Fetal intracardiac transfusions in patients with severe rhesus isoimmunisation

Six patients with pregnancies of 19-31 weeks' duration showing evidence of erythroblastosis fetalis were treated with 25 fetal intracardiac blood transfusions. Complications related to the procedure occurred on five occasions in three patients. In two of the six patients the fetus died, but it was unlikely that death was related to the intracardiac transfusions. Fetal intracardiac blood transfusion may result in potentially severe complications but offers an alternative when transfusion cannot be performed into the umbilical cord.     

Fetal circulation during epidural analgesia for caesarean section

Fetal blood flow was examined during epidural analgesia in six women with uncomplicated pregnancies undergoing elective caesarean section. A non-invasive, ultrasonic technique was used to measure blood flow in the fetal descending aorta and intra-abdominal part of the umbilical vein before induction of analgesia with etidocaine and bupivacaine and 15 and 30 minutes afterwards. No appreciable change in fetal blood flow was observed.     

Fetal haematology in rhesus isoimmunisation

Haematological studies were carried out in pure fetal blood samples obtained fetoscopically in 29 rhesus isoimmunised pregnancies at 18-24 weeks' gestation, and the values were compared with those obtained in 62 normal control pregnancies. Fetal reticulocytosis or erythroblastaemia was seen only in association with a haemoglobin concentration of 4 g/dl or less. Ten of the 14 fetuses with a haemoglobin concentration below 4 g/dl showed ultrasonographic evidence of hydrops.     

Risk of minor and major fetal malformations in diabetics with high haemoglobin A1c values in early pregnancy

Maternal haemoglobin A1c (HbA1c) values were measured before the end of the 15th week of gestation in 142 pregnancies in women with insulin dependent diabetes. In pregnancies complicated by fetal malformations (n = 17) the mean initial HbA1c value was 9.5 (SD 1.8)% of the total haemoglobin concentration, which was significantly (p less than 0.001) higher than in pregnancies without malformations (8.0 (SD 1.4)%; n = 125). HbA1c values did not differ between pregnancies complicated by minor and major fetal malformations, but the rate of malformations showed a positive relation to the HbA1c value in early pregnancy (chi 2 = 11.9; p = 0.001). Fetal malformations occurred in six out of 17 pregnancies (35.3%) in mothers whose initial HbA1c value was 10% or more, in eight out of 62 pregnancies (12.9%) in mothers with initial values between 8.0% and 9.9%, and in only three out of 63 pregnancies (4.8%) in mothers with an initial value below 8.0%. These data support the hypothesis that the increased incidence of fetal malformations in mothers with insulin dependent diabetes is associated with maternal hyperglycaemia during organogenesis. Hence diabetic women who are planning to have a child--especially those with a high HbA1c value--should receive intensified metabolic control.     

Essential hypertension and pregnancy.

Approximately 1% of pregnancies are complicated by essential hypertension. During pregnancy the blood pressure often stabilizes or improves. In patients with sustained hypertension, prospective controlled studies have demonstrated enhanced fetal survival when the blood pressure was controlled with antihypertensive medication. Such medication must be chosen carefully to avoid fetal and mateerial toxicity, and diuretics and salt restriction during pregnancy should be avoided. Among patients with essential hypertension the problem accelerates late in pregnancy in 2% to 11%; the acceleration may be predicted by determination of maternal mean arterial pressures and intravascular volumes early in pregnancy. The treatment of accelerated hypertension is identical to that of severe pre-eclampsia. Fetal loss is considerable but can be lessened by careful fetal and maternal monitoring and early controlled delivery. The risks of pregnancy in most patients with essential hypertension are small, and essential hypertension is not a uniform contraindication to pregnancy.     

Experience with fetal monitoring in a university teaching hospital.

Fetal monitoring during labour may be expected to decrease perinatal losses and the number of infants born with brain damage. In a prospective study of intrapartum fetal monitoring in selected high-risk pregnancies in a Winnipeg hospital the monitoring rate was 26.5% and the cesarean section rate in the monitored group was 22.0%. The fetal outcome in the monitored group was better than in the unmonitored group. The establishment of a fetal intensive care unit is believed to be strongly desirable in improving fetal surveillance during labour. Fetal monitors should be stationed in the delivery room as well as in the first-stage room.     

脐带异常174例临床分析

探讨脐带异常的临床表现和产前预测的可能性。方法 :比较脐带正常与脐带异常在分娩方式、羊水性状及新生儿Apgar评分差异 ,以及脐带异常在胎心监护和彩色B超监测的预测值和准确率。结果 :脐带异常发生率为 18.2 0 % ,其中以脐带缠绕发生率占脐带异常的绝大部分 (87.93 % )。初产妇、过期妊娠脐带异常发生率最高。脐带异常发生羊水污染、剖宫产及新生儿低评分均明显高于脐带正常者 (P <0 .0 5 )。胎心监护阳性预测值、准确率分别为 87.2 8%、84.5 5 % ;彩色B超阳性预测值、准确率分别为 95 .15 %、97.92 %。结论 :脐带异常对围产儿存在严重危害。在产前应用胎儿监护、B超预测脐带异常有较高的阳性预测值和准确率。结合临床其它因素可为母婴提供最大的安全保障。     

Use of the lambda sign in fetal reduction of dizygotic triplets after intracytoplasmic sperm injection

With the increased use of artificial reproductive technologies, there are ever greater numbers of multifetal pregnancies. The increased incidences of monozygotic twins and triplet gestations can be attributed to several factors. It is important to differentiate the chorionicity in the management of multifetal pregnancies because monochorionic gestations lead to an increased risk of prematurity, twin-to-twin transfusion, morbidity, and mortality. In a dizygotic triplet pregnancy, increased risks of obstetric complications result from the monozygotic twins, such as twin-to-twin transfusion, as well as from the presence of triplets. Fetal reduction can lower these risks. During the first trimester, a "lambda sign" on ultrasound can differentiate between monozygotic twins and a separate fetus. In this paper, we present selective fetal reduction of 1 of the monozygotic twins in order to reduce the risks resulting from either monozygotic twins or from triplets. By sacrificing 1 monozygotic twin, we believe the quality of life of the remaining babies in this case were improved.     

Outcomes following selective fetoscopic laser ablation for twin-to-twin transfusion syndrome: a single-centre experience

INTRODUCTIONFetoscopic laser photocoagulation (FLP), a treatment option for twin-to-twin transfusion syndrome (TTTS) in monochorionic twin pregnancies, is currently the treatment of choice at our centre. We previously reported on our experience of FLP from June 2011 to March 2014. This paper audits our fetal surgery performance since then.METHODS15 consecutive patients who underwent FLP for Stage II–III TTTS before 26 weeks of gestation from June 2011 to January 2017 were retrospectively reviewed, consisting of five cases from our initial experience and ten subsequent cases. Perioperative, perinatal and neonatal outcomes were analysed.RESULTSOf 15 pregnancies, 10 (66.7%) and 5 (33.3%) were for Stage II and III TTTS respectively, with FLP performed at an earlier Quintero stage in the later cohort. Overall mean gestational ages at presentation, laser and delivery were comparable between the cohorts at 19.7 (15.4–24.3) weeks, 20.3 (16.3–25.0) weeks and 31.2 (27.6–37.0) weeks, respectively. 2 (13.3%) cases had intra-amniotic bleeding and 1 (6.7%) had iatrogenic septostomy. 1 (6.7%) case had persistent TTTS requiring repeat FLP, and another (6.7%) had preterm premature rupture of membranes at seven weeks post procedure. The overall perinatal survival rate was 21 (75.0%) out of 28 infants. One mother underwent termination of pregnancy for social reasons at 1.4 weeks post procedure. Double survival occurred in 8 (57.1%) out of 14 pregnancies, while 13 (92.9%) had at least one survivor.CONCLUSIONFLP requires a highly specialised team and tertiary neonatal facility. Continual training improves maternal and perinatal outcomes, ensuring comparable standards with international centres.     

Prenatal asphyxia, hyperlacticaemia, hypoglycaemia, and erythroblastosis in growth retarded fetuses

The umbilical venous oxygen and carbon dioxide tensions, pH, lactate and glucose concentrations, nucleated red cell (erythroblast) count, and haemoglobin concentration were measured in 38 cases of intrauterine growth retardation in which fetal blood sampling was performed by cordocentesis. The oxygen tension was below the normal mean for gestational age in 33 cases; in 14 it was below the lower limit of the 95% confidence interval for normal pregnancies. The severity of fetal hypoxia correlated significantly with fetal hypercapnia, acidosis, hyperlacticaemia, hypoglycaemia, and erythroblastosis. These findings indicate that "birth asphyxia" is not necessarily due to the process of birth.     

动态监测脐动脉血流及胎心监护在高危孕妇的胎儿窘迫诊断中的应用

目的探讨动态监测胎儿脐动脉血流及胎心监护在高危孕妇胎儿窘迫诊断中的应用价值。方法对2010年1月～2011年12月在我院产科住院的300例高危妊娠孕妇行脐动脉血流s／D值测定及胎心监护监测。并比较分娩后胎儿宫内窘迫发生率、羊水情况、新生儿Apgar评分及脐带绕颈率。结果S／D值≥3、胎心监护异常时,产时（Ⅳ组）在羊水过少发生率（66．7％）、胎儿窘迫发生率（43_3％）、新生儿Apgar评分（48．3％）均明显高于胎心监护及S／D比值正常的孕妇（I组）（47．2％、27_3％、27．3％）。而脐带绕颈在剖宫产发生产时胎儿窘迫也显著高;于胎心监护及S／D比值正常组（I组）（35．0％vs18．2％、66．7％vs44．9％）。Ⅱ组羊水过少发生率（52．0％）、胎儿窘迫发生率（32．O％）、羊水污染发生率（Ⅱ～Ⅲ°）（28．0％）及剖宫产率（60．0％）均高于I组（47．2％、27．3％、18．8％、44．9％）,但差异无统计学意义。Ⅱ组脐带绕颈率明显低于I组（4．0％vs18．2％）,差异有统计学意义,而Ⅱ组剖宫产率（60．0％）高于Ⅲ组（51．3％）,差异无统计学意义。而脐动脉S／D值与胎心监护联合应用在诊断胎儿窘迫的灵敏度、特异度、阳性率与阴性率均较脐动脉S／D值或者胎心监护单独使用有明显升高。结论胎心监护与脐动脉血流S／D值联用能明显提高胎儿窘迫的判断率,对于改善围产儿预后具有积极的临床意义。     

彩色多普勒超声诊断胎儿脐带绕颈250例分析

目的探讨彩色多普勒超声对胎儿脐带绕颈诊断的价值。方法应用彩色多普勒超声对250例胎儿脐带绕颈进行诊断并检测胎儿脐动脉血流参数,与临床分娩结果进行对照分析。结果250例彩色多普勒超声诊断脐带绕颈中,产时有脐带绕颈243例,诊断符合率97．2％;胎儿脐动脉S／D比值〉3．0,RI〉0．8的17例,其中9例经孕妇吸氧后好转,7例即行剖宫产,1例胎儿于产前死亡。结论彩色多普勒超声诊断胎儿脐带绕颈准确率高,对围产期保健和临床选择分娩方式等具有重要的指导意义。     

生物物理相评分及脐动脉S/D值与妊娠期高血压疾病围产儿预后的关系

目的： 探讨生物物理相评分（BPS）、脐动脉血流S/D值与妊娠高血压疾病围产儿预后的关系.方法： 采用B超、胎儿电子监护仪对45例妊娠高血压孕妇产前行生物物理相评分,监测脐动脉血流S/D值,并分析其结果. 结果： 生物物理相评分和脐动脉血流S/D值与妊娠高血压疾病围产儿预后有相关性,其中生物物理相评分与其相关性更大. 结论： 生物物理相评分与脐动脉S/D值联合监测可提高胎儿宫内缺氧状态的诊断率, 胎儿肌张力监测更具敏感性,为临床及时纠正宫内缺氧和胎儿预后的估计提供可靠依据.     

FGR孕妇血清皮质醇浓度与胎盘11β-HSD2表达水平的关系

目的:探讨FGR孕妇及胎儿脐血清皮质醇浓度的改变与胎盘组织11β-HSD2表达水平间的关系。方法:用放射免疫法测定孕妇及脐血清皮质醇浓度;用免疫组织化学方法结合计算机多媒体彩色病理图像分析技术测定胎盘组织11β-HSD2表达水平;实验所的数据均经SPSS统计软件分析处理。结果:FGR组孕妇及胎儿脐带血清皮质醇浓度和胎盘组织11β-HSD2表达水平明显高于对照组(901.07±365.15vs602.96±237.24;552.75±205.02vs155.40±66.20;101.33±33.48vs135.13±29.951);孕妇血清皮质醇浓度与胎儿脐血清皮质醇浓度呈正相关(r=0.817,P<0.01);孕妇及胎儿脐血清皮质醇浓度与胎儿体重呈负相关(r=-0.388,P<0.05;r=-0.588,P<0.01);胎儿脐血清皮质醇浓度与胎盘组织11β-HSD2表达水平呈负相关(r=-0.385,P<0.05);胎盘组织11β-HSD2表达水平与胎儿体重呈正相关(r=0.649,P<0.01)。结论:母体孕期高浓度的血清皮质醇经胎盘灭活减少,使胎儿血清皮质醇浓度增高导致胎儿宫内发育迟缓。血清皮质醇浓度升高及胎盘组织11β-HSD2表达水平下降是导致FGR的病因之一。     

CONSERVATIVE MANAGEMENT OF TWIN PREGNANCY WITH SINGLE FETAL DEATH

Objective. Analysis of the cause of intrauterine death of one fetus of twin and to evaluate the outcome of conservative management of twin pregnancy with single fetal death. Method. A retrospective review was undertaken on PUMC hospital records of women who delivered twin between Jan. 1987 and Dec. 1998. Result. During the recent 12 years, 99 pregnant women were documented as twin pregnancies. Of the twin pregnancies during this period, 13 were complicated by a single intrauterine death. Four women suffered this complication during their first trimester. In the remain 9 cases one fetus died dm-ing second or third trimester.The cesarean section was given in three pregnant women soon after a single intrauterine death because of the survival fetal distress. No consumptive coagulopathy was apparent in all 13 pregnant women. It is wise that the pregnancy was managed conservatively, with regular coagulation parameters obtained. Condosion. Our results suptmrt conservative management in twin pregnancies complicated by single fetal death.     

妊娠晚期胎儿脐动脉及大脑中动脉血流在胎儿缺氧中的价值

目的:预测胎儿宫内缺氧。方法:应用彩色多普勒超声检测我院130例晚期妊娠孕妇胎儿脐动脉(UMA),大脑中动脉(MCA)的血流速度波形,评估胎儿宫内缺氧状况,产后防视新生儿结局。结果:胎儿大脑中动脉S/D.R I在宫内缺氧的胎儿,大脑中动脉阻力指数显著降低,而脐动脉阻力指数明显升高。若以大脑中动脉S/D(4,R I(0.6,脐动脉S/D(4.R I(0.7预测胎儿缺氧有明显的临床使用价值。结论:产前监测胎儿UMA.MCA的血流指数,可以了解胎儿胎盘循环、胎儿颅脑循环及周围循环状态,预测胎儿宫内缺氧状况。     

分娩方式对新生儿脐血儿茶酚胺水平的影响

目的 比较不同分娩方式对新生儿脐动、静脉血浆儿茶酚胺类激素水平的影响.方法 新生儿共150例,分为正常新生儿组(90名)及胎儿窘迫组(60例).再根据分娩方式的不同分为5组,各30例,分别为阴道分娩组、分娩镇痛组、择期剖宫产组、阴道助产组(施行低位产钳助产术)和急诊剖宫产组.于胎儿娩出断脐后立即采集脐动、静脉血各3 ml,分别置于抗凝管中,即刻离心,分离血浆,采用酶联免疫吸附剂测定(ELISA)法分别测定血浆去甲肾上腺素(NE)、肾上腺素及多巴胺的水平.结果 (1)各组脐动脉血NE及肾上腺素水平差异均有统计学意义(均P＜0.01),其中阴道助产组最高[(73±6) ng/L,(37.8±1.8)ng/L],其次为急诊剖宫产组、阴道分娩组及分娩镇痛组,择期剖宫产组最低[(35±5)ng/L,(27.2±1.2) ng/L].多巴胺水平阴道助产组[(33.7±4.5) ng/L]及急诊剖宫产组[(32.9±4.5) ng/L]高于其他各组,差异均有统计学意义(均P＜0.01);(2)各组脐静脉血NE及肾上腺素水平差异均有统计学意义(均P＜0.01),且高低顺序与脐动脉一致.阴道助产组及急诊剖宫产组多巴胺水平比其他各组高,差异均有统计学意义(均P＜0.01).(3)无论脐动、静脉,胎儿窘迫组NE、肾上腺素、多巴胺水平均高于正常新生儿组,差异有统计学意义(P＜0.01),胎儿窘迫组生后1、5 及10 min Apgar评分均低于正常新生儿组,差异有统计学意义.结论 对于无剖宫产指征的个体,阴道分娩可提高新生儿脐血儿茶酚胺类激素的水平,分娩期自控硬膜外镇痛可抑制新生儿应激反应;与正常新生儿相比,胎儿窘迫者脐血儿茶酚胺水平较高,既是新生儿提高自身对缺氧耐受力的表现,也是其缺氧状态的客观反映.     

脐血液动力学指标在围产儿预后预测中的意义

目的：探讨脐血流阻力指标(S／D、PI、RI)在正常与高危妊娠中的变化及其与围产儿预后的关系。方法：1998年3月至1999年3月住院的正常与高危产妇共计110例,均于产前1周内行多普勒超声检查,并统计相关临床资料。结果：高危妊娠时脐血流阻力指数较正常时明显升高,各组中S／D值超过警戒值(2.20)及危险值(2.66)者围产儿预后不良发生率较S／D值正常者显著升高。结论：彩色多普勒超声测定脐血流阻力指数是一种简便、无创、有效的围产期监测手段,以S／D值2.20为警戒线;S／D值2.66为危险线可能更有助于胎儿缺氧的早期诊断,确保围产儿安全。     

超声多普勒测定妊娠高血压综合征脐动脉血流评价

应用脉冲多普勒技术测定了正常妊娠妇女和妊娠高血压综合征妇女(以下简称妊高征)各40例的脐动脉多普勒血流速波收缩期振幅/舒张期振幅(S/D)的比值和阻力指数(RI)。结果表明妊高征组中6例S/D≥3(检出率15％),7例出生儿结果不良(检出率17.5％),3例胎儿宫内发育迟缓(检出率7.5％)。说明这是一项监护高危妊娠胎儿预后的简便方法。     

妊娠晚期胎儿脐带绕颈的联合监护情况分析

目的:探讨胎儿脐带绕颈的孕妇妊娠晚期应用彩超、脐血流速度测定和胎心无负荷试验联合监护,判断胎儿预后的价值。方法:应用彩超确诊为胎儿脐带绕颈并测定脐动脉血流速度S/D值和胎心无负荷试验NST ,比较分析2 13例胎儿脐带绕颈孕妇(观察组)和2 2 0例无胎儿脐带绕颈孕妇(对照组)妊娠晚期情况。结果:观察组NST无反应型、可疑型或S/D值≥3发生率,比对照组明显增高(P <0 . 0 1) ,胎儿宫内窘迫和剖宫产发生率明显增高(P <0 .0 1) ,但两组新生儿重度窒息发生率无显著性差异(P >0 . 0 5 )。结论:脐血流参数测定S/D值与胎心NST联合应用,可以提高脐带绕颈胎儿宫内缺氧状态的诊断,为临床及时纠正宫内缺氧和选择分娩方式提供可靠依据