超声筛查胎儿浅表软组织包块技巧

【摘要】 目的 探讨二维及三维超声筛查胎儿浅表软组织包块的技巧。方法 采用垂直胎儿体表横切、纵切及切线位相结合的扫查方法对2016年1~12月在成都市温江区妇幼保健院及四川省妇女儿童中心医院接受系统筛查的9835例胎儿与2015年1~12月未采用该方法在医院接受系统筛查的9856例胎儿进行对比研究,分析两组胎儿浅表软组织包块阳性率的差异。结果 2016年采用垂直胎儿体表横切、纵切及切线位扫查相结合的方法筛查胎儿浅表软组织,其浅表软组织包块阳性率明显高于2015年未采用该方法筛查胎儿软组织的包块阳性率,差异有显著性（P＜005）,在2016年研究组的9835例胎儿筛查出13例软组织包块,阳性率为013%,出生或引产结果证实漏诊1例,2015年对照组的9856例胎儿筛查出3例浅表软组织包块,阳性率为003%,漏诊12例。结论 采用垂直胎儿体表横切、纵切及切线位相结合的扫查技巧筛查胎儿浅表软组织可明显提高浅表软组织包块的检出率,可在临床中推广应用。     

胎膜早破患者胎儿心电图分析

目的分析孕妇胎膜早破对胎儿心脏的影响。方法根据342例孕妇胎膜早破时间不同分为3组,分别为6-12h组,〉24h组及〉36h组,再对孕妇胎儿心电图改变进行对照分析。结果胎膜早破时间越长,对胎儿影响越大,出现异常胎儿心电图改变几率越大,预后亦较差。结论孕妇胎膜早破时间不同对胎儿心脏有不同程度影响,应及早治疗,减轻胎儿及新生儿病死率。     

Papel complementario de la resonancia magnética en el estudio del sistema urinario fetal

Urinary system birth defects represent the abnormality most often detected in prenatal studies, accounting for 30% to 50% of all structural anomalies present at birth. The most common disorders are urinary tract dilation, developmental variants, cystic kidney diseases, kidney tumors, and bladder defects. These anomalies can present in isolation or in association with various syndromes. They are normally evaluated with sonography, and the use of magnetic resonance imaging (MRI) is considered only in inconclusive cases. In this article, we show the potential of fetal MRI as a technique to complement sonography in the study of fetal urinary system anomalies. We show the additional information that MRI can provide in each entity, especially in the evaluation of kidney function through diffusion-weighted sequences.     

Poly(I:C) source,molecular weight and endotoxin contamination affect dam and prenatal outcomes,implications for models of maternal immune activation

The viral mimetic polyinosinic:polycytidylic acid (poly(I:C)) is increasingly used to induce maternal immune activation (mIA) to model neurodevelopmental disorders (NDDs). Robust and reproducible phenotypes across studies are essential for the generation of models that will enhance our understanding of NDDs and enable the development of improved therapeutic strategies. However, differences in mIA-induced phenotypes using poly(I:C) have been widely observed, and this has prompted the reporting of useful and much needed methodological guidelines. Here, we perform a detailed investigation of molecular weight and endotoxin variations in poly(I:C) procured from two of the most commonly used suppliers, Sigma and InvivoGen. We demonstrate that endotoxin contamination and molecular weight differences in poly(I:C) composition lead to considerable variability in maternal IL-6 response in rats treated on gestational day (GD)15 and impact on fetal outcomes. Specifically, both endotoxin contamination and molecular weight predicted reductions in litter size on GD21. Further, molecular weight predicted a reduction in placental weight at GD21. While fetal body weight at GD21 was not affected by poly(I:C) treatment, male fetal brain weight was significantly reduced by poly(I:C), dependent on supplier. Our data are in agreement with recent reports of the importance of poly(I:C) molecular weight, and extend this work to demonstrate a key role of endotoxin on relevant phenotypic outcomes. We recommend that the source and batch numbers of poly(I:C) used should always be stated and that molecular weight variability and endotoxin contamination should be minimised for more robust mIA modelling.     

11~13+6周规范化超声检查的临床应用

目的 评估11~13⁺⁶周规范化超声检查筛查胎儿严重畸形的效能。方法 分析接受11~13⁺⁶周超声检查且有随访结果的3 515胎胎儿早孕期超声表现,并评估11~13⁺⁶周规范化超声检查诊断胎儿畸形的价值。结果 11~13⁺⁶周规范化超声检查诊断胎儿畸形的敏感度为80.00%（60/75）、特异度为99.42%（3 420/3 440）、准确率为99.00%（3 480/3 515）,阳性预测值为75.00%（60/80）、阴性预测值为99.56%（3 420/3 435）。严重结构畸形分布5大系统,共21种畸形。结论 11~13⁺⁶周规范化超声检查可筛查胎儿异常包括胎儿严重结构畸形及染色体畸形。     

超声评价子痫前期患者胎儿主动脉峡部血流指数

目的 通过测量峡部血流指数（IFI）定量分析子痫前期（PE）患者胎儿主动脉峡部（AOI）血流变化特点与规律。方法 纳入38例PE患者（PE组）和孕周相匹配的38名正常单胎妊娠孕妇（对照组）。采集胎儿AOI、脐动脉（UA）、静脉导管（DV）的多普勒频谱,计算IFI,并分为Ⅰ~Ⅲ型,计算PE组胎儿AOI、UA舒张期血流及心房收缩波（DA-a）消失或反向率。结果 对照组胎儿IFI均为Ⅰ型,IFI值为1.40±0.09,AOI舒张期血流均为前向;PE组胎儿IFI Ⅰ型21胎,Ⅱ型10胎,Ⅲ型7胎,IFI值为0.81±0.80;2组IFI差异有统计学意义（t=4.439,P<0.001）。PE组胎儿AOI、UA舒张期血流和DV-a波消失或反向率分别为44.74%（17/38）、13.16%（5/38）和0,与对照组比较差异有统计学意义（χ²=25.796,P<0.001）。结论 PE患者胎儿IFI降低。检测胎儿AOI多普勒频谱可于胎儿循环缺氧早期检测其血流动力学变化。