羊水肌酐、乳酸对羊水粪染胎儿窘迫的预测价值

目的:通过检测羊水肌酐、乳酸水平,探讨其对预测羊水粪染病例胎儿窘迫的价值。方法:采用济南市妇幼保健院剖宫产分娩的122例孕妇,其中羊水粪染54例为研究组,羊水清、产前监护无胎儿缺氧表现的78例为对照组。测定羊水。结果:①研究组羊水中肌酐水平、水平乳酸高于对照组,有统计学意义(P<0.05);乳酸水平、肌酐水平在羊水Ⅲ度粪染组与对照组有统计学意义,Ⅰ度及Ⅱ度粪染组与对照组无统计学意义。②对照组肌酐、乳酸频数分布显示其值接近正态分布曲线,羊水乳酸95%的参考值为2.80～6.99mmol/L,羊水肌酐为45.04～201.84μmol/L,以羊水乳酸值>6.99mmol/L诊断羊水粪染病例发生胎儿窘迫的敏感性为56.2%,特异性为83.3%,阳性预测值及阴性预测值分别为62.5%和55.5%。以羊水肌酐值>201.84μmol/l诊断羊水粪染病例发生胎儿窘迫的敏感性为82.4%,特异性为89.12%,阳性预测值及阴性预测值分别为89.12%和91.43%。结论:羊水乳酸、肌酐值测定对提高羊水粪染病例胎儿窘迫的诊断准确性有一定的临床价值,以羊水肌酐值的敏感性和特异性为高。     

活跃期羊水乳酸水平对单纯胎心基线变异性降低胎儿窘迫的预测价值

目的探讨活跃期羊水乳酸水平对单纯胎心基线变异性降低胎儿窘迫预测价值。方法暨南大学第二附属医院2004年5月至2008年9月,选择162例在活跃期胎心电子监护中出现单纯胎心基线变异性降低的足月、单胎、头位的初产妇,随机分为研究组82例,胎心电子监护同时经阴道取羊水测定乳酸水平;对照组80例仅行胎心电子监护。比较两组的剖宫产率、胎儿窘迫发生率及研究组脐动脉血pH值与出生前1h内羊水乳酸值的相关性。结果研究组脐动脉血pH值与出生前1h内羊水乳酸水平具有明显的负相关性(r=-0.752,P<0.01)。研究组17例脐动脉血pH<7.20者羊水乳酸水平为(11.06±1.82)mmol/L,较脐动脉血pH≥7.20者羊水乳酸水平(7.45±1.19)mmol/L明显升高(P<0.05)。研究组剖宫产率为35.4%,明显低于对照组的52.5%,两者比较差异有统计学意义(P<0.05);研究组脐动脉血pH<7.20发生率较对照组明显降低(分别为20.7%和36.2%),差异有统计学意义(P<0.05);羊水乳酸值>8.9mmol/L为异常值诊断单纯胎心基线变异性降低胎儿窘迫的敏感度、特异度、阳性预测值及阴性预测值分别为82...     

羊水乳酸水平及胎心监护预测胎儿窘迫的价值

目的　探讨羊水乳酸水平及胎心监护图形预测胎儿窘迫的价值。方法　 2 0 0 3年 8月至 2 0 0 4年 8月暨南大学医学院第二附属医院测定 90例第一产程活跃期出现不良胎儿监护图形 (观察组 )和 10 0例正常胎儿监护图形 (对照组 )的羊水及新生儿脐动脉血乳酸水平 ,其中对照组 30例同时进行母血、脐血及羊水乳酸水平检测。结果　脐血乳酸水平明显高于母血乳酸水平 ,但较羊水为低 (P <0 0 1)。羊水与脐血乳酸水平存在正相关关系(r =0 92 3,P <0 0 1) ,而母血与脐血乳酸水平无相关关系 (r =- 0 15 7,P >0 0 5 )。观察组中自然分娩率低于对照组 (P <0 0 1) ,剖宫产率及新生儿窒息率均高于对照组 (P <0 0 5 )。胎儿监护异常减速羊水乳酸水平为(10 6 0± 1 6 9)mmol/L ,明显高于对照组的 (7 18± 0 91)mmol/L(P <0 0 1) ,轻度变异减速及心动过速羊水乳酸水平分别为 (7 5 0± 1 4 6 )mmol/L ,(7 36± 1 14 )mmol/L ,与对照组比较 ,差异无显著性意义 (P >0 0 5 )。结论　胎儿监护异常减速与胎儿窘迫密切相关。羊水乳酸水平可望成为一种简便、有效的判断胎儿窘迫的生化指标。     

羊水胎粪污染与胎儿窘迫

羊水胎粪污染与胎儿窘迫刘维超，蒋殷宗，顾美礼，邓丽波长期以来，临床上多以羊水中有无粪染及粪染程度判断胎儿预后。但Ｙｅｏｍａｎｓ等￣［１，２］则持不同看法。为了解羊水粪染及其程度对胎儿的影响究竟如何，对我院５年来在产程中出现羊水粪染并行胎心监护的产妇进...     

妊娠晚期羊水指数与最大羊水暗区垂直深度预测不良妊娠预后的比较

目的比较妊娠晚期应用羊水指数(AFI)≤5cm及最大羊水暗区垂直深度(MVP)≤2cm诊断羊水过少,在预测不良妊娠预后中的价值。方法回顾性分析妊娠37~41周+6经彩超诊断羊水过少并分娩的单胎孕妇688例的临床资料。观察胎儿窘迫、羊水胎粪污染、新生儿窒息、新生儿入重症监护室(NICU)及新生儿脐血pH值。结果 AFI≤5cm组胎儿窘迫、羊水粪染、监护异常、新生儿窒息及新生儿入NICU率与MVP≤2cm组比较,差异均无统计学意义(P0.05);AFI≤5cm羊水过少孕妇中,妊娠41~41周+6组胎儿窘迫(29.0%和14.9%,P=0.01)及羊水粪染发生率(22.6%和7.9%,P=0.001)较妊娠37~40周+6组高。以MVP≤2cm为羊水过少诊断标准,得到相同的结果。结论妊娠41~41周+6孕妇以MVP≤2cm为羊水过少诊断标准,可以避免过度诊断,且不改变妊娠预后。     

羊水胎粪污染的产科处理方法探讨

目的 探讨羊水胎粪污染的产科处理时机与方法。方法 对1998年1月至1998年12月在我院分娩的、产程中羊水为Ⅱ～Ⅲ度污染的220例初产妇的母婴结局进行回顾性分析,其中破膜时羊水粪染(Ⅰ组)有120例,产程中羊水由清亮变为污染(Ⅱ组)有100例;另随机选择同期产程中羊水清亮的210例产妇为对照组。结果 1254例产妇中,羊水胎粪污染的发生率为17.5％;粪染组在母体合并症、胎心监护异常发生率、剖宫产率及新生儿窒息率上均高于对照组(P<0.01);Ⅱ组在胎心监护异常及新生儿窒息的发生率上高于羊水粪染Ⅰ组(P<0.01)。结论 重视羊水粪染的临床处理。在伴发母体合并症、胎心监护异常及产程中羊水由清亮变为粪染时处理需积极,以及早剖宫产及缩短第二产程为宜。在无上述情况下,可在严密监护下阴道分娩。     

新生儿窒息与羊水粪染的关系

对８７ 例孕龄３７ ～４２ 周新生儿窒息及其羊水状况、胎心电子监护进行分析, 探讨新生儿窒息与羊水粪染的关系。结果：新生儿窒息与羊水粪染有关。新生儿重度窒息组为Ⅲ度羊水粪染比例高,而新生儿轻度窒息组为Ⅰ、Ⅱ度羊水粪染比例高（ Ｐ＜ ０ ．０５） ; Ⅲ度羊水粪染者胎心电子监护的异常发生率显著高于Ⅰ、Ⅱ度羊水粪染者（ Ｐ ＜ ０ ．０１） ;胎心电子监护对新生儿窒息的阳性预测率为２９ ．０９ ％ （１６／５５） 。结论：新生儿窒息的发生与羊水粪染程度密切相关。出现Ⅲ度羊水粪染应立即结束分娩, 出现Ⅰ、Ⅱ度羊水粪染时必须在胎心电子监护下密切观察产程进展, 一旦出现异常尽快结束分娩,以降低新生儿窒息的发生率。     

羊水Ⅲ度污染产后新生儿不良结局分析

目的探讨羊水Ⅲ度污染对新生儿的影响.方法 1999年9月至2004年3月清华大学附属玉泉医院住院分娩者共发生胎儿窘迫256例,其中以羊水Ⅲ度污染119例为观察组,其余137例为对照组,观察产后新生儿窒息等不良结局的发生率.结果羊水Ⅲ度污染组新生儿窒息率(16.8%)、新生儿肺炎率(13.5%)、缺氧缺血性脑病发生率(2.5%)均高于对照组(8.0%、6.6%、0.7%)(P＜0.05),羊水Ⅲ度污染组的新生儿窒息、新生儿肺炎、缺氧缺血性脑病等发生率与其分娩方式无关.结论羊水Ⅲ度污染,对新生儿有严重不良影响,须高度重视并尽快结束分娩,以减少新生儿不良结局的发生.     

血气分析对羊水Ⅲ度粪染新生儿胎粪吸入综合征的预测价值

目的:探讨脐动脉和桡动脉血气分析对羊水Ⅲ度粪染新生儿胎粪吸入综合征(MAS)的预测价值。方法:选择2010年7月至2012年7月无合并症的足月羊水Ⅲ度粪染新生儿100例作为粪染组。随机选择同期分娩的230例足月妊娠无合并症羊水清的新生儿作为对照组。结果:①粪染组脐动脉血pH 7.21±0.11、HCO322.56±3.47 mEq/L都明显低于对照组7.26±0.07、23.83±2.19 mEq/L,差异有统计学意义(P0.01)。粪染组脐动脉血PaCO255.74±9.96 mmHg、BE-5.44±4.62 mmol/L均明显高于对照组52.94±8.01 mmHg和-3.18±2.51 mmol/L,差异有统计学意义(P0.01)。②桡动脉血pH7.30新生儿MAS发生率为73.08%,与桡动脉血pH≥7.30新生儿MAS发生率22.97%比较,差异有统计学意义(P0.01)。以桡动脉血pH7.30为异常指标预测MAS发生的阳性预测值为73.08%,敏感性52.77%,特异性89.06%。③粪染组新生儿缺氧缺血性脑病(HIE)6例,均显示脐动脉血pH7.10且桡动脉血pH7.30。结论:桡动脉血pH7.30对预测MAS发生有一定的价值。羊水Ⅲ度粪染胎儿缺氧发生几率明显增高。脐动脉血气pH7.10且桡动脉血pH7.30的新生儿发生HIE几率明显升高。     

羊水过少117例临床分析

目的　探讨羊水过少的病因及其相关因素 ,寻找正确的处理方法 ,降低围生儿病死率。方法　对羊水过少 117例临床资料进行分析。结果　羊水过少高发于 40周后 ;B超对羊水量的估计准确率可达 95 % ;羊水过少出现最多的妊娠并发症为妊高征和胎儿宫内生长迟缓 (IUGR) ;羊水过少脐带缠绕及脐带过短发生率明显高于对照组 ,有显著差异 (P <0 0 1) ;羊水量越少 ,羊水粪染率及胎儿窘迫发生率越高 ,羊水过少组新生儿窒息率明显高于对照组。结论　羊水过少确诊后适时以剖宫产结束分娩为宜。     

A randomized clinical trial of the intrapartum assessment of amniotic fluid volume: amniotic fluid index versus the single deepest pocket technique

OBJECTIVE: The purpose of this study was to determine whether an intrapartum assessment of amniotic fluid identifies a pregnancy that is at risk for an adverse outcome. STUDY DESIGN: Parturients who were admitted for delivery were assigned randomly to have the amniotic fluid assessed either by amniotic fluid index or by the presence of a 2 x 1 pocket. RESULTS: The amniotic fluid index was obtained in 499 pregnancies, and the 2 x 1 technique was performed in 501. Oligohydramnios was diagnosed in 25% of amniotic fluid index pregnancies versus 8% with the use of the 2 x 1 pocket technique (P <.001). Both techniques failed to identify patients who underwent an amnioinfusion for fetal distress (P=.864) or who experienced variable (P=.208) or late decelerations (P=.210) that influenced delivery, fetal distress in labor (P=.220), caesarean delivery for fetal distress (P=.133), and admission to neonatal intensive care unit (P=.686). CONCLUSION: Neither the amniotic fluid index nor the 2 x 1 pocket technique that was undertaken as a fetal admission test identifies a pregnancy that is at risk for an adverse outcome.     

Intrapartum transcervical amnioinfusion for meconium-stained amniotic fluid.

OBJECTIVE: To assess the rates of cesarean deliveries and perinatal outcome following intrapartum transcervical amnioinfusion in women with meconium-stained amniotic fluid (MSAF) in a setting with no electronic fetal monitoring or specialized neonatal care. MATERIALS AND METHODS: In this prospective comparative study with 150 women who were in labor and had MSAF, 50 of the women received a transcervical amnioinfusion and the remaining 100 women received standard care. The inclusion criteria were a pregnancy of at least 37 weeks' duration, a single live fetus in cephalic presentation, no major medical or obstetric complications, and no known fetal malformation. The amnioinfusion was performed with 1000 mL of normal saline solution through a red rubber catheter. RESULTS: Amnioinfusion was associated with a significant decrease in the incidence of low Apgar score (<7) at 1 min (12% vs. 47%; relative risk [RR], 0.26; 95% confidence interval [CI], 0.12-0.56); low Apgar score at 5 min (4% vs. 23%; RR, 0.17; 95% CI, 0.04-0.71); and meconium aspiration syndrome (4% vs. 18%; RR, 0.22; 95% CI, 0.05-0.92). There was also a trend towards a lesser incidence of cesarean deliveries (18% vs. 30%; RR, 0.6; 95% CI, 0.31-1.16) and perinatal deaths (4% vs. 13%; RR, 0.31; 95% CI, 0.07-1.31). The incidence of maternal hospital stays longer than 3 days was significantly lower in the amnioinfusion than in the control group (24% vs. 48%; RR, 0.5; 95% CI, 0.29-0.85). There were no major complications related to amnioinfusion. CONCLUSIONS: Intrapartum amnioinfusion for MSAF is a simple, safe, effective, and inexpensive procedure feasible in settings where intrapartum monitoring is limited. It is associated with improved perinatal outcome and could lower cesarean delivery rates in low-resource countries.     

羊水中饱和卵磷脂测定的意义

应用改良Ｔｓａｉ法测定５０例正常妊娠晚期及２１例临产妇女羊水中饱和卵磷脂（ＳＰＣ）的含量。结果：羊水中ＳＰＣ随孕周增加而增加，临产后增加更明显。提示：羊水ＳＰＣ测定是一种特异性、敏感性、准确性较高的方法，能在妊娠晚期预测新生儿呼吸窘迫综合征。     

检测脐血及羊水中儿茶酚胺水平诊断胎儿窘迫

应用高效液相色谱技术，对足月正常分娩儿（１１例）、胎儿窘迫儿（３０例）的脐动脉血浆、及足月后羊水（３６例）中儿茶酚胺水平进行测定。结果表明：胎儿窘迫时，儿茶酚胺水平增高，以去甲肾上腺素（ＮＥ）、肾上腺素（Ｅ）为主，其增高的程度与新生儿窒息发生有关，并与Ａｐｇａｒ评分呈负相关。相关系数分别为ｒ＿（ＮＥ）＝－０．６３９（Ｐ＜０．０１），ｒ＿Ｅ＝－０．４５９（Ｐ＜０．０５）。儿茶酚胺增加是胎儿缺氧的早期表现。因此，监测胎儿儿茶酚胺水平，可作为早期诊断胎儿窘迫的一个指标。     

羊水内皮素-1与围产儿缺氧的关系

目的　探讨羊水内皮素１（ＥＴ１） 与围产儿缺氧的关系。方法　采用放射免疫法对１６１例孕（ 产）妇进行羊水ＥＴ１ 水平检测。将其分为正常妊娠组１１０ 例,对其中足月妊娠３０ 例同时进行母血和脐血ＥＴ１ 水平检测;宫内缺氧组５１ 例。结果　（１） 羊水ＥＴ１ 水平在正常妊娠组孕１４ ～２７ 周时为（７．７４０±２ ．１３３）ｎｇ／Ｌ,至妊娠晚期时为（１８．６４０ ±１ ．９６８）ｎｇ／Ｌ,随孕周增加呈上升趋势（ Ｐ＜ ０．０１） 。（２） 脐血ＥＴ１ 水平明显高于母血ＥＴ１ 水平,但较羊水为低（Ｐ＜０．０１） 。羊水与脐血ＥＴ１ 水平存在正相关关系（ｒ＝０．９５２,Ｐ＜０．０１）,而母血与脐血无相关关系（ｒ＝ ０．３３８,Ｐ＞ ０ ．０５） 。（３） 宫内缺氧组中,出现胎儿窘迫者羊水ＥＴ１ 水平为（３０．６５４ ±５．８３２）ｎｇ／Ｌ,较正常妊娠组明显升高（ Ｐ＜０．０１） ;出现重度新生儿窒息死亡者羊水ＥＴ１ 水平为（９６０ ．６５０ ±２３６ ．６９８）ｎｇ／Ｌ,为正常晚期妊娠的６０ 倍左右（ Ｐ＜０ ．００１） 。结论　正常妊娠羊水中存在ＥＴ１ ,且随妊娠进展而增加。胎儿缺氧时羊水ＥＴ１ 水平升高,并随缺氧程度加重而显著上     

Erythropoietin in amniotic fluid as a marker of chronic fetal hypoxia

Objective: To determinate the erythropoietin concentration in amniotic fluid in normal pregnancies and pregnancies with suspected hypoxia. Method: The erythropoietin concentration of 164 samples of amniotic fluid was determined by ELISA. The samples were taken by amniotomy during birth, as well as amniocentesis conducted during prenatal care. Results: A distribution of 1.07–7.29 U/l (10th–90th percentile) within the normal group (n=106) was determined. Significantly elevated erythropoietin levels in amniotic fluid were determined in maternal hypertension (P=0.039) and low birth-weight children (P=0.0032). A correlation with the child's sex could be excluded. Conclusion: Elevated erythropoietin levels in amniotic fluid indicated chronic fetal hypoxia.     

A novel model of polyhydramnios: amniotic fluid volume is increased in aquaporin 1 knockout mice

OBJECTIVE: To test the hypothesis that amniotic fluid volume is increased in aquaporin 1 knockout mice. STUDY DESIGN: Transgenic mice deficient in aquaporin 1 protein were generated by targeted gene disruption, as described previously. After a cesarean section was performed, intact, individual gestational sacs were removed from the uterus and weighed. Amniotic fluid volume, osmolality, and fetal and placental weights were determined. Data were analyzed by a 1-way analysis of variance for ranks; Dunn's post hoc test was used to analyze significant trends. RESULTS: Analysis of 16 litters showed 35 wild-type, 52 heterozygote, and 33 aquaporin 1 knockout mice. The knockout mice had a greater volume of amniotic fluid and lower amniotic fluid osmolality than their wild-type and heterozygote counterparts. There were no significant differences in fetal or placental weights among the groups. CONCLUSIONS: Aquaporin 1 null fetuses produce a greater volume of more dilute amniotic fluid. Our findings show that aquaporin 1 water channels in fetal membranes may contribute to amniotic fluid volume regulation. We speculate that idiopathic polyhydramnios may be associated with a deficiency of aquaporin 1 channels in human fetal membranes. Transgenic aquaporin 1 knockout mice provide a unique animal of polyhydramnios.