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1.
目的探讨对反复无应激试验(no-stress test,NST)无反应型孕妇进行脑-胎盘率(PIMCA/PIUA)检测的临床意义。方法运用彩色多普勒超声检测200例孕37~41周反复NST无反应型孕妇的胎儿大脑中动脉(MCA)和脐动脉(UA)的血流阻力指标(包括S/D、RI、PI)、计算各自的脑-胎盘率,并根据胎儿有否不良结局分为两组进行比较分析。结果不良结局组测得的MCA各阻力指标明显低于正常组(P〈0.01),UA各阻力指标明显高于正常组(P〈0.05),脑-胎盘率明显低于正常组(P〈0.01)。在PIMCA/PIUA〈1组,胎儿不良结局发生率明显高于PIMCA/PIUA〉1组(P〈0.01);以PIMCA/PIUA〈1预测胎儿不良结局的敏感性为25.7%,特异性为98.2%。结论脑-胎盘率检测对于胎儿不良结局的预测具有不错的临床价值,当反复NST无反应型孕妇(无其他高危因素)的脑-胎盘率〈1时须警惕胎儿不良结局的发生。  相似文献   

2.
33例胎盘早剥的B超诊断   总被引:17,自引:0,他引:17  
目的对产前B超检查产后证实为胎盘早剥的病例进行分析,以提高B超对胎盘早剥的确诊率。方法对我院1988年1月至2003年4月间33例胎盘早剥的声像图表现及临床资料进行回顾性分析。结果产前B超诊断胎盘早剥符合率为84.8%(28例),其中前壁胎盘及重度胎盘早剥符合率高(93.7%,100%),而后壁胎盘及轻度早剥无临床症状符合率低(72.77%;0)。胎盘早剥的超声图像特征为胎盘与子宫壁间为暗区、低回声,中等回声或混合回声15例,胎盘局部增厚6例,胎盘边缘或绒毛膜板下突出肿块8例(误为绒毛膜血管瘤1例)。彩色多普勤血流显像显示胎盘剥离区无血流信号。结论产前B超捡查对诊断胎盘早剥具有很重要的临床价值,为临床处理及分娩方式的选择提供了依据。  相似文献   

3.
目的分析不典型胎盘早剥早期诊断的特点。方法选择2011年09月~2014年10月我院收治的胎盘早剥孕妇100例作为研究对象,将其随机分为研究组(产前诊断确定为不典型胎盘早剥)与对比组(产后诊断确定为不典型胎盘早剥),对两组临床资料进行分析。结果研究组胎儿死亡0例,产后出血15例;对比组胎儿死亡4例,产后出血9例。两组数据对比差异有统计学意义(P0.05)。结论早期注意观察孕妇的临床症状,在此基础上结合B超检查等结果对孕妇进行诊断,可及时发现不典型胎盘早剥,从而采取相应措施有效改善母婴预后情况。  相似文献   

4.
目的:分析胎盘早剥的发病诱因、临床表现、辅助检查及母儿结局,以提高早期确诊率,降低母儿并发症。方法:回顾性分析2009年1月至2011年12月我院确诊并治疗的61例胎盘早剥患者的临床资料,分析其发病诱因、临床症状、辅助检查及母儿结局。结果:我院胎盘早剥发生率0.67%,其中轻型37例,重型24例;有明确发病诱因者38例,其中合并妊娠高血压疾病者居多。临床表现多为腹痛、阴道流血、阴道流液。B超诊断率50.82%。剖宫产52例,经阴分娩9例,产后出血13例,子宫胎盘卒中10例,DIC7例,行子宫B-lynch缝合术9例,轻型与重型胎盘早剥剖宫产率无统计学差异(P>0.05),但产后出血、子宫胎盘卒中、DIC、行子宫B-lynch缝合术有统计学差异(P<0.05)。围产儿死亡10例,新生儿窒息8例,转新生儿科23例,轻型与重型围产儿死亡率有显著统计学差异(P<0.01),新生儿转科率及新生儿窒息发生率则无统计学差异(P>0.05)。结论:胎盘早剥临床表现复杂,早期识别诊断,及时处理,可改变围生期母婴结局。对B超检查提示胎儿脐动脉血流S/D高的患者需重视。  相似文献   

5.
目的:探讨前置血管的临床特点及围生儿结局。方法:回顾性分析2005年1月至2012年12月在四川大学华西第二医院分娩的、产后确诊的5例前置血管患者的临床资料。结果:5例患者中,产前经腹部B超检查诊断3例,产前B超诊断率60%,产前诊断的平均孕周为25+2周;产后明确诊断2例。5例均存在高危因素,分别为:低置胎盘2例,合并帆状胎盘2例,合并球拍状胎盘2例,合并副胎盘1例,体外受精-胚胎移植术后1例。产前诊断的3例患者临产前行择期剖宫产,围生儿结局良好;产后诊断的2例患者,1例因疑"胎儿窘迫"急行剖宫产,术后新生儿转入NICU,另一例入院前发生胎膜早破、前置血管破裂,胎死宫内引产。结论:超声检查是产前诊断前置血管的主要方法,加强对高危人群的筛查、提高产前诊断率和临产前行剖宫产可改善围生儿结局。  相似文献   

6.
IADPSG诊断标准用于北京市妊娠期糖尿病诊断的探讨   总被引:1,自引:0,他引:1  
目的探讨国际妊娠期糖尿病专家组(IADPSG)妊娠期糖尿病(GDM)的诊断标准是否适宜。方法对2667例孕妇进行血糖筛查试验,阳性者进行葡萄糖耐量试验(OGTT)。按照教科书和IADPSG两种诊断标准对孕妇进行诊断并分组,非糖尿病孕妇2325例作为对照组,对各组母儿妊娠结局进行比较。结果血糖筛查试验阳性780例,OGTT试验达到教科书标准和IADPSG标准者分别为270例和276例,检出率分别为10.50%和10.72%(P〉0.05);两种诊断标准各GDM组间比较,产母子痫前期、羊水过多、低出生体重儿、巨大儿的发生率和剖宫产率差异均无统计学意义(P〉0.05),而与对照组相比,剖宫产率、巨大儿及低出生体重儿发生率差异存在统计学意义(P〈0.05),IADPSG组产母子痫前期发生率也显著高于对照组(P〈0.05)。结论用IADPSG标准诊断GDM可使治疗更有针对性,需要进一步的临床研究来证明降低GDM的诊断标准能够带来益处。  相似文献   

7.
妊娠期糖代谢异常相关因素的研究   总被引:25,自引:1,他引:24  
目的 探讨妊娠期糖尿病(GDM)及妊娠期糖耐量低减(GIGT)发病的高危因素。方法 采用前瞻性对照研究的方法,对2004年2月至8月,在北京大学第一医院妇产科门诊行产前检查诊断的糖代谢异常孕妇[其中GDM85例(GDM组)、GIGT63例(GIGT组)]和125例糖代谢正常孕妇(对照组)的临床资料进行单因素及多因素logistic回归分析,探讨各因素对GDM和GIGT发病的影响。结果 (1)GDM组及GIGT组孕妇平均年龄、孕前体重指数、确诊前孕妇平均每周体重增长均明显高于对照组(P〈0.05)。(2)GDM组及GIGT组孕妇每日主食及水果摄人量也明显高于对照组(P〈0.05),而且GDM组与GIGT组比较,差异有统计学意义(P〈0.05)。(3)GDM组、GIGT组及对照组糖尿病遗传家族史发生率分别为42.4%、36.5%及19.2%;孕前月经不调发生率分别为16.5%、23.8%及6.4%;多囊卵巢综合征(PCOS)发生率分别为5.9%、3.2%及0;妊娠期外阴阴道念珠菌病(VVC)发生率分别为15.3%、17.4%及7.2%。GDM组及GIGT组以上各指标与对照组比较,差异均有统计学意义(P〈0.05)。(4)多因素logistic回归分析显示,孕妇年龄、月经不调、孕前体重指数、确诊前孕妇平均体重增加、自然流产史、VVC均为妊娠期糖代谢异常的高危因素。结论 孕妇年龄、月经不调、自然流产史、孕前肥胖、孕期体重增加过快、VVC,为GDM和GIGT发病的独立高危因素。PCOS、糖尿病家族遗传史对GDM发病有一定影响,但不是独立高危因素。  相似文献   

8.
妊娠晚期出血有前置胎盘、胎盘早剥、胎盘边缘血窦破裂出血和帆状胎盘血管前置破裂等疾病,其中以前置胎盘最常见.我院在1980年1月至1990年12月住院分娩病人中,前置胎盘分娩88例,占分娩总数0.67%.其中低置胎盘40例,边缘性或部分性前置胎盘33例,中央性前置胎盘15例.产前根据临床和B 超检查结果作诊断,产后检查胎盘位置及外观  相似文献   

9.
目的分析不典型胎盘早剥的临床特点及诊疗方法。方法回顾性分析我院2010年1月~2014年12月收治的胎盘早剥患者78例的临床资料,将其分为典型组42例和不典型组36例。比较两组患者的误诊率、实验室指标及母婴结局。结果典型组患者经B超检查确诊37例,漏诊6例,漏诊率为11.90%;不典型组患者经B超检查确诊24例,漏诊12例,漏诊率为33.33%。不典型组的血纤维蛋白原进行性下降率、血红蛋白进行性下降率及血小板进行性下降率等指标均显著低于典型组,差异有统计学意义(P0.05)。典型组的剖宫产率、产后出血率、胎儿窘迫率及早产低体质量等指标均显著低于不典型组,差异有统计学意义(P0.05)。结论不典型胎盘早剥具有症状、体征不明显的特点,易出现漏诊、误诊,因此要多种诊断方法联合应用予以确认,提高早期诊断率。临床上要加强胎盘早剥的预防工作,积极治疗各类合并症及并发症,改善母婴结局。  相似文献   

10.
目的:检测子痫前期(PE)患者胎盘中miR-210和缺氧诱导因子1α(HIF-1α)表达水平,分析二者表达相关性及其与PE患者临床病理的关系。方法:选取深圳市南山区人民医院(我院)2016年1月—2018年2月收治的46例PE孕妇为研究对象,根据子痫前期病情程度分为轻度组21例和重度组25例,另选择同期在我院孕检正常并在妊娠结束行剖宫产孕妇34例为对照组,通过常规指标检测分析PE患者临床症状,采用荧光定量聚合酶链反应(PCR)检测胎盘中miR-210、HIF-1α mRNA表达,采用免疫组织化学染色法检测胎盘中HIF-1α表达,分析PE患者胎盘中miR-210和HIF-1α的表达相关性及与患者基本病理资料的关系。受试者工作特征(ROC)曲线分析miR-210、HIF-1α mRNA表达水平对PE的诊断价值。结果:PE患者收缩压(SBP)、舒张压(DBP)和尿蛋白(PRO)水平高于对照组(P<0.05),且重度PE组高于轻度PE组(P<0.05)。PE患者胎盘组织中miR-210、HIF-1α水平高于对照组(P<0.05),且重度PE组高于轻度PE组(P<0.05)。胎盘组织中miR-210、HIF-1α水平与PE患者SBP、DBP、PRO水平及PE严重程度相关(P<0.05)。PE患者胎盘中miR-210与HIF-1α表达呈正相关(P<0.05)。ROC分析显示miR-210、HIF-1α mRNA的截断值分别为1.06、1.27时,诊断PE时的敏感度分别为80.43%和78.26%,特异度分别为70.59%和82.35%。结论:miR-210和HIF-1α在PE患者胎盘组织中高表达,二者表达水平呈正相关,共同参与PE发生、发展。  相似文献   

11.
目的分析不典型胎盘早剥产前易漏诊的原因,改善母胎预后。方法回顾性分析17年间胎盘早剥产前未确诊的43例(观察组)患者的资料,并与同期产前确诊为胎盘早剥的63例(对照组)比较。结果观察组临床表现主要为腰酸、腹胀或胎心监护异常,早剥面积及总出血量均明显低于对照组。而死胎、死产、新生儿死亡、新生儿窒息及早产儿出生率与对照组比较差异无统计学意义。产科DIC等并发症与对照组比较差异无统计学意义。结论胎盘早剥漏诊的主要原因为发病诱因和临床症状不典型,虽轻型早剥占较大比例,但对母胎仍具有较大危害。  相似文献   

12.

Objective

This study aimed to explore the clinical characteristics and outcomes of placental abruption.

Materials and methods

A total of 62 placental abruption cases were collected from the Second Hospital of Jilin University between January 2007 and December 2012. A retrospective study was conducted to explore the risk factors for placental abruption, clinical characteristics, and maternal and fetal outcomes.

Results

Risk factors for placental abruption mainly include preeclampsia (39%) and premature rupture of membrane (10%). Abdominal pain (68%) and bleeding (35%) comprise the classical symptoms of placental abruption but the clinical picture varies from asymptomatic, in which the diagnosis is made by inspection of the placenta at delivery, to massive abruption leading to fetal death and severe maternal morbidity. Emergency cesarean section was performed in 45 cases (73%) of placental abruption. Sixty-two placental abruption cases were divided into 2 groups according to whether uteroplacental apoplexy occurred. The incidence of preeclampsia and the duration (time between on-set of clinical symptom and placenta delivery) in the observational group were significantly higher than that of the control group, showing statistical significance (P < 0.01).

Conclusion

The diagnosis of placental abruption should consider risk factors, symptoms, physical signs, dynamic ultrasound monitoring, and cardiac care. Early diagnosis and treatment can improve maternal and infant prognosis.  相似文献   

13.
OBJECTIVE: To analyze the association of second-trimester maternal serum alpha-fetoprotein (MSAFP) and free beta human chorionic gonadotrophin (MSbeta-hCG) levels to placental abruption. METHODS: Fifty-seven women with placental abruption and 108 control women without placental abruption were tested for second-trimester MSAFP and MSbeta-hCG levels as a part of a trisomy 21 screening program. Discriminatory cutoff levels for MSAFP were sought to predict placental abruption. RESULTS: The median of the MSAFP multiples of median (MoM) (1.21) was significantly higher in the abruption group than in the control group (1.07) (p = 0.004). In multivariate analysis, elevated MSAFP remained an independent risk factor for placental abruption when adjusting for other risk factors (parity >/= 3, smoking, previous placental abruption, preeclampsia, bleeding in II or III trimester, and placenta previa). MSAFP >/= 1.5 MoM had a sensitivity of 29% and a false-positive rate of 10%. The levels of the MSbeta-hCG MoM did not differ between the cases and the controls. CONCLUSION: Although second-trimester MSAFP levels are higher in women with subsequent placental abruption, the clinical usefulness of this test is limited due to low sensitivity and high false-positive rate.  相似文献   

14.
Clinical presentation and risk factors of placental abruption   总被引:10,自引:0,他引:10  
BACKGROUND: To study the risk factors of placental abruption during the index pregnancy. METHODS: One hundred and ninety-eight women with placental abruption and 396 control women were identified among 46,742 women who delivered at a tertiary referral university hospital between 1997 and 2001. Clinical variables were compared between the groups. Multivariate logistic regression analysis was applied to identify independent risk factors. The clinical manifestations of placental abruption were also studied. RESULTS: The overall incidence of placental abruption was 0.42%. The independent risk factors were maternal (adjusted OR 1.8; 95% CI 1.1, 2.9) and paternal smoking (2.2; 1.3, 3.6), use of alcohol (2.2; 1.1, 4.4), placenta previa (5.7; 1.4, 23.1), pre-eclampsia (2.7; 1.3, 5.6), and chorioamnionitis (3.3; 1.0, 10.0). Vaginal bleeding (70%), abdominal pain (51%), bloody amniotic fluid (50%), and fetal heart rate abnormalities (69%) were the most common manifestations. Neither bleeding nor pain was present in 19% of the cases. Overall, 59% had preterm labor (OR 12.9; 95% CI 8.3, 19.8), and 91% were delivered by cesarean section (34.7; 20.0, 60.1). Of the newborns, 25% were growth restricted. The perinatal mortality rate was 9.2% (OR 10.1; 95% CI 3.4, 30.1). Retroplacental blood clot was seen by ultrasound in 15% of the cases. CONCLUSIONS: Maternal alcohol consumption and smoking, and smoking by the partner turned out to be independent risk factors for placental abruption. Smoking by both partners multiplied the risk. The liberal use of ultrasound examination contributed little to the management of women with placental abruption.  相似文献   

15.
The relationship between clinical diagnosis and placental findings for 561 consecutive cases of delivery at 24 to 31 weeks' gestation were analyzed, and the following results were obtained. 1) The incidence of premature rupture of the membranes (PROM), threatened premature delivery, toxemia and abruption placentae were 40.6, 36.4, 7.8 and 3.0%, respectively. 2) The incidence of chorioamnionitis, retroplacental hematoma (RPH) and placental infarction were 35.1, 18.0, and 13.0%, respectively. 3) Chorioamnionitis of the placenta was found 58.3% in PROM and 26.0% of cases of threatened premature delivery. 4) RPH was found in 70.6% of placenta of abruption and 36.4% of toxemia. 5) Placental infarction was found in 86.4% of toxemia cases and 35.3% of abruption. Each clinical diagnosis was related specifically to each placental finding in cases delivered at 24 to 31 weeks of gestation.  相似文献   

16.
目的分析胎盘早剥异常胎心监护图形特征,总结图像规律,以提高早期诊治胎盘早剥的能力。 方法选取2015年1月至2019年11月中山大学附属第一医院产科收治的胎盘早剥且胎心监护异常的56例病例,按出现胎心监护异常时临产情况分为已临产组(25例)和未临产组(31例),并对其胎心监护图形等资料进行分析;按胎盘早剥产前诊断与漏诊分为产前诊断组(30例)和产前漏诊组(26例),对其胎心监护异常的类型进行比较。 结果胎盘早剥常见的胎心监护异常类型为无加速、微小变异、变异减速及宫缩波异常。微小变异在胎盘早剥未临产组胎监异常类型所占比例(51.6%)明显高于临产组(8%),两组差异有统计学意义(χ2=12.07,P<0.01);延长减速在未临产组胎监异常类型所占比例(6.5%)明显低于临产组(48%),两组差异有统计学意义(χ2=12.74,P<0.01)。宫缩波异常在产前诊断组胎监异常类型所占比例(50%)明显高于产前漏诊组(3.8%),两组差异有统计学意义(χ2=14.54,P<0.01);变异减速在产前漏诊组胎监异常类型所占比例(46.2%)明显高于产前诊断组(16.7%),两组差异有统计学意义(χ2=5.73,P=0.02)。 结论准确判读胎心监护图形,有助于早期发现胎盘早剥。当胎心监护出现微小变异、延长减速或宫缩波异常时,需警惕胎盘早剥的发生。  相似文献   

17.
AIM: This study examined the clinical significance of patients complicated by circumvallate placenta in comparison with patients with a normal placenta. METHODS: Data were collected from 139 singleton deliveries complicated by circumvallate placenta and from 7666 unaffected controls managed at Japanese Red Cross Katsushika Maternity Hospital between 2002 and 2005. RESULTS: The incidence of premature delivery, oligohydramnios, non-reassuring fetal status on cardiotocogram, placental abruption and intrauterine fetal death in patients complicated by circumvallate placenta were significantly higher than those in control patients. The odds ratio of placental abruption in patients complicated by circumvallate placenta was 13.1 (95% confidence limits: 5.65-30.2). CONCLUSION: A circumvallate placenta is associated with a higher incidence of serious perinatal complications such as placental abruption.  相似文献   

18.
Peripartum hemorrhage is associated with a high maternal and fetal morbidity and mortality and is one of the leading causes of maternal death worldwide (25%). The major causes of hemorrhage are placenta previa, premature abruption of the placenta and uterine atony. In cases with placental abruption or bleeding from the vasa previa there is an extremely high risk for the fetus as well as for the mother. The diagnosis of hemorrhage is suspected from the clinical manifestations and confirmed by ultrasonography. The prognosis for both mother and child can be markedly improved if the risk factors for hemorrhage are recognized early and the problem is treated rapidly and appropriately.  相似文献   

19.
胎盘早剥漏诊31例临床分析   总被引:4,自引:1,他引:3  
目的探讨胎盘早剥漏诊的相关因素,提高对不典型病例的认识,减少胎盘早剥的漏诊或误诊。方法回顾性分析1999年1月至2008年9月在上海浦东新区人民医院住院分娩的67例胎盘早剥患者的临床资料,将产前漏诊的31例作为漏诊组,产前确诊的36例作为对照组,比较漏诊的危险因素、临床特征和母儿结局。结果胎盘早剥发生率0.27%(67/24848),其中漏诊率46.27%(31/67),围生儿死亡率22.39%(15/67)。漏诊组发生阴道出血、子宫张力增高、重度胎盘早剥发生率低于对照组(P分别0.001,0.01和0.05)。漏诊组胎儿窘迫发生率高于对照组(P0.05)。两组腹痛、血性羊水、子宫卒中发生率比较,差异无统计学意义(P0.05)。漏诊组B超检出率10%,明显低于对照组的76.92%(P0.01)。两组患者的休克、凝血功能障碍、子宫切除、新生儿重度窒息比较,差异无统计学意义(P0.05)。漏诊组早产、围生儿死亡、死胎低于对照组(P0.05)。结论早期识别胎盘早剥的不典型征象,注意动态观察,可降低母婴危险。  相似文献   

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