[申覆] 醫學六-27

看板medstudent (醫學生)作者jeannie (jeannie)時間14年前 (2011/08/03 13:44)推噓0(0推 0噓 2→)

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人類早期懷孕的流產之中，最重要的原因是： (A)環境及藥物因素 (B)母親子宮因素 (C)母親內分泌因素 (D)胚胎品質不佳答案: D 建議答案: A或D 疑義要點及理由: 根據Williams Obstetrics(22nd. ed.), by Cunningham,F. Gary MD(ed.), McGraw-Hill Incorporated (2005) 在121頁中"CIGARETTE SMOKING"及131頁"MEDICATION"的章節中敘及環境及藥物對早期懷孕流產的重要性: Various adverse outcomes have been linked to smoking during pregnancy. Included are spontaneous abortion, low birthweight due to either preterm delivery or fetal growth restriction, infant and fetal deaths, and placental abruption. With rare exceptions, any drug that exerts a systemic effect in the mother will cross the placenta to reach the embryo and fetus. 另外根據CDC(Centers for Disease Control and Prevention) 公布在網站上(http://www.cdc.gov/)最新一篇統計資料顯示: http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6001a1.htm?s_cid=ss6001a1_w In 2007, 78.1% of abortions were performed by curettage at ≦13 weeks' gestation, and 13.1% were performed by early medical abortion (a nonsurgical abortion at ≦8 weeks'gestation). 可知官方統計有高達13.1%的induced abortion是由於藥物所引起的，但仍有而在本題題幹中的敘述"人類早期懷孕的流產之中最重要的因素為何" 並未詳述造成流產的原因是由於人工流產(induced abortion)或自然流產(spontaneous abortion)，不可否認若題幹說明何者為"自然流產"之最重要因素，(D)選項胚胎品質不佳無庸置疑為最佳選項;但若是綜合統計人工流產及自然流產的比率，前述所提及藥物造成人工流產.未知懷孕造成工作環境有毒物質暴露.吸菸酒精咖啡因的環境因素亦為自然流產之大宗，由此可知環境及藥物因素所造成流產比率之重要性。因此建議將答案(A) 環境及藥物因素也納入標準答案之中。更改答案為(A)及(D)。 ※ 編輯: jeannie 來自: 140.112.24.143 (08/03 13:45)