胎儿心脏异常的超声诊断与临床处理原则

先天性心脏畸形（CHD）是最常见的先天性畸形，约占活产总数的80／万～100／万。CHD种类繁多、病因复杂、难以预防，且常常预后不良。因此，CHD的产前诊断尤为重要。目前，胎儿心脏的超声检查技术日臻成熟，CHD的产前检出率能达90．0％以上。     

胎儿泌尿系统异常的超声诊断与临床处理

胎儿泌尿系统异常是产前超声所能诊断的常见类型。产前超声检查的目的是早期发现异常并为临床医生提供诊断信息及了解疾病的严重程度，为宫内处理、随访或适时终止妊娠提供依据。它是一种敏感性较高的无创性检查方法。胎儿泌尿系统异常分为肾脏、输尿管、膀胱及尿道等异常，本文就超声影像学诊断、注意事项及临床处理三方面进行讨论。     

遗传技术与产前诊断

产前诊断(prenatal/antenatal diagnosis),又称宫内诊断(intrauterine diagnosis),是对胎儿在出生前是否患有先天性缺陷或遗传性疾病作出的诊断.     

胎儿肺脏影像学异常的临床认识和处理

胎儿肺脏位于胸腔，分左右两肺。胸腔由脊柱胸段、肋骨、胸骨、横膈组成，胸腔表面覆盖胸膜。胸腔内除了肺脏，与之相邻的器官还有：心脏及大血管、气管、食管、淋巴管等，这些器官均位于纵隔内。胎儿肺脏随孕周的增加而渐渐发育，其中最关键的阶段是妊娠5～26周。如果这个时期肺脏发育受到干扰，就可能导致产后呼吸功能不良或呼吸衰竭。因此，这关系到新生儿能否正常自主呼吸，能否正常生存的重大问题。     

胎儿心脏结构异常的诊断和处理

胎儿心脏结构异常即先天性心脏病(congenital heart disease,CHD)是最常见的出生缺陷,也是导致新生儿死亡的重要原因。在我国每年新增CHD患儿超过15万例,发生率为7‰~8‰,居出生缺陷首位。严重的CHD不仅影响患儿的生存质量,也给家庭、社会带来了沉重负担。因此本文重点就CHD的产前诊断及临床处理进行总结概述。     

胎儿影像学研究进展及展望

胎儿影像学主要包括超声、X线及磁共振（MRI）检查。X线由于具有放射性，目前已很少用于妊娠期胎儿检查。超声检查由于直观，无射线，费用低，是胎儿影像学检查的主要部分。近年来，胎儿MRI的使用开始增多，在某些方面可以提供超声检查所不能提供的信息。     

胎儿先天性泌尿系统畸形的诊治

国外报道胎儿先天性泌尿系畸形的发生率为 0 5 % ,国内北京报道发生率为 1 9%。因此胎儿先天性泌尿系统畸形的早期诊断、早期治疗十分重要。1　胎儿先天性泌尿系统畸形的诊断1.1　临床上正确理解遗传疾病、先天性疾病、出生缺陷及家族性疾病等概念的内涵和外延　　明确先天性、遗传性疾病的分类、病因、发病规律 ,了解泌尿系胚胎发育机制是诊断和处理此类疾病的基础。1.2　泌尿系一般疾病的诊断原则及方式亦适用于胎儿先天性泌尿系统畸形的诊断强调重视一般病史中的近亲婚育史、孕期中微生物感染、放射、药物等因素的影响。这是临床诊断最…     

胎儿MRI在先心病诊断中的应用

先天性心脏病目前是全球范围内最前见的出生缺陷,在胎儿期和新生儿期的发病率和死亡率非常高,因此,产前准确诊断非常重要。超声心动图是产前评价心脏解剖和诊断心脏畸形的主要影像学手段。近年来,随着胎儿磁共振成像(MRI)技术的快速发展,胎儿MRI已逐渐应用于产前评价先天性心脏病。对于产科和儿童心血管医生来说,了解近年来胎儿MRI的发展及其在诊断先天性心脏畸形中的作用是非常重要的。本文将详细介绍胎儿心脏磁共振成像目前所面临的挑战、成像新技术、成像标准切面以及其在产前先心病诊断中的应用价值。     

胎儿影像学异常的临床认识和处理——胎儿侧脑室增宽的临床认识和处理

脑室增宽（ventriculomegaly，VM）是指脑脊液过多地积聚于脑室系统内，致使脑室系统扩张，其中侧脑室增宽最为常见。明显的侧脑室扩张与围生期胎儿发病率和病死率有密切关系；轻度的侧脑室扩张，常可伴有其他结构异常或染色体核型异常。因此，产前发现并诊断胎儿脑室增宽具有重要意义。     

胎儿附属物异常的宫内诊断和临床管理

随着产前超声技术的进步,各种胎儿附属物异常的宫内明确诊断和临床干预成为可能。胎盘血管瘤、血管前置和帆状血管、羊膜带综合征以及羊水过多、过少等的宫内治疗已经取得良好的临床效果。由于胎儿附属物的异常经常导致较高的胎儿、新生儿和孕妇的发病率和死亡率。因此,产前超声检查时应对胎儿附属物进行详细地扫查以明确诊断、及时进行宫内治疗和产时产后并发症的预防。     

胎儿侧脑室增宽的临床认识和处理

脑室增宽(ventriculomegaly,VM)是指脑脊液过多地积聚于脑室系统内,致使脑室系统扩张,其中侧脑室增宽最为常见。明显的侧脑室扩张与围生期胎儿发病率和病死率有密切关系;轻度的侧脑室扩张,常可伴有其他结构异常或染色体核型异常。因此,产前发现并诊断胎儿脑室增宽具有重要意义。1超声对胎儿脑室增宽的评价及诊断标准脑室系统包括侧脑室、第三脑室、中脑导水管、第四脑室。产前超声检查中,侧脑室最容易观察,其宽度及形态检查是产前系统超声检查中的重要内容,而单纯第三脑室及第四脑室增宽罕见,不是本文讨论的重点。侧脑室房部宽度是侧脑室增…     

胎儿超声遗传标记物的临床认识和处理

近十余年来，随着超声技术的发展和超声工作者经验的提高，超声检查被逐步应用于胎儿染色体异常的筛查中，遗传学超声检查应运而生。大多数染色体异常的胎儿或多或少存在一些解剖结构的异常，有些表现为明显的脏器结构异常，有些仅表现为微小结构的异常即发现超声遗传标记物，     

常见胎儿消化系统超声异常的临床认识与处理

在胚胎早期（第5孕周），原始消化管分化为前肠、中肠及后肠。而其中前肠衍生为食管、胃、十二指肠前端（前2／3）、胰腺及肝脏；中肠将衍生为十二指肠末端（后1／3）、空肠、回肠、升结肠及横结肠前端（前2／3）；后肠将衍生为横结肠后1／3、降结肠、乙状结肠、直肠及肛门上段，以及膀胱及阴道的组成部分。本文重点介绍常见胎儿消化系统超声异常，并对其临床诊断和处理谈谈个人的看法。     

The effects of pain and its management on mother and fetus

Childbirth is frequently accompanied by pain. For religious, cultural and philosophical reasons many groups have sought to prevent treatment of pain. Pain may have adverse effects on the mother and fetus. The psychological effects of severe pain should not be overlooked particularly where it is associated with an adverse fetal or maternal outcome. There are a number of different forms of pain relief in labour with differing side-effects and efficacies. The controversy concerning medical management of women in labour has been used to dissuade women from requesting pain relief. This debate has encouraged the use of a patient-centred philosophy of care that encourages the patient to retain control. However, good pain relief may allow the women to retain control if administered in a sensitive manner. The ideal analgesic in labour is discussed. Recent and future developments of analgesia in childbirth are discussed with respect to this.     

The fetus with an abdominal wall defect: management and outcome

Despite prenatal diagnosis, maternal transport and early perinatal treatment in specialized hospitals, improvement in overall mortality has not been observed among newborns with abdominal wall defects (omphalocele and gastroschisis). A comparison has been made, for both anomalies, between 55 cases treated in the periods 1967-1979 and 30 treated in the periods 1980-1985. In this last group 14 prenatally detected cases were separated from cases discovered at birth. Recent advances in treatment have reduced mortality rates for both of these anomalies. This was especially true for gastroschisis; in omphalocele cases, associated abnormalities appeared to be an unavoidable limiting factor in survival. With prenatal diagnosis a surprising increase in mortality rate was observed among omphalocele cases detected before birth. A possible reason for this is the total number of antenatally diagnosed cases that, with maternal transport, are concentrated in centers where surgical facilities are available. Before introduction of antenatal diagnosis, most of these cases would never have been observed by the pediatric surgeon because of death prior to referral or treatment. Gastroschisis cases may benefit more from antenatal recognition and early treatment because multiple abnormalities or immaturity are not so important limiting factors in survival as in omphalocele cases. Reduced trauma and contamination of exposed viscera, immediate treatment and adequate supportive measures may significantly reduce mortality rate in gastroschisis cases. Operative delivery of fetuses with an abdominal wall defect is controversial. The risk of vaginal route delivery has been over emphasized. Intrapartum rupture of an omphalocelic sac was an extremely rare event before introduction of antenatal diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)