Good outcome in prune-belly syndrome despite associated severe anomalies

A boy aged 4.5 years with prune-belly syndrome (PBS) and associated urethral stenosis, oligohydramnios, imperforate anus and vesicosigmoid fustula is described. In contrast to the anticipated poor prognosis, vesicostomy and divided transverse colostomy performed after birth followed by prophylaxis of infection and bicarbonate supplementation have resulted in a good outcome. The vesicosigmoid fistula might have served in utero as a natural diversion protecting from pressure-induced renal damage. It is suggested that the main determinant of prognosis in PBS is the presence and degree of kidney dysplasia at birth as reflected by the neonatal renal function after performance of an indicated urinary diversion procedure rather than the presence of severe associated anomalies.Supported in part by grants from the National Institute of Health AM 37223-01 and the Medical School and Graduate School Research Committees of the University of Wisconsin and a Research Career Development Award KO4 AM 00421 (RWC), by the Pearl M. Stetler Foundation (SD) and by a National Kidney Foundation fellowship (IZ)     

人工破膜对诊断羊水过少的价值

目的 :探讨人工破膜在诊断羊水过少中的意义。方法 :观察组是根据人工破膜时所流出的羊水量判断羊水多少 ;对照组则用同期产前超声检查所见判断羊水多少。以产时所见羊水量作为最终诊断。结果 :人工破膜和超声诊断羊水过少的符合率分别是 79 73 %和 82 76 % ;两者无显著差异 (P >0 0 5 ) ;人工破膜漏诊率 2 84% ,超声是 6 15 % ,两者无显著差异 (P >0 0 5 )。结论 :人工破膜是诊断本病的一种有价值的方法 ,结合超声检查可作为诊断本病的依据     

Prognostic factors in fetal hydronephrosis: a multivariate analysis

With the increasing use of obstetric echography fetal hydronephrosis has been reported more frequently. The purpose of this study was to identify prognostic factors associated with adverse outcome, such as renal failure and death, in fetal hydronephrosis. One hundred and forty-eight children with fetal hydronephrosis were admitted, submitted to a systematic protocol, and prospectively followed. Prognostic factors associated with fetal echography and clinical and laboratory findings on admission were studied. The median follow-up was 39 months. The analysis was conducted in two steps. In a univariate analysis, variables associated with adverse outcome were identified by the Kaplan-Meier method. The variables that were significantly associated with adverse outcome were then included in a multivariate analysis. This analysis, using the multivariate Cox’s model, was performed to identify variables that were independently associated with a worse prognosis. Only variables that remained independently associated with adverse outcome were included in the final model. After final adjustment by Cox’s multivariate model, three variables were identified as independent predictors of adverse outcome: oligohydramnios, prematurity, and glomerular filtration rate lower than 20 ml/min. Thus, in the presence of oligohydramnios, prematurity, and abnormal renal function, the medical team must plan appropriate follow-up for infants at health centers prepared to investigate and treat uropathies in newborns. Received: 24 August 1998 / Revised: 7 December 1998 / Accepted: 11 December 1998     

足月妊娠羊水过少对围产结局的影响

目的 :分析足月妊娠孕产妇羊水过少对围产结局的影响。方法 :应用 B超羊水最大深度法及羊水指数法估测羊水量 ,并测定脐动脉收缩期最大血流速度 (S)和舒张末期血流速度 (D)的比值 (S/D) ,比较分析 2 4 0例羊水过少 (观察组 )和 2 4 0例羊水正常的足月妊娠妇女 (对照组 ) B超测量羊水量与实际过少的符合率、分娩情况及新生儿预后。结果 :AFI小于 3.5 cm时 ,B超测量羊水量与实际羊水过少符合率为 10 0 % ;AFI为 3.5～ 5 .0 cm时为 80 % ;AFI为 5～ 8cm时为 5 8% ;观察组择期剖宫产和急诊剖宫产率均显著高于对照组 (P<0 .0 1) ;阴道分娩的成功率明显低于对照组 (P<0 .0 1) ;胎儿宫内窘迫与羊水轻度混浊的发生率明显高于对照组 (P<0 .0 1) ;新生儿轻度窒息发生率明显高于对照组 (P<0 .0 1) ;重度窒息率两组间差异无显著性 (P>0 .0 5 )。结论 :加强对羊水过少的产前及产时监护 ,对重度羊水过少者不予试产 ,对试产的孕产妇产程中出现异常及时行急诊剖宫产而不过度试产。对于羊水过少 ,同时又合并其它高危因素者 ,应禁止试产 ,以剖宫产结束妊娠。     

延期妊娠并发羊水过少对围产儿影响的临床分析

目的:探讨延期妊娠分娩对围产儿的影响。方法:对延期妊娠352例临床资料进行分析(羊水过少组78例,羊水 正常组274例),观察围产儿的情况并进行对比分析。结果:延期妊娠并发羊水过少组胎儿窘迫、新生儿窒息、胎盘成熟度Ⅲ+级 及胎盘钙化均显著高于羊水正常组。结论:延期妊娠并发羊水过少确诊后适时以剖宫产结束分娩为宜。     

Reversible oligohydramnios in the second trimester of pregnancy in two patients with long-term diclofenac exposure

The use of non-steroidal anti-inflammatory drugs like diclofenac in the third trimester of pregnancy can cause severe side effects, in particular oligohydramnios, premature closure of ductus arteriosus, and fetal kidney damage. However, the treatment with non-steroidal anti-inflammatory drugs until gestational week 28 is accepted as relatively safe. Here we describe two retrospectively reported cases of early-onset oligohydramnios associated with long-term diclofenac exposure of at least 150 mg per day. The pathological findings were detected at gestational weeks 22 and 23, respectively. Amniotic fluid turned to normal after discontinuation of diclofenac in both cases, suggesting causality. Although early-onset oligohydramnios is a rare complication, caution for long-term diclofenac use in high doses is recommended even before gestational week 28.     

足月妊娠胎儿的羊水量与心室Tei指数的关系

目的：探讨足月妊娠胎儿的羊水量与心室 Tei指数的关系及其临床意义。方法选择足月妊娠孕妇152例,其中羊水过少者50例,羊水偏少者52例,羊水正常者50例,应用彩色多普勒超声诊断仪监测胎儿心室Tei指数,比较3组胎儿的心室Tei指数。结果羊水正常组、羊水偏少组、羊水过少组右心室的 Tei 指数值分别为0．375±0．123、0．764±0．189、0．865±0．294;左心室的Tei指数值分别为0．363±0．151、0．670±0．219、0．778±0．298;羊水正常组、羊水偏少组、羊水过少组的左、右心室Tei指数依次升高（P＜0．05）。结论足月妊娠羊水过少的胎儿可出现心室Tei指数升高,监测Tei指数对评估羊水过少胎儿缺血缺氧的风险可能具有重要临床价值。     

羊水过少对围生期结局的影响

目的探讨晚期妊娠羊水过少对围生期结局的影响。方法2003年7月至2004年12月郑州市妇幼保健院应用超声测定羊水指数(AFI),对估测羊水量及分娩时羊水总量<300mL的230例妊娠妇女临床情况及围生期结局进行分析。结果羊水过少高发于孕40~42 6周,占7·58%(101/1332);有妊娠合并症、并发症的高危妊娠羊水过少多发生于孕37~39 6周,占71·43%(75/105)。围生儿死亡率为43·5/万。用超声测定羊水指数作为监测羊水量的指标,符合率为95·92%(188/196)。剖宫产率为71·74%(165/230)。结论诊断羊水过少孕妇,应根据综合检查结果及妊娠是否存在高危因素选择最佳分娩方式及时终止妊娠,可以明显改善围生儿预后。     

B超诊断羊水偏少孕妇阴道试产120例临床分析

目的　分析足月妊娠妇女 B超检查示羊水偏少时 ,阴道试产对妊娠结局的影响。　方法　应用羊水池垂直深度 (AFD)法估测羊水量 ,并测定脐动脉收缩期最大血流速度 (S)和舒张末期血流速度 (D)的比值 (S/ D)及 2 4h尿雌三醇与肌酐的比值 ,比较分析 12 0例 B超诊断羊水偏少者 (观察组 )和 12 0例羊水量正常的足月妊娠妇女 (对照组 )阴道试产后的分娩结局。　结果　两组新生儿重度窒息发生率和新生儿死亡率差异无显著性 (P>0 .0 5 ) ,观察组急诊剖宫产率明显升高 (P<0 .0 1)。　结论　 B超诊断羊水偏少的足月妊娠妇女 ,在严密监护下可行阴道试产     

晚期妊娠并发羊水过少对围产儿的影响

目的观察晚期妊娠并发羊水过少对围产儿预后的影响。方法103例晚期妊娠并发羊水过少组与264例同期妊娠分娩产妇羊水正常组进行对比分析。结果羊水过少组羊水Ⅱ°以上粪染、胎盘成熟Ⅲ级及胎盘钙化、胎儿宫内窘迫率、新生儿窒息率及剖宫生产率明显高于羊水正常组(P<0.05)。结论羊水过少是胎儿慢性宫内缺氧最敏感的特异性指标,对围产儿预后有严重影响,一经确诊,应积极引产,估计短时间内不能分娩者宜行剖宫产结束分娩。