马蹄内翻足的产前诊断与产后评价

马蹄内翻足是一种较常见的先天畸形,产前诊断主要是依靠超声检查。产前正确诊断有助于了解病情,做好心理准备及决定是否继续妊娠;产后准确评价畸形严重程度对指导治疗和判断预后等有重要作用。本文就马蹄内翻足的病因、病理、产前诊断与产后评价的方法等进行综述。     

Breastfeeding duration: prenatal intentions and postnatal practices

A study of 78 primiparas examined the role of prenatal intent and postnatal experiences in breastfeeding duration Those fully breastfeeding 3 months after the birth of the baby had a higher level of education, timed their decision to breastfeed earlier, intended to breastfeed longer and had a more negative attitude to formula feeding Commitment and confidence scores were not related to breastfeeding duration in first-tune mothers Breastfeeding duration was also related to the timing of the first breastfeed and extent of mother-infant contact in the 72 hours after birth but not to the number of feeding problems     

Immediate and long-term outcomes in children with prenatal diagnosis of selected isolated congenital heart defects.

OBJECTIVES: To compare the immediate postinterventional and long-term outcomes of children with a prenatal and those with a postnatal diagnosis of isolated congenital heart defects. METHODS: This was a retrospective study of 257 children admitted over a 10-year period to our pediatric cardiology unit with one of four different cardiac lesions: transposition of the great arteries, atrioventricular canal defect, tetralogy of Fallot and pulmonary atresia; 208 were diagnosed postnatally and 49 prenatally. Management was identical in the two patient groups. RESULTS: The median age at admission was 22 days in the postnatal group and 10 days in the prenatal group. In the prenatal group there was a higher median preoperative O2 saturation level (P=0.07), fewer cases of preoperative cardiac failure (P=0.03), fewer cases of preoperative closure of the duct (P=0.04), a shorter median duration of postoperative mechanical ventilation (P=0.03), less need for resurgery (P=0.02) and a shorter median duration of stay in the intensive care unit (P=0.05). Postoperative survival was 96% in the prenatal group and 90% in the postnatal group. Assessment of long-term survival revealed a longer catheter intervention-free interval in the prenatal group (P=0.03). At the 1-year follow-up, residual impaired cardiac function was less frequent in the prenatal than in the postnatal group (P=0.04). Overall survival at maximum follow-up was 92% in the prenatal and 84% in the postnatal group. CONCLUSIONS: Prenatal diagnosis of isolated congenital heart defects allows admission for surgery in a more stable condition and is associated with lower short-term and long-term morbidity and mortality.     

胎儿单侧小脑发育不全的产前超声诊断

目的探讨胎儿单侧小脑发育不全（UCH）产前超声声像图特征。 方法总结2018年1月至2019年12月于南方医科大学附属深圳妇幼保健院,在胎儿系统超声检查中诊断为UCH的6例胎儿的产前超声声像图表现,与MRI、引产后超声及病理解剖结果进行对比,并结合产前诊断该疾病的相关文献对UCH胎儿产前超声诊断特点及临床预后进行分析。 结果6例UCH胎儿产前超声声像图典型表现：两侧小脑半球不对称和（或）小脑横径减小,伴或不伴蚓部异常,发育不全侧小脑减小,形态失常,其中3例受累侧小脑半球边界不规则,对侧小脑形态及大小均正常。临床预后：6例胎儿中1例活产,随访至1岁,未出现神经症状。结合本研究6例UCH胎儿及文献报道的36例胎儿产前和产后检查结果分析均显示：单纯UCH胎儿、不合并颅内异常的UCH胎儿以及无产前生长受限、早产等不良孕产史的UCH胎儿短期预后均好于合并颅内异常的UCH胎儿。 结论UCH有特征性产前超声表现,产前超声发现小脑半球不对称,一侧小脑减小、形态失常时可作出诊断,诊断不明确时可结合MRI进行鉴别诊断。     

单纯室间隔缺损的产前及产后超声诊断分析

目的 探讨单纯性室间隔缺损产前及产后超声表现的差异。方法 回顾性分析244例单纯性室间隔缺损患儿超声心动图资料,对患儿随访至出生后1年。与产后结果对比,将产前检查的胎儿分为正确组和错误组,评价室间隔缺损类型、大小及心室水平分流情况并进行统计学分析。结果 244例患儿中,正确组181例,错误组63例;两组缺损类型差异无统计学意义（P=0.061）;两组产后缺损大小和分流速度差异有统计学意义（P均<0.05）,分流方向差异无统计学意义（P=0.408）;正确组产前和产后缺损大小差异有统计学意义（P<0.05）,分流方向差异无统计学意义（P=0.087）。结论 产前超声可检出单纯性室间隔缺损,缺损本身的解剖特点可能影响产前检查结果,同一病变产前产后超声表现差异明显。     

Musculoskeletal development: a review

The early development of the limbs, the skeletal and muscular systems, and the joints and early changes in joint mobility are reviewed. The musculoskeletal system is vulnerable to failures of specific morphogenetic processes in the embryonic period. Congenital anomalies and postural deformities also may arise in the fetal period. Awareness of prenatal and postnatal events and their timing will assist health care workers in management of pediatric clients.     

Correlation between prenatal and postnatal penile and clitoral measurements

BACKGROUND.: A correlation between prenatal and postnatal penile and clitoral sizes has not been reported. These data would substantiate the ability of prenatal ultrasound (US) scan to predict postnatal measurements. The aims were to correlate prenatal and postnatal penile and clitoral measurements and to ascertain the possible advantage of using prenatal penile width rather than length to predict postnatal measurements. METHODS.: This was a longitudinal study. Fetal penis and clitoris were measured by high-resolution US between gestational weeks 14 and 29. Postnatal measurements of external genitalia were performed during the first postnatal week. All measurements were performed twice consecutively. A correlation between the measurements sets was sought. RESULTS.: Paired prenatal and postnatal measurements were performed on 46 males and 48 females. Prenatal penile and clitoral length values correlated significantly with postnatal length at p < 0.05 each. CONCLUSIONS.: Prenatal US findings appear to be reliable indicators of postnatal penile and clitoral length measurements. Penile width measurement did not add new information. ? 2012 Wiley Periodicals, Inc. J Clin Ultrasound 40:394-398, 2012.     

胎儿半椎体的产前超声诊断

目的 探讨产前超声对胎儿半椎体的诊断价值.方法 回顾分析我院诊断的3例胎儿半椎体病例的产前二维及三维超声表现,并与产后超声检查、其他影像学检查及病理结果进行对照.结果 3例胎儿超声检查均可见脊柱形态改变,受累节段仅有一半的椎体.其中1例经出生后影像学证实,1例经尸检病理证实,1例尚在随访中.结论 胎儿半椎体具有特征性超声表现,不合并其他畸形时多数预后良好,仔细的中孕期超声检查有助于早期发现病变并给予适当的遗传咨询.

Abstract：

Objective To investigate the diagnostic value of prenatal ultrasonography in the fetal hemivertebra. Methods The ultrasonographic findings of three fetuses with hemivertebra diagnosed in our hospital were reviewed and compared with those of postnatal ultrasonography,other image modalities,and autopsy. Results In all fetuses,a distortion of the spine was observed where only one half of the vertebra could be identified. The parents opted for termination of the pregnancy in one case and the deformity was confirmed by autopsy. The other two fetuses were delivered and in one fetus the diagnosis was confirmed by radiological assessment. Conclusions Hemivertebra can be diagnosed accurately by second-trimester ultrasonography. The prognosis is mostly favorable when no other anomalies are associated. Meticulous examination may disclose the lesion and help decide the fate of pregnancy.     

Prenatal ultrasonographic diagnosis of posteromedial bowing of the leg: two case reports.

Congenital posteromedial bowing of the leg was prenatally detected in two pregnancies, at 20 and 31 weeks of gestation. Posteromedial bowing is a rare anomaly of unknown etiology. The prenatal course, monitored by ultrasonography, and the postnatal clinical and radiographic outcomes are discussed and show a complex differential diagnosis. The initial postnatal therapy is conservative. Leg length discrepancy can eventually be treated by lengthening or epiphysiodesis on the contralateral side.     

Echogenic fetal lung masses: comparison of prenatal sonographic and postnatal CT findings

PURPOSE: The aim of this retrospective study was to compare changes in size and appearance of fetal lung masses detected on prenatal sonography with those on postnatal CT. PATIENTS AND METHODS: Sixteen fetuses with echogenic lung masses had undergone serial sonography in utero as well as postnatal CT scanning. Changes in size of the masses were determined by comparing initial and follow-up sonograms. The appearance of the lesions on postnatal CT scans was classified as consolidation, cavity, ground-glass opacity, or atelectasis. All sonographic and CT findings were analyzed by 2 experienced radiologists who were unaware of previous imaging results. RESULTS: The initial mean size of the fetal lung masses on prenatal sonography was 31 (anteroposterior dimension)x25(width)x36(craniocaudal length) mm. Follow-up serial sonography revealed complete regression of 10 masses, no change in 4, partial regression of 1, and increased size in 1. On postnatal chest CT, the mean mass size was 32x22x28 mm; 6 lesions showed no size change from that on the initial sonograms, 6 showed partial regression, and 4 showed an increase in size. Of the 10 cases with apparently complete regression on prenatal sonography, all showed positive findings on postnatal CT. CONCLUSIONS: The discrepancy between prenatal sonographic and postnatal CT findings supports the assumption that regression of lung masses during serial prenatal sonographic follow-up does not always indicate their complete regression.     

泄殖腔外翻脊柱畸形的产前超声诊断

目的 探讨产前超声诊断泄殖腔外翻（OEIS综合征）脊柱畸形的价值。方法 收集我院经尸体解剖确诊的29胎OEIS综合征脊柱畸形,分析OEIS综合征脊柱畸形的产前超声声像图,并与产后尸体解剖检查、尸体X线表现进行对照研究。结果 尸体解剖检查证实29胎OEIS脊柱畸形均为闭合性脊柱裂,其中26胎经产前超声检出。24胎有包块型脊柱裂均发生于骶尾部,其中9胎脊膜膨出,12胎脊髓脊膜膨出,3胎脂肪脊髓脊膜膨出;16胎合并脊髓栓系、11胎合并脊柱侧弯、3胎骶尾椎发育不良、4胎合并椎体畸形;2胎包块较大脊柱裂的颅后窝消失。2胎无包块型脊柱裂的产前超声显示存在脊髓栓系。尸体解剖检查证实产前超声所见,发现漏诊3胎有脊髓栓系的无包块型脊柱裂。尸体解剖检查及尸体X线发现29胎均有骶尾椎发育不良。结论 OEIS综合征脊柱畸形常为骶尾部有包块型闭合型脊柱裂,颅脑声像多正常,可合并脊髓栓系、脊柱侧弯、椎体异常。产前超声对OEIS综合征有包块型脊柱裂的检出率高;OEIS综合征无包块型脊柱裂的产前超声可检出脊髓栓系。     

产前超声诊断胎儿外耳畸形的价值探讨

目的探讨超声诊断胎儿外耳畸形的声像图特征及临床应用价值。方法回顾分析我院13例胎儿外耳畸形的声像图资料,分析其漏误诊原因。结果产前超声筛查出7例胎儿外耳畸形,漏诊6例。13例外耳畸形中9例为单纯性的外耳畸形,4例合并多系统畸形;8例伴羊水过多。10例行染色体核型分析,诊断为21-三体2例,18-三体3例。结论胎儿外耳畸形有其特殊的声像图表现,产前超声检查胎儿外耳可为产前诊断胎儿畸形提供丰富的诊断信息。     

Predictors of severity for postnatal cytomegalovirus infection in preterm infants and implications for treatment

Postnatal cytomegalovirus (CMV) infection is common in neonates and is mostly acquired through infected breast milk from seropositive mothers. In this review, risk factors of postnatal CMV transmission and predictors of severity, preventive measures and treatment of symptomatic postnatal CMV infection in preterm infants are discussed. Several viral, transmission route and host factors have been associated with a higher risk of postnatal CMV transmission from mother to child. Severity predictors of symptomatic postnatal CMV infection may include extreme prematurity (gestational age <26 weeks), timing of postnatal infection as well as comorbidities. Further research in postnatally infected preterm infants at risk for severe symptoms is essential with respect to preventive measures involving the infected breast milk and antiviral treatment.     

产前超声在前脑无裂畸形诊断中的临床价值分析

目的：探讨分析产前超声在前脑无裂畸形诊断中的临床价值。方法选取2010年1月至2013年1月接受产前胎儿系统超声检查的15000例孕妇资料进行回顾性分析。结果15000例接受产前胎儿系统超声检查的孕妇中共有11例胎儿被检出存在前脑无裂畸形的现象。其中5例为无叶全前脑畸形,3例胎儿的超声图片显示为半叶前脑无裂畸形,3例胎儿的超声图片信息显示为叶状前脑无裂畸形。合并畸形的情况为3例胎儿为唇腭裂畸形,1例胎儿为无鼻畸形,1例胎儿为眼距畸形,2例胎儿为dandy-w alker综合征。此外还有2例胎儿为羊水多,1例为多囊肾。11例胎儿经过尸检后证实为前脑无裂畸形。结论产前超声检查在前脑无裂畸形诊断中的准确率较高,临床价值较高,值得推广。     

The type and frequency of fetal renal disorders and management of renal pelvis dilatation.

OBJECTIVE: This study describes the frequency of sonographically detected fetal renal disorders, the correlation of fetal renal pelvis dilatation (RPD) with the need for postnatal surgery, and proposed management of RPD. METHODS: The study population consisted of 342 fetuses with prospectively identified isolated renal abnormalities and known follow-up. Fetuses with RPD were considered separately with respect to underlying renal disease, postnatal testing, and the need for surgical correction. Obstructive RPD was defined as the need for surgical treatment. Nonobstructive RPD included those cases that required no therapy. The correlation between prenatal RPD and the need for postnatal evaluation was examined. RESULTS: Renal pelvis dilatation was the primary postnatal sonographic finding in 66.4% of cases. The remainder were distributed between multicystic dysplastic kidney, duplication malformations, and reflux, with a smaller number of other diagnoses. Renal pelvis dilatation in the obstructive group was significantly greater than in the nonobstructive group. However, 10% of fetuses with maximum RPD of 10 mm or less had an obstructive process, whereas 58% of fetuses with RPD of greater than 10 mm did not have obstruction. There were no cases in which preterm delivery was necessitated by RPD. CONCLUSIONS: Renal pelvis dilatation is the most common fetal renal abnormality. The greater the RPD, the more likely it is due to obstruction. However, the overlap between obstruction and no obstruction dictates postnatal evaluation. In that RPD, regardless of degree, did not change the timing of delivery, a single follow-up sonographic examination either late in pregnancy or after delivery is considered adequate for follow-up of RPD detected earlier in pregnancy.     

孕妇产前TORCH检测对优生优育产生的影响分析

目的:分析产前TORCH检测对优生优育的影响.方法:选取80例2017年6月至2019年1月不孕患者为研究组,选取同期接受优生优育检查的正常女性80例为对照组,比较两组产前TORCH检测结果.结果:研究组TORCH-IgM抗体总阳性率22.50％,CMV-IgM抗体阳性率10.00％,HSV-IgM抗体阳性率6.25％...     

Anterior mediastinal lymphangioma: Pre‐ and postnatal sonographic findings

Anterior mediastinal lymphangiomas are very rare in utero with only a few cases reported in literature. We present a case of anterior mediastinal lymphangioma that was diagnosed on prenatal sonography (US) at 22 weeks' gestation. It appeared as a well‐defined, multi‐septated anechoic mass, in the anterior mediastinum between the heart base and right chest wall. There was no solid component and no internal flow on color Doppler US. The pre‐ and postnatal US findings are correlated with prenatal MRI and postnatal CT findings. © 2012 Wiley Periodicals, Inc. J Clin Ultrasound 41 :383–385, 2013     

Prenatal diagnosis of fetal urinary ascites.

We report on a rare in utero appearance of the rupture of the fetal bladder caused by low urinary tract obstruction with subsequent urinary ascites. The findings on prenatal sonography, postnatal X-ray examinations and postnatal surgical treatment are described and the literature is reviewed.     

Prenatal diagnosis of a giant foetal lymphangioma and haemangiolymphoma in the second trimester using 2D and 3D ultrasound

Lymphangiomas are benign tumours of the lymphatic system. Early prenatal diagnosis is important to permit a planned delivery and provide adequate postnatal care. It thereby improves prognosis and allows the option of terminating the pregnancy if poor outcome is predicted. We report two cases, a giant haemangiolymphoma and a lymphangioma. 2D and 3D US findings are presented and differential diagnosis, therapeutic options and prognosis are discussed.     

Diastematomyelia: pre- and postnatal multimodal diagnostic approach

Diastematomyelia is a relatively rare congenital abnormality presenting as a sagittal separation of the spinal cord. Although cases of diastematomyelia have been previously reported, fully documented approaches by both prenatal and postnatal diagnostic workup are rare in the literature. We present a fully studied case of diastematomyelia type I investigated by prenatal US and MRI and postnatal US, MRI and radiography.