36例多胎妊娠新生儿预后及其影响因素的分析

目的分析多胎妊娠新生儿预后及影响预后的因素。方法对我院近五年36例多胎妊娠的新生儿预后资料及其影响因素进行回顾性分析。结果（1）5年孕妇总数2665例,双胎妊娠33例,发生率为1.238%。3胎妊娠3例,发生率为1.125‰。（2）双胎早产率27.28%,3胎早产率100%。（3）双胎新生儿窒息18.18%（Apgar评分≤7）,3胎新生儿窒息77.78%（Apqar评分≤7）。（4）二次住院保胎率,双胎90.90%,3胎100%。建卡率均为100%。（5）双胎平均分娩孕周为37＋2w,剖宫产率78.79%,新生儿体重平均（2415±955）g。3胎平均分娩孕周为34＋4w,剖宫产率100%,新生儿体重平均（2000±1000）g。结论多胎妊娠发生率有所提高。加强围产期高危监护,实行孕期住院保胎,仍是提高多胎妊娠分娩孕周、新生儿体重,降低早产率、新生儿窒息率的有效方法。     

双胎之一宫内死亡的原因及处理

目的探讨双胎之一宫内死亡的原因及处理。方法回顾性分析2000年1月～2008年12月我院收治的28例双胎妊娠其一宫内死亡的原因及处理。结果双胎之一宫内死亡的主要原因:脐带因素10例、双胎输血综合征5例、胎儿畸形2例、原因不明11例。结论孕早中期双胎之一宫内死亡后存活的胎儿预后良好,胎龄较大的胎儿死亡后,可增加存活胎儿的围产期患病率,尤其是单卵双胎;应加强对孕妇及存活儿的监护,选择合适的分娩时机;对孕34周以后发现的双胎之一宫内死亡者应考虑终止妊娠。     

妊娠晚期胎儿宫内死亡196例临床分析

目的与方法探讨胎儿宫内死亡的原因及处理方法回顾性分析，1995年～1999年本院收治的196例胎儿宫内死亡原因及诊治过程。结果5年本院共分娩18586例，死胎196例，占10．5％o，其中单胎死亡177例，占90．31％，均行利凡诺尔引产，胎儿宫内死亡的主要原因胎盘因素29例（帆状胎盘4例），脐带因素6例，溶血8例，子宫破裂1例，羊水因素8例，不明原因115例，双胎之一胎儿宫内死亡共19例，发生率是7．1％，8例即行剖宫产，11例经治疗自娩。平均治疗7w主要死亡原因脐带因素5例，胎儿畸形1例，帆状胎盘3例，原因不明10例，其中单卵双胎13例，双卵双胎4例，不详2例。结论胎盘因素和脐带因素是胎儿宫内死亡的首要原因，早期双胎之一胎儿死亡后存活儿预后较好，应积极治疗及时终止妊娠。     

双胎之一胎儿宫内死亡15例临床分析

目的　探讨双胎妊娠一胎儿死亡的原因 ,对存活儿的处理及分娩方式。方法　回顾性分析 1997年 1月～ 2 0 0 0年 12月我院收治的 15例双胎之一胎儿宫内死亡的临床资料。结果　双胎之一胎儿死亡的主要原因 :双胎输血综合征 4例 ,帆状胎盘 4例 ,胎盘早剥 1例 ,原因不明 6例。阴道顺娩 12例 ,引产 2例 ,剖宫产 1例。确诊胎儿死亡到分娩间隔时间平均5 5天。结论　孕中晚期发现双胎之一胎儿死亡 ,随无凝血机制变化 ,为减少存活儿围产期病死率及患病率 ,根据成熟胎儿情况 ,适时终止妊娠 ,期待治疗时间不宜过长。分娩方式 :如无产科指征 ,阴道分娩对母婴是安全的     

双胎妊娠一胎死宫内原因及期待治疗的探讨

目的 探讨双胎妊娠中1胎死于宫内的死因及对母亲和存活胎儿的影响.方法 对1996年1月至2006年12月在我院分娩的双胎之一为宫内死胎的23例产妇临床资料进行回顾性分析.结果 双胎之一为宫内死胎的发生率占双胎的4.72%,其中单绒毛膜双胎14例,占60.87%,双绒毛膜双胎9例,占39.13%(519).胎儿死因脐带因素占34.79%,胎盘因素8例占34.8%,妊娠并发症5例占21.7%,双胎输血综合征2例占8.7%,胎儿畸形1例占4.35%(219),不明原因6例占26.09%.期待治疗最长达72天,双胎之一胎死官内后对母体的凝血功能影响不大.结论 脐带异常、胎盘异常是胎死宫内的重要原因;双胎之一胎死宫内对母体及存活儿有一定影响.但孕周小,胎儿尚不成熟,行期待治疗可延长孕龄至足月,以提高围生儿的存活率.     

期待疗法用于双胎妊娠一胎死亡的临床评价

目的探讨期待疗法用于双胎妊娠一胎死亡的可行性、有效性及安全性。方法对采取期待治疗的39例双胎妊娠一胎死亡的临床资料进行回顾性分析。结果期待治疗时间：最长20周,最短1周。终止妊娠时间：≤34周3例,35周—37周14例,〉37周19例。分娩方式：阴道分娩16例,剖宫产20例,孕妇无1例发生凝血功能障碍,发生新生儿窒息4例,29例新生儿全部成活。结论严密监测下双胎妊娠一胎死亡采取期待疗法,对孕妇的凝血功能无明显影响,使妊娠时间延长,减少早产的发生,存活胎儿的生存质量提高,明显改善新生儿的成活率。     

海口地区145例双胎妊娠临床分析

目的 分析双胎妊娠的危害,选择合适的分娩方式,改善妊娠结局.方法 对145例双胎妊娠的孕周、分娩方式、并发症进行回顾性分析.结果 平均分娩孕周35周,剖宫产107例占73.80%,阴道产38例占26.20%,并发症以早产、胎膜早破、贫血、妊高病多发;娩胎间隔时间和新生儿窒息无相关性(P＞0.05).结论 双胎妊娠并发症多,孕期应积极治疗,分娩方式应以胎方位、胎儿大小、孕周等综合因素来决定.     

妊娠晚期突发意外性胎死宫内原因分析

目的分析妊娠晚期突发意外性胎儿宫内死亡原因,为进一步改善国产期保健工作、减少医患矛盾提供依据.方法应用回顾性分析方法,对1998年以来在辽宁地区发生的突发意外性胎儿宫内死亡522例进行临床原因分析.分析指标包括:孕妇年龄、孕周、孕产次、是否进行系统孕期保健和产前检查、胎死宫内距最后一次产前检查时间、临床分析及生化、病毒、遗传检测和胎儿尸体解剖结果,进行综合判定胎儿死亡原因.结果单胎妊娠胎儿宫内死亡的发生率为0.54%,双胎妊娠胎儿宫内死亡的发生率为0.97%,两者比较P＜0.01;胎儿宫内猝死在进行系统孕期保健孕妇和未进行系统孕期保健孕妇均有发生,比例为46.55%对比53.45%;引起胎儿宫内猝死原因如下:脐带因素占48.28%、胎儿因素占20.50%、胎盘因素占12.45%、宫内感染因素占3.07%、妊娠合并症和并发症占7.47%、羊水异常占2.87%、不明原因占4.02%、双胎输血综合征为双胎妊娠特有并发症,占双胎死亡原因的14.89%.结论1.双胎患者发生妊娠中晚期突发意外性胎儿宫内死亡率高于单胎妊娠;2.系统围产期保健不能避免胎儿宫内猝死,胎儿宫内猝死常具有较大的不可预见性和无法避免性;3.引起胎儿宫内猝死的原因众多,但脐带因素、胎儿及胎盘因素是主要原因.     

双胎妊娠围生儿预后相关因素分析

目的　探讨双胎妊娠新生儿窒息、围生儿死亡的相关因素。方法　回顾分析 2 5 5例双胎妊娠新生儿Apgar评分、新生儿窒息、围生儿死亡与孕周、新生儿体重、分娩方式的关系。结果　双胎妊娠孕 37～ 39+ 6w组Apgar评分最高、新生儿窒息率最低 ,≥ 2 5 0 0g组Apgar评分最高 ,新生儿窒息率、围生儿死亡率最低。孕周、新生儿体重 4组比较差异均有非常显著性(P <0 0 1)。剖宫产组比阴道分娩组Apgar评分高 ,新生儿窒息率、围生儿死亡率均低 ,2组比较Apgar评分、围生儿死亡率差异无显著性 (P >0 0 5 )。 2组比较新生儿窒息率差异有非常显著性 (P <0 0 1)。结论　双胎妊娠估计每个胎儿体重≥ 2 5 0 0g时 ,宜选择 37～ 39+ 6w终止妊娠为宜。加强孕期、围生期保健 ,积极防治各种并发症 ,适当放宽剖宫产指征 ,避免早产 ,减少低体重儿出生 ,是降低双胎围生儿死亡率、改善其预后的重要措施。     

S0N0NT检测早孕期双胎妊娠NT合并胎儿染色体异常产前诊断的价值

目的探讨S0N0NT检测早孕期双胎妊娠胎儿NT筛查染色体异常的研究。方法选择2015年1月至2016年4月本院及协作医院孕11~13+6w双胎早孕,应用自动颈后透明层厚度测量(Sonography-based Nuchal Translucency)S0N0NT检测早孕期双胎妊娠胎儿NT筛查染色体异常,对发现的双胎妊娠胎儿NT增厚者,进行绒毛活检术或羊膜腔穿刺术行染色体检查,确诊染色体异常的胎儿在超声引导下行选择性减胎术治疗,并对妊娠结局进行跟踪分析。结果 10例NT增厚,4例染色体异常,分别为21-三体综合征2例,1例Turner综合征,1例染色体微缺。另6例患者在早中期超声复查中,发现其中3胎儿结构异常,分别为颈部淋巴管囊肿、心脏异常、全身水肿等。10例患者中4例染色体异常患者行选择性减胎。3例足月分娩,新生儿均未见异常。结论双胎妊娠应注重早孕期染色体筛查,确诊宫内胎儿染色体异常的患者可在超声引导下行选择性减胎术治疗,而对早中期超声检查发现其中的三胎儿结构异常者,根据父母意愿,选择妊娠去留,为临床及孕妇提供客观的诊断依据。     

825例重度子痫前期患者的分娩时机与围产儿结局分析

目的探讨重度子痫前期孕妇的分娩时机及新生儿的结局。方法对825例重度子痫前期的患者,根据病情进一步治疗,期待治疗和终止妊娠,分析不同治疗方法的预后。结果孕周〉32周的新生儿和围产儿病死率低于32周前终止妊娠者,（P〈0.01）结论孕周已近34周的重度子痫前期患者,经促胎肺治疗后即可终止妊娠。而孕32周之前的重度子痫前期患者,在严密监测下尽量延长孕周,以增加胎儿的成熟度并不增加母亲并发症。     

Monozygotic twins discordant for 18q21.2qter deletion detected by array CGH in amniotic fluid

Discordant chromosomal anomalies in monozygotic twins may be caused by various timing issues of erroneous mitosis and twinning events. Here, we report a prenatal diagnosis of heterokaryotypic monozygotic twins discordant for phenotype. In a 28-year-old woman, ultrasound examination performed at 26 weeks of gestation, detected intrauterine growth restriction and unilateral cleft lip and palate in twin B, whereas twin A had normal fluid, growth and anatomy. Molecular karyotyping in twin B identified a 18q21.2qter deletion, further confirmed by FISH analysis on amniocytes. Interestingly, in twin A, cytogenetic studies (FISH analysis and karyotype) on amniocytes were normal. Genotyping with microsatellite markers confirmed the monozygosity of the twins. At 32 weeks of gestation, selective termination of twin B was performed by umbilical cord coagulation and fetal blood samples were taken from the umbilical cord in both twins. FISH analyses detected mosaicism in both twins with 75% of cells being normal and 25% harboring the 18qter deletion. After genetic counseling, the parents elected to terminate the second twin at 36 weeks of gestation. In postmortem studies, FISH analyses revealed mosaicism on several tissues in both twins. Taking into account this observation, we discuss the difficulties of genetic counseling and management concerning heterokaryotypic monozygotic twins.     

妊娠急性脂肪肝10例及其相关资料临床分析

目的 探讨妊娠期急性脂肪肝（AFLP）的临床特点,以便早期诊断和及时治疗,降低孕产妇及围生儿的死亡率.方法 对近4年我院收治的10例妊娠期急性脂肪肝患者的临床资料进行回顾性分析.结果 9例患者为初产妇,平均发病孕周为36＋6周,单胎8例,双胎2例.4例存活孕妇均行剖宫产结束分娩,3例入院时出现凝血功能障碍行剖宫产加子宫全切.孕产妇共存活4例,死亡率为60%;围生儿死亡9例,死亡率为75%.结论 妊娠急性脂肪肝是发生在妊娠晚期的一种严重并发症,早期诊断、尽快终止妊娠是提高母儿预后的关键;对于AFLP患者的分娩方式选择我们主张以剖宫产尽快结束分娩为宜;对于出现凝血功能障碍者,就在剖宫产的同时行子宫全切,以挽救患者生命.     

Advanced abdominal pregnancy: an increasingly challenging clinical concern for obstetricians

Advanced abdominal pregnancy is rare. The low incidence, high misdiagnosis rate, and lack of specific clinical signs and symptoms explain the fact that there are no standard diagnostic and treatment options available for advanced abdominal pregnancy. We managed a case of abdominal pregnancy in a woman who was pregnant for the first time. This case was further complicated by a concurrent singleton intrauterine pregnancy; the twin pregnancy was not detected until 20 weeks of pregnancy. The case was confirmed at 26 weeks gestational age using MRI to be an abdominal combined with intrauterine pregnancy. The pregnancy was terminated by cesarean section at 33 + 5 weeks gestation. We collected the relevant data of the case while reviewing the advanced abdominal pregnancy-related English literature in the Pubmed, Proquest, and OVID databases. We compared and analyzed the pregnancy history, gestational age when the diagnosis was confirmed, the placental colonization position, the course of treatment and surgical processes, related concurrency rate, post-operative drug treatment programs, and follow-up results with the expectation to provide guidance for other physicians who might encounter similar cases.     

Maternal vascular endothelial growth factor receptor and interleukin levels in pregnant women with twin-twin transfusion syndrome

Twin-twin transfusion syndrome (TTTS) is an unusual and serious condition that occurs in twin pregnancies when identical twins share a placenta but develop discordant amniotic fluid volumes. TTTS is associated with an increased risk of fetal death and birth defects if untreated. This study investigated the soluble levels of biomarkers including growth factors and interleukins in pregnant women with and without TTTS during pregnancy. We quantified plasma levels of VEGF-R1, VEGF-R2, IL-1β, IL-6 and IL-8 in twin pregnant women with (n=53) and without TTTS (n=72) and in women with single pregnancy (n=30) by ELISA and analyzed the association of maternal circulating biomarker levels with TTTS. Our results showed that maternal VEGF-R1 levels were significantly higher in twins compared to single pregnancy (P<0.05) and were decreased in the second trimester compared to the first trimester (P = 0.065, 0.019 and 0.072 for twins with and without TTTS and single pregnancy, respectively). VEGF-R2 levels had a trend to be lower in twins compared to single pregnancy. In addition, soluble VEGF-R1 and VEGF-R2 levels were significantly decreased while IL-6 levels were increased after surgical treatment with laser in twin pregnant women with TTTS (P = 0.016, 0.041 and 0.04, respectively). These results suggest that IL-6, VEGF-R1 and VEGF-R2 are involved in vascular regulation and stabilization in twin pregnancies and may contribute to the pathogenesis of TTTS and thus play a prognostic role in the surgical treatment of TTTS.     

Warfarin-associated fetal intracranial hemorrhage: a case report

A 27-yr-old woman who had been taking warfarin for 10 yr after mitral valve replacement became pregnant. After knowing her pregnancy, she received heparinization for nine weeks instead of warfarin, and took oral anticoagulant again. At 24 weeks of gestation, fetal ultrasound and MRI showed a left subdural hematoma, and the pregnancy was terminated. Subdural hematoma was demonstrated on autopsy. Fatal bleeding of the fetus is a rare complication of maternal warfarin medication, occurring mostly in the second or third trimester. There is no alternative regimen available, so that regular monitoring by fetal ultrasound and strict control of warfarin dose with regular measurement of prothrombin time are the best way to prevent intrauterine fetal death due to bleeding.     

Evaluierung des intrauterinen Fruchttods

Aims

Intrauterine death is a multifactorial major complication during pregnancy. In this retrospective analysis the pathological anatomical findings of fetuses and placentas as well as maternal factors were evaluated.

Material and methods

A retrospective screening of post-mortem examinations, corresponding placental examinations and clinical data on maternal status (1998–2008) was carried out. A classification of all findings was made with the ReCoDe system and induced abortions and cases with incomplete data were excluded from the study.

Results

A total of 84 pregnancies involving 87 fetuses (9 siblings) were evaluated. The median gestation age was 20 weeks (range 12–41). The evaluation based on the ReCoDe system revealed that intrauterine death was mainly associated with placental diseases (n?=?63) and to a lesser extent with fetal malformations (n?=?15) or maternal diseases (n?=?4). Idiopathic cases were rare (n?=?2).

Conclusions

Placental examination is important for explaining intrauterine death because in most cases an association with placental diseases can be found but fetal malformation and maternal diseases must be taken into account.     

Study on the regulation of cell adhesion molecule expression and function in placenta from women with intrahepatic cholestasis of pregnancy

Intrahepatic cholestasis of pregnancy (ICP) is a common complication of pregnancy manifested as skin pruritus of cholestasis. ICP occurs mainly in the second or third trimester of pregnancy and may cause fetal distress, unexpected intrauterine fetal death and does serious harm to maternal and fetal health. The pathogenesis of ICP is still unclear. In ICP placentas, placental syncytiotrophoblasts are the most direct contact between maternal high bile acid environment and fetus. Our previous study found that in ICP placental syncytiotrophoblasts, both mRNA expression level and protein expression level of vascular cell adhesion molecule-1 (VCAM-1), were significantly elevated. Since VCAM-1 is important in inflammatory injury of lymphocytes, we speculate that ICP pathogenesis may be associated with VCAM-1 up-regulation which may lead to inflammatory injury and cause intrauterine fetal distress, intrauterine fetal death and other adverse outcomes. Elucidation of this mechanism should help reveal the ICP pathogenesis and facilitate the clinical treatment of intrauterine fetal death.