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妇产科学

时间 : 2009-11-25 21:44:52 来源:jpkc.bjmu.edu.cn

[摘要]

羊水栓塞
Amnionicfluidembolism
  Amnionicfluidentersthecirculationasaresultofabreachinthephysiologicalbarrierthatnormallyexistsbetweenmaternalandfetalcompartments.Sucheventsappeartobecommon,ifnotuniversal,withbothsquamesofpresumedfetaloriginandtrophoblastsbeingcommonlyfoundinthematernalcirculation.Theremaybematernalexposuretovariousfetalelementsduringtrauma,ormorecommonlyduringlaborordeliveryassmalllacerationsdevelopintheloweruterinesegmentorcervix.Alternately,cesareansectionaffordsampleopportunityformixtureofmaternalbloodandfetaltissues.

子宫破裂
uterinerupture
  uterinerupturemaydevelopasaresultofpreexistinginjuryoranomaly,itmaybeassociatedwithtrauma,oritmaycomplicatelaborinapreviouslyunscarreduterus.
Ruptureoftheuterusmaycommunicatedirectlywiththeperitonealcavity(complete)ormaybeseparatedfromitbythevisceralperitoneumovertheuterusorthatofthebroadligament(incomplete).

胎膜早破:
  PretermRupturedMembranes.Anintenseinflammatoryreactionatthesiteofprematurelyrupturedmembraneswasnotedasearlyas1950,andthissuggestedinfection.McGregorandcolleagues(1987)demonstratedthatinvitroexposuretobacterialproteasesreducedtheburst-ingloadoffetalmembranes.Thus,microorganismsgivenaccesstofetalmembranesmaybecapableofcausingmembranerupture,pretermlabor,orboth.
  BacterialVaginosis.Bacterialvaginosisisaconditioninwhichthenormal,lactobacillus-predominantvaginalfloraisreplacedwithanaerobicbacteria,Gardnerellavaginalis,andMycoplasmahominis(Hillierandcol-leagues,1995).Diagnosticfeaturesinclude(1)vaginalpHgreaterthan4.5,(2)anamineodorwhenvaginalse-cretionsaremixedwithpotassiumhydroxide,(3)vagi-nalepithelialcellsheavilycoatedwithbacilli("cluecells"),and(4)fewwhitecellswithamixedflora(ascomparedwiththenormalpredominanceoflacto-bacilli)onGramstainingofvaginalsecretions.Bacterialvaginosishasbeenassociatedwithpretermbirth,pretermrupturedmembranes,infectionofthechorionandamnion,aswellasamnionicfluidinfection(Hillierandcolleagues,1995).Platz-Christensenandcolleagues(1993)haveprovidedsomeevidencethatbacterialvagi-nosismayprecipitatepretermlaborbyamechanismsimilartothecytokinenetworkpathwayproposedforamnionicfluidbacteria(Pig.34-4).Incontrast,Thorsenandassociates(1996),inaprospectivestudyof3600Danishwomen,foundthatbacterialvaginosisdiagnosedbefore24weekswasnotrelatedtorupturedmembranesbefore37weeksortolowbirthweight.
   
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