以胎儿宫内窘迫为指征的剖宫产154例分析

目的：探讨胎儿宫内窘迫剖宫产指征。方法：依据超声多普协听诊胎心率，胎儿监护和羊水情况将将因胎儿宫内窘迫行剖宫产的孕产妇154例分为两组，Ⅰ组诊断标准相对严格，Ⅱ组标准有些放宽，结果：Ⅰ级新生儿窒息率为50％，Ⅱ组新生儿窒息率为6．8％，两组新生儿窒息率比较差异极显著（P＜0．01），表现以Ⅰ组为诊断标准的剖宫产新生儿窒息率明显高于以Ⅱ组为诊断标准的剖宫产新生儿窒息率，结论：胎儿窒息内窘迫应采用多指标来诊断。     

胎心监护异常与分娩方式的关系

目的:分析胎心监护异常与分娩方式的关系.方法:因胎心监护异常行剖宫产者,术中分析羊水污染、脐带异常等相关因素并与新生儿Apgar评分对照.结果:以胎心监护异常为诊断依据诊断胎儿窘迫行剖宫产的500例,羊水污染占34.8%,脐带异常占36%,新生儿窒息率为9.6%.羊水污染与胎儿宫内窘迫、新生儿窒息密切相关,41～41 6周和≥42周合并羊水过少者的羊水污染及新生儿窒息率明显高于37～40 6周者,在高危妊娠中因胎心监护异常诊断胎儿窘迫符合率明显高于非高危妊娠者.结论:对OCT可疑及37～40 6周,羊水清,无其他高危因素,胎心监护无周期性变化及早期减速,早期加速,轻度可变减速者,可在严密监护下经阴道试产;对妊高征、过期妊娠合并羊水过少者,一旦出现OCT阳性应及时剖宫产.     

178例以胎儿窘迫为指征剖宫产临床分析

目的：探讨以胎儿窘迫为剖官产指征掌握是否合理。方法：回顾分析我院1年来以胎儿窘迫为指征的剖官产术。依据胎心监护、羊水情况分为3组：A组(胎心监护异常)；B组(胎心监护异常，伴羊水污染)；C组(无胎心改变，单纯羊水Ⅱ度或Ⅲ度污染)；把3组术中所见胎儿窘迫相关因素及新生儿评分加以对照。结果：B组新生儿窒息率和胎儿窘迫相关因素明显高于A和C组。结论：B组作为胎儿窘迫及时剖官产是合理的，A组绝大多数病例与术前诊断不相符，A组和C组都应综合伴随高危因素、产程进展等决定合理的分娩方式。     

羊水污染的临床意义

我院2005～2007年分娩总数1190例，其中羊水胎粪污染有256例，发生率为21．5％。羊水Ⅲ。污染者胎心电子监护异常及新生儿不良结局的发生均显著高于Ⅰ°和Ⅱ°羊水污染者。胎心监护异常组新生儿的不良结局发生率明显高于胎心监护正常和仅有胎心监护变异或消失组（P〈0．05）。结果提示：羊水Ⅲ。胎粪污染，有明确的胎儿宫内窘迫，应尽快娩出胎儿；Ⅰ°或Ⅱ°污染，应加强胎心监护和产程观察，选择适当的分娩途径。     

羊水污染与新生儿窒息相关分析

目的：为适时采取妥善处理来降低围产儿病死率、减少新生儿窒息发生率。方法：通过对分娩期产程中羊水污染的临床观察,并与胎心监护相结合,综合评估胎儿在宫内的安危。结果：1 493例分娩数中有398例羊水污染,占26.7%,其中Ⅰ度污染9%,Ⅱ度污染9.84%,Ⅲ度污染为16.67%。经临床观察,羊水Ⅱ度、Ⅲ度污染时新生儿Apgar评分低值者增多,若羊水Ⅱ度、Ⅲ度污染出现在潜伏期、伴胎心率异常、变异消失则新生儿窒息发生率明显增高。结论：适时妥善处理胎儿宫内窘迫是降低新生儿病死率窒息率的关键。     

脐血流测定与胎心监护诊断胎儿宫内窘迫的临床价值

目的　探讨联合应用脐血流测定与胎心监护在诊断胎儿宫内窘迫中的临床作用。方法　对 184例单胎、住院分娩孕妇产前、产时进行脐血流测定与胎心监护检查 ,分A、B、C、D 4组 ,A组为脐血流测定与胎心监护均正常 ;B组为脐血流测定与胎心监护均异常 ;C组为脐血流测定异常 ,胎心监护正常 ;D组为脐血流正常、胎心监护异常。产后追踪分析其产前、产时胎儿宫内窘迫发生率及胎儿预后。结果　A组胎儿宫内窘迫发生率最低 (新生儿窒息率为 0 ,羊水污染率 2 0 % ,异常胎心率 2 1.3 % ) ;B组最高 (窒息率 9.1% ,羊水污染率 3 6.4% ,异常胎心率 5 4.5 % ) ,其次是D组、C组。结论　脐血流与胎心监护联合应用可弥补单纯脐血流或胎心监护诊断胎儿宫内窘迫的不足 ,提高诊断胎儿宫内窘迫的正确率 ;能正确预测胎儿宫内安危及胎儿预后的可靠性 ;脐血流测定、胎心监护均正常表示胎儿宫内情况良好 ,脐血流测定、胎心监护均异常提示胎儿情况危急 ,需引起足够重视 ,采取积极的措施。     

胎心监护预测胎儿窘迫的临床价值

目的：探讨胎心监护预测胎儿窘迫的临床价值。方法：通过分析1000例孕妇产前胎心监护的资料，结合产时羊水性状及产后新生儿Apgar评分，以评价两种胎心监护方法预测胎儿窘迫的临床价值。结果：NST试验正常者816例，新生儿预后大多良好；重复NST试验异常者41例，羊水Ⅱ～Ⅲ度污染者16例，新生儿轻度窒息者9例；NST＋OCT联合试验阳性者26例，羊水Ⅱ～Ⅲ度污染者21例，新生儿轻度窒息者14例。结论：NST＋OCT联合试验用于预测胎儿窘迫比重复NST试验更有应用价值，很大程度上提高了诊断准确率，为积极治疗提供可靠的依据，降低了围生儿窒息率及病死率，值得在临床广泛推广应用。     

探讨寂静型胎心监护波形对围产儿预后的预测作用

目的:对胎儿进行产前监护,探讨胎儿宫内窘迫出现的胎心监护异常波形对围产儿预后的预测作用.方法:对胎儿宫内窘迫的128例按产前电子监护中短变异异常、长变异异常、长变异短变异均异常(寂静型)的波形进行分组,分别观察电子监护不同波形对胎儿窘迫的预测作用,并与产时羊水性状、脐动脉血气分析及阿氏评分进行比较.结果:产前可疑胎儿宫内窘迫的128例中有26例出现羊水污染,其中短变异异常3例,长变异异常7例,寂静型16例;阿氏评分≤7分的15例中长变异异常2例,寂静型13例;脐动脉血pH值≤7.2的21例中长变异异常6例,寂静型15例.胎儿酸中毒、羊水污染、新生儿窒息(阿氏评分≤7)的3种波形异常的发生率与无上述情况的发生率比较差异有统计学意义(P＜0.05),尤以寂静型为著;3种波形的剖宫产率组间比较差异有统计学意义(P＜0.05).结论:产前寂静型胎心监护波形可提前筛选预测胎儿宫内窘迫,为临床作出前瞻性诊断,改善围产儿预后.     

入室试验在预测胎儿宫内窘迫的效果评价

目的探讨入室试验在预测胎儿宫内窘迫的效果。方法应用胎心监护仪对926例足月、单胎、头位的临产孕妇进行胎心电子监护，并按入室试验结果分为反应型组768例，可疑型组112例，危险型组46例，分析三组临产产妇年龄、孕周、有关高危因素、Apgar评分、羊水污染以及脐带异常的情况。结果三组产妇Apgar评分、羊水污染和脐带异常情况差异有显著统计学意义（P〈0．001）。结论入室试验可以作为预测胎儿宫内窘迫的筛选试验。     

胎心监护联合脐动脉、肾动脉、大脑中动脉血流动力学监测对胎儿宫内窘迫的诊断价值

目的 探讨胎心监护联合脐动脉、肾动脉、大脑中动脉血流动力学监测对胎儿宫内窘迫的诊断价值。方法 选择2017年6月至2020年6月于我院产检并分娩的150例孕妇作为研究对象,根据胎儿娩出情况将其分为宫内窘迫组(60例)和对照组(90例)。比较两组的胎心监护情况、新生儿结局及脐动脉、肾动脉、大脑中动脉血流动力学指标;分析胎心监护联合脐动脉、肾动脉、大脑中动脉血流动力学监测对胎儿宫内窘迫的诊断效能。结果 宫内窘迫组的胎心监护异常率、平均胎心率及羊水污染程度≥Ⅱ级、新生儿Apgar评分≤7分占比高于对照组(P<0.05)。宫内窘迫组的脐动脉、肾动脉收缩期峰值速度/舒张末期速度(S/D)、阻力指数(RI)、搏动指数(PI)高于对照组,大脑中动脉S/D、RI、PI低于对照组(P<0.05)。胎心监护联合脐动脉、肾动脉、大脑中动脉血流动力学监测对胎儿宫内窘迫的诊断灵敏度、特异度、准确度、阳性预测值、阴性预测值高于单一监测,误诊率、漏诊率均低于单一监测(P<0.05)。结论 胎心监护联合脐动脉、肾动脉、大脑中动脉血流动力学监测对胎儿宫内窘迫的诊断价值更高。     

Treatment of fetal supraventricular tachyarrhythmias

Supraventricular tachyarrhythmia has been encountered in 18 fetuses at the Yale-New Haven Medical Center during the past 4 years. Fourteen of these fetuses had supraventricular tachycardia and underwent in utero antiarrhythmic therapy with maternally administered digoxin either alone, or on combination with verapamil, propranolol, or procainamide. Thirteen of the 14 fetuses had successful in utero conversion of cardiac rhythm to normal sinus rhythm. The 14th patient underwent successful therapy after birth. All 14 fetuses survived despite severe fetal hydrops at the time of diagnosis in 13 of 14. The four remaining fetuses had either atrial flutter (3) or fibrillation. Two of the fetuses with atrial flutter died at birth, the 3rd survived after electrical cardioversion at birth. The fetus with atrial fibrillation converted to normal sinus rhythm and survived after maternal administration of digoxin. Using M-mode and pulsed Doppler echocardiography, the nature and electrophysiologic mechanism of the arrhythmia may be deduced. The latter information is reviewed along with the fetomaternal pharmacology of various antiarrhythmic agents to devise a rational antiarrhythmic treatment program.     

Fetal small bowel simulating an abdominal mass at sonography

A focal, well-marginated, homogeneous hyperechoic mass was identified within the fetal abdomen of five early gestations varying in age from 16 to 20 weeks ECA (estimated conceptual age). Initially, the possibility of a congenital abdominal tumor mass was raised. Serial sonography subsequently demonstrated progressive dissolution of the masses, each of which assumed the characteristic appearance of normal small bowel by 30 weeks ECA. The recognition of this normal fetal small bowel maturation pattern is important lest it be confused with congenital retroperitoneal or gastrointestinal tract abnormalities.     

胎儿超声心动图检测胎儿房性期前收缩的临床研究

目的：探讨胎儿超声心动图对胎儿房性期前收缩观察价值及其临床意义。方法：采用彩色多普勒超声心动图对404例孕龄16～42周(平均32．5周)的胎儿进行研究．分析胎儿房性期前收缩的超声心动图特征及其检出率。结果：共检出胎儿房性期前收缩41例，检出率为10．1％。其中下传33例，不下传5例．部分下传3例。41例胎儿均不伴有先天性心血管畸形或其它畸形，出生后听诊均未闻及明显心脏杂音或心律不齐。结论：胎儿房性期前收缩为胎儿期最常见的心律失常，不伴有明显心血管畸形或其它胎儿畸形，绝大多数预后良好。     

Fetal echocardiography: Present and future applications

Fetal heart motion was observed by T-M-mode echocardiography from the twelfth to fortieth week of gestation in 47 apparently normal pregnancies. In the earliest case (at 12 weeks), cardiac pulsations were recorded in a fetus in which the heart sounds couldnot be detected by Doppler ultrasound. The left and right ventricular dimensionsand left-to-right ventricular ratios were determined in 24 of the 35 fetuses in which high-quality images were obtained. Interventricular septal motion was evaluated in 30 of these 35 fetuses. Potential clinical applications of echocardiography in evaluating fetal status are also presented.     

In utero ultrasound diagnosis of congenital heart disease

Two hundred and one pregnancies considered at high risk for congenital heart disease (CHD) underwent fetal cross-sectional echocardiographic (CSE) examination. In 190 cases a structurally normal heart was correctly predicted; seven cases of CHD were identified, but in two of them the specific diagnosis was inaccurate. One false positive diagnosis of a small ventricular septal defect was made. There were three false negative diagnoses: two of ventricular septal defects and one of aortic coarctation. We conclude that severe heart malformations can be reliably identified or excluded by CSE in utero, but important anatomical details may be missed. Therefore, prognosis should be based only on the structures identified to multiple-scan planes.     

Ultrasound in the diagnosis and management of urinary tract disorders in the fetus

Ultrasonic echography allows display of the fetal kidneys and urinary bladder from the 16th week of pregnancy, and the possibility of detection of a number of major congenital abnormalities of the urinary tract from that time. In the second half of pregnancy ultrasound has the key role in monitoring the progress of previously diagnosed abnormalities, particularly those of an obstructive nature. Sonologists thereby have an increasing responsibility in the obstetric care of the patient not only in the narrow field of diagnosis but in the wider field of management. Examples of conservative and surgical management of obstructive lesions are given.     

Fetal weight estimates in late pregnancy with emphasis on macrosomia

The effectiveness of three methods (Shepard et al, Hadlock et al, and Hansmann) for estimating fetal weight was evaluated in 150 patients at greater than 36 weeks menstrual age. All infants were greater than 2,500 at birth. Only the method of Hadlock et al did not systematically underestimate birth weight. When separate weight subclasses (2,500 to 4,999 g) were examined, the method of Hadlock et al showed better consistency. All models, however, had significant underestimates for the largest subclasses, 4,000 to 4,999 g. The ability to predict the macrosomic infant (greater than or equal to 4,000 g) was only slightly better using the method of Hadlock et al than by the formula of Shephard et al.     

Mathematical modeling of fetal growth: V. Fetal weight changes at term

Fetal growth after 37 weeks menstrual age was investigated by comparing ultrasound estimates of fetal weight with corresponding weights of newborns. Using a weight estimation equation with minimal systematic error, evidence was found that fetuses delivered at term do not increase in weight the last two weeks before delivery. This change in fetal growth is regarded as a biological process that is needed to prepare the fetus for its life after birth. Only one of three subsets, that of estimated weights below 3000 g, showed significant weight increase after 37 weeks. This subset had, however, on average the longest scan-delivery interval. We conclude that conventional birthweight standards are influenced both by a cessation of fetal growth approximately two weeks before delivery and by an association between fetal size and the duration of gestation.