胎儿脐动脉及大脑中动脉阻力参数正常值

目的了解本地区低危人群胎儿脐动脉（umbilical artery，UA）及大脑中动脉（middle cerebral artery，MCA）搏动指数（pulsatility index，PI）、阻力指数（resistance index，RI）、收缩期峰值流速与舒张末期流速比值（S／D）的正常参考值范围。方法随机选取2218例孕20～40周的无合并症单胎孕妇，检测脐动脉（近胎儿侧）及大脑中动脉（中段）血流，记录PI、RI、S／D进行分析。结果脐动脉的血流阻力随着胎龄的增加而降低，大脑中动脉的血流阻力在孕20-26周随孕周的增加而增高，孕26～28周时达高峰，28周以后随着孕周的增加而降低。结论了解胎儿脐动脉及大脑中动脉血流阻力在不同孕周的变化规律，对判断及随访胎儿宫内缺氧状况，协助临床做出正确的产科处理具有重要意义。     

多普勒超声技术用于诊治5例母胎间输血所致胎儿贫血

目的 探讨多普勒超声技术用于诊治母胎间输血（FMH） 所致胎儿贫血的临床应用价值.方法 2002-08-2005-05暨南大学附属第一医院收治5例由孕妇主诉胎动减少或消失、怀疑FMH的病例, 孕周29～35周, 立即记录其胎心监护（CTG）图形, 分别在脐带穿刺或输血前后记录大脑中动脉收缩期血流峰值（MCA-PSV）和脐静脉最大血流速（UVmax）及大脑中动脉和脐动脉血流阻力指数（PI）, 胎儿血红蛋白（FHb） 和红细胞容积（HCT）也由脐带穿刺或输血前后获得.结果 所有病例CTG图形均表现为正弦曲线图形,所有病例MCA-PSV和 UVmax均明显升高,而FHb、HCT则降低,但PI正常.5例中例4为抢救胎儿生命进行了即刻宫内输血.FMH通过Kleihauer Test最后诊断.5例均即刻终止妊娠,胎儿预后均较好.结论 多普勒超声测量MCA-PSV、UVmax是及时诊治FMH所致急性胎儿贫血的最重要方法.     

胎儿脐动脉血流速度与围产儿预后的关系

胎儿脐动脉血流速度与围产儿预后的关系李扬黄醒华胎儿脐动脉血流速度波形是反应胎儿胎盘循环状态的指标之一。当胎盘血管阻力增加时，脐动脉舒张期血流速度下降，血流速度波形表现异常。为探讨胎儿脐动脉血流与围产儿预后的关系，我们对１００例孕妇进行了脐动脉血流速度...     

彩色多普勒超声检查胎儿脐动脉血流预测胎儿宫内状况及预后

本文应用 Acusonl 128彩色电脑超声仪检查了180例16～40孕周孕妇的胎儿脐动脉缸流,分了血流指标 PI 和 A/Bratio(脐动脉收缩期血流速度峰值与舒张期血流速度峰值之比)的数值.结果表明,多普勒(Doppler)脐动脉血流频谱的改变能比胎儿心率改变更早地反映胎儿宫内缺氧,血流频谱的异常程度与胎儿宫内缺氧的程度相一致,脐动脉舒张期血流停滞或倒流示胎儿处于重度缺氧和中毒状态.极易发生围产儿死亡.血流频谱异常还可预测胎儿的预后.本文提示:Doppler 脐动脉血流检查是一项有极高临床价值的新方法,值得推广使用.     

胎儿脑及脐动脉血流检测的临床意义

应用彩色多普勒超声，检测正常妊娠妇女４８例（正常妊娠组），妊高征患者３４例（妊高征组），妊高征合并胎儿生长迟缓（ＩＵＧＲ）５４例（ＩＵＧＲ组）儿大脑中动脉及脐动脉血流速波，计算血流的收缩末期峰值与舒张末期峰值的比值、脉搏指数、阻力指数。     

胎儿脑、肾及脐动脉血流速度波型与围产儿结局

目的 探讨胎儿血流速度波型与围产儿结局的关系及高危妊娠胎儿缺氧时血液动力学变化的特点.方法 采用超声多普勒检测了46例正常晚期妊娠和32例高危妊娠胎儿脐动脉(UmA)、大脑中动脉(CMA)及肾动脉(RA)的搏动指数(PI)、阻力指数(RI)、收缩末期和舒张末期血流速度峰值的比值(S/D)三项阻力指标,并与围产儿结局进行对比分析.结果 高危组UmA、RA的RI、PI及S/D均高于正常组;胎儿CMA与RA的搏动指数比值,即PICMA/PIRA与围产儿结局的符合率最高,PICMA/PIRA≥1者,无围产儿结局不良,而＜1者有83.33%出现围产儿结局不良.结论 高危妊娠胎儿缺氧时脏器血流量改变,表现为肾血管血流阻力明显增高,脑血管阻力明显降低,胎儿血管的血液动力学状况与缺氧有良好相关性.RA的阻力指标可敏感预测围产儿缺氧.     

胎儿脐动脉血流异常波形与围产儿结局的关系

胎儿脐动脉血流异常波形与围产儿结局的关系杨玉英江森郝素媛戴笙张慧琴张薇张运王淑琨应用彩色多普勒超声技术，可以从胎儿血流动力学的角度预测胎儿宫内发育状况。我们应用彩色多普勒超声，监测胎儿脐动脉血流，现将脐动脉血流异常波形与围产儿结局的关系分析如下。一...     

彩色多普勒超声在预测死胎中的作用

死胎是指妊娠大于23+6周、无生命迹象的胎儿,是围产儿死亡的主要原因之一,产前有效预测死胎,对降低围产儿死亡率具有重大意义。利用彩色多普勒超声监测不同孕期母体子宫动脉血流参数,特别是妊娠中期子宫动脉搏动指数(PI)对与子痫前期、胎盘早剥、小于胎龄儿(SGA)相关的死胎预测有重要意义;监测胎儿各项多普勒血流参数,如脐动脉、大脑中动脉、静脉导管、腹内脐静脉等,能够反映胎儿宫内缺氧状况,提高胎儿窘迫的诊断率;联合监测母体及胎儿各项血流参数,全面评估胎儿宫内缺氧程度并及时干预,可避免死胎的发生。     

胎儿大脑中动脉收缩峰期血流速度与二维超声预测重型α地中海贫血的对比研究

目的:探讨和比较应用超声多普勒技术测量胎儿大脑中动脉收缩峰期血流速度(MCA-PSV)与二维超声预测胎儿重型α地中海贫血(地贫)的价值。方法:为129例具有重型α地贫风险的胎儿行二维及多普勒超声检查,测量胎儿MCA-PSV并行羊膜腔穿刺或脐血穿刺术进行α地贫基因诊断。MCA-PSV用中位数的倍数(MOM)表示。结果:重型α地贫胎儿MCA-PSV明显高于非重型α地贫胎儿,差异有显著的统计学意义(P0.001)。MCA-PSV1.29MOM预测胎儿重型α地贫的检出率为81.25%,高于二维超声(P0.05);MCA-PSV联合二维超声对胎儿重型α地贫的检出率为90.63%。MCA-PSV最早可在孕16周预测胎儿重型α地贫,MCA-PSV预测胎儿重型α地贫的平均孕龄小于二维超声(P0.05)。结论:MCA-PSV预测胎儿重型α地贫优于二维超声。MCA-PSV联合二维超声可提高胎儿重型α地贫的检出率。超声多普勒测量胎儿MCA-PSV对早期预测胎儿重型α地贫,早期处理以减少产科并发症的发生具有临床价值。     

静脉导管、脐静脉和脐动脉及大脑中动脉血流检测对子痫前期胎儿预后分析

目的:探讨子痫前期(PE)胎儿静脉导管(DV)、脐静脉(UV)和脐动脉(UA)及大脑中动脉(MCA)血流检测对围生儿预后分析。方法:应用彩色多普勒超声检测PE胎儿的DV、UV和UA及MCA血流参数,并与相应孕周正常妊娠胎儿的血流测值进行对照分析,研究分析其与胎儿不良结局的关系。结果:28~31+6周及36周~分娩前,重度PE胎儿的DV、UV血流测值较正常、轻度PE胎儿升高(P0.05),轻度PE与正常胎儿比较差异无统计学意义(P0.05)。32周~35+6周,PE胎儿的DV血流参数测值PLI、PVIV、PIV及Qdv/Quv随着PE严重程度呈上升趋势(P0.05)。28周~分娩前,重度PE胎儿UA血流测值较正常、轻度PE胎儿升高(P0.05),轻度PE胎儿UA血流测值RI、PI、S/D与正常胎儿比较差异无统计学意义(P0.05),28~36周PE胎儿的MCA血流测值RI、PI、S/D与正常胎儿比较差异有统计学意义(P0.05)。PE胎儿DV、UV、UA血流测值与新生儿的出生体重、Apgar评分、脐动脉血氧饱和度、脐静脉p H值呈负相关。PE胎儿DV的PVIV、PIV,UV的Qdv/Quv,UA的PI、S/D和MCA的RI值与新生儿出生结局相关(P0.05)。结论:DV、UV血流频谱变化可反映PE胎儿宫内状况及预测出生不良结局,若结合UA、MCA血流频谱进行联合分析,将能更准确地评估胎儿的宫内状况。     

胎儿血流速度波形预测围产儿预后的价值

应用彩色多普勒超声对１０４例晚期妊娠妇女进行胎儿脐动脉（ＵＡ）、肾动脉（ＲＡ）及大脑中动脉（ＭＣＡ）的血流速度波形（ＦＶＷｓ）检查。多普勒指标包括ＵＡ、ＲＡ和ＭＣＡ的搏动指数（ＰＩ）、ＭＣＡ与ＵＡ的ＰＩ比值（Ｍ／ＵＮ）和ＭＣＡ与ＲＡ的ＰＩ比值（Ｍ／ＲＰＩ）。围产儿预后不良的标准包括：（１）新生儿Ａｐｇａｒ评分＜７分。（２）新生儿出生体重≤相应胎龄的第１０百分位数。（３）羊水过少或羊水混浊。结果显示：所有多普勒指标与围产儿预后均有明显相关性（Ｐ＜０．０５）；作为预测围产儿预后的指标，它们的特异性差异均无显著性（Ｐ＞０．０５），Ｍ／ＲＰＩ和Ｍ／ＵＰＩ的敏感性明显高于ＵＡＰＩ、ＲＡＰＩ和ＭＣＡＰＩ（Ｐ＜０．０５）；而且，Ｍ／ＲＰＩ、Ｍ／ＵＰＩ、ＭＣＡＰＩ和ＲＡＰＩ预测围产儿预后的敏感性和特异性在正常妊娠和高危妊娠之间无明显差别，而ＵＡＰＩ在高危妊娠时的敏感性明显高于正常妊娠（Ｐ＜０．０５）。说明：所有多普勒指标与围产儿预后有关，但是作为预测围产儿预后的指标，Ｍ／ＲＰＩ和Ｍ／ＵＰＩ比其它指标准确，而且，不受各种高危因素影响。     

胎盘疾病超声检查

超声评价胎盘包括胎盘的结构及功能。位置结构异常包括前置胎盘、血管前置、胎盘植入、胎盘早剥等。脐血流反映胎儿胎盘灌注,子宫动脉对于预测与子宫胎盘功能不良的妊娠并发症有一定的价值。     

动脉栓塞治疗难治性产后出血6例分析

目的 :探讨动脉栓塞治疗难治性产后出血的临床价值。方法 :用Seldinger技术对 6例难治性产后出血患者行经皮髂内动脉或子宫动脉超选择插管术 ,通过数字减影血管造影 (DSA)明确盆腔血管走向及造影剂外溢情况后 ,双侧分别注入明胶海绵条栓塞。结果 :6例插管栓塞均 1次成功 ,手术时间短 ,止血速度快 ,并且保留子宫及其生理功能。其中 2例术后再次生育。但 1例术后发生右下肢动脉血栓形成 ,手术取栓后愈合。结论 :动脉栓塞术治疗难治性产后出血快速 ,有效 ,安全 ,并保留了子宫。     

Comparative outcomes of hysteroscopic examinations performed after uterine artery embolization or laparoscopic uterine artery occlusion to treat leiomyomas

Hysteroscopic examination of the uterine cavity revealed that patients previously treated for intramural myoma(s) by uterine artery embolization had a significantly higher incidence of abnormal findings compared with patients treated by laparoscopic occlusion of uterine arteries (59.5% vs. 2.7%). In particular, there was a higher incidence of necrosis in the uterine cavity of patients subjected to uterine artery embolization (43.2%) compared with patients after surgical uterine artery occlusion (2.7%).     

The effect of loading dose of magnesium sulfate on uterine,umbilical, and fetal middle cerebral arteries Doppler in women with severe preeclampsia: A case control study

IV MgSO₄ administration in women with severe preeclampsia resulted in a decrease in umbilical artery, uterine artery, and fetal middle cerebral artery Doppler indices.

Objective: To evaluate Doppler parameters of the umbilical artery (UmA), uterine artery (UA), and fetal middle cerebral artery (MCA) before and after MgSO₄ administration in women with severe preeclampsia. Methods: A case control study included 100 pregnant women with severe preeclampsia. Umbilical artery, uterine artery, and fetal middle cerebral artery Doppler were measured before and 20 minutes after intravenous administration of 6 g of magnesium sulfate. Results: There was a significant difference between maternal systolic blood pressure (173.20 ± 22.72 vs. 156.60 ± 19.18), diastolic blood pressure (109.60 ± 9.14 vs. 101.90 ± 10.05), and heart rate (80.52 ± 11.52 vs. 88.48 ± 12.08) before and after administration of MgSO₄ in the studied patients (p value < 0.001). There was a significant difference between umbilical artery, middle cerebral artery, and uterine artery Doppler parameters before and after administration of MgSO₄ in the studied patients (p value < 0.001). There was no significant difference between umbilical artery/middle cerebral artery with regard to RI and PI. However, there was significant difference with regard to the S/D ratio (p value < 0.001). The decrease in the values of Doppler parameters before and after administration of MgSO₄ was more in the middle cerebral artery than in the umbilical artery. Conclusion: Intravenous administration of magnesium sulfate in pregnant women with severe preeclampsia resulted in a decrease in umbilical artery, uterine artery, and fetal middle cerebral artery Doppler indices with reduced resistance to blood flow in these vessels.     

Utero-placental perfusion Doppler indices in growth restricted fetuses: effect of sildenafil citrate

Objective: To assess efficacy and tolerability of sildenafil citrate on utero-placental blood flow and fetal growth in pregnancies complicated by fetal growth restriction (FGR).

Methods: From March 2015, a randomized controlled trial of 54 patients at 24?weeks or more complicated by FGR and abnormal Doppler indices were randomly allocated 1:1 into an intervention arm (receive sildenafil citrate, 50?mg) or a control arm (receive placebo). The primary outcomes were changes occurred in the Doppler parameters 2?h following drug administration.

Results: Baseline characteristics were similar between groups. Significant difference was observed in the Delta uterine and umbilical Doppler indices among sildenafil group as compared to placebo group (p?p?=?0.979). Sildenafil was also associated with pregnancy prolongation (p?=?.0001), increased gestational age at delivery (p?=?.004), improved neonatal weight (p?=?.0001), and less admission to neonatal intensive care unit (p?=?.03). No adverse effects reported in both treatment arms.

Conclusion: Sildenafil citrate, by its vasodilator effect, can improve utero-placental blood flow in pregnancies complicated by FGR and abnormal Doppler.

Clinical Trial.gov Registry: NCT02362399     

Outcomes of hypogastric artery ligation and transcatheter uterine artery embolization in women with postpartum hemorrhage

Objective

This study aimed to report our experience of emergent bilateral hypogastric (internal iliac) artery ligation (HAL) in the management of intractable postpartum hemorrhage (PPH) in a tertiary care center.

妊高征患者的胎儿血流速度波形改变特点研究

目的：研究妊高征患者的胎儿脐动脉、肾动脉以及大脑中动脉的血流速度波形的变化特点。方法：妊高征患者９６例，正常妊娠１４８例，于产前１周内行彩色多普勒超声检测胎儿脐动脉、肾动脉和大脑中动脉的搏动指数（ＰＩ），产后随访新生儿预后。结果：随着妊高征的加剧，胎儿脐动脉和肾动脉的ＰＩ上升，大脑中动脉的ＰＩ则改变不明显。在围产儿预后良好和不良的两组中，随着妊高征的加重，胎儿脐动脉、肾动脉和大脑中动脉的ＰＩ均有上升的趋势，但预后不良组的改变比对照组明显。按正常妊娠和轻度、中度、重度妊高征分成４组，胎儿窘迫者脐动脉和肾动脉的ＰＩ上升，大脑中动脉的ＰＩ下降。结论：妊高征和胎儿窘迫对胎儿脐动脉和肾动脉的血流波形改变有协同作用，对大脑中动脉的改变有阻抗作用     

The placental bed vascular pathology revisited: a risk indicator for cardiovascular disease

Aim: The present paper intends in the first place to clarify the confusing terminology for describing the vascular pathology of the placental bed in relation to long-term risk of cardiovascular disease.

Methods: Systematic review of relevant topics.

Results: The maternal blood supply to the placenta is achieved by some 100 utero-placental spiral arteries with an outside diameter varying between 200 and 600 microns. Defective physiological changes of the myometrial segment of utero-placental spiral arteries and, particularly in preeclampsia associated to hypertensive disease, the presence of atherosclerosis in their proximal segment are a cause of obstructive vascular pathology. On the other hand, basal arteries which supply the inner myometrium and basal decidua are not affected by physiological change and maintain their musculoelastic structure. They can be identified by their external diameter of less than 120 microns. Acute atherosis is an aspecific vascular lesion that occurs in basal as well as spiral arteries inside, as well as outside, the placental bed in association with a variety of obstetrical conditions.

Conclusions: An increased risk of future cardiovascular disease, should be linked to atherosis or, at a later stage, atherosclerosis of utero-placental spiral arteries, rather than to that of decidual basal arteries.     

高危妊娠胎儿血流速度波形与不同程度胎儿窘迫的关系

对妊娠晚期的高危孕妇２４４例，于分娩前一周内行彩色多普勒超声监测胎儿脐动脉（ＵＡ）、肾动脉（ＲＡ）以及大脑中动脉（ＭＣＡ）的血流速度波形（ＦＶＷｓ）的搏动指数（ＰＩ），产后随访围产儿预后。根据新生儿出生体重、Ａｐｇａｒ评分和羊水的性质分成预后正常、轻度、中度和重度预后不良等四级。结果：２４４例高危妊娠中，１４６例围产儿预后良好，６９例为轻度预后不良，１２例中度预后不良，１７例为重度预后不良。ＵＡ、ＲＡ和ＭＣＡ的ＦＶＷｓ与围产儿预后不良的程度均有明显的相关性。ＵＡＰＩ预测中度和重度预后不良的准确性较高，ＲＡＰＩ预测中度预后不良的准确性高于轻度和重度，ＭＣＡ在重度预后不良中改变最明显。说明胎儿ＵＡ、ＲＡ和ＭＣＡ的ＦＶＷｓ在胎儿窘迫时均有改变，但在不同程度的胎儿窘迫中，其敏感性不同