彩色多普勒超声对输卵管妊娠未破型与妊娠黄体的鉴别诊断

目的：探讨彩色多普勒超声对输卵管妊娠未破型与妊娠黄体的鉴别诊断价值。方法：回顾性分析2009年2月至2013年3月在我院经手术病理证实的50例输卵管妊娠未破型包块和同期50例经临床证实的正常妊娠黄体的彩超影像特征,并进行对比观察。结果：统计的50例输卵管妊娠未破型与50例妊娠黄体相比,除体积差异较小外（P＞0.05）,在内部回声、血流分布、阻力指数、收缩期峰值等方面均差异明显,有统计学意义（P＜0.05）。结论：输卵管妊娠未破型与妊娠黄体在超声影像上存在内部回声、血流分布、阻力指数、收缩期峰值等方面的显著差异,利用这些方面的不同可大大降低二者的误诊率,提高早期宫内孕与输卵管异位妊娠的诊断准确率。     

经阴道彩色多普勒超声对宫外孕破裂与卵巢黄体破裂的鉴别诊断价值

目的 分析宫外孕破裂与卵巢黄体破裂的鉴别诊断中经阴道彩色多普勒超声的应用价值。方法 选取40例宫外孕破裂患者（设为宫外孕破裂组）与40例卵巢黄体破裂患者（设为卵巢黄体破裂组）,患者均接受经阴道彩色多普勒超声诊断,对比两组超声检查结果及影像学表现。结果 经阴道彩色多普勒超声检查宫外孕破裂、卵巢黄体破裂准确率分别为85.00%、87.50%,误诊率分别为15.00%、12.50%。两组患者血流信号形态、血流频谱及血流参数比较,差异具有统计学意义（P<0.05）。宫外孕破裂超声声像特征：未见宫内孕囊声像,附件区多为高回声,包块多呈不规则状且边界不清。对血流频谱进行分析,发现以高阻力型最多,信号以点状分布;妊娠囊结构分辨困难。卵巢黄体破裂超声声像：附件区可见囊实性包块,呈不规则状且边界不清。对血流信号进行分析,发现以环状、半环状为主,血流信号充盈且未见过多血流信号;血流频谱以低阻力型最多,超声信号以低回声为主,包块内部偶见强回声。结论 经阴道彩色多普勒超声诊断宫外孕破裂与卵巢黄体破裂的影像学表现差异明显,能够作为鉴别诊断的主要方法。     

彩超诊断恶性滋养叶疾病价值探讨

目的：探讨彩色多普勒血流显像（CDFI）在恶性滋养叶疾病诊治中的应用价值。方法：选取25例经临床、病理证实的恶性滋养细胞肿瘤患者,以CDFI观测子宫形态、病变区血流速度及阻力指数（砒）及治疗前后的与绒毛膜促性腺激素（β—HCG）。结果：25例恶性滋养叶疾病患者中,恶性葡萄胎16例、绒毛膜上皮癌9例,超声诊断符合率100％;治疗前后RI、β—HCG和病灶直径均变化明显（P〈0．01）。结论：彩超对滋养叶疾病诊断与鉴别诊断及评估治疗效果具有重要价值。     

彩色多普勒超声（CDFI、PD）在妇产科疾病诊断中的应用价值分析

目的：探讨分析彩色多普勒超声（CDFI、PD）在妇产科常见疾病诊断中的应用价值。方法：收集临床上经手术、病理及非手术治疗证实的503例常见妇产科病例,对其二维声像图及彩色多普勒（CDFI、PD）的显像特征及其变化进行分析。结果：经手术、病理证实的372例疾病中：子宫肌瘤85例,腺肌瘤79例,不全流产88例,异位妊娠42例,畸胎瘤40例,葡萄胎11例,胎盘早剥26例;非手术治疗的131例疾病中,黄体血肿48例,胎儿宫内窘迫62例,胎盘早剥20例。结论：彩色多普勒超声（CDFI、PD）能够为常见妇产科疾病提供较准确的诊断依据,有着重要的临床应用价值。     

阴道彩超检测卵巢动脉主干血流对卵巢肿瘤定性诊断的研究

目的：研究用阴道彩色超声多普勒血流显象（ＴＶＳ－ＣＤＦＩ）技术检测卵巢动脉主干血流定性诊断卵巢肿瘤。方法：应用ＴＶＳ—ＣＤＦＩ技术检测正常妇女５６例、卵巢良性肿物６２例及卵巢恶性肿瘤３２例卵巢动脉总干血流的Ａ（收缩期末血流速度峰值）、Ｂ（舒张期末血流速度峰值）、ＰＩ（搏动指数）、ＲＩ（阻力指数）值，并观察其图型特点。结果：卵巢恶性肿瘤的Ｂ、ＰＩ、ＲＩ与正常卵巢及良性肿瘤测值差异有显著性（Ｐ＜０．０５）；恶性卵巢肿瘤内血管为低阻力血管，卵巢动脉主干也随之发生变化，致ＰＩ、ＲＩ降低；将ＰＩ＝１．２０，ＲＩ＝０．６２作为诊断卵巢恶性肿瘤的界值，其灵敏度、特异度、阳性预测值、阴性预测值指标与声像图诊断相比，均明显提高。结论：ＴＶＳ－ＣＤＦＩ检测卵巢动脉总干血流对鉴别卵巢肿瘤的良、恶性具有重要的意义。     

卵巢子宫内膜异位囊肿剥除术对IVF周期中卵巢反应性和妊娠结局的影响

目的：探讨卵巢子宫内膜异位囊肿剥除术后对体外受精（IVF）周期控制性超排卵中卵巢反应性和妊娠结局的影响。方法：选取体外受精．胚胎移植（IVF-ET）助孕且曾在腹腔镜下行卵巢子宫内膜双侧异位囊肿剥除术20例（25周期）患者及32例单侧异位囊肿剥除术（40周期）患者为研究对象,以同期因输卵管因素行IVF助孕的104例（129周期）患者作为对照组,收集卵巢反应性及妊娠结局相关指标,作回顾性病例对照研究。结果：3组在年龄、体质量指数、不孕年限、基础卵泡刺激素（FSH）水平、促性腺激素（Gn）天数、受精率和人绒毛膜促性腺激素（hCG）日雌二醇（E2）水平无统计学意义（P〉0．05）。3组妊娠率差异也无统计学意义（P〉0．05）,且单侧囊肿剥除组妊娠率最高（50．0％）。双侧囊肿剥除组获卵数、优质胚胎率及可冷冻的胚胎个数分别为[（4．95±3．46）个、（56．0±32．0）％、（1．40±1．96）个],明显低于单侧囊肿剥除组[（9．38±4．62）个、（70．1±20．2）％、（3．45±3．05）个]和输卵管组[（10．37±4．14）个、（85．1±19．9）％、（4．36±3．19）个],差异有统计学意义（P〈0．01）;其Gn总用量也明显高于输卵管组和单侧囊肿剥除组（P〈0．05）。单侧异位囊肿剥除术的手术侧卵巢的获卵数[（3．34±2．92）个]低于未手术侧卵巢[（6．06v2．27）个]（t=5．784,P〈0．01）。结论：卵巢子宫内膜异位囊肿剥除术可影响IVF周期中卵巢反应性,如导致Gn用量增加,获卵数、优质胚胎数和可冷冻胚胎个数减少,对IVF-ET有一定不良影响,而对IVF妊娠结局无明显影响。     

经阴道彩色多普勒能量超声对早期妊娠黄体的临床研究

目的:通过经阴道彩色多普勒能量超声(TV-CDPI)对早期妊娠黄体的检测,探讨其在早期妊娠诊断与鉴别诊断、评估预后的价值。方法:检测179例早期妊娠黄体形态、血供分布及血流动力学参数(RI和PSV),其中宫内早孕68例,异位妊娠35例,先兆流产44例,难免流产32例。结果:早期妊娠黄体二维声像图可分为4种类型,与不同妊娠组别有一定的相关性(P<0.01)。不同组别的妊娠黄体血供分布与血流动力学参数(RI、PSV)比较差异有非常显著性(P<0.01)。结论:TV-CDPI对早期妊娠黄体形态、血供分布及血流动力学参数的检测和观察,对早期妊娠的鉴别诊断、预后评价有重要的价值。     

血清孕酮诊断难免流产及异位妊娠的价值

目的 探讨血清孕酮测定在诊断难免流产及异位妊娠中的价值。方法 ８８例因早孕先兆流产入院的病人,每周测定１次血清孕酮,直至流产或安胎成功出院。测定２０例异位妊娠病人血清孕酮。测定５２例正常宫内早孕妇女血清孕酮作为对照。结果 正常早孕各孕周间孕酮值无显著性差异（Ｐ〉０．０５）。正常早孕、先兆流产与难免流产间孕酮值有显著差异（Ｐ〈０．０５,Ｐ〈０．０００５）,正常早孕、先兆流产、难免流产与异位妊娠间均有     

胎儿宫内窘迫时的胎儿胎盘血液动力学改变

目的：评价彩色多普勒超声检查在围产儿监护方面的价值。方法：对２２例胎儿宫内缺氧（宫内窘迫组）和６例围产儿死亡（围产儿死亡组）的胎儿胎盘血管超声结果进行分析，同时与同期５５５例妊娠３６～４０周正常妊娠胎儿（正常妊娠组）比较。使用仪器为ＵＭ９ＨＤＩ彩色多普勒超声诊断仪。结果：与正常妊娠组比较，胎儿宫内窘迫组胎儿肾动脉、脐动脉和胎盘床动脉阻力均显著升高，大脑中动脉阻力无变化；围产儿死亡组中，除胎儿外周血管阻力升高外，其大脑中动脉阻力明显降低，以及脐动脉和肾动脉舒张期血流缺如或返流。结论：胎儿宫内缺氧使胎儿血液动力学发生明显的变化，血液动力学变化，对预测胎儿宫内缺氧具有一定的价值。     

经阴道彩色多普勒超声诊断异位妊娠的临床价值

目的通过对异位妊娠二维声像图及彩色多普勒血流特征的分析，提高对异位妊娠诊断和鉴别诊断的水平。方法对手术病理证实的72例异位妊娠患者附件包块的二维图像和血流频谱特征进行回顾性分析。结果异位妊娠包块中的血流显像有特征性表现：血流阻力指数〈0．4。72例中38例为非典型异位妊娠，二维超声诊断符合率为50．2％，结合彩色多普勒技术诊断符合率为98．8％。结论经阴道彩色多普勒超声检查，对异位妊娠诊断的准确性高，在诊断非典型异位妊娠方面有较高的使用价值。     

Flow velocity waveforms in the maternal uteroplacental and fetal umbilical placental circulations

A simple continuous-wave Doppler ultrasound system was used to record arterial flow velocity time waveforms from branches of the maternal uterine artery in the placental bed and the fetal umbilical arteries. The systolic-diastolic ratio of flow velocities was measured as an index of peripheral resistance. In normal pregnancy both circulations exhibit high diastolic flow velocities caused by low resistance. The study group consisted of 172 pregnancies with high fetal risk of which 53 resulted in delivery of a small-for-gestational age infant. The last study-to-delivery interval was less than 10 days. In the small-for-gestational age fetuses in whom both umbilical and uterine studies were normal there was good fetal outcome (19 cases). Neonatal morbidity occurred among those with abnormal umbilical studies with low diastolic flow velocities, indicating high resistance. Of these studies there were two subgroups. An abnormal uterine study (13 cases) indicated a primary maternal uteroplacental lesion and a normal study (21 cases) a primary fetal lesion. In cases of severe maternal hypertension, abnormal uterine artery waveforms were associated with abnormal umbilical artery waveforms.     

Effects of dexamethasone on the uterine and umbilical vascular beds during basal and hypoxemic conditions in sheep

OBJECTIVE: The purpose of the study was to test the hypotheses that maternal treatment with dexamethasone leads to a reduction in basal umbilical blood flow and diminishes the fetal umbilical hemodynamic response to acute hypoxemic stress in sheep. STUDY DESIGN: While under general anesthesia, 23 ewes and their fetuses were instrumented with vascular catheters and transonic blood flow probes around a uterine and umbilical artery at 117 days of gestation (term, approximately 145 days). At 124 days, the ewes were injected intramuscularly with 2 doses of either dexamethasone (12 mg) or saline solution at 24-hour intervals. All animals experienced 2 episodes of hypoxemia during treatment (125+/-1 days) and after treatment (128+/-1 days). RESULTS: Maternal dexamethasone treatment caused a sustained increase in fetal arterial blood pressure (from 41+/-3 mm Hg to 45+/-3 mm Hg) and a transient fall in umbilical vascular conductance (from 6.2+/-0.9 mL. min(-1). [mm Hg](-1) to 5.4+/-0.7 mL. min(-1). [mm Hg](-1)). During both episodes of hypoxemia, there was a significant increase in umbilical blood flow in the controls, but not in the dexamethasone-treated animals. CONCLUSION: Maternal dexamethasone treatment with doses used in human clinical practice significantly decreased basal umbilical vascular conductance and prevented the normal increase in umbilical blood flow that is induced by acute hypoxemia in fetal sheep.     

Ultrasound markers of implantation

Implantation is a dynamic process that requires a genuine dialog between the embryo and the mother. Assisted reproductive technologies (ART) have demonstrated that successful implantation depends basically on the quality of the embryo and endometrial receptivity. During the past 20 years, various implantation markers have been evaluated in the ovary as well as in the uterus.

The follicular size seems to correlate with the indices of recovery, maturity and fertilization of oocytes, while the thickness and the endometrial pattern indicate the receptivity state of the endometrium, being non-receptive if it is less than 7 mm and when a 'triple layer' morphology is not visualized.

Perifollicular color mapping has been related to the quality of the embryo and pregnancy achievement, whereas endometrial color mapping is a uterine receptivity factor, independent of endometrial thickness. Embryo transfer would not be indicated if the resistance index of the uterine arteries was higher than 3, or if there was no color mapping.

We are researching three-dimensional and power Doppler markers of implantation. Combining different ultrasound (follicular diameter, endometrial morphology and thickness) and Doppler (perifollicular and endometrial color mapping, perifollicular and uterine velocimetry) parameters into scoring systems could allow us to predict with more certainty the possibility of achieving pregnancy.     

Effects of therapeutic amniocentesis on uterine and umbilical artery velocimetry in cases of severe symptomatic polyhydramnios

The objective of this study was to determine the effects of removal of amniotic fluid in cases of symptomatic severe polyhydramnios on Doppler waveform indices of the uterine and umbilical arteries and flow velocities of the uterine arteries. Nine women underwent therapeutic amniocentesis during ten pregnancies for symptomatic polyhydramnios due to Beckwith-Wiedemann Syndrome (n = 1), esophageal atresia (n = 2), chorioangioma (n = 1), twin–twin transfusion syndrome (n = 3), a presumed autosomal recessive syndrome (n = 2), and an unbalanced double translocation (n = 1; partial dup 3q and partial del 9p syndrome). An average of 2.78 ± 0.9 (range 1–4) 1 of fluid were removed at each procedure between the gestational ages of 18 and 34 weeks (mean of 28 weeks). The systolic/diastolic (S/D) ratio, pulsitility index (PI), and resistance index (RI) of the uterine and umbilical arteries were obtained before and after the procedure using color and pulsed Doppler. After angle correction, the peak systolic velocity (PSV) and mean velocity (MV) in centimeters/second (cm/s) of the uterine arteries were also determined. The presence or absence of a uterine artery waveform notch was determined. Dominant uterine arteries were defined as those with lower impedance indices or higher flow velocities. Statistical analysis was performed with the Wilcoxon signed-rank test. Significance was set at P < 0.05. There was a significant increase in the median value of the uterine artery MV (43.8 vs. 81.1 cm/s, P = 0.005) and PSV (74.2 vs. 125.5 cm/s, P = 0.007) after amniocentesis. The uterine S/D (3.0 vs. 1.84, P = 0.007), PI (1.12 vs. 0.68, P = 0.008), and RI (0.60 vs. 0.45, P = 0.005) impedance indices significantly decreased following amniocentesis. When uterine arteries were categorized as dominant vs. nondominant, there were greater improvements in impedance indices and flow velocities in the nondominant uterine arteries. There were three cases of unilateral and one case of bilateral early diastolic notches of the uterine artery waveforms which either resolved (n = 4) or improved (n = 1). There was no effect on the umbilical artery impedance indices. Therapeutic amniocentesis significantly improved uterine artery impedance indices and resulted in improved flow velocities, while there was no effect on umbilical artery waveform indices. The procedure resulted in the disappearance or improvement of the uterine waveform notch. Our findings suggest that in cases of severe polyhydramnios abnormal uterine artery velocimetry may not be due to lack of trophoblastic invasion of the spiral arteries but to increased intrauterine pressure secondary to polyhydramnios.     

彩色多普勒超声监测药物流产前后子宫血流变化及其机制探讨

目的　探讨药物流产前后子宫血流的变化及药理作用机制。方法　 1999年 6月至 2 0 0 2年 2月应用彩色多普勒 (CDFI)对 5 8例药物流产患者子宫动脉和滋养层动脉进行检测 ,比较用药前后子宫动脉和滋养层动脉的血流变化 ,同时比较药物流产组与对照组血清NO-2 /NO-3 水平。结果　服药后比服药前子宫动脉和滋养层动脉的阻力指数 (RI)、收缩期与舒张期血流速度比值 (S/D)增高 ,血流峰值速度 (Vmax)和血流量 (PBF)明显减低 ,差异有显著性意义 (P <0 0 5 ) ;孕妇血清NO-2 /NO-3 水平比非孕妇女显著增高 ,服药后比服药前降低 ,差异有非常显著性意义 (P <0 0 1) ;病理检查显示 :药物流产后的蜕膜和绒毛细胞变性 ,其血管内皮细胞向管腔内突起 ,基底膜中断。结论　应用CDFI监测子宫血流变化与药理作用和病理检查结果相符 ,可作为临床观察药物流产效果的可靠手段。     

Clinical applications of Doppler velocimetry: an overview

Doppler velocimetry has recently become a useful procedure for real-time and non-invasive evaluation of fetal hemodynamics. Analysis of flow velocity waveforms in various types of vessels enables not only clarification of the fetal physiology and pathophysiology of various disorders, but also determination of the most appropriate intervention, from the viewpoint of an integrated management protocol. The unique change in both the arterial and venous flow in normal and compromised fetuses has been demonstrated. Herein, we review the dinical applications of the Doppler technique in monitoring the fetus.     

Prediction of feed intolerance and necrotizing enterocolitis in neonates with absent end diastolic flow in umbilical artery and the correlation of feed intolerance with postnatal superior mesenteric artery flow

Objectives.?To evaluate the role of postnatal superior mesenteric artery (SMA) flow in predicting feed intolerance and NEC in the babies who had AEDF in comparison with gestation matched SGA and AGA with normal flow.

Design.?This was a prospective cohort study conducted in 62 eligible babies admitted in NICU. Babies were enrolled in 3 groups. Group 1 (n = 23) was SGA and AEDF, group 2 (n = 20) was SGA and group 3 (n = 19) was AGA and both with normal UA flow. In all babies baseline SMA flow was measured before test feed (0.5 ml) and repeated every 15 minutes for 1 hour after the feed.

Results.?Feed intolerance was seen in 69.5% of babies in group1 (p = <0.001) as compared to 20% and 17.5% in group 2 and 3. Four (17.3%) babies developed NEC in group1 (p = 0.02) but none in other 2 groups. Baseline peak systolic velocity (PSV) and time average mean velocity (TAMV) at 60 min post feed were significantly (p = 0.01 and 0.028 respectively) lower in group1 than group3. TAMV and PSV at 60 min post feed were significantly lower (p = 0.028 and 0.03) in babies with feed intolerance as compared to no feed intolerance group. Absent end diastolic flow and hypoglycemia were independent risk factors for feed intolerance.

Conclusion.?SGA babies with AEDF had higher incidence of feed intolerance and NEC. Serial SMA flow studies specially the 60 min post feed study may help in differentiating which babies are likely to develop feed intolerance.     

Adjuvant low-dose aspirin therapy in poor responders undergoing in vitro fertilization: a prospective, randomized, double-blind, placebo-controlled trial

OBJECTIVE: To evaluate the effect of adjuvant low-dose aspirin on utero-ovarian blood flow and ovarian responsiveness in poor responders undergoing IVF. DESIGN: Prospective randomized, double-blind, placebo-controlled study. SETTING: University-affiliated teaching hospital. PATIENT(S): Sixty patients classified as poor responders undergoing IVF. INTERVENTION(S): Supplementation with low-dose aspirin (80 mg daily) or placebo to a long down-regulation protocol. MAIN OUTCOME MEASURE(S): Doppler measurement of intraovarian and uterine pulsatility index was performed before (baseline) and after ovarian stimulation (day of hCG administration). Duration of use and dose of gonadotropins, cycle cancellation rate, number of mature follicles recruited, and oocytes retrieved were also measured. RESULT(S): High cancellation rates were found in both groups (33.3% vs. 26.7%, placebo vs. treatment). There were no significant differences in total dose of hMG used (66 vs. 57 hMG, 75 IU ampules), median number of mature follicles recruited (3.5 vs. 3.0), or median number of oocytes retrieved (4 vs. 3). No significant differences were found in either intraovarian or uterine artery pulsatility index measured at baseline or on the day of hCG administration. CONCLUSION(S): Supplementation with low-dose aspirin failed to improve either ovarian and uterine blood flow or ovarian responsiveness in poor responders undergoing IVF.