介入性超声在产科的应用

介入性超声是在超声引导下把穿刺针、引流管、药物等正确地放置到所要到达的病灶、囊腔、体腔或其他特定部位,以达到诊断或治疗的目的.介入性超声在产科的应用使胎儿能与成人一样可作血、尿等生化、染色体等各方面的监测,还能对胎儿作宫内治疗,如羊膜腔给药,胎儿输血及胎儿脑积水、肾积水、腹水等进行宫内引流.1 超声引导下的羊膜腔穿刺羊膜腔穿刺是产科普通的手术,在超声引导下进行可提高取材率,减少并发症,既简单、方便,又安     

产程时限研究进展及适宜的产程干预时机选择

六十余年来,国内外对产程时限的划分达成了共识,Friedman提出的产程曲线成为了全球大部分产科工作者进行产程管理的标准。但随着当今分娩人群的变化、产程中缩宫素使用、人工破膜、分娩镇痛等产程干预措施的实施以及临床研究方法的改进和完善,既往一直沿用的产程时限受到了众多学者的质疑并逐渐呈现出不适应当代分娩人群的趋势。因此,重新评估既有的并建立新的正常产程时限标准,对指导产程处理、减少不必要的产科干预具有重要意义。我国新产程标准的出台,更推进了相关产科干预措施实施的必要性探讨。回顾国内外不同学者对产程时限的研究,就低危产妇入院时机选择、缩宫素使用时机、人工破膜及分娩镇痛实施时机等方面进行综述,以期对新产程标准下产科干预时机有所认识。     

胎儿脉搏氧测定的临床价值

胎儿脉搏氧测定是国外近十年兴起的产程中胎儿监护技术，仪器探头直接与胎儿面部皮肤接触，无须采血即可实时观察胎儿的血氧饱和度，能较敏感和精确地反映胎儿宫内情况，减少不必要的产科干预，提高围生期预后，而且操作较简便，对母亲和胎儿均不会造成不良影响，是很有前途的胎儿监护技术。综述该技术的原理、基本操作、适应证与禁忌证及临床应用价值。     

美国妇产科医师学会“产科超声指南2016”要点解读

<正>超声检查具有无创性、无辐射的优势。随着二维、三维超声技术的提高,超声在产科中的应用越来越广泛,由之前只对胎儿生长情况的评估到现在的胎儿畸形诊断、宫内监测。美国妇产科医师学会(the American college of obstetricians andGynecologists,ACOG)在2009年发布"产科超声"实践指南,2016年在美国放射学会和美国超声医学协会制定的"2013年超声指南"的基础上,制定并     

胎儿血氧饱和度监测在预测胎儿酸中毒中的应用

目的研究胎儿血氧饱和度（FSO2）预测胎儿酸中毒的阈值及准确性。方法2002—12—2004-06对广东省人民医院及青海红十字会医院的226例产妇在宫口开大3cm以上者行FSO，监测及电子胎儿监护仪监护，应用受试者工作特征曲线评估FSO2阈值；研究将30％作为FSO2阈值，评估其预测胎儿酸中毒的准确性。结果第二产程FSO2较第一产程下降，二者均值差异有显著性；脐动脉血气与FSO2呈相关性；将30％作为FSO2阈值，预测胎儿宫内缺氧的敏感性、特异性、阳性预测值、阴性预测值及准确性分别为88．9％、96．8％、84，2％、97．6％、95．6％。结论将30％作为FSO2的阈值是适宜的；FSO2可提高诊断胎儿宫内酸中毒的准确性。     

产前超声诊断的现状与发展思考

超声影像诊断应用于产科观察胎儿并诊断胎儿疾病已有三十余年的历史，近年来发展更为迅速并成为产科不可缺少的影像诊断工具。超声诊断不仅可以用来显示正常胎儿的形态结构，实时地观察到胎儿在宫内的运动、行为及胎儿的血流动力学变化，而且能对胎儿的主要结构畸形进行筛查。     

应用产程图监护产程中产力异常

应用产程图监护产程中产力异常３０００５２天津市中心妇产科医院王淑雯一、产程图临床应用产道、产力、胎儿及其附属物是分娩的三大要素，随着产程的进展三者之间的关系相互影响，相互协调，不断地发生着动态变化。近年来对产程的研究不仅仅限于产科动力学研究，而更强调...     

脐带血血气分析的临床意义

血气分析至今仍是评价体内酸碱状态——气体代谢及物质代谢的一个金标准。自从 196 0年 Saling首先报道用胎儿头皮血血气分析可以反映胎儿气体代谢及酸碱状态以来 ,为产科临床提供了判断胎儿宫内缺氧及酸中毒的重要手段。自 1983年 Daffos首次成功地在 B超引导下经羊膜腔穿刺取胎儿脐带血以后 ,脐带血血气分析可用于实践。但在产程中 ,由于阵阵子宫收缩 ,以及产妇不好配合 ,操作会有困难 ,且这种有创性操作不宜反复进行 ,所以常常在胎儿出生后 ,即刻在直视下穿刺脐带动脉或静脉取血 ,但其结果仅反映在出生前短期内的血气状况 ,不能作连续…     

胎儿脉搏氧测定的临床价值

胎儿脉搏氧测定是国外近十年兴起的产程中胎儿监护技术,仪器探头直接与胎儿面部皮肤接触,无须采血即可实时观察胎儿的血氧饱和度,能较敏感和精确地反映胎儿宫内情况,减少不必要的产科干预,提高围生期预后,而且操作较简便,对母亲和胎儿均不会造成不良影响,是很有前途的胎儿监护技术.综述该技术的原理、基本操作、适应证与禁忌证及临床应用价值.     

B型超声预测胎儿体重的研究进展

Ｂ型超声预测胎儿体重的研究进展朱洁萍戴钟英为了正确地制定产科处理措施，减少产科并发症，准确地估计胎儿体重是十分重要的工作。过去临床上常用的方法是根据子宫高度、子宫宽度及腹围的测量来估计胎儿体重。７０年代末期以来，随着超声技术的发展，Ｂ型超声检查成为预...     

预防初次剖宫产指南对促进阴道试产的作用

剖宫产术是处理妊娠并发症和合并症、解决难产和宫内缺氧的重要手段。但近年剖宫产率的上升并未明显降低孕产妇和围产儿发病率及死亡率,相反增加了剖宫产术后并发症的发生率。文章分析剖宫产的风险,从孕期管理,个性化引产,提高助产技术,新产程的运用,胎儿监护的管理,臀位外倒转以及剖宫产后阴道试产等7个方面阐述有关预防剖宫产、促进阴道试产问题。     

胎膜早破的引产

综合考虑破膜原因、潜在风险等，近足月及足月胎膜早破（premature rupture of membrane，PROM）的引产较期待治疗更具积极意义。所有无阴道分娩禁忌证的PROM产妇均可考虑在破膜后2～12 h或24 h内进行引产。缩宫素、米索前列醇、地诺前列酮及机械性方法等均可用于PROM患者的引产，但在引产前应注意排除感染、头盆不称等不宜阴道分娩的情况，并根据患者产次、子宫颈Bishop评分选择更适宜的引产方法。引产过程中也应注意动态评估母儿状况和产程进展，进行个体化管理。     

Usefulness of ultrasound in the delivery room

The use of diagnostic ultrasound and the diffusion of the technique improved the obstetric treatment and the usefulness of ultrasound increases in the delivery room for maternal and fetal care and as method of diagnosis of some obstetric complications. The knowledge of intrapartum ultrasound imaging can be considered useful for the obstetric team, since there is evidence that ultrasound can improve the obstetric management. The mean indications are described: fetal biometry and estimated fetal weight, amniotic fluid volume, fetal situation and presentation, placental localization and anatomy, assessment of size and location of uterine leiomyomas, fetal cardiac activity, evaluation of umbilical cord and fetal cardinal movements intrapartum. Besides, the use of ultrasound is reported in obstetric and postpartum complications. Actually ultrasonography, as a non-invasive, safety and low-cost technique, offers a diagnostic method in particular conditions during labour, delivery and postpartum.     

Le suivi échographique de la deuxième partie du travail

In the second stage of labor, fetal head rotation and fetal head position are determinant for the management of labor to attempt a vaginal delivery or a cesarean section. However, digital examination is highly subjective. Nowadays, delivery rooms are often equipped with compact and high performance ultrasound systems. The clinical examination can be easily completed by quantified and reproducible methods. Transabdominal ultrasonography is a well-known and efficient way to determine the fetal head position. Nevertheless, ultrasound approach to assess fetal head descent is less widespread. We can use translabial or transperineal way to evaluate fetal head position. We describe precisely two different types of methods: the linear methods (3 different types) and the angles of progression (4 different types of measurement). Among all those methods, the main pelvic landmarks are the symphysis pubis and the fetal skull. The angle of progression appears promising but the assessment was restricted to occipitoanterior fetal position cases. In the coming years, ultrasound will likely play a greater role in the management of labor.     

产时超声监测改善分娩结局

超声逐渐用于产时判断胎方位和胎头位置来评估产程进展，辅助临床进行分娩管理。文章依据临床指南和临床研究，阐述产时超声监测的参数指标及其对改善分娩结局的作用。     

引产在剖宫产术后再次妊娠阴道试产中的应用

既往一次子宫下段剖宫产史的妇女再次妊娠，如无禁忌证，可建议剖宫产术后再次妊娠阴道试产（trial of labor after cesarean，TOLAC）。TOLAC的患者可能因为母体或胎儿因素需要较早终止妊娠，即引产。应充分评估等待自然临产与引产的风险利弊、引产与择期重复剖宫产（elective repeat cesarean section，ERCS）的利弊，在充分医患交流相关信息的前提下本着个体化原则双方共同决定引产与否及其方式，并组织良好的多学科团队制定个体化方案，以期获得良好的母儿结局。     

Ultrasound evaluation of the postdate pregnancy

In summary, ultrasound plays an important role in the evaluation of the postterm pregnancy, and its use should be considered in the following situations: 1) estimation of fetal weight in the potentially macrosomic infant before vaginal delivery is attempted; 2) frequent evaluation for oligohydramnios using the amniotic fluid index for the expectant management of the postdate pregnancy; 3) placental evaluation prior to elective induction of labor in a poorly dated pregnancy; and 4) evaluation of the postterm fetus for possible congenital abnormalities.     

Sonographische Beurteilung der Einstellung und des Höhenstandes vor vaginal-operativer Entbindung

Ultrasound scanning is routinely performed intrapartum in many delivery rooms. Investigations have shown that transperineal ultrasound using the angle of progression to quantify fetal head descent before operative vaginal delivery has the potential to reduce the rate of cesarean sections without increasing maternal and neonatal morbidity. However, recently Ramphul et al. could not confirm the influence of the use of ultrasound for assessing the position of the fetal head on morbidity. Currently, no study has yet been carried out to systematically assess the acceptability of ultrasound for women in labor. It is generally agreed that sonography is highly operator-dependent and the skill and experience required to obtain and interpret sonographic images should not be underestimated. In the hand of an experienced operator, ultrasound is a very useful tool; however, only one study has systematically looked at the level of expertise required to obtain reliable information by transperineal ultrasound. Further research is required to demonstrate that routine use of ultrasound prior to performing an operative vaginal delivery is a valid, reproducible, acceptable and safe intervention, which can enhance decision-making about the ongoing management of a prolonged second stage of labor.     

INTERPRETING THE ELECTRONIC FETAL MONITOR Strategies for Management

Electronic fetal monitoring offers the practitioner involved in the intrapartum care of women a mechanism to validate the fetus' physiologic adaptation to the labor and delivery experience. Utilizing a predetermined framework for constant assessment of fetal well-being will assist the clinician in the bedside management of these patients. This pathway of reassurance for fetal evaluation is an effective tool in the intrapartum observations of the fetus. If the fetus can demonstrate his physiologic well-being, labor may continue. However, if there are no signs of reassurance, immediate delivery of the fetus should be considered.     

Interpreting the electronic fetal monitor. Strategies for management

Electronic fetal monitoring offers the practitioner involved in the intrapartum care of women a mechanism to validate the fetus' physiologic adaptation to the labor and delivery experience. Utilizing a predetermined framework for constant assessment of fetal well-being will assist the clinician in the bedside management of these patients. This pathway of reassurance for fetal evaluation is an effective tool in the intrapartum observations of the fetus. If the fetus can demonstrate his physiologic well-being, labor may continue. However, if there are no signs of reassurance, immediate delivery of the fetus should be considered.