帆状胎盘血管前置破裂的围产儿预后分析

帆状胎盘血管前置破裂是一种对胎儿危害极大,以产前出血为症状,引起围产儿死亡的临床疾病。本文总结本院12年帆状胎盘并发前置血管破裂的病例,研究本病发生发展的规律,探讨早期诊断和正确处理的方法,以降低围产儿死亡率。临床资料本院1995年1月-2006年12月12年间共分娩25487例,有107例为帆状胎盘,发生率0.42%。其中血管前置16例,13例并发前置血管破裂。孕周<37周3例,≥37周10例,初产妇9例,经产妇4例。临床症状主要为阴道出血,量50~300m l,>100m l者6例,胎儿均迅速死于宫内,其中3例在家中出血后即感胎动消失,来院时胎儿已死亡。其中3例出血1h…     

剖宫产围产儿死亡54例分析

目的降低剖宫产围产儿死亡率，提高人口素质。方法分析2005年1月至2005年12月无锡市各医院剖宫产围产儿死亡54例死亡原因。结果剖宫产围产儿死亡率2．9‰（54／19 529）。剖宫产围产儿死亡中死胎18．5％（10／54）。死产9．3％（5／54），新生儿死亡72．2％（39／54）。剖宫产围产儿死因主要为MAS、RDS、早产、畸形，剖宫产围产儿死亡的主要手术指征为胎儿窘迫、胎盘因素、妊娠合并症、社会因素。结论为了降低剖宫产围产新生儿的死亡率，必须加强产前和产程中监护，正确掌握手术指征和决择手术时机，提高复苏抢救水平为关键。     

2006—2008年广州市越秀区围产儿死亡情况分析

目的为了进一步了解分析本地区围产儿死亡原因,为制定有效的干预措施提供科学依据,达到提高围产保健质量,降低围产儿死亡率的目的。方法本文对近三年来越秀区辖区内产科医院的国产儿死亡病例进行分析统计。结果3年期间辖区内十一间产科医院的围产儿死亡病例共计1128例,围产死亡率平均为17．60‰,死胎占84．22％,死产占3．55％,早期新生儿死亡占12．23％,导致围产儿死亡的主要因素为：胎儿畸形（占54．08％）、脐带因素（占17．02％）,母体因素（占11．70％）、早产低体重儿（占7．53％）、胎盘因素（占4．60％）、新生儿重度窒息（占1．15％）。结论加强出生缺陷的监测,通过产前诊断尽早发现畸形,在28周前终止妊娠,从而减少围产儿死亡。做好产前保健,加强孕期监护,积极防治先兆早产,及时防治胎儿窘迫和妊娠并发症,提高对新生儿窒息的抢救质量及复苏后治疗护理水平也是降低围产儿死亡率的关键。     

彩色多普勒超声诊断帆状胎盘和血管前置的临床价值及漏诊误诊原因分析

目的 探讨产前彩色多普勒超声诊断帆状胎盘及血管前置的临床价值及漏诊和误诊原因分析。方法 回顾性分析2015年1月~2018年7月我院行产前彩色多普勒超声筛查946例孕妇的彩色多普勒声像图及临床特点,分析帆状胎盘和血管前置的超声诊断情况、影像学特点及妊娠结局。结果 共946例孕妇中,产科证实帆状胎盘117例,超声诊断帆状胎盘106例,漏诊11例,误诊7例,漏诊率:9.40%（11/117）,误诊率:0.84%（7/829）,诊断符合率:98.10%（928/946）;产科证实血管前置19例,超声诊断血管前置16例,漏诊3例,误诊3例;漏诊率:15.79%（3/19）,误诊率:0.32%（3/727）,诊断符合率:99.37%（940/946）。帆状胎盘彩色多普勒超声显示脐带入口在胎盘边缘的游离胎膜内,经羊膜和绒毛膜之间进入胎盘;血管彩色多普勒超声显示胎膜血管位于胎儿先露前方跨越宫颈内口或者接近宫颈内口。有69.91%（79/113）的超声帆状胎盘孕妇选择剖宫产,另外30.09%（34/113）选择顺产;有19例产前超声诊断为血管前置孕妇均选择剖宫产,其中5例胎膜早破急诊剖宫产手术,但新生儿情况良好。结论 彩色多普勒超声能较好的显示胎盘形状、胎盘脐带插入口位置及宫颈内口血管情况,提高诊断帆状胎盘及血管前置诊断率,改善妊娠结局,降低围生期胎儿死亡率,但因各种因素影响,存在一定漏诊和误诊。     

无锡市妇幼保健院1988—1995年围产儿死亡率分析

本文报告了无锡市妇幼保健院1988－1995年8年间分娩围产儿39113例，围产儿死亡829例，围产儿死亡率21．19‰，其中死产发生率2．28‰，死胎发生率9．26‰。，早期新生儿死亡率9．66‰。分析了围产儿死亡原因，提出进一步实施最佳围产方案，加强围产保健和监护工作，以降低围产儿死亡率。     

高邮地区2005年一2007年围产儿死亡调查分析

目的探讨围产儿死亡原因,以提高围产期保健工作质量及降低围产儿死亡率。方法对高邮地区2005年-2007年的98例围产儿死亡资料进行调查分析。结果高邮地区2005年-2007年围产儿死亡98例,死亡率分别为8．09‰、7．52‰、4．18‰,呈逐年下降趋势,其中死胎53．06％,死产4．08％,新生儿死亡42．86％。围产儿死亡原因主要为不明原因、胎儿畸形、早产、新生儿窒息、脐带因素、胎盘因素等。结论加强国产期监护,预防为主,提高孕期监测质量和宫内诊断技术,加强高危孕产妇的管理和严格遵守高危妊娠转诊制度,不断提高产科质量,是降低围产儿死亡率的重要手段。     

围产儿死亡及死因分析

本文对我院１９８４－１９９５年间１７７例围产儿死亡及其死因进行了回顾性分析。本组围产儿死亡率为１４．６８‰。死亡围产儿中早产儿占４２．９４％，畸形儿占１８．６４％。新生儿首位死因为窒息，胎死宫内首位原因为脐带、胎盘因素所致的宫内缺氧。资料表明降低围产儿死亡率的主要环节是防治早产，加强对畸形儿的筛查，做好围产期保健，防治胎儿宫内缺氧，提高产科质量，搞好新生儿窒息抢救工作。     

孕妇被动吸烟与围产儿不良结局

为了解孕妇被动吸烟对转帐产儿健康影响的情况,对我院1995年10月－1996年6月住院待产妇进行了相关因素调查并追踪至产后7天,桉孕期有,无被动吸烟自然分为吸烟组（又根据吸烟量分为A,B两组）和对照组,观察各组新生儿出生体重,IUGR,早产,新生儿窒息,围产儿死亡等的发生率,结果显示,被动吸烟组的新生儿体重明显低于对照组：IUGR的发生率则明显高于对照组,差异显著（P＜0．01,P＜0．005）,并且吸烟量越多则新生儿体重越低,IUGR的发生率越高,吸烟A,B两组比较差异显著（P＜0．01）,另外,被动吸烟组的早产率（17．0％）,新生儿窒息率（12．9％）,围产儿死亡率（1．6％）亦高于对照组（3．0％,4．2％,0．6％）,经统计学处理除围产儿死亡率外,差异均有显著性（P＜0．005）,提示：孕妇被动吸烟可严重影响胎儿的生长发育及健康,对胎儿不利。     

妊娠肝病围产儿死亡80例临床分析

目的：探讨妊娠肝病围产儿死亡的相关因素，对这一高危人群的围产期管理提出可行性建议和措施。方法：对1991年1月－2000年12月在我院诊断为妊娠肝病患者的围产儿死亡80例进行回顾性分析。结果：10年间我院肝病孕妇的围产儿死亡率为17．99‰，而且以死胎为主，占65．00％。围产儿死亡有性别差异，男性死亡率为21．64‰，显著高于女性死亡率10．11‰（P＜0．01）。前后5年比较围产儿死亡率无显著下降（P＞0．05），其中本市城区和郊区的围产儿死亡率有下降趋势，而外来人口围产儿死亡率有上升趋势。母体患重型病毒性肝炎、慢性乙型肝炎和妊娠急性脂肪肝（AFLP）者，围产儿死因主要为妊高征和胎儿及新生儿窒息。母体HBV携带者围产儿死因主要为脐带因素、胎膜早破和窒息。结论：妊娠肝病可使围产儿死亡率明显增加，其导致围产儿死亡的根本原因是重症肝病引起的妊高征和胎儿宫内缺氧。外来人口、男性胜儿等是围产儿死亡的高危因素。加强对肝病孕妇特别是外来人口的孕期管理，积极治疗肝病，必要时尽早终止妊娠，提高产时处理及新生儿复苏水平是降低妊娠肝病围产儿死亡率的关系。     

130例发育不一致性双胎妊娠结局分析

目的探讨发育不一致性双胎的妊娠结局。方法以双胎胎儿体重差〉25％为诊断标准，回顾分析130例发育不一致性双胎（研究组）和414例发育一致双胎（对照组）的临床资料，比较两组孕产妇一般情况、并发症、分娩方式和围产儿预后等方面差异。结果研究组分娩孕周明显低于对照组，孕妇平均年龄、受孕方式、胎儿性别比较无统计学意义。研究组早产、晚期流产、羊水过多、胎儿畸形、胎盘早剥、双胎输血综合征的发生率分别为57．7％、12．3％、21．5％、5．4％、3．8％、8．5％，明显高于对照组（分别为49．8％、2．9％、12，3％、0，9％、1．2％、1．6％），两者相比差异有统计学意义（P〈0．05）。两组的剖宫产和阴道助产差异无显著性（P〉0，05）。研究组新生儿平均体重明显低于对照组，围产儿总死亡率及双胎之一胎死宫内率、新生儿窒息、新生儿高胆红素血症、新生儿肺透明膜病变、新生儿进入NICU比率在研究组中均明显高于对照组，差异有统计学意义（P〈0．05）。结论发育不一致性双胎妊娠并发症及围生儿患病率和死亡率明显高于发育一致性双胎。及早发现和处理双胎发育不一致，是改善胎儿和新生儿预后的关键。     

Chorionic plate vascular anatomy determines the efficacy of amnioreduction therapy for twin-twin transfusion syndrome

The objective of the study was to determine whether vascular anatomy of monochorial placenta influences the therapeutic efficacy of serial amnioreduction in chronic mid-trimester twin-twin transfusion syndrome (TTTS). Twenty-six consecutive monochorial pregnancies complicated by TTTS and treated by serial amnioreduction were studied. The placental anastomoses were delineated postnatally by perfusion studies. Amniotic fluid index, amniotic fluid pressure, number of amnioreductions, interval between amnioreduction, and neonatal outcome were correlated with the presence or absence of superficial anastomotic channels and type of cord insertion. Placentae were divided into two groups according to the presence (n = 9) and absence (n = 14) of superficial anastomosis. Gestational age at diagnosis, delivery, percentage discordance in estimated birth weight were comparable in the two groups. The amniotic fluid index, liquor volume removed, and amniotic pressure at first amnioreduction were also comparable between groups. In the group without superficial arterio-arterial/veno-venous (AA/VV) anastomoses, amnioreduction was required more often (P < 0.05). Perinatal mortality in terms of intrauterine deaths (IUD) and neonatal death was more common in the group without AA/VV anastomotic channels (P < 0.05). There was no difference in incidence of velamentous/marginal cord insertion between the two groups. TTTS lacking superficial AA or VV anastomosis are more likely to require frequent amnioreduction and are associated with increased perinatal mortality and morbidity, whereas the presence of such shunts was associated with increased therapeutic efficacy of amnioreduction and a more favourable prognosis.      

B超诊断胎儿宫内窘迫在临床中的意义

目的通过B超探讨胎儿宫内窘迫的原因,判断胎儿宫内生理病理状态及预后.方法通过观察胎心率、脐带、羊水、胎动,做出诊断.结果胎心率、胎动异常是判断胎儿有无缺氧及其程度的主要指标;脐带、羊水是造成胎儿宫内窘迫的主要原因.B超诊断与产后符合率100%.结论超声诊断快捷、准确、简单、经济、无创,为观察产程、选择分娩方式提供有力依据,对预防和降低围产儿死亡率具有重要的意义.     

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     

The impact of prenatal diagnosis on congenital anomaly outcomes: Data from 1997 to 2016

The term prenatal diagnosis comprises a variety of techniques aimed to determine the health and condition of the embryo or foetus. Its main goal is to identify at an early stage of the pregnancy, if possible, malformations or other conditions that could increase the risk of a negative outcome in the pregnancy. The aim of this study was to assess the impact of prenatal diagnosis in Portugal in pregnancies with congenital anomalies. A cross sectional study was implemented using data for the years 1997 to 2016 from the Portuguese registry of congenital anomalies (RENAC), a population-based registry that follows EUROCAT guidelines. Analysis was restricted to malformations that are potentially detectable by prenatal diagnosis. The effect of prenatal diagnosis on outcome (death vs live birth) was estimated using a regression model. Main results indicate that prenatal diagnosis was performed in 56.1% (n?=?7605) of all registered cases. At least one malformation was detected for the first time through ultrasound (47.4%), invasive tests (5.6%) and other tests (2.2%). When analysed severe CA, 54.2% was detectible by prenatal ultrasound distributed as follows: 17.4% were diagnosed before 14 weeks of gestation, 47.6% between 14 and 23 weeks and 35.0% with 24 or more weeks of gestation. TOPFA was the option for 21.3% of these CA.Over the 20 years of analysis, there was a statistically significant increase trend in the detection rate of congenital anomalies through prenatal diagnosis compared to detection at birth or after birth (p?<?0.001).After adjusting for confounding (year, maternal age, presence of more than one malformation), prenatal diagnosis was associated with more severe outcomes (TOPFA, 40.3%; Death 3.5%) and increased the risk of the pregnancy ending in foetal death (OR?=?2.56; 95%CI?=?2.06–3.18). These results are in accordance that more severe anomalies are more easily detected prenatally.Considering the results, it is important to raise awareness about the importance of pregnancy planning and preventing the risk factors more associated with CA. More information about prognosis for children with congenital malformations is important for parents and health professionals after prenatal detection.     

新疆昌吉地区10年围产儿死亡原因分析及对策

目的分析围产儿的死亡原因,提出预防措施,提高围产医学质量,降低围产儿死亡率。方法回顾性总结2000年～2009年共73例围产儿死亡的临床资料,分析比较其死亡的主要原因。结果 10年总分娩人数6452人,围产儿死亡73人,死亡率11.31‰,死亡原因排前三位的依次为早产、畸形、新生儿窒息。结论加强优生优育教育,进一步提高产前诊断水平、产儿科诊治水平,是降低围产儿死亡率的关键。     

Variations in Placental Attachment of Umbilical Cord

The purpose of this study was to evaluate the variations in the placental attachment of umbilical cord by dissection method. The Placental attachment of Umbilical Cord was examined after careful dissection of membranes in 110 specimens. Various types of Umbilical Cord insertions were noticed and measured its distance from placental margin. Details were recorded and analyzed. A total of 110 specimens were observed, of which 83(75.45%) showed normal, 18(16.36%) were marginal, 8(7.27%) showed furcate and only 1(0.9%) specimen was velamentous insertion. As other congenital anomalies are often associated with umbilical cord insertion anomalies, early diagnosis of the latter would give an insight into the former.     

5459例孕晚期脐带血染色体细胞遗传学分析

目的评价脐带血细胞染色体核型分析在孕晚期产前诊断中的应用价值。方法对有产前诊断指征的孕妇在B超引导下经脐静脉穿刺抽取脐带血行淋巴细胞培养、染色体制备及核型分析。结果成功培养脐带血细胞5456例,培养成功率为99.9%（5456/5459）,共检测出170例染色体非多态性结构异常。其中包括染色体数目异常140例,17例染色体易位;4例染色体缺失;9例嵌合体。同时还检测出71例染色体倒位。结论胎儿进行脐带血产前诊断,染色体数目三体征是脐血检查的主要异常核型,脐静脉穿刺是孕晚期产前诊断的重要方法。对于减少染色体畸形儿的出生具有重要的意义。     

B超引导下游离脐静脉穿刺术用于产前诊断的分析

目的：探讨B超引导下游离脐带穿刺术成功率和安全性。方法：对153例因各种原因行产前诊断的孕妇进行B超引导下游离脐静脉穿刺术。结果：1．43例18w－21w孕妇穿刺成功率为87．3％，60例22w-28w孕妇成功率97．5％，50例28w以上的成功率为100％，总成功率95．5％。2．并发症：96例穿刺经过胎盘，胎盘渗血32．3％（31／96），脐带穿刺后渗血16．3％（25／153）。胎儿心动过缓者占5．9％（9／153）。术后未出现晚期流产、胎死宫内、早产、宫内感染等并发症。结论：B超引导下游离脐带穿刺术用于产前诊断是一项成功率高而且安全的方法。     

Umbilical cord anomalies are more frequent in twins after assisted reproduction

BACKGROUND: The objective of this study is to analyse differences in cord characteristics between naturally conceived twins and twins born after assisted reproduction. METHODS: Between 1985 and 2004, the East Flanders Prospective Twin Survey (EFPTS) registered 4159 twin pairs. We compared cord characteristics between 2119 naturally conceived dizygotic (DZ) twin members and 2243 DZ twin members originating from assisted reproductive technologies (ART). Data were adjusted for intra-twin correlation, year of birth, maternal age, gestational age, parity, sex of the child and number of placentas. RESULTS: Marginal cord insertion, velamentous cord insertion and single umbilical artery (SUA) occur more frequently in twins following infertility treatment (P < 0.001). The incidence of velamentous cord insertion increases proportionate with 'invasiveness' of reproductive techniques: 3.6% in naturally conceived twins versus 5% in twins after artificial induction of ovulation (AIO) [odds ratio (OR) 1.45; 95% confidence interval (CI) 0.99-2.11], 7.4% in twins after IVF (OR 1.49; 95% CI 1.26-1.77) and 10.4% in twins after ICSI (OR 1.31; 95% CI 1.14-1.51). SUA has the highest incidence in twins after AIO: 1.9% compared with 0.6% in naturally conceived twins (OR 3.19; 95% CI 1.66-6.11). CONCLUSIONS: Umbilical cords of twins born after ART have more pathologic characteristics when compared with cords of naturally conceived twins.     

Umbilical cord blood procalcitonin as a risk factor for mortality in very premature infants

Fetal inflammatory response syndrome is implicated as a cause of fetal or neonatal injury. We analyzed the relationship between the procalcitonin umbilical cord blood level and neonatal outcome. A total of 237 preterms born in a level III perinatal medicine unit of a French university hospital were enrolled in a prospective observational study. Measurement of the procalcitonin umbilical cord blood level was performed at birth. After hospitalization, surviving infants were enrolled in the regional follow-up program. Outcome data were recorded on standardized questionnaires. The main outcome measures were neonatal mortality and impaired functional outcome at 2?years of corrected age. The terciles of procalcitonin levels were calculated. Preterm infants of the third tercile were defined as infants with elevated procalcitonin. Among the 237 infants, 13 (5.5%) died during the neonatal period, 20 (8.4%) were lost to follow-up, and 31 (13.1%) were classified as having an impaired functional outcome. After adjustment, elevated cord blood procalcitonin (>0.33?ng/ml) was significantly associated with an increase in mortality (adjusted odds ratio [aOR]?=?8.3 [1.4-48]; p?=?0.018), but not with the 2-year impaired functional outcome (aOR?=?1.0 [0.4-2.5]; p?=?0.93). Elevated umbilical blood cord procalcitonin concentration is an independent risk factor of mortality in preterm infants at less than 33?weeks' gestation.