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世界核心医学期刊文摘（妇产科学分册） 2006年第6期2卷 11-12页

作者： buhimschi C. S buhimschi i.a Yu C 张新艳(译) 柳蕴(校) Yale University Department of Obstetrics Gynecology and Reproductive Sciences FMB 339 333 Cedar St NewHaven CT 06520 United States 不详

Objective: The remodeling of uterine connective tissue during labor can lead to the reorgani.ation of the extracellular matrix that, in turn, may influence the biomechani.al properties of the myometrial wall. We hypothesized that the stretching of the lower uterine segment in laboring women with dystocia changes the viscoelastic properties of the uterine wall. Study design: We tested the tensile strength of lower uterine segment myometrium in 68 pregnant women at term. The biomechani.al, structural, and biochemi.al properties were compared among 3 groups: (1) 39 laboring women who underwent pri.ary low- transverse cesarean delivery for labor dystocia, (2) 12 nonlaboring women who underwent pri.ary elective low- transverse cesarean delivery and (3) 17 women who underwent an elective repeat low- transverse cesarean delivery at term. The tensile properties were quanti.ated with a stretching regimen that was designed to mimic the conditions of labor. Parameters such as slope, yield point, and break point were recorded, analyzed, and interpreted. Biochemi.al properties were determined by the measurement of the sulfated glycosaminoglycans, hydroxyproline, and pyridinoline- deoxypyridinoline. Histologic properties of the connective tissue were assessed by collagen birefringence. Lastly, the association between these properties and biomechani.al responses were compared among groups. Results: Lower uterine segment myometrium specimens obtained from laboring women were stiffer compared with specimens from women who were not in labor (P = .013) or had scarred myometrium (P ired to reach the yield point was simi.ar between labor and nonlabor groups (P = .216). Likewise, a previous lower uterine segment scar did not alter the yield point. The break point was simi.ar among all groups (P = .317). Sulfated glycosaminoglycan levels were unaffected by labor or scarring (P = .354). Scarred lower uterine segment myometrium had a higher collagen content c

关键词：子宫下段剖宫产子宫下段瘢痕横切口剖宫产拉伸强度难产生物力学特性子宫结缔组织分娩妇女子宫肌层脱氧吡啶啉

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阴道低位羊水池葡萄糖浓度测量是未足月胎膜早破妇女感染的预测指标而非敏感指标

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世界核心医学期刊文摘（妇产科学分册） 2006年第9期2卷 4-5页

作者： buhimschi C.S. Sfakianaki.a.K. Hamar B.G. 张旸 Yale University Department of Obstetrics Gynecology and Reproductive Science LLCI 804 1333 Cedar Street New Haven CT-06520 United States Dr

Objective: We sought to identify the use of vagi.al amniotic fluid (vAF) glucose measurements in predicting infection of the amniotic fluid retrieved by transabdomi.al amniocentesis (aAF) in women with preterm premature rupture of the membranes (PPROM). Study design: Fluid was retrieved by aAF was retreived from 35 consecutive women with PPROM on whom an amniocentesis was clini.ally indi.ated to rule out intra- amniotic infection/inflammation and successfully completed. aAF was cultured for aerobic, anaerobic bacteria, Ureaplasma and Mycoplasma species. Clini.al laboratory analysis for aAF included glucose concentration, Gram stain, lactate dehydrogenase, and white and red blood cell count. vAF was analyzed only for glucose concentration. Glucose concentration for the paired abdomi.al- vagi.al AF samples (aAF- vAF) was determined by using well- established clini.al and research laboratory methods. At the end of enrollment we stratified our patients into 2 groups: (1) positive microbial cultures (+ )AFC (n = 17, gestational age [GA]: 27.3 ± 0.7 weeks) or (2) negative microbial cultures (- )AFC (n = 18, GA: 31.3 ± 0.5 weeks). Cohen kappa measure of concordance and receiver operating characteristic (ROC) curve analysis were used to test the ability of the vagi.al “ pool” glucose measurements to discrimi.ate between women with positive or negative AF cultures. Results: Women with (+ )AFC ruptured and delivered at an earlier GA compared with the (- )AFC group (p iod was simi.ar (P = .35). There was a signifi.ant linear correlation between aAF and vAF glucose concentrations (r = 0.783, P ith intra- amniotic infection (iAi) had signifi.antly lower aAF [mean ± SEM (+ )AFC: 11.4 ± 3.2 vs (- )AFC 23.0 ± 2.8 mg/dL, P = .01] and vAF glucose levels [(+ )AFC: 10.1 ± 2.8 vs (- )AFC: 19.8 ± 2.9 mg/dL, P = .02] compared with the noninfected group. Cohen kappa measure of concordance indi.ated “ substantial" agreement between aAF and vAF glucose

关键词：葡萄糖浓度未足月胎膜早破妇女感染浓度测量羊水池阴道敏感指标预测指标

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维普期刊数据库

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世界核心医学期刊文摘（妇产科学分册） 2005年第7期1卷 7-8页

作者： buhimschi C.S. Norwitz E.R. Funai E. 张剑萍 Yale University Dept. Obstet. Gynecol. Reprod. Sci. LLCI 804 333 Cedar Street New Haven CT 06520 United States Dr

Objective: Serum levels of soluble fms- like tyrosine ki.ase 1 (sFlt- 1), vascular endothelial growth factor (VEGF), and placental growth factor (PlGF) are altered in women with clini.al preeclampsia. We sought to identify whether simi.ar alterations in uri.ary levels of these proteins cluster hypertensive disorders in pregnancy, and identify women with severe preeclampsia (sPE). Study design: Free uri.ary levels of sFlt- 1, VEGF,and PlGF were measured by immunoassay in 68 women enrolled prospectively in the following groups: nonpregnant reproductive age (NP- CTR n = 14), healthy pregnant control (P- CTR n = 16), pregnant hypertensive and proteinuric women who did not meet criteria for severe preeclampsia (pHTN n = 21), and women with sPE (n = 17). Results: There was no difference in gestational age at the time of enrollment among groups (median [range]: sPE: 31 [24- 40], pHTN: 34 [16- 40], P- CTR: 28 [7- 39] wks). Uri.ary excretion of VEGF was signifi.antly increased in sPE women compared with NP- CTR (P =. 023), but did not differ among pregnant groups. Uri.ary PlGF levels were signifi.antly increased in pregnant compared with nonpregnant women, but were decreased in all hypertensive women compared with healthy P- CTR (P i.ary sFlt- 1 concentrations were signifi.antly increased in women with sPE relative to all other groups (P igher sFlt- 1 uri.ary output compared with P- CTR group (P =. 001). A cutoff >2.1 in the ratio log [sFlt- 1/PlGF] had 88.2% sensitivity and 100% specificity in differentiating women with sPE from normotensive controls. We also described that the log[sFlt- 1/PlGF] ratio identified women with sPE better than proteinuria alone (P =. 03). Our regression model revealed that uric acid correlated best with log[sFlt- 1/PlGF] ratio (r = 0.628; P =. 005). Conclusion: sPE is associated with increased uri.ary output of the antiangiogenic factor sFlt- 1 and a decreased output of PlGF at the time of clini.al manifestatio

关键词：重度先兆子痫血管生成相关因子胎盘生长因子排出量正常妊娠无显著性差异妊娠组免疫测定法随机使用

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维普期刊数据库

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枕后位胎儿分娩时孕妇的子宫收缩力

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实用妇产科杂志 2003年第5期 327-327页

作者： buhimschi CS ,左万兴

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超声测量子宫肌层厚度预测未足月胎膜早破和羊水过少妇女的潜伏期

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世界核心医学期刊文摘（妇产科学分册） 2006年第1期2卷 4-4页

作者： buhimschi C. S. buhimschi i. A. Norwitz E. R. 张旸(译) 马超(校) Dr. C.S. buhimschi Yale University Department of Obstetrics Gynecology and Reprod. Sci. LLCI 804 333 Cedar Street New Haven CT 06520 United States 不详

Term labor is associated with global thinning of the myometrium. We hypothesized that a thickened myometrium at the time of preterm premature rupture of membranes (P- PROM) predicts less myometrial wall stress and, consequently, a longer latency interval. Study design: Myometrial thickness was measured prospectively in 76 pregnant women enrolled in the following groups: PPROM (n = 28, mean [range], gestational age [GA]: 29.5 weeks [w] [21.0 w- 33.0 w]), preterm nonlabor control group (P- CTR), (n = 21, GA: 27.5 w [23.0 w- 32.0 w]) and term nonlabor control (T- CTR) (n = 27, GA: 38.6 w [37.0 w- 41.6 w]). All PPROM women had oligohydramnios (AFi: 1.4 cm [0.0 cm- 5.1 cm]). MT was measured ultrasonographi.ally at the mi.anterior, fundal, posterior, and lower uterine segment wall in cases and controls with an intraoperator variability in the PPROM group displayed uniform thickness of the uterine body (mean ± SEM, anterior: 10.6 ± 0.6 mm, fundal: 10.7 ± 0.7 mm, posterior: 8.9 ± 0.5 mm, P = .078). At mi.anterior site the myometrium of the PPROM group was thicker compared to both P- CTR (P is difference was preserved at the fundus (PPROM vs P- CTR, P itive correlation between fundal MT and latency period (r = 0.43, P = 0.02) that persisted after adjusting for GA (P = .04). A fundal MT less than 12.1 mm was 93.7% sensitive and 63.6% specific for the identifi.ation of women whose latency period was less than 120 hours. Conclusion: Signifi.ant thickening of the anterior and fundal walls of the uterus follows PPROM. A thick myometrium in nonlaboring patients with PPROM is associated with longer latency interval. Sonographic evaluation of MT may represent an alternative clini.al tool for the prediction of a short latency interval in women with PPROM.

关键词：未足月胎膜早破子宫肌层超声测量羊水过少潜伏期厚度妇女 PPROM 预测 CTR

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维普期刊数据库

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