新生儿的出生体质量可用于衡量胎儿宫内营养状况,也与妊娠结局密切相关。随着新生儿出生体质量的增加,分娩期新生儿和母体的致伤、致残、致死风险逐渐增高,新生儿成年期心血管疾病及代谢性疾病发病风险也增加。因此,提高对巨大儿的风险认识,降低巨大儿的发生率非常必要,也是提高妊娠期保健质量的重要方面。孕妇的体质量指数(body mass index,BMI)和妊娠期体质量增加(gestational weight gain,GWG)是衡量孕妇营养状况的指标,肥胖、BMI过高、GWG过度导致巨大儿、大于胎龄儿(large for gestational age infant,LGA)发生风险增加。孕妇营养是新生儿出生体质量的重要影响因素,可以通过人为方式进行干预。孕妇在妊娠前、妊娠期适量摄入营养可减少巨大儿的出生率。
OBJECTIVES: To analyze the technical aspects of uterine artery embolization with dextran microspheres and to evaluate the effectiveness of this technique as the primary treatment of uterine fibroids in a series of 38 patients. METHODS: Thirty-eight volunteers (age range, 24-48 years; mean, 37.2 years) with symptoms caused by uterine fibroids (menorrhagia, mass-related symptoms, and pelvic pain) were randomly included in this study. The fibroids were single in 32 patients and multiple in 6 patients. According to the tumor location, subserous fibroids were found in 4 patients and interstitial or submucosal fibroids in 34. Tumor size was from 2 to 10.9 cm in diameter. We performed embolization with a single Headhunter catheter using the right-femoral artery approach, injection of dextran microspheres (225-450 micro m), and an absorbable gelatin sponge. Follow-up included clinical and sonographic examinations at one-month intervals for 6 months. RESULTS: Embolization was successfully performed in all patients. Post-procedural pain control was good in 35 (92%) patients. In most patients, symptoms were improved at 3 months (36/38, 95%). Clinical failure of the treatment occurred in only 2 patients (2/38, 5%). Progressive reduction in leiomyoma size was revealed during sonographic follow-up, and the reduction rate at the sixth month after embolization was 68%. The tumor had vanished in five submucosal fibroid patients. Histopathological tests showed that the tumor was degenerative as fibrosis and hyalinosis. CONCLUSIONS: Uterine artery embolization with dextran microspheres is a micro-invasive method for the treatment of uterine fibroids. It is clinically effective in most patients and induces a progressive reduction in the size of fibroids. Based on this study, we believe that this new technique is much more suitable for submucosal fibroids with massive menorrhagia.
