超高龄孕妇终止妊娠时机探讨

目的探讨超高龄孕妇终止妊娠时机对母婴结局的影响。 方法回顾性分析佛山市第一人民医院产科2016年2月至2019年1月160例超高龄孕妇分娩的资料,依据产妇分娩时妊娠周数分为超预产期妊娠组（40~41周,共33例）和正常足月妊娠组（37~39^＋6周,共127例）。对两组患者的年龄、距离前次妊娠时间、分娩前血红蛋白水平、产时体质量指数（BMI）等指标的组间比较采用t检验,对两组患者直接剖宫产、阴道试产失败后转剖宫产、阴道助产、顺产、产后出血、新生儿转儿科、羊水过少、羊水混浊、急性胎儿窘迫、胎膜早破、巨大儿的发生率的组间比较采用χ²检验。 结果超预产期妊娠组与正常足月妊娠组在年龄、距离前次妊娠时间、分娩前血红蛋白水平、产时BMI、直接剖宫产率、阴道试产失败后转剖宫产率、阴道助产率、顺产率、产后出血发生率、新生儿转儿科发生率、胎膜早破发生率、巨大儿发生率等方面差异无统计学意义（P均>0.05）。超预产期妊娠组与正常足月妊娠组比较,羊水过少发生率（15.15% vs 3.15%,χ²=5.026,P=0.025）、羊水混浊发生率（33.33% vs 3.15%,χ²=24.648,P<0.001）、急性胎儿窘迫发生率（12.12% vs 1.57%,χ²=5.414,P=0.020）均明显增高,差异有统计学意义。 结论超高龄孕妇应选择足月后预产期前终止妊娠,降低发生围产儿不良结局的概率。     

孕中期血清学筛查、超声、NIPT联合在胎儿染色体异常筛查中的价值

目的探讨孕中期血清学筛查中位数倍数(MoM)低值、超声、无创产前基因检测(NIPT)联合在胎儿染色体异常筛查中的应用价值。方法选择在我院行孕中期筛查的1068例单胎孕妇中筛选出需行羊水染色体核型分析检测的高危孕妇195例,以羊水染色体核型分析检测结果为金标准,分析血清游离绒毛膜促性腺激素β(β-hCG)和甲胎蛋白(AFP)MoM低值、超声、NIPT对胎儿染色体异常的筛查价值。结果195例孕妇行羊水染色体核型分析共检测出染色体异常18例,195例孕妇经超声筛查显示胎儿可能存在染色体异常77例,经NIPT筛查显示高风险24例,经血清学筛查检出AFP MoM值<0.4者64例,经血清学筛查检出游离β-hCG MoM值<0.25者69例。血清学筛查AFP和游离β-hCG MoM低值、超声、NIPT联合检查对胎儿染色体异常筛查价值明显优于各项单独检查(P<0.05)。结论孕中期血清学筛查AFP和游离β-hCG MoM低值、超声、NIPT联合检查对胎儿染色体异常具有较高的检出率,能够准确反映胎儿异常。     

Tobramycin: Maternal-Fetal Pharmacology

To investigate the maternal-fetal transfer of tobramycin (TBM) and its distribution in the fetus, a single dose of 2 mg/kg was administered intramuscularly to 35 pregnant patients (13 first trimester, 22 second trimester) 0.5 to 34 h before hysterectomy. TBM concentration was assayed microbiologically in maternal serum, fetal tissues (placenta, brain, lung, liver, and kidney), and fluids (amniotic, cerebrospinal fluid [CSF], urine, and serum). Mean maternal serum half-life (1.54 h) and mean peak serum concentration of TBM were within ranges reported for nonpregnant adults. In fetal serum, half-life was 5.2 h, and TBM levels did not exceed 0.58 μg/ml. For intervals up to 34 h, the mean TBM concentration in placental tissues was 1.4 μg/g. Concentration differences related to fetal maturation were found for fetal CSF, amniotic fluid, and fetal kidney. No antimicrobial activity was found in the fetal CSF of >16 weeks' gestation. TBM was present predominantly in the second trimester amniotic fluid specimens. Fetal kidney concentrations reached 7.2 μg/g at 34 h after maternal drug administration. Higher TBM concentrations were related to advanced maturation of the fetal kidney. Second trimester fetal urine concentrations for TBM ranged from 0.1 to 3.4 μg/ml, and the fetal urinary half-life was 3.7 h. Knowledge of fetal pharmacology is essential for weighing the fetal benefits or risks of antimicrobial therapy for the infected gravid patient.     

Amino acid metabolism during starvation in human pregnancy

To evaluate the factors regulating gluconeogenesis in pregnancy, plasma amino acid levels were determined during the course of an 84-90 hr fast in physically healthy women studied during wk 16-22 of gestation (before undergoing therapeutic abortion), and in nonpregnant controls. The effect of pregnancy on the glycemic response to exogenous alanine administration during starvation was also investigated.In the nonpregnant group fasting resulted in a 2- to 3-fold increase in the levels of plasma valine, leucine, isoleucine, and alpha-aminobutyrate, while the concentration of alanine and glycine fell. In the pregnant group, the levels of most amino acids were significantly reduced in the postabsorptive state. With starvation, the plasma concentration of alanine fell more rapidly in the pregnant group and was significantly below that of the nonpregnant subjects for the first 60 hr of the fast. In contrast, a significant elevation in plasma glycine, serine, and threonine was observed in the pregnant group after 84 hr of fasting, whereas similar increments were not demonstrable until after 10 days of fasting in previously studied nonpregnant obese subjects. Paralleling the changes in maternal plasma, amniotic fluid levels of valine, leucine, and isoleucine increased while that of alanine fell during the fast.Although the plasma glucose concentration was lower in the pregnant group at termination of the fast, intravenous alanine administration (0.15 g/kg), resulted in a prompt, comparable increase (20-25 mg/100 ml) in plasma glucose in both groups of subjects.It is concluded that (a) pregnancy accelerates and exaggerates the hypoalaninemic and hyperglycinemic effects of starvation; (b) lack of key endogenous substrate rather than altered intrahepatic processes may limit hepatic gluconeogenesis in pregnancy and contribute to gestational hypoglycemia; (c) maternal caloric deprivation profoundly alters the levels of amino acids in amniotic fluid.     

超声软指标联合母体血清甲胎蛋白和人绒毛膜促性腺激素筛查胎儿染色体异常

目的 观察孕中期超声软指标联合检测血清甲胎蛋白（AFP）和人绒毛膜促性腺激素（HCG）用于筛查胎儿染色体异常的价值。方法 对1 625名接受孕中期产前检查孕妇以常规腹部超声检测胎儿超声软指标，采用免疫层析法检测母体血清AFP和HCG。将胎儿多个超声软指标（≥2个）阳性者归为高危孕妇（高危组），行羊膜腔穿刺术及羊水细胞染色体核型检查；对低危孕妇进行产后随访，与筛查结果进行对比。结果 共检出64胎胎儿染色体异常，包括染色体数目异常35胎、结构异常29胎。于高危组167名中发现40胎胎儿染色体异常，包括染色体数目异常23胎、结构异常17胎。母体血清AFP及HCG水平筛查胎儿染色体异常的敏感度分别为64.60%和98.50%，特异度分别为66.00%和14.40%，曲线下面积（AUC）分别为0.701和0.788，截断值分别为56.24 ng/ml和19.36 ng/ml；母体血清AFP联合HCG筛查胎儿染色体异常的敏感度为71.88%，特异度为93.66%，AUC为0.796。超声软指标联合检测母体血清AFP、HCG诊断胎儿染色体异常的敏感度均高于单项指标（P均<0.05）。结论 孕中期超声软指标联合母体血清AFP、HCG检测可提高检出胎儿染色体异常的敏感度，有效筛选胎儿染色体异常的高危孕妇。     

产前筛查先天性缺陷与胎儿染色体异常的研究

目的 探讨孕中期血清标志物在产前筛查胎儿染色体异常的作用和价值.方法 对2555例孕中期(14～22周)孕妇血清甲胎蛋白、β-HCG和uE3 3项指标进行检测,并结合孕妇年龄、孕周、体质量、是否双胎、有无糖尿病等,采用仪器配套软件计算风险概率,对南风险孕妇进行染色体检查确认.结果 2555例孕妇中筛查出唐氏综合征高风险210例,占筛查总数的8.2％;18-三体综合征高风险26例,占筛查总数的1.0％;神经管缺陷高风险29例,占筛查总数的1.1％.高风险孕妇中有207例自愿进行了羊水细胞染色体检查或胎儿脐血染色体检查,检测出染色体异常核型12例,异常率为5.8％.结论 孕中期孕妇血清唐氏综合征、18-三体综合征、神经管缺陷联合筛查胎儿先天缺陷是行之有效的方法,可以作为产前筛查的常规项目.     

Correlation between fetal gastric size and amniotic fluid volume

PURPOSE: Since abnormal conditions of the fetal digestive tract may alter both amniotic fluid volume and fetal gastric volume, we sought to determine whether amniotic fluid volume is correlated with fetal gastric volume in normal pregnancy. METHODS: A total of 280 fetal gastric size measurements were made prospectively from routine sonographic examinations of women with normal singleton pregnancies between 16 and 42 weeks of gestation. The fetal stomach was defined as the largest area including the pyloric site on transverse or oblique real-time sonographic scans. Gastric volume was calculated according to the formula for a prolate ellipsoid. The amniotic fluid index (AFI) was used for the evaluation of amniotic fluid volume. RESULTS: Both fetal gastric volume and AFI were significantly correlated with gestational age (R2= 0.422 and R2= 0.128, respectively). Only a weak correlation was found between gastric volume and AFI (R2= 0.036, p <0.001). On multivariate linear regression analysis adjusting for gestational age and fetal biometric measurements, gastric volume was not an independent and significant predictor of AFI. CONCLUSIONS: Although sonographically determined fetal gastric volume measurements appear to be useful in the assessment of fetal digestive tract anomalies, fetal gastric volume has no clinically significant effect on the amniotic fluid volume in normal pregnancy.     

2616例孕中期孕妇的血清特异性标志物筛查结果分析

目的探讨孕中期产前筛查的临床应用价值,并探讨影响其风险值的主要因素。方法检测2616例孕中期（14～24周）孕妇血清中的甲胎蛋白（AFP）、人绒毛膜促性腺激素β亚单位（[3-HCG）和游离雌三醇（uE3）的浓度,其中AFP、β-HCG使用电化学发光法,uE3使用酶联免疫法检测;使用T21$SOFTw筛查软件评估风险。建议唐氏综合征或18-三体综合征高风险孕妇行胎儿羊水染色体核型分析,神经管缺陷高风险者接受高分辨超声检查。结果唐氏综合征、18-三体综合征、神经管缺陷高风险发生率分别为5．73％、0．34％、1．11％;高风险孕妇经产前诊断确诊唐氏综合征1例,神经管缺陷2例,其它染色体异常疾病3例。结论对孕中期孕妇进行产前筛查,是减少患染色体疾病和神经管缺陷患儿出生的有效方法;在筛查软件中应对诸多影响因素予以校正,而孕周的准确与否对筛查结果影响较大。     

The fetal gastrointestinal tract is exposed to melatonin and superoxide dismutase rich amniotic fluid throughout prenatal development

Amniotic fluid (AF) is the first fluid to enter the gastrointestinal tract. Preterm birth is leading to a sudden interruption of AF swallowing. Understanding the composition of amniotic fluid is crucial to implement strategies preventing intestinal injury in preterm infants. We hypothesized that the fetal gastrointestinal tract (GIT) is exposed to melatonin and antioxidant enzymes via amniotic fluid throughout prenatal development. Amniotic fluid samples from 76 pregnant women with a median (range) gestational age of 38.0 (14.3–40.1) weeks have been collected. Immediately after birth blood samples were collected from the umbilical vein (n = 53). Median (Interquartile range) melatonin concentration was 30.5 pg/ml (12.7–118.3) and superoxide dismutase 1 (SOD1) concentration was 84 ng/ml (59–123). Extracellular glutathione peroxidase concentration was either not detectable or exceptionally low. We found a positive correlation between melatonin concentration in amniotic fluid and gestational age (Spearman’s correlation coefficient, r = 0.570, p<0.001), while SOD1 concentration in amniotic fluid was inversely correlated with gestational age (r = −0.246, p = 0.032). Compared to serum samples, melatonin concentration was statistically significantly higher in amniotic fluid (p<0.001). Our results indicate that the fetal gastrointestinal system is continuously exposed to melatonin and SOD1 via the amniotic fluid throughout prenatal development.     

Association of amniotic fluid index with estimated fetal weight.

OBJECTIVE: The relationship between amniotic fluid volume and gestational age has been described previously. The association of body weight and urine output has been observed in human neonates. Our goal was to assess the correlation of the amniotic fluid index (AFI) with estimated fetal weight (EFW) in the third trimester. METHODS: We conducted a retrospective observational study on 426 pregnant women with singleton gestations who were referred to our unit for sonographic evaluation in the third trimester. The AFI, EFW, and EFW percentile corrected for gestational age were evaluated. The sonographic examinations were stratified into 3 gestational age categories: 28 through 33.9 weeks, 34 through 37.9 weeks, and 38 weeks and later. Maternal and fetal outcome variables were collected from medical records. Linear regression, Mann-Whitney U, and Kruskal-Wallis tests were used for statistical analysis. RESULTS: There was no significant relationship between the AFI and EFW in the entire group of patients (R = 0.08; P = .096). There was a significant relationship between the AFI and EFW after 38 weeks' gestation (R = 0.30; P = .003). In addition, in female fetuses the EFW percentile correlated with higher AFI values at all gestational ages (R = 0.31; P < .001); this, however, was not observed in male fetuses. CONCLUSIONS: There is no relationship between the AFI and EFW during the third trimester, although a positive relationship between the AFI and EFW was noted late in gestation. In pregnancies with female fetuses, the AFI was positively associated with EFW percentile before 38 weeks' gestation.     

妊娠期甲状腺功能减退对母婴妊娠结局的影响

目的:探讨妊娠期甲状腺功能减退(以下简称甲减)对母婴妊娠结局的影响。方法:选取2016年1月至2019年6月在无锡市妇幼保健院产科门诊检查并住院分娩的甲减孕妇771例,其中临床甲减病例81例作为甲减组、临床亚甲减病例690例作为亚甲减组,随机选取同期420例正常孕妇为对照组,对其甲状腺功能(TSH和FT4水平)、妊娠并发症及结局(妊娠期糖尿病、妊娠期高血压疾病、胎膜早破、羊水异常、产后出血)、围产儿不良结局(胎儿宫内窘迫、流产或死胎、早产、新生儿窒息等)进行比较分析。结果:30698例孕妇中甲减发生率为2.51%(771/30698)。3组间年龄、孕前BMI、产次和孕周的比较,差异无统计学意义(P<0.05)。甲减组、亚甲减组在孕中期、孕晚期的TSH水平均高于对照组(P<0.05),FT4水平均低于对照组(P<0.05);甲减组在孕中期、孕晚期的TSH水平高于亚甲减组(P<0.05),FT4水平低于亚甲减组(P<0.05)。甲减组的妊娠糖尿病、妊娠期高血压疾病、胎膜早破、羊水异常等的发生率均高于对照组(P<0.05),亚甲减组的妊娠糖尿病、妊娠期高血压疾病、胎膜早破等发生率高于对照组(P<0.05),而甲减组的妊娠糖尿病、胎膜早破等发生率水平高于亚甲减组(P<0.05)。甲减组、亚甲减组的胎儿宫内窘迫、早产及新生儿窒息发生率均高于对照组(P<0.05),而甲减组的新生儿窒息发生率高于对照组(P<0.05)。结论:孕妇有较高的甲减发生率,并与母婴不良结局增加有关;应早期筛查和治疗妊娠期甲减,控制孕妇甲状腺激素水平,改善母婴妊娠结局。     

Maternal serum and amniotic fluid levels of human placental lactogen in gestational diabetes

Abstract. Human placental lactogen (hPL) levels were measured radioimmunologically in maternal serum and in amniotic fluid between the 37th and 39th weeks of gestation in sixteen gestational diabetic and thirty normal pregnant women. There was no significant difference in maternal serum hPL levels between diabetic (6.1 μ g/ml) and normal pregnant women (6.4 μ g/ml). In contrast, the diabetic group was found to have significantly ( P< 0.001) higher concentrations of amniotic fluid hPL (1.2 μ g/ml) than normal pregnant women (0.8 μ g/ml).     

广东省顺德地区6 503例孕中期羊水染色体核型结果分析

目的 探讨羊水细胞异常核型发生的频率、类型与不同产前诊断指征之间的关系,评估羊水穿刺术诊断染色体疾病的临床价值。方法 选取2009年7月～2018年7月在广东医科大学顺德妇女儿童医院产前诊断中心具有产前诊断指征的孕妇6 503例,进行羊水穿刺,胎儿羊水细胞染色体核型分析。结果①6 503例羊水细胞中,检出染色体异常核型358例,异常率5.51%。染色体数目异常264例,其中21三体128例,18三体51例,13三体20例,性染色体数目异常65例; 染色体的结构异常66例; 嵌合体28例。各产前诊断指征中,染色体异常检出率分别为3.34%,3.15%,61.95%,17.22%,37.14%,5.60%和0.62%,经χ²检验发现,高龄组与血清学筛查高风险组,高龄组与不良孕产史组,血清学筛查高风险组与不良孕产史组,差异均无统计学意义(χ2=0.147～2.279,均P>0.05); 其余各组之间两两比较,差异均有统计学意义(χ2=7.411～997.801,均P<0.01)。②2 456例高龄孕妇中,年龄35～39岁组与年龄≥40岁组胎儿染色体异常检出率分别为2.70%和5.63%,两者比较,差异有统计学意义(χ2=11.059,P<0.01)。③无创产前基因筛查(NIPT)对21三体、18三体和13三体的检测准确度分别为80.28%,75.86%和44.00%,对性染色体异常的检测准确度为55.17%,对其他染色体异常的检测准确度为22.73%。结论 ①对具有明确产前诊断指征的孕妇行羊膜腔穿刺术,进行羊水细胞染色体核型分析非常重要,可有效地检出染色体异常胎儿,避免其出生,提高人口素质。②高龄孕妇,尤其是≥40岁的高龄孕妇,进行产前诊断非常必要。③NIPT对筛查胎儿染色体疾病准确率较高,但只是筛查手段,不能完全代替羊水细胞核型分析。     

Ultrasonographic demonstration of floating particles in amniotic fluid

This prospective study of 131 pregnant women was designed to determine the incidence and significance of floating particles in amniotic fluid. Floating particles ranging in size from 1 to 5 mm were seen in the amniotic fluid of pregnant women at 15 to 40 weeks' gestation. Since vernix is rarely present before 35 weeks' gestation, a source other than flakes of vernix must be sought to explain the floating particles in amniotic fluid in early gestations. There was no significant difference in the sizes or numbers of particles at different gestational ages (from 15 to 40 weeks). Therefore, it is concluded that ultrasonographic demonstration of floating particles in amniotic fluid cannot be considered an indicator of fetal maturity.     

Maternal serums and amniotic fluid levels of human placental lactogen in gestational diabetes.

Human placental lactogen (hPL) levels were measured radioimmunologically in maternal serum and in amniotic fluid between the 37th and 39th weeks of gestation in sixteen gestational diabetic and thirty normal pregnant women. There was no significant difference in maternal serum hPL levels between diabetic (6.1 microgram/ml) and normal pregnant women (6.4 microgram/ml). In contrast, the diabetic group was found to have significantly (P less than 0.001) higher concentrations of amniotic fluid hPL (1.2 microgram/ml) than normal pregnant women (0.8 microgram/ml).     

Pregnancy-induced hypertension and preeclampsia: levels of angiogenic factors in malaysian women

Preeclampsia (PE) is a major contributor to maternal and fetal mortality. The cause of preeclampsia remains unclear, but oxidative stress on the endothelium leading to endothelial dysfunction is said to be the root cause of the disease. The aim of this study was to measure and determine the plasma levels of key angiogenic factors in pregnancy as an indicator for the early onset of preeclampsia in pregnancy. Plasma levels of circulating a soluble fms like tyrosine kinase-1 (sFlt-1), an anti-angiogenic factor, vascular endothelial growth factor (VEGF) and placental growth factor (PIGF), both pro-angiogenic factors were analyzed in normal pregnant Malaysian women (control group, n = 34), women with pregnant induced hypertension (PIH, n = 34) and women with preeclampsia (PE, n = 34) all at three gestational ages, 24–28 weeks (early pregnancy: EP), 32–36 weeks (late pregnancy: LP) and 6 weeks after delivery (postpartum: PN). The plasma levels of angiogenic factors were determined by ELISA. sFlt-1 levels were elevated in PIH and PE patients as compared to controls. PIGF and VEGF were significantly decreased in PIH and PE as compared to the controls. These results suggest that elevated concentration of sFlt-1 and suppressed levels of PIGF and VEGF may contribute to the development of hypertension in pregnancy which precedes preeclampsia.     

超声软指标前额空间比联合NIPT检测在早孕期胎儿染色体异常筛查中的应用价值

目的：观察超声软指标前额空间比(PFSR)联合无创产前基因(NIPT)检测在早孕期胎儿染色体异常筛查中的应用价值。方法：选取2020年1月~2023年2月于我院接受早孕期羊水染色体核型检测的高危孕妇80例,均行产科超声及NIPT检测,以羊水穿刺染色体检测为金标准,比较超声软指标PFSR、NIPT及两者联合检测筛查早孕期胎儿染色体异常的应用价值。结果：80例孕妇中,经羊水染色体核型检测筛查出11例(13.75%)存在染色体异常,其中21-三体6例,18-三体2例,13-三体2例,Turner综合征1例。采用超声软指标PFSR检测筛查早孕期胎儿染色体异常的敏感性、特异性及准确性分别为63.64%、86.96%、83.75%;NIPT检测为72.73%、88.41%、86.25%;PFSR联合NIPT检测为90.91%、98.55%、97.50%。PFSR联合NIPT检测筛查的特异性及准确性均高于单一检测(P<0.05),三种检测方法的敏感性比较差异不显著(P>0.05)。结论：超声软指标PFSR联合NIPT检测能提高筛查早孕期胎儿染色体异常的应用价值,其特异性及准确性较高,值得推广。     

兰州地区健康孕妇凝血四项及D-二聚体检测结果分析

目的分析兰州地区不同孕期健康孕妇凝血四项及D-二聚体(DD)检测结果,为临床准确评估孕妇出凝血状态提供参考。方法对7 802名健康孕妇及168名非孕女性(非孕对照组)进行回顾性分析。按孕周将7 802名孕妇分为早孕组、中孕组、晚孕组,分析其凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、凝血酶时间(TT)、纤维蛋白(Fib)浓度、DD的检测结果。结果随着妊娠的进展,孕妇PT、APTT、TT逐渐缩短,而Fib和DD逐渐升高。非孕对照组与妊娠期各组比较、妊娠期各组之间比较,Fib与DD差异均有统计学意义(P<0.01)。结论初步确定了兰州地区不同孕期健康孕妇凝血四项及DD的评估标准,提高了出凝血功能检测在孕妇中的临床应用价值。     

Pharmacokinetics and pharmacodynamics of labetalol in the pregnant sheep.

The maternal-fetal disposition of labetalol, a combined alpha-1 and beta adrenergic blocker, and its pharmacodynamics in pregnancy are not well understood. This study describes the pharmacokinetics, cardiovascular and metabolic effects of labetalol in the mother and in utero fetus after a 100-mg maternal i.v. bolus administration, in the chronically instrumented pregnant sheep. Labetalol shows a triexponential decline in the mother with a total body clearance of 30.8 +/- 3.83 ml/min/kg, an apparent steady-state volume of distribution (nonparametric) of 3.02 +/- 0.18 liters/kg and terminal elimination half-life of 2.79 +/- 0.66 hr. These estimates are similar to the reported values in pregnant women. Labetalol rapidly crosses the sheep placenta. The peak fetal plasma concentration was 33.7 +/- 5.8 ng/ml, the fetal exposure to labetalol as calculated by the fetal to maternal area under the curve ratio was 14.37 +/- 1.54% and the apparent fetal elimination half-life was 3.71 +/- 0.5 hr. Labetalol persists in the amniotic and fetal tracheal fluids up to 24 hr with concentrations reaching 2- to 4 times the fetal plasma concentration. Whereas there were no significant maternal or fetal cardiovascular effects, some very significant metabolic effects were observed, including fetal and maternal lactic acidosis and hyperglycemia. Lactic acid accumulates in the fetal blood and amniotic fluid with peak concentrations (6.0 +/- 0.31 and 5.5 +/- 0.26 mM, respectively) showing a more than 300% increase over control values. The exact mechanism by which labetalol causes these metabolic effects is not clear, but it may involve its partial beta-2 agonist activity.     

妊娠中期唐氏筛查在高龄孕妇产前诊断中必要性探讨

目的探讨唐氏筛查在高龄孕妇产前诊断中的意义。方法有产前诊断指征的高龄孕妇899人,孕中期17-24周行羊膜腔穿刺,取羊水检查胎儿染色体。结果发现染色体异常6例在146例唐氏综合症筛查阳性（即孕妇血清甲胎蛋白（AFP）和游离性雌三醇（uE3）以及游离人绒毛膜促性腺激素（-βhCG）三联指标检测,将三联指标测定值输入唐氏综合征风险计算软件,以1/270为高危切割值,≥1/270确定为唐氏综合征筛查阳性）的高龄孕妇中,发现染色体异常6例唐氏综合征发生率为4.11%（6/146）,高龄孕妇中未行唐氏筛查人数750人次,染色体异常人数12人,唐氏综合征发生率0.67%（5/750）。结论对高龄孕妇行孕中期血清血液筛查胎儿唐氏综合征,其筛查效率高于孕中期未行血清血液筛查的高龄孕妇,建议对高龄孕妇行孕中期胎儿唐氏综合征产前筛查。