B超引导下的脐静脉穿刺术在产前诊断应用中的安全性研究

目的探讨B超引导下的脐静脉穿刺术在产前诊断中的成功率和安全性。方法回顾性分析1990年3月～2003年6月对2403例因各种原因在B超引导下的脐静脉穿刺术进行产前诊断的孕妇临床资料,观察穿刺手术的成功率和并发症。结果一次性穿刺成功为2368例(98．5％),二次穿刺成功为2384例(99．2%)。75．5％的孕妇可在5min内完成穿刺术,93．0％的孕妇在10min内完成穿刺术。手术并发症包括：脐带或胎盘渗血315例(13．1％),胎儿心动过缓125例(5．2％),一次性穿刺失败35例(1．5％),流产18例(0．8％),早产4例(0．2e%),绒毛膜羊膜炎2例(0．1％)。结论脐静脉穿刺术是一项较为安全而简单易行的产前诊断取材技术。     

游离脐带穿刺术36例分析

游离脐带穿刺术３６例分析张彦平，叶国玲，刘琪，席梅英，雷小莹脐带穿刺术（ｃｏｒｄｏｃｅｎｔｅｓｉｓ）又称经腹脐静脉穿刺术（Ｐｅｒｃｕｔａｎｅｏｕｓｆｅｔａｌｕｍｂｉｌｉｃａｌｂｌｏｏｄｓａｍｐｌｉｎｇ，ＰＵＢｓ），是采集胎血的新技术，自１９８３年以来...     

早产胎盘的病理分析

报道我院1985－1988年间妊娠28周至不满37周的198例早产胎盘的病理分析，肉眼所见异常，前置及低置胎盘（5．34％），双叶及边缘窦破裂（各0．97％），巨大胎盘（2．91％），脐带过短（4．85％），及带帆状附着（3．88％）等的发生率足月胎盘舯比较差异有显著意义（P＜0．05或P＜0．01），165例的镜栓所见，胎膜炎及脐血管炎19例（11．52％），其中8例非胎膜早破后感染造成早产占4．85％，妊高娠胎盘72例（占早产总数的36．36％），其中65例（90．28％）有包培因管 病变，值得注意的有18例（25％）临床未诊断妊高征，病理检查发现蜕膜血管病变，复习病历证明诊断被忽略，结合胎盘病理检查分析，早产可能原因最主要的是胎盘，羊水，脐带有关因素，胎膜早破中20例伴妊高征，是否因蜕膜血管病变，影响胎膜韧性之故，值得进一步研究。     

直接胎儿穿刺取血法及并发症的研究

目的　探讨 B超引导下直接胎儿穿刺取血的适应证、胎儿血判定方法、穿刺方法与并发症的关系。　方法　对 90例宫内妊娠 16～ 36周、有医疗穿刺指征的孕妇 ,在 B超引导下进行直接胎儿血穿刺。穿刺前后分别进行胎心监护 ,穿刺后 2 h及 2 4h B超了解胎盘情况。　结果　 90例穿刺病例中无胎儿丢失及胎盘早剥等严重母儿并发症。穿刺过程中胎心变化发生率为 35 .6 % (32 / 90 ) ,均在 6 0 s内恢复 ;穿刺后 4h内出现胎心变化发生率为 2 .2 % (2 / 90 ) ;胎心变化与取血量及穿刺部位正相关 r分别为 0 .2 7及 0 .36。穿刺后 2 h及 2 4h出现胎盘变化 1例 ,发生率为 1.1%。 90例无因穿刺并发症需紧急终止妊娠者 ;胎儿娩出后脐带未见特殊异常。　结论　在高分辨度彩超定位下 ,直接胎儿穿刺取血是安全可靠的。由胎儿血直接提供的有关胎儿染色体、宫内感染、代谢状况、内分泌状况及血液病学等相关因素的资料 ,是进行准确的胎儿宫内诊断不可替代的重要依据     

母血白细胞介素-6与早产亚临床绒毛膜羊膜炎及早产儿预后的关系

目的：探讨母血白细胞介素6（IL－6）与早产亚临床绒毛膜羊膜炎及早产儿预后的关系。方法：用酶联免疫吸附实验测定67例早产孕妇及32例相同孕周正常孕妇血IL－6，分娩时取部分胎盘胎膜送病检，记录1周内早产儿情况。结果：早产组血IL－6、WBC明显高于对照组（P＜0．05），组织学绒毛膜羊膜炎阳性组血清IL－6、C－反应蛋白（CRP）均明显高于组织学绒毛膜羊膜炎阴性组（P＜0．01）。母血IL－6≥10ng/L比IL－6＜10ng／L有较高的组织学绒毛膜羊膜炎和明显的新生儿发病率。结论：母血IL－6是预测早产亚临床绒毛膜羊膜炎及早产明显的新生儿发病率一项有用的指标。     

不同妊娠期骨代谢状况的研究

测定不同妊娠期孕妇血清及新生儿脐血游离钙（Ｃａ〕、骨型酸性磷酸酶（ＴＲ－ＡＣＰ）及碱性磷酸酶（ＡＬＰ），并与非妊娠妇女进行对照。结果显示：对照组、妊娠早中期组、妊娠晚期组及新生儿组游离Ｃａ分别为１．１６±０．０７、１．１３±０．０７、１．０９±０．１１、１．２５±０．０６ｍｍｏｌ／Ｌ，并随孕周增加而明显下降。新生儿组游离Ｃａ值显著高于妊娠晚期组（Ｐ＜０．０１）。提示：胎盘逆浓度主动转运游离Ｃａ，同时ＴＲ－ＡＣＰ、ＡＬＰ活性随孕周增加而升高，说明孕妇骨代谢非常活跃。     

应用PTC针取胎儿血进行产前诊断49例临床分析

目的 应用PTC针胆带穿刺取胎儿血进行产前诊断,评价其安全性及准确性,探索穿刺技巧。方法 用PTC穿刺针在超声引导下对49例经遗传咨询筛选符合宫内诊断指征者进行了51次脐带穿刺术。结果 穿刺成功率94.1(48/51),最终取血成功率为98.0%(48/49),发现染色体平衡易位3例,21三体1例,甲型血友病1例,宫内CMV感染伴胎儿异常1例,亲子鉴定非丈夫血缘1例,结论 使用PTC穿刺针进行脐带穿刺有较高的准确性及成功率,是较为有效的产前诊断方法。     

孕妇缺铁性贫血561例调查及体内铁状况分析

目的：调查了解孕妇体内铁代谢状况及影响贫血发生的因素，提出预防措施。方法：对561例孕妇进行血红蛋白（Hb）、血清铁（Fe）、血铁蛋白（SF）、运铁蛋白饱和度（TS）、血锌卟啉（ZPP）进行测定，并对有关影响因素实行专人问卷调查。结果：妊娠缺铁性贫血的发生率为17．29％，随着孕周的进展贫血发生率增高，孕20周后贫血发生率上升显著，SF、Fe、TS下降明显，孕28－36周时贫血发生率最高达29．91％，铁缺乏症发生率高达82．05％，此阶段孕妇的Fe、SF、TS降至最低，处于贮铁耗尽状态，ZPP显著上升。结论：建议对孕妇的补铁可从孕2周后开始。孕28周后Hb＜105g/L时可考虑诊断缺铁性贫血并予以干预治疗。     

超声引导下脐静脉穿刺术在先天畸形胎儿产前诊断中的应用

目的:探讨超声引导下脐静脉穿刺术在先天畸形胎儿产前诊断中的应用价值及安全性。方法:产前检查中B超提示胎儿畸形的孕妇27例,进行超声引导下脐静脉穿刺术,对所抽取的脐静脉血进行核型分析。结果:超声引导下脐静脉穿刺术穿刺成功率为96.3%(26/27),1例穿刺失败,在26例成功病例中一次性穿刺成功率为80.8%(21/26)。27例穿刺术中发生一过性并发症1例,为脐血管穿刺点渗漏;所有患者均未发生流产、早产、胎死宫内、宫内感染等严重并发症。26例终止妊娠,病理检查20例为单发畸形,6例为多发畸形,1例足月分娩一侧腋下畸胎瘤患儿,术后患儿恢复良好。染色体核型分析成功24例,其中6例为染色体异常,阳性率为25%。结论:超声引导下脐静脉穿刺术操作简单、成功率高、安全性高,在先天畸形胎儿产前诊断中有较高的应用价值。     

孕妇B族溶血性链球菌带菌与母婴预后的关系

目的 调查孕妇Ｂ族溶血性链球菌（ＧＢＳ）带菌率。探讨ＧＢＳ带菌与产科不良妊娠结局的关系。方法 对１０３９便孕妇于不同时期孕２０周前;孕２０－２８周：孕３４周以后）的阴道分泌物及产时标本（新生儿咽、耳、脐、胎盘、母血）,用３％ＴＨ肉汤选择性增菌培养基进行ＧＢＳ培养。结果 （１）１０３９例孕妇中ＧＢＳ带菌率１１．０７？％。筛查３次的ＧＢＳ阳性率为２９．７３％,显著高于筛查２次者（１５．５０％,Ｐ〈０．     

各孕期产前诊断取材技术的临床应用

目的:探讨各孕期产前诊断取材技术的准确性、安全性,研究提高取材成功率和减少并发症的方法。方法:在妊娠7~12周,超声引导下行绒毛吸取术28例;妊娠14~22周超声引导下行羊膜腔穿刺术50例;妊娠22~37周超声引导下行脐带穿刺术123例。结果:绒毛吸取术、羊水穿刺、脐带穿刺的成功率分别为96.4%(27/28)、100%(50/50)、93.5%(115/123)。在201例中发现3例21三体、1例18三体、1例Turner综合征;4例绒毛性别鉴定男性胚胎;9例Ⅷ因子<40%;2例检测到CMV-DNA;1例CMV-IgM阳性并心肌酶谱高于正常;亲子鉴定非丈夫血缘3例;1例DMD,共25例(绒毛5例、羊水2例、胎儿血18例),得出产前诊断结果后终止妊娠。占所有产前诊断病例的12.4%(25/201)。另诊断出2例非同源染色体平衡易位;3例非同源染色体罗氏易位。结论:根据孕周和产前诊断指征选择恰当的取材时机,在不同孕周取得胎儿不同标本,按照本研究的方法可以提高产前诊断取材的准确率和成功率。     

Pathologic aspects of the umbilical cord after percutaneous umbilical blood sampling

Percutaneous umbilical blood sampling (cordocentesis) appears to be a valuable new procedure for prenatal diagnosis. In order to evaluate whether focal injury of the umbilical vessels caused by the needle puncture is potentially harmful, we completely examined 50 umbilical cords collected between 1 hour and 20 weeks after cordocentesis. Macroscopic evidence of the needle entry was found in 37 cases, including one giant hematoma of the cord. Within 48 hours after the procedure, microscopic examination of transverse sections taken at the puncture site revealed distinct perforation of the vessel wall, associated in four cases with a small hematoma encircling the vessel. One week after cordocentesis, the vessel wall was partially reformed. There were no histologic differences between needle entry in a vein or in an artery. No thromboses of the umbilical vessels were found.     

Efficacy and safety of cordocentesis for prenatal diagnosis.

OBJECTIVE: To assess the efficacy and safety of diagnostic cordocentesis. METHODS: Between January 1991 and May 2004, 2,010 cordocentesis were performed in the outpatient setting in 2,010 women with singleton pregnancies. A fixed needle guide and a 22-gauge percutaneous needle were used and no more than 2 attempts were allowed at 1 visit. In most cases, the umbilical vein was the target vessel. The results of each procedure and pregnancy outcomes were recorded and analyzed. RESULTS: The most frequent indication for cordocentesis was risk of severe thalassemia (59.0%), followed by a need for rapid karyotyping (30.0%). Most of the procedures (97%) were performed in the free cord loop and the remaining at the cord insertion. The overall success rate was 98.4%, with 80.0% of the successful procedures performed at the first needle insertion and the remaining 20% at the second insertion. Transient bleeding was observed at the puncture site in 19.8% of cases and transient fetal bradycardia in 4.9% of cases. The total fetal loss and cordocentesis-related loss rates within 2 weeks of cordocentesis were 2.7% and 1.0%, respectively, before 24 weeks of gestation and 1.9% and 0.8% after 24 weeks. The other obstetric complications were unremarkable. CONCLUSIONS: Cordocentesis is a simple, safe, and reliable procedure for prenatal diagnosis.     

Cordocentesis at 16-24 weeks of gestation: experience of 1,320 cases

The objective of this study was to assess the safety and efficacy of diagnostic cordocentesis at midpregnancy. 1,320 singleton pregnancies with no obvious congenital anomalies, a gestational age of 16-24 weeks, and proper indications underwent cordocentesis using the freehand technique. The results of each procedure was prospectively collected and subsequently analysed for the results and pregnancy outcomes. The mean maternal age was 31.1 years and the mean gestational age at the time of cordocentesis was 19.8 weeks. The most common indication was the risk of severe thalassaemia syndrome (69.8%) and was followed by rapid karyotyping. Of 1,320 cordocenteses, 1,281 (97%) were done successfully at the first attempt. The mean duration of the procedure was 10.5 min and was significantly longer in the first 50 cases of practice for each operator. The maternal blood contamination rate was higher when the cord insertion was targeted. The procedure-related complications included transient bleeding at puncture site (20.2%), transient fetal bradycardia (4. 3%), chorioamnionitis (two cases), and cord haematoma (one case). Of 1,281 successful cases, 184 fetuses had severe disease. The total fetal loss rate was 3.2% and the procedure-related loss was 1%. The other obstetric complications were comparable with those in the general population. We conclude that cordocentesis at midpregnancy is a useful, relatively safe, and effective procedure for prenatal diagnosis.     

Safety of fetal blood sampling by cordocentesis in fetuses with single umbilical arteries

OBJECTIVES: To examine the safety of cordocentesis in fetuses with single umbilical arteries. METHODS: Retrospective analysis of all cases of cordocenteses in fetuses with single umbilical arteries over a five-year period at one centre. We analysed the records for pregnancy details, outcomes, and procedure-related complications, and compared these to similar data for cordocenteses procedures performed, during the same period, for similar indications in fetuses with three-vessel cords. RESULTS: Twenty-nine eligible cases were identified. All procedures were performed for the indication of fetal structural abnormalities, and seven fetuses (24%) had abnormal karyotypes. The median gestational age at the time of the procedure was 21 weeks (range 19-34 weeks). There were no procedure-related fetal losses but the umbilical artery was inadvertently punctured in one case, resulting in prolonged bradycardia with spontaneous recovery. These outcomes compare favourably to those of a total of 134 cordocenteses procedures in fetuses with three-vessel cords. CONCLUSION: Cordocentesis in cases with single umbilical arteries does not appear to carry more risk than in cases with three-vessel cord, and should continue to be performed by adequately trained specialists when indicated. Extra care should be undertaken to avoid puncturing the umbilical artery.     

283例脐血管穿刺诊断胎儿染色体异常临床分析

目的:评价超声引导下脐血管穿刺术在产前诊断中的应用,探讨胎儿染色体异常的临床高危因素,提高脐血管穿刺对胎儿异常染色体核型的检出率.方法:选取在我院超声引导下经腹脐血管穿刺并行染色体检查的孕妇283例,进行染色体核型分析,比较不同产前诊断指征组的异常染色体检出率及相关因素分析.结果:穿刺成功率100%,胎儿脐血管穿刺的主要并发症为穿刺点出血33例(11.66%),胎心心动过缓5例(1.77%).共检出异常染色体核型25例,检出率8.83%.发现夫妇中有染色体异常与胎儿染色体异常存在相关性(r=22.348,P=0.000).结论:超声引导下经腹脐血管穿刺抽取脐血在产前诊断中是较成熟有效的操作技术.夫妇双方有染色体异常是进行产前诊断的必要指征.     

The association of umbilical cord hemangioma with fetal vascular birthmarks

OBJECTIVE: To report a rare case of umbilical cord hemangioma and to discuss its association with vascular birthmarks. METHODS: A case of umbilical cord hemangioma diagnosed by ultrasound at 28 weeks of gestation is reported. After labor induction at 38 weeks of gestation, a male infant was born. Examination of the newborn showed disseminated port wine flat skin lesions covering a significant part of his body. Reviewing the scientific literature revealed the association between umbilical cord hemangioma and fetal mortality and morbidity, in particular, vascular malformations. RESULTS: A total of 24 umbilical cord hemangioma cases were reported in detail. Of them, 37.5% were associated with perinatal mortality and 29.2% ended in the delivery of a normal healthy infant. Fetal morbidity was recognized in 33.3%. CONCLUSION: This case illustrates the importance of prenatal diagnosis of umbilical cord hemangioma for prenatal counseling.     

介入性产前诊断技术在双胎妊娠中的应用

目的 通过分析双胎妊娠产前诊断结果 及妊娠结局,探讨双胎介入性产前诊断技术的有效性及安全性.方法 超声介导下对有各种产前诊断指征的164例双胎妊娠行介入性产前诊断操作,包括羊膜腔穿刺(简称羊穿)111例、脐带穿刺(简称脐穿)53例,分析产前诊断结果,追踪术后并发症及妊娠结局.率的比较采用x2检验或Fisher精确概率法.结果 (1)共261个胎儿行染色体检查,染色体异常检出率为6.13%(16/261).(2)羊穿组与脐穿组的术后2周内胎儿丢失率分别为0.00%(0/191)、3.85%(3/78),P=0.024;总的胎儿丢失率分别为3.87%(6/155)和5.45%(3/55),P=0.618;早产率分别为51.22%(42/82)和38.71%(12/31),P=0.235.(3)产前诊断后18例双胎行选择性减胎术,其中2例自然流产,1例早产儿死亡,余15例均获一健康活婴.结论 (1)介入性产前诊断技术在双胎妊娠中有效可行,羊穿相对安全、简单,脐穿操作难度大、风险稍高.(2)双胎妊娠产前诊断后的中孕期选择性减胎术仍然是安全的,应根据其绒毛膜性质和胎儿异常的情况,选择合适的减胎方式.

Abstract：

Objective To evaluate the effectiveness and safety of invasive procedures of prenatal diagnosis for twin gestations through analysing the results and outcomes of twins.Methods Invasive prenatal diagnostic procedures guided by ultrasound were introduced to 164 twin pregnancies with various indications,including 111 amniocentesis,and 53 cordocentesis.The results of prenatal diagnosis,complications and outcomes of these twins were analyzed with Chi-square test or Fisher's exact test.Results (1) Chromosome was examined in 261 fetuses and 6.13% (16/261)had abnormal karyotypes.(2) Comparing amniocentesis with cordocentesis,the fetal loss rate within two weeks after the procedure were 0.00% (0/191) and 3.85% (3/78),respectively (P=0.024).The total fetal loss rate and preterm delivery rates in amniocentesis and cordocentesis group were 3.87% (6/155) and 5.45% (3/55),51.22% (42/82)and 38.71% (12/31),respectively (P=0.235and 0.618).(3) Selective feticide was performed on 18 cases after prenatal diagnosis.Fifteen cases had survival neonates,two cases suffered from spontaneous abortion,and two cases had preterm labor with neonatal death.Conclusions (1) Invasive prenatal diagnostic procedures are effective and feasible in twins.Amniocentesis is a relative safer and simpler alternative to cordocentesis,which demanding higher skill and carrying higher fetal loss rate.(2) Mid-trimester selective feticide after prenatal diagnosis appears safety.Before the procedure,the chorionicity and fetal condition should be considered,in order to choose suitable feticide procedures.     

Sonographic atypical vascular coiling of the umbilical cord

OBJECTIVE: To investigate whether an atypical umbilical coiling pattern at prenatal sonography is associated with adverse pregnancy outcome. METHODS: A targeted sonographic evaluation of the umbilical cord (UC) was performed in 758 women with singleton gestation, and gestational age above 20 weeks. Atypical coiling was defined as the presence of a spring-shape UC (supercoiling) or an unusual, aperiodic coiling pattern (uncoordinated coiling). Umbilical artery Doppler assessment was conducted in cases with atypical coiling. Pregnancy and neonatal outcomes were investigated. RESULTS: Of the study population, 7 and 16 fetuses had an umbilical cord with uncoordinated coiling and supercoiling respectively. Three umbilical cords had a single umbilical artery. Eight patients delivered before 34 weeks of gestation. Eight fetuses were growth restricted. In seven cases, abnormal sonographic findings were detected (three meconium peritonitis, two severe hydronephrosis and two cardiac anomalies). One fetus affected by trisomy 18 presented multiple anomalies. Perinatal death occurred in three cases. Of the surviving newborns, eight were admitted to NICU. Umbilical artery Doppler waveforms presented a systolic notch in seven (30.4%) cases. CONCLUSIONS: The presence of an atypical umbilical cord vascular coiling is associated with an increased risk of unfavourable pregnancy outcome. The identification of an umbilical artery notch at Doppler investigation is frequently associated with an atypical UC coiling pattern.