胎儿心律失常的类型及伴发心脏结构异常的临床研究

目的 探讨胎儿心律失常的类型及其与伴发心脏结构异常的相关性.方法 对306例孕龄20～ 39周,临床上疑有胎儿心律失常或存在其他异常的孕妇进行彩色多普勒超声心动图检查.结果 在306例研究对象中检测出心律失常者62例,其中期前收缩39例,包括房性期前收缩31例,室性期前收缩8例;心动过速15例,包括窦性心动过速10例,窒上性心动过速5例;心动过缓8例,包括窦性心动过缓5例,房室传导阻滞3例.62例心律失常胎儿中先天性心血管畸形5例.结论 胎儿心律失常为胎儿期最常见的非结构性异常,多不伴有明显心血管畸形或其他胎儿畸形,绝大多数预后良好,持续性胎儿心动过缓多与严重先天性心脏结构缺损有关,应引起医生及孕妇警惕.     

米非司酮对引产胎儿细胞因子分泌、肝细胞增殖及肝功能影响的研究

目的通过观察使用米非司酮对引产胎儿细胞因子分泌、肝细胞增殖及肝功能的影响,探讨米非司酮对胎儿安全性的影响。方法胎儿娩出后立即抽取脐动脉血,应用全自动生化分析仪对胎儿肝功能进行检测;应用放射性同位素一胸腺嘧啶核苷（^3H—radioactive isotope Thy midine,^3H—TdR）掺入实验,体外研究米非司酮对胎儿肝细胞增殖活性的影响;放射免疫分析研究血清白细胞因子-2（interleukin-2,IL-2）及肿瘤坏死因子（tumor necrosis factor,TNF）-α的水平。结果孕妇体内米非司酮用药组胎儿的肝功能无明显变化,但是肝细胞增殖能力明显受抑制,在体外实验的高浓度和低浓度纽,用药组与对照纽肝细胞增殖能力有显著差别,差异有统计学意义（P〈0．05）,提示高浓度米非司酮单纯体外应用可以明显抑制胎儿肝细胞增殖。用药组IL-2明显升高,与未用药组有明显区别,差异有统计学意义（P〈0．05）,而TNF—α的水平两组间无明显差别,差异无统计学意义（P〉0．05）,提示米非司酮有明显的促进IL-2分泌的作用。结论米非司酮对胎儿肝脏功能无明显影响,但是可以抑制肝细胞的增殖,还可明显促进IL-2分泌,从而影响胎儿的免疫系统功能,使胎儿体内免疫抑制反应减弱,免疫排斥反应增强。提示米非司酮对胎儿的安全性有一定的影响。     

产前超声诊断完全型胎儿房室间隔缺损的价值

目的探讨产前超声对完全型胎儿房室间隔缺损的诊断价值。方法对产前超声诊断的15例胎儿房室间隔缺损的声像图特征进行回顾性分析,随访临床结果。结果产前诊断的15例完全型房室间隔缺损胎儿引产后均得到证实,超声诊断准确率100％（15／15）;典型声像图特征：四腔心切面上,心内膜垫十字交叉消失,房间隔下部和室间隔上部缺失,左右房室瓣异常,形成一较大的房室通道彩色多普勒超声所见：心腔中央仅显示1条房室血流,心室收缩时血流返流入心房。结论产前超声是诊断完全型胎儿房室间隔缺损的准确、可靠的方法,具有重要的临床价值。     

超声检查在中孕期胎儿畸形筛查中的初步应用(附5428例胎儿形态学超声筛查结果分析)

目的:探讨超声检查在中孕期胎儿畸形筛查中的应用及其价值。方法:总结和分析2007年7月~2009年12月在皖南医学院附属弋矶山医院产前诊断门诊就诊的5 428例单胎妊娠20~28周孕妇的胎儿形态学超声筛查结果。结果:5 428例胎儿超声形态学筛查共发现62例胎儿畸形,畸形胎儿占筛查总数的1.142%,其中单发性结构畸形49例,多发性结构畸形13例,随访有终止妊娠记录59例,超声诊断的胎儿主要畸形与随访结果相符合。结论:产前超声检查在中孕期胎儿畸形筛查中有着极其重要的作用,具有推广应用价值。     

Perinatal diagnosis and management of oropharyngeal fetus in fetu: A case report

Fetus in fetu is an extremely rare congenital anomaly. We describe the perinatal diagnosis and management of a fetus with oropharyngeal and cervical fetus in fetu. High‐resolution ultrasonography with 3‐dimensional rendering can identify increased risks of airway obstruction in utero. Early identification allows a multidisciplinary team to be assembled for a scheduled ex utero intrapartum treatment procedure.     

CMV-Specific Cell-Mediated Immunity in Immunocompetent Adults with Primary CMV Infection: A Case Series and Review of the Literature

Cytomegalovirus-specific cell-mediated immunity (CMV-CMI) in actively infected healthy immunocompetent hosts has been poorly investigated. Conversely, correlates of maternal protective immunity for the fetus after primary infection in pregnancy continue to be studied. The kinetics and magnitude of CMV-specific CMI in immunocompetent primary CMV-infected adults are described. A literature review on CMV-CMI in primarily infected pregnant women and its correlation to the risk of vertical virus transmission is included. Immunological measurements after infection were performed by enzyme-linked ImmunoSPOT assay enumerating IFN-γ secreting CMV-specific T cells, at a single cell level, upon in vitro stimulation with viral antigens. Simultaneously, serological and virological profiles of infected patients were investigated. Patients displayed mild-to-moderate clinical and laboratory profiles for infection, and all showed positive EliSpot results in the early stage of infection (<20 days after onset). The virus-CMI was strong in the majority of patients (58.8%) in which the lowest CMV-DNAemia levels (<300 copies/mL) were detected. Significantly higher viral loads were observed in patients with weak CMV-CMI at the same time-point post-infection (up to 15,104 copies/mL; p < 0.001). T cell response magnitudes to IE-1 and pp65-UL83 peptides were overlapping and stable over time. In these case series, the early presence of CMV-CMI was probably pivotal in controlling viral replication and led to spontaneous viral clearance.     

Is the First of the Two Born Saved? A Rare and Dramatic Case of Double Placental Damage from SARS-CoV-2

The current coronavirus pandemic has affected, in a short time, various and different areas of medicine. Among these, the obstetric field has certainly been touched in full, and the knowledge of the mechanisms potentially responsible for placental damage from SARS-CoV-2 occupy a certain importance. Here we present here a rare case of dichorionic twins born at 30 weeks and 4 days of amenorrhea, one of whom died in the first few hours of life after placental damages potentially related to SARS-CoV-2. We also propose a brief review of the current literature giving ample emphasis to similar cases described.     

Outcome after prenatal diagnosis of the hypoplastic left heart syndrome

Objective—To derive accurate survival figures in the current surgical era for counselling in early pregnancy after the diagnosis of fetal hypoplastic left heart syndrome.
Setting—A tertiary referral centre for paediatric cardiology and cardiac surgery.
Design—A retrospective study of the outcome in all cases of hypoplastic left heart syndrome presenting in fetal life between mid-1993 and the end of 1996.
Patients—The diagnosis was made in 30 fetuses. In four of 12 identified before 24 weeks' gestation the mothers chose to terminate the pregnancy. There was an intention to treat in 24 of the remaining fetuses.
Main outcome measure—Survival to six months of postnatal life.
Results—Of the 24 infants, five were not offered Norwood stage 1 because of trisomy 18 (n = 2), unfavourable cardiac anatomy (n = 2), or neurological impairment (n = 1). One further infant did not survive to cardiac surgery after gastrointestinal surgery. Of the remaining 18 patients, eight had features that were considered to increase the risk of surgical repair. Of the 18 patients who underwent Norwood stage 1, there were nine survivors. There was a survival rate of 70% in infants undergoing surgery with no complicating features, a 50% survival of the all surgical candidates, and 37.5% survival from an intention to treat position.
Conclusions—At the initial diagnosis of fetal hypoplastic left heart syndrome, the overall survival appears to be less than 40%. Evaluation must include detailed extracardiac and intracardiac assessment to predict the risks of surgical treatment. Prenatal counselling can be modified as pregnancy advances, depending on the detection or exclusion of complicating factors.

Keywords: fetus;  congenital heart disease;  hypoplastic left heart syndrome     

Typing of the immunological system in human embryos by coelocentesis

Coelocentesis offers a new opportunity for gaining access to the human embryos from 28 d postfertilization. However, while some studies about its biochemical composition have been reported, our knowledge about immunological pattern of this compartment is still limited. For this reason, we studied the human coelomic fluids sampled from 6.6 to 10 wk of gestation. The majority of cellular population consisted in mesenchymal/epithelial cells. In fluids sampled before 10 wk we found only a preT Cell Receptor expression and an absence or a very low frequency of B lymphocytes, T lymphocytes and NK (natural killer) antigens. These preliminary data suggest that the immunological system in human embryos could be in the ideal conditions to start a process of tolerance induction.