胎儿头皮血气分析对过期妊娠产时胎儿监测的价值

应用胎儿头皮血（胎血）血气分析对４３例过期妊娠及４０例足月妊娠产时胎儿进行对照监测，同时采取母体桡动脉血（母动脉）．胎儿娩出后立即采取脐动脉血（脐动脉）及脐静脉血（脐静脉）进行血气分析．结果：过期组胎血ｐＨ及ＰＯ２明显低于，ＰＣＯ２明显高于对照组，过期组与对照组脐静脉的ｐＨ、ＰＣＯ２、ＰＯ２均值比较差异显著，过期组胎血ｐＨ与母血、脐动脉、脐静脉血ｐＨ呈直线正相关；过期组母／儿　ｐＨ＞０．２０的发生率明显高于对照组；多因素相关分析表明；过期组胎儿窘迫、新生儿窒息与胎血、脐静脉、脐动脉血ｐＨ均有相关性，表明应用胎儿头皮血血气分析对过期妊娠产时胎儿进行监测的必要性及其实用价值。     

脐血乳酸水平及胎心监护图形预测胎儿窘迫的价值

目的　探讨新生儿脐动脉血乳酸水平及胎心监护图形预测胎儿窘迫的价值。方法　测定 73例胎心监护图形为不良图形 (胎心基线异常、重度变异减速、轻度变异减速、心动过速 )的新生儿(病例组 )和 118例产前无胎儿窘迫征象 ,出生后 1分钟Apgar评分≥ 9分的新生儿 (对照组 )出生后脐动脉血乳酸水平。结果　病例组中产钳助产率明显高于对照组 (P <0 0 1) ,顺产率低于对照组 (P<0 0 1)。病例组中 ,胎心重度变异减速多发于第二产程 ;胎心基线异常的新生儿Apgar评分≤ 7分的发生率高于重度变异减速、轻度变异减速、心动过速的新生儿 (P <0 0 5 )。病例组中 ,胎心基线异常者脐动脉血乳酸水平为 (4 5 5± 0 2 3 )mmol/L ;重度变异减速者为 (3 84± 0 40 )mmol/L ,出现以上两种图形的新生儿脐动脉血乳酸水平均明显高于对照组 (P <0 0 1)。轻度变异减速者脐动脉血乳酸水平为 (2 63± 0 3 2 )mmol/L ;心动过速者脐动脉血乳酸水平为 (2 5 5± 0 46)mmol/L。并且轻度变异减速与心动过速者脐动脉血乳酸水平与对照组比较 ,差异无显著性 (P >0 0 5 )。结论　测定新生儿脐动脉血乳酸水平是一种有效、准确的诊断胎儿窘迫的方法。胎心基线异常、重度变异减速与胎儿窘迫的发生密切相关 ;轻度变异减速、心动过速与胎     

安宝治疗产时胎儿窘迫40例临床分析

目的探讨安宝治疗产时胎儿窘迫效果.方法对40例诊断为产时胎儿窘迫并准备行剖宫产终止妊娠的病例作为研究组,术前给予安宝治疗;并随机选择40例符合相同条件的病例作为对照组.观察治疗后产妇的心率变化、宫缩抑制情况、异常胎监图形恢复情况、新生儿出生后Apgar评分和脐静脉血pH.结果应用安宝后产妇虽有心率加速,但无一例＞130/min,无一例自诉不适;用药后宫缩显著抑制(P＜0.01);异常胎监图形明显恢复(P＜0.01);新生儿窒息发生率显著低于对照组(P＜0.05),新生儿出生后1分钟Apgar评分显著高于对照组(P＜0.05);脐静脉血pH虽高于对照组,但无统计学差异,估计与例数偏少有关.结论安宝通过有效抑制宫缩、改善子宫-胎盘血流灌注,对于产时胎儿窘迫者用药是安全、有效的.     

妊娠肝内胆汁淤积症患者脐带血管病变及血管活性物质的表达与胎儿窘迫发生的关系

目的 探讨妊娠肝内胆汁淤积症(ICP)患者脐带血管病理改变、脐带血管活性物质表达的变化与胎儿窘迫发生的关系.方法 应用HE染色法制片,光镜下观察25例ICP伴有胎儿窘迫(ICP窘迫组)、25例ICP不伴胎儿窘迫(ICP对照组)以及27例正常妊娠妇女(正常妊娠组)新生儿脐带血管病理改变;应用免疫组化辣根过氧化物酶-生物素标记(SABC)法测定内皮型一氧化氮合酶(eNOS)、诱导型一氧化氮合酶(iNOS)及内皮素1(ET-1)蛋白在各组脐静脉内皮细胞中的表达量,以平均吸光度(A)值表示;应用循环酶法测定脐静脉血总胆酸水平并进行相关性分析.结果 (1)脐静脉血总胆酸水平:ICP窘迫组为(19.0±2.3)μmol/L,ICP对照组为(9.0±1.7)μmol/L,正常妊娠组为(4.4±1.5)μmol/L,各组分别比较,差异均有统计学意义(P＜0.05).(2)脐静脉病理改变:ICP患者脐静脉内皮细胞单层扁平结构丧失,细胞向管腔耸立,梭形排列,细胞排列不均甚至脱落.ICP窘迫组患者脐静脉内皮细胞出现此病理改变的发生率(92%,23/25)明显高于ICP对照组(68%,17/25),差异有统计学意义(P＜0.05).(3)脐静脉内皮细胞中eNOS蛋白表达量:ICP窘迫组为0.09±0.06,ICP对照组为0.21±0.08,正常妊娠组为0.47±0.07,各组分别比较,差异均有统计学意义(P＜0.05).脐静脉内皮细胞中iNOS蛋白表达量:ICP窘迫组为0.20±0.04,ICP对照组为0.21±0.05,正常妊娠组为0.26±0.04,两ICP组分别与正常妊娠组比较,差异均有统计学意义(P＜0.01,P＜0.05);而ICP窘迫组与ICP对照组间比较,差异无统计学意义(P＞0.05).(4)脐静脉内皮细胞中ET-1蛋白表达量:ICP窘迫组为0.49±0.08,ICP对照组为0.32±0.07,正常妊娠组为0.14±0.06,两ICP组分别与正常妊娠组比较,差异均有统计学意义(P＜0.01,P＜0.05).(5)脐静脉血总胆酸水平与其病理改变的关系:脐静脉血总胆酸水平升高是脐静脉病理改变的危险因素;且与脐血管内皮细胞eNOS、iNOS的蛋白表达量呈负相关关系(r1=-0.88、r2=-0.45,P＜0.01);与脐血管内皮细胞ET-1蛋白的表达量呈正相关关系(r3=0.79,P＜0.01).结论 ICP患者脐静脉血高胆酸状态可能损伤脐静脉内皮细胞,且与其eNOS、iNOS蛋白表达下调、ET-1蛋白表达上调有关,脐静脉的这些改变可能与ICP患者胎儿窘迫的发生有关.     

羊水乳酸水平及胎心监护预测胎儿窘迫的价值

目的　探讨羊水乳酸水平及胎心监护图形预测胎儿窘迫的价值。方法　 2 0 0 3年 8月至 2 0 0 4年 8月暨南大学医学院第二附属医院测定 90例第一产程活跃期出现不良胎儿监护图形 (观察组 )和 10 0例正常胎儿监护图形 (对照组 )的羊水及新生儿脐动脉血乳酸水平 ,其中对照组 30例同时进行母血、脐血及羊水乳酸水平检测。结果　脐血乳酸水平明显高于母血乳酸水平 ,但较羊水为低 (P <0 0 1)。羊水与脐血乳酸水平存在正相关关系(r =0 92 3,P <0 0 1) ,而母血与脐血乳酸水平无相关关系 (r =- 0 15 7,P >0 0 5 )。观察组中自然分娩率低于对照组 (P <0 0 1) ,剖宫产率及新生儿窒息率均高于对照组 (P <0 0 5 )。胎儿监护异常减速羊水乳酸水平为(10 6 0± 1 6 9)mmol/L ,明显高于对照组的 (7 18± 0 91)mmol/L(P <0 0 1) ,轻度变异减速及心动过速羊水乳酸水平分别为 (7 5 0± 1 4 6 )mmol/L ,(7 36± 1 14 )mmol/L ,与对照组比较 ,差异无显著性意义 (P >0 0 5 )。结论　胎儿监护异常减速与胎儿窘迫密切相关。羊水乳酸水平可望成为一种简便、有效的判断胎儿窘迫的生化指标。     

母血、脐血中脂联素水平与胎儿体重之间关系的研究

目的:研究母血和脐血中脂联素水平与胎儿体重之间的关系。方法:随机选取102例无母儿合并症、并发症的足月单活胎病例。按新生儿出生体重分为3组:3000g组、3000~3999g组和≥4000g组。分析比较各组的临床指标及母血、脐血脂联素水平。结果:脐血中脂联素浓度比母血高2.90倍,脐血和母血脂联素浓度无相关性(r=0.132,P=0.199)。3组的母血脂联素浓度比较,差异无统计学意义(P=0.074);脐血脂联素浓度比较,差异有统计学意义(P=0.011);母血脂联素浓度与新生儿出生体重无相关性(r=0.015,P=0.883);脐血浓度与新生儿出生体重有关(r=0.263,P=0.008)。不同性别新生儿病例的母血脂联素水平比较,差异无统计学意义(P0.05)。母血脂联素浓度与孕产妇孕周呈正相关(r=0.201,P=0.045),脐血脂联素浓度与孕妇孕前体重指数呈正相关(r=0.227,P=0.026),女性围产儿脐血脂联素浓度高于男性(P=0.020)。结论:母血和脐血脂联素浓度无明显相关性;脐血脂联素可能参与了胎儿体重的调节。     

母血和脐血中HIF-1α、VEGF-A、PlGF的表达和胎儿生长受限的相关性分析

目的探讨母血和脐血中缺氧诱导因子-1α(HIF-1α)、血管内皮生长因子-A(VEGF-A)、胎盘生长因子(PlGF)的表达和胎儿生长受限的相关性分析。方法选择2017年7月至2019年7月广东省妇幼保健院接诊的80例产科住院分娩的生长受限的患儿为生长受限组,并选择同期接诊的80例住院分娩的正常胎儿作为对照组,比较两组新生儿生长发育指标、脐动脉血流指标、母血和脐血中血清HIF-1α、VEGF-A、PlGF的表达情况,分析其相关性。结果生长受限组新生儿的胎盘质量、出生体重、出生头围和出生身长均低于对照组(P 0.05);生长受限组脐动脉血流的RI、PI和S/D指标水平均高于对照组,母血和脐血中HIF-1α高于对照组,VEGF-A、PlGF均低于对照组(P 0.05);Spearman相关分析显示,血清HIF-1α和新生儿的出生体重、出生头围、出生身长、RI、PI、S/D均呈相关,和VEGF-A、PlGF均呈正相关(P 0.05)。结论生长受限胎儿的母血和脐血中HIF-1α表达升高,VEGF-A、PlGF的表达均降低,和出生体重、出生头围和出生身长、脐动脉血流之间密切相关。     

选择性剖腹产脐带血浆中的前列腺素

本文从选择性剖腹产分娩后,立即在脐带血浆中取血,测得前列腺素E(PGE)、前列腺素F(PGF)和13,14双氢-15酮前列腺素F(PGFM)。结果,PGE在脐静脉中之水平,和PGF,PGFM在脐动静脉的水平,在阴道分娩后比选择性剖腹产后明显增高。 PGE和PGF在婴儿脐带血浆和血清中的浓度比母亲血中浓度高,而PGE在脐静脉中更高。在胎血循环中PGE来源于胎盘,控制胎儿和胎盘的血流动力学,并维持着动脉导管的张力。因此,胎盘分泌PGE,对胎儿生存很重要。由于PGE的浓度在胎羊血循环中,于分娩前短期内开始上升,而在人妊娠、分娩发动及阴道分娩后脐动静脉血中PGE浓度的差异可能与临产本身比与晚期妊娠胎     

脐带螺旋指数和脐动脉血流S/D值与胎儿窘迫的相关研究

目的探讨脐带螺旋指数(umbilical coiling index,UCI)和脐动脉血流S/D比值与胎儿窘迫的相关性。方法回顾性分析420例胎儿窘迫者和对照组临产前S/D比值、分娩15min后脐带螺旋周数、长度及UCI。结果胎儿窘迫组平均脐带螺旋指数为(0.29±0.04)周/cm,其中脐带螺旋过少占40.0%(168/420),脐带螺旋过多占45.2%(190/420),与对照组(9.4%,45/480;9.8%,47/480)比较,差异均有统计学意义(P0.05);脐带螺旋过少和正常者脐动脉血流S/D比值明显低于脐带螺旋过多者(P0.05)。结论脐带螺旋指数异常与胎儿窘迫有密切的相关性,脐带螺旋过多者脐动脉血流S/D比值也明显升高。     

妊娠期肝内胆汁淤积症儿缺氧脑损伤的研究

目的:探讨妊娠期肝内胆汁淤积症(ICP)患者胆汁酸水平、胎儿缺氧与胎儿脑损伤的关系.方法:选择2006年3月至9月在我院诊治的ICP患者(ICP组)及正常孕妇(正常妊娠组)各30例.采用彩色多普勒超声检测胎儿大脑中动脉收缩期峰值流速/舒张末期流速(S/D)、阻力指数(RI);用全自动生化分析仪测定母血及新生儿脐动脉血清胆汁酸(BA)、乳酸、和pH值;采用酶联免疫吸附试验(ELISA法)测定新生儿脐动脉血清神经元特异性烯醇化酶(NSE)浓度,并对两组的结果进行分析和比较.结果:①ICP组母血及脐血BA水平均高于正常妊娠组(P<0.01),并且ICP组母血与脐血BA呈正相关关系(r=0.937,P<0.01).②ICP组脐血乳酸水平和NSE值均高于正常妊娠组(P<0.01);而ICP组脐血pH值、大脑中动脉血流S/D值、RI值均低于正常妊娠组(P<0.01);ICP组脐血NSE浓度分别与队、乳酸水平呈正相关(P<0.01);与砌值、大脑中动脉血流S/D值及脐血pH值呈负相关(P<0.01).结论:ICP胎儿存在缺氧和脑损伤,ICP胎儿脑损伤与胎儿缺氧及高浓度胆汁酸密切相关,对ICP患者胎儿大脑中动脉血流和脐动脉血pH值、乳酸浓度及NSE的联合检测,可早期诊断ICP胎儿缺氧,早期发现新生儿脑损伤.     

Fetal scalp blood sampling and transcutaneous PO2

Continuous transcutaneous PO2 monitoring has yielded some interesting information about the relationships of fetal oxygenation and the fetal heart rate. Notwithstanding the factors that may adversely affect the results obtained by this technique, further insights regarding fetal oxygenation may be gained. Ultimately, the clinical application of this instrument in high-risk situations is possible, yielding more information about the fetus during labor. Fetal scalp blood sampling, performed meticulously, will provide accurate blood pH values and should be employed when a differentiation between fetal stress and distress must be made. Other means of obtaining information about fetal acid-base balance are being developed and may become important tools in selected instances.     

Intrapartum Fetal Intensive Care: 2-Year Experience

Summary: Reappraisal of 2,279 electronically-monitored labours in the fetal intensive care unit enabled the formation of a policy for the management of high risk pregnancies in labour. In the presence of meconium, major cardiotocographic heart rate abnormalities were as predictive of perinatal outcome as fetal acidosis (pH < 7.25). However, fetal scalp pH estimation did significantly reduce the incidence of Caesarean section for fetal distress. The perinatal mortality in the study was 1.32 per 1,000 births.     

Fetal gastroschisis: a report of 2 cases

BACKGROUND: The risk of stillbirth in fetuses diagnosed with gastroschisis may range from 6% to 12%. Currently there is no agreement on the role of antepartum fetal surveillance, as fetal death within days of reassuring antepartum fetal testing has been reported. CASES: In 2 cases of fetal gastroschisis, fetal gastric distension was associated with decreased fetal movements and nonreactive nonstress tests. Despite reassuring biophysical profile and normal umbilical artery Doppler sonograms, 1 fetus underwent intrauterine death. CONCLUSION: Poor prognostic factors in fetal gastroschisis may include a new finding of persistent fetal gastric distension in association with decreased fetal movements or a nonreactive nonstress test.     

Continuous Intrapartum Fetal Monitoring: A Prospective Randomized Comparison of 2 Types of Fetal Scalp Electrode

Summary: This trial was conducted to compare 2 commonly used fetal scalp electrodes with regard to ease of use, frequency and extent of neonatal injury and quality of cardiotocographic record. A randomized design was employed to study a group of 106 patients divided between a Surgicraft Copeland clip fetal scalp electrode (52 patients) and a Meditrace spiral single helix scalp electrode (54 patients). Patients were eligible for trial entry if they required an intrapartum fetal scalp electrode, at term with a singleton cephalic pregnancy. Ease of application was rated by the operator using a linear analogue score. Unidentified traces were reviewed independently for quality by 2 obstetricians and neonates were examined on day-2 postpartum for injury. The Meditrace spiral fetal scalp electrode was significantly easier to apply (unpaired t-test p <0.02). It also obtained higher ratings for trace quality (unpaired t-test p <0.02). There were no serious neonatal injuries and no difference was found between the 2 electrodes in this regard.     

Fetal Cardiac Arrhythmias and Fetal Acid-Base Status

Summary: Three cases of fetal cardiac arrhythmia (one of nodal extrasystoles, one of nodal tachycardia and one of auricular flutter), are described in which there was evidence of acidosis during labour and/or at the time of delivery. The subsequent progress of these infants is described and the findings discussed in relation to previous observations on fetal cardiac arrhythmias.     

Neural Network Predicts Fetal Hematocrit in Fetal Isoimmunization

A neural network was used for prediction of fetal hematocrit in the fetal isoimmunization syndrome.

In cases of isoimmunization, fetal hematocrit was predicted by artificial intelligence. Using parametric variables of last measured fetal hematocrit, gestational age, estimated fetal weight, interval since the last transfusion, antibody titer, and the nonparametric criteria of type of isoimmunization and sequence of transfusion, a neural network was programmed. The fetal hematocrit predicted by a formula based on an expected hematocrit decrease of 1% per day was compared with fetal hematocrit predicted by the neural network for accuracy of prediction of fetal anemia. Correlation coefficients, sensitivity, specificity, and positive and negative predictive values were compared for accuracy of the prediction.

Fetal hematocrit predicted by the neural network correlated more closely with actual fetal hematocrit than hematocrit predicted by the formula. Both predictors showed only a modest correlation with actual values (R = 0.36 and 0.08, respectively). The neural network had significantly better sensitivity to predict fetal anemia than the formula of hematocrit decrease of 1% per day (P < 0.05).

A neural network can identify more anemic fetuses with a hematocrit less than 20% than the formula of hematocrit decrease of 1 % per day.