. Echocardiography indicated segmental ventricular wall motion abnormalities (apical) and reduced left ventricular function, confirming the diagnosis of acute anterior wall STEMI. The patient promptly underwent emergency coronary angiography and percutaneous coronary intervention and confirmed coronary artery dissection. Postoperative care included antiplatelet, anticoagulation, and supportive treatment. At 34+3 weeks of gestation, with the condition of acute anterior wall STEMI being relatively stable, a cesarean section was successfully performed. Regular cardiology follow-ups were scheduled postpartum, and cardiac function was normal in two years after discharge.

    冠状动脉夹层急性ST段抬高型心肌梗死妊娠孕晚期

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    妊娠合并复发性子宫内膜间质肉瘤1例

    江敬红程静何小艳李家福...
    233-237页
    查看更多>>摘要：本文报道了1例妊娠合并复发性子宫内膜间质肉瘤的临床特点以及诊治经过。患者2017年行腹腔镜下手术剔除子宫肌瘤，术后病理诊断为低级别子宫内膜间质肉瘤，因患者强烈的生育需求，在知情选择的情况下密切随访，病情稳定未复发的状态下备孕并成功受孕。此次妊娠期间规律产前检查，孕37周+4常规彩超检查时发现盆腔一大小6.3 cm×4.5 cm的稍低回声光团。盆腔MRI提示右侧附件区、前盆壁、左侧盆壁髂血管旁见多发实性结节，较大者约58 mm×28 mm；弥散加权成像示盆腔多发结节、肿块，可见明显扩散受限。诊断为盆腔内多发实性结节、肿块，考虑肉瘤复发可能性大。完善颅脑CT及肺部CT，均提示未见明显转移病灶，请妇科肿瘤放化疗科会诊，产前诊断考虑妊娠合并肿瘤复发可能性大，排除手术禁忌证后，孕38周＋3全身麻醉下行子宫下段剖宫产术，娩出一活女婴。剖宫产术中快速冰冻病理证实切除包块为子宫内膜间质肉瘤复发，随即行筋膜外全子宫切除术+双侧卵巢及输卵管切除术+阑尾切除术+大网膜切除术+盆腔病损切除术（右侧）+盆腔粘连松解术。术后常规病理再次证实为复发性低级别子宫内膜间质肉瘤。术后恢复可，患者顺利出院。术后随访2年，未见远处转移复发病灶。 This paper reported the clinical characteristics, diagnosis, and treatment of a case of recurrent endometrial stromal sarcoma with term pregnancy. The patient had undergone laparoscopic surgery to remove hysteromyoma before conception in 2017, which was pathologically diagnosed as low-grade endometrial stromal sarcoma after surgery. Due to her strong reproductive willingness, the patient attempted to conceive in light of her stable condition and no evidence of recurrence and was closely followed up with an informed choice. She conceived successfully in 2020 and underwent regular pregnancy examinations. Ultrasound examination at 37+4 weeks of gestation revealed a slightly hypoechoic mass of about 6.3 cm×4.5 cm size in the pelvic cavity. After admission, a pelvic MRI indicated multiple solid nodules in the right adnexa uteri and beside the iliac vessels in the left pelvic wall and anterior pelvic wall with the larger one being about 58 mm×28 mm. Diffusion-weighted imaging showed multiple pelvic nodules and masses with significant diffusion restriction. The patient was diagnosed as having multiple solid nodules and masses in the pelvic cavity, and the recurrence of sarcoma was highly suspected. Brain CT and lung CT showed no obvious metastatic lesions. A consultation involving the Department of Gynecological Tumor Chemoradiotherapy was held and the sarcoma recurrence during pregnancy was prenatally diagnosed. After ruling out the contraindications for surgery, a cesarean section was performed in the lower segment of uterus under general anesthesia and a live female baby was delivered at 38＋3 weeks. The excised mass was confirmed as recurrent uterine stromal sarcoma by rapid freezing pathology during cesarean section. A combination surgery was performed subsequently, including total extra-fascial hysterectomy, bilateral oophorectomy, bilateral salpingectomy, appendectomy, greater omentum resection, pelvic lesion resection (right side), and pelvic adhesiolysis. Recurrent low-grade uterine stromal sarcoma was reconfirmed by postoperative pathology. The patient was discharged after recovery. After two years of follow-up, no distant metastasis recurrences were found.

    妊娠并发症,肿瘤子宫内膜间质细胞瘤肿瘤复发,局部

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    产前超声诊断胎儿先天性梨状窝瘘1例

    宋宴鹏李明张宇航高雪莲...
    238-240页
    查看更多>>摘要：本文报道1例产前超声诊断的胎儿先天性梨状窝瘘病例。孕妇孕17周+2产前常规超声检查发现胎儿左侧颈部椭圆形囊性包块，孕23周行产前系统超声筛查发现胎儿左侧颈部囊性包块，在颈部冠状位切面探及囊性包块上端与喉部有一细窄窦道形成，考虑先天性梨状窝瘘。生后21 d，患儿左侧颈部包块明显隆起，吃奶时出现呛咳及呼吸时伴有喘鸣音。生后21 d超声检查及生后25 d CT检查均发现左侧颈部囊性包块及囊内有气体。生后26 d全身麻醉下行颈部开放性囊肿切除术+高位瘘管缝扎及瘘管切除术，术中诊断为先天性梨状窝瘘。患儿术后愈合良好，随访至3月龄未出现并发症。 This article reported a case of fetal congenital pyriform sinus fistula (CPSF) diagnosed by prenatal ultrasound. An oval cystic mass in the left side of the fetal neck was detected during routine prenatal ultrasonography at 17+2 weeks of gestation, which was also found in the systemic ultrasound screening at 23 weeks. Besides, a narrow fistula between the cyst and pharynx was observed in the coronal view of the neck, raising the suspicion of CPSF. On day 21 after birth, the cystic mass bulged out of the neck and the neonate started choking and coughing during feeding alongside wheezing respiration. Ultrasound examination showed a strong gas echo in the cystic mass, which was also confirmed by CT scan on day 25. On day 26, cystectomy, ligation of high fistula, and fistulectomy were performed, and the diagnosis of CPSF was confirmed. The baby recovered after the operation and was healthy during follow-up till three months.

    梨状隐窝瘘胎儿超声检查,产前

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    预防性眼部用药对新生儿眼健康的影响：Cochrane系统综述

    胡焕青徐韬刘菲
    240页
    查看更多>>摘要：新生儿眼炎如不及时治疗，可能导致失明。世界卫生组织建议“局部眼部用药预防淋球菌性和衣原体新生儿眼炎”，但其依据是低确定性的证据。2020年9月Cochrane发表了一项系统综述[1]，探讨预防性眼部用药对新生儿眼病预防是否有效。
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    持续气道正压通气治疗慢性高血压合并睡眠呼吸暂停低通气综合征的双胎孕妇3例

    吕晓王晶玉魏俊杨京晶...
    241-244页
    查看更多>>摘要：本文报告3例慢性高血压合并阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea-hypopnea syndrome，OSAHS）的双胎孕妇应用持续气道正压通气（continuous positive airway pressure，CPAP）后的母儿结局。3例双胎孕妇均合并慢性高血压；均因夜间有打鼾、呼吸暂停症状，行多导睡眠图监测，诊断为OSAHS。病例1孕28周行CPAP治疗后1个月，血压缓慢升高，伴尿蛋白增加，孕34周并发溶血、肝酶升高、血小板减少综合征剖宫产；病例2孕11周行CPAP治疗，孕期血压平稳，孕37周行剖宫产；病例3孕13周行CPAP治疗4个月后血压升高，尿蛋白阳性，经药物治疗，血压降低，尿蛋白转阴，孕32周因并发胎膜早破行剖宫产，CPAP治疗至分娩，母婴结局良好。由这3例认为，CPAP可能延缓慢性高血压合并OSAHS双胎孕妇孕期血压上升的时间，有助于减少不良母婴结局。 This paper reports the maternal and fetal outcomes of three twin pregnancies with chronic hypertension and obstructive sleep apnea-hypopnea syndrome (OSAHS) who were treated with continuous positive airway pressure (CPAP). All three women with twin pregnancies were diagnosed with chronic hypertension. Furthermore, symptoms such as snoring and apnea assisted the diagnosis of OSAHS through polysomnography monitoring. Case 1 was treated with CPAP at 28 gestational weeks. The blood pressure increased gradually after the first month of CPAP treatment, with an elevated urine protein concentration. At 34 gestational weeks, the pregnant woman underwent a cesarean section due to the development of hemolysis, elevated liver enzymes, and low platelet syndrome. Case 2 was treated with CPAP at 11 gestational weeks, with stable blood pressure throughout the pregnancy, and was delivered through cesarean section at 37 weeks of pregnancy. Case 3 started CPAP at 13 gestational weeks for four months, and increased blood pressure and urine protein were observed. Medication brought the blood pressure down, and urine protein became negative. At 32 gestational weeks, a cesarean section was performed because of premature rupture of the membrane. Her CPAP treatment continued till delivery with good maternal and infant outcomes. The treatment outcomes of the three cases suggest that CPAP may prolong the time of blood pressure rise among twin pregnancies where chronic hypertension and OSAHS coexist, which potentially reduces the occurrence of adverse maternal and infant outcomes.

    高血压睡眠呼吸暂停,阻塞性连续气道正压通气妊娠,双胎

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    胎母输血综合征并产后绒毛膜癌1例

    刘宇茵贺芳李晔
    245-247页
    查看更多>>摘要：本文报道1例确诊胎母输血综合征的患者，在足月妊娠、经阴道分娩20 d后因晚期产后出血就诊，确诊为绒毛膜癌，给予化学及手术治疗后达到完全缓解。随访1年，未见疾病进展。绒毛膜癌是胎母输血综合征的危险因素之一，建议对孕期诊断胎母输血综合征的患者进行胎盘病理检查，产后密切随访人绒毛膜促性腺激素水平变化，以早期诊断绒毛膜癌，改善患者预后。 This paper reports a case of fetomaternal hemorrhage (FMH), which was diagnosed as choriocarcinoma due to late postpartum hemorrhage 20 days after full-term vaginal delivery. The patient fully recovered after chemotherapy combined with surgical treatment, and no disease progression was observed during a one-year follow-up. Choriocarcinoma is one of the risk factors for FMH. Therefore, it is suggested that the placenta should be examined in any suspected cases of FMH. Maternal human chorionic gonadotrophin (hCG) level should also be monitored after delivery for early diagnosis and better prognosis of choriocarcinoma.

    胎母输血综合征绒毛膜癌产后出血绒毛膜促性腺激素

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    临界高血压对妊娠结局的影响及孕期血压控制阈值的探讨

    冯至真魏玉梅李晔
    248-252页
    查看更多>>摘要：2022年发布的“中国高血压临床实践指南”下调了成人高血压的诊断标准，但未调整妊娠期高血压的诊断标准。成人高血压诊断标准变化对妊娠期高血压的诊断及妊娠结局的影响并不明确。临界高血压包括血压升高及1期高血压。与正常血压孕妇相比，临界高血压孕妇发生不良妊娠结局的风险升高，但目前缺乏相关的孕期管理指南。本文探讨了临界高血压对妊娠结局的影响及孕期理想的血压控制水平，旨在改善母儿结局，优化妊娠期临界高血压疾病的管理。 The "Clinical Practice Guidelines for Hypertension in China", released in 2022, has lowered the diagnostic criteria for hypertension. However, no adjustments were made to the diagnostic criteria for hypertension during pregnancy. The impact of adult hypertension diagnostic criteria on the diagnosis of gestational hypertension and pregnancy outcomes remains unclear. Borderline hypertension includes elevated blood pressure and stage 1 hypertension. Compared to pregnant women with normal blood pressure, women with borderline hypertension have an increased risk of adverse pregnancy outcomes. Still, there are no associated guidelines for pregnancy management for now. This article explores the influence of borderline hypertension on pregnancy outcomes and the optimal level for blood pressure control during pregnancy, aiming to improve maternal and fetal outcomes and optimize the management of borderline hypertension during pregnancy.

    妊娠期高血压临界高血压妊娠结局血压控制

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    早产/低出生体重相关远期慢性肾脏病发病机制研究进展

    丁方睿郑军高雪莲
    253-257页
    查看更多>>摘要：随着新生儿重症监护技术的发展，早产儿尤其是超早产儿出生率及存活率逐渐升高，但是伴随而来的早产儿远期预后问题也逐渐凸显。在肾脏疾病领域，现有临床研究数据显示早产/低出生体重儿在儿童期和成人期慢性肾脏病发病率显著高于足月儿，提示早产/低出生体重是远期慢性肾脏病发生的危险因素，但是目前国内外对早产/低出生体重相关远期慢性肾脏病关注度低，对涉及其中的机制认识不足。现有研究认为肾单位减少学说、足细胞丢失学说是慢性肾脏病的重要机制，但详细分子机制尚不明确。因此本文对早产/低出生体重相关远期慢性肾脏病发病机制的研究进展进行综述。 With the development of neonatal intensive care, both the live birth rate and survival rate of preterm infants, especially in extremely preterm infants, have escalated. However, the long-term adverse prognosis of preterm infants became increasingly conspicuous. In the field of kidney disease, the existing clinical data have substantiated a higher susceptibility to chronic kidney disease (CKD) development during childhood or adulthood in preterm and low-birth-weight infants when compared with full-term infants. This suggests that preterm and/or low birth weight increases the risk for long-term CKD. Nonetheless, little attention has been paid to long-term CKD associated with preterm and/or low birth weight and the mechanism involved in this process is unknown. Current studies have suggested that reduced nephron and podocyte depletion are involved in this process, but detailed molecular mechanism remains inadequate. Therefore, this article reviews the research progress of long-term CKD correlated with preterm and/or low birth weight.

    肾功能不全,慢性足细胞婴儿,早产婴儿,低出生体重

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    宫颈环扎与双胎早产防治的研究进展

    吴培莉薛晴刘璇璇孙笑...
    258-261页
    查看更多>>摘要：早产是双胎妊娠最常见的产科并发症。宫颈环扎术是近年来双胎早产预防措施的研究热点，其在双胎妊娠宫颈机能不全的临床应用价值存在一定的争议。此外，感染（炎症）状态与双胎宫颈环扎术后的妊娠结局也密切相关。研究推荐对于宫颈长度≤15 mm或宫颈扩张的双胎妊娠孕妇行宫颈环扎术，暂不推荐对于宫颈长度15~25 mm和以病史为指征的双胎妊娠患者行宫颈环扎术。双胎宫颈环扎术前评估羊膜腔内感染或炎症的临床意义有待进一步探究，但需排除抗生素使用对手术治疗效果评价的影响。 Preterm birth is the most common maternal complication in twin pregnancies. In recent years, cervical cerclage has been of long-standing interest in the prevention of preterm birth in twin pregnancies. However, its clinical application in the treatment of cervical insufficiency of twin pregnancies remains a controversial subject. In addition, infection or inflammation conditions are considered to be closely related to the perinatal outcomes of twin pregnancies after cervical cerclage. This paper reviews the research progress on cervical cerclage in twin pregnancies, recommending cervical cerclage for twin pregnancies with cervical length≤15 mm or cervical dilatation, while it is not suggested for those with cervical length of 15-25 mm or history-indicated cervical cerclage. The clinical significance of preoperative evaluation of intraamniotic infection or inflammation of twin pregnancies needs to be further explored, but it is necessary to avoid the effect of antibiotic use on the evaluation of surgical effects.

    妊娠,双胎早产环扎术,宫颈绒毛膜羊膜炎

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