羊水胎粪污染与新生儿结局

我院１９９２年１～１２月头位生产羊水胎粪污染４１６例，发生率２１．９％，早产及过期妊娠羊水粪染发生率显著高于足月产（Ｐ＜０．００５）．羊术Ⅲ度粪染者胎心电子监护异常及新生儿不良结局的发生率均显著高于Ⅰ度与Ⅱ度粪染者（Ｐ＜０．００５）．９例胎粪吸入综合征，有７例为羊水Ⅲ度粪染．脑心电子监护异常组新生儿不良结局发生率明显高于胎业正常和仅有胎心基线变异减少或消失组（Ｐ＜０．００５），阳性预测率６７．０３％．本研究结果提示，羊水Ⅲ度粪染有明确的胎儿宫内窘迫，应尽快娩出胎几，Ｉ度与Ⅱ度羊水粪染，应加强胎心电子监护，不必过早干预．早产羊水粪染发生率高不支持“胎粪排出乃胎儿肠道成熟标志”的理论．     

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。     

羊水乳酸水平对羊水粪染病例胎儿窘迫的诊断价值

目的探讨羊水乳酸水平在羊水粪染病例中诊断胎儿窘迫的临床价值。方法2003年8月至2004年12月暨南大学第二临床医学院测定72例第一产程活跃期出现羊水粪染(观察组)和52例羊水清、胎儿监护图形正常且有良好新生儿结局(对照组)的羊水及新生儿脐动脉血乳酸水平。结果对照组羊水乳酸值近似正态分布,其95%参考值为5.4~8.9mmol/L。对照组活跃期和分娩时羊水乳酸水平差异无显著性意义(P>0.05)。羊水Ⅲ度粪染的羊水乳酸水平明显高于对照组(P<0.01)。羊水Ⅰ度及Ⅱ度粪染而胎儿监护正常的病例羊水乳酸值与对照组比较,差异无显著性意义(P>0.05)。但羊水Ⅱ度粪染合并胎心基线异常或(和)重度变异减速病例的羊水乳酸水平明显升高(P<0.01)。观察组发生胎儿窘迫及新生儿窒息的病例,其活跃期羊水乳酸水平均明显高于对照组(P<0.01)。以活跃期羊水乳酸值>8.9mmol/L为异常值来诊断胎儿窘迫发生的敏感性、特异性、阳性预测值及阴性预测值分别为61.9%、88.2%、68.4%和84.9%。结论羊水乳酸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临床价值。     

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。     

羊水Ⅲ度胎粪污染与新生儿结局

羊水Ⅲ度胎粪污染与新生儿结局林文琴王楸郑彩薇（温州医学院附属第一医院）羊水粪染（ｍｅｃｏｎｉｕｍ－ｓｔａｉｎｅｄａｍｎｉｏｔｉｃｆｌｕｉｄ）是产科临床上较常见的现象，对其临床意义有不同的看法〔１〕。为了解其对胎儿的确切影响，我们对１８２例羊水Ⅲ度污染...     

足月妊娠分娩期羊水粪染220例临床分析

羊水胎粪污染在产科较为常见 ,为探讨其产科处理及降低对新生儿的不良影响 ,现对我院产程中出现羊水粪染的2 2 0例足月妊娠病例进行回顾性分析。1　临床资料1.1　研究对象　 2 0 0 1年 3月至 2 0 0 1年 9月在我院分娩产妇12 5 4例 ,产程中发现羊水Ⅱ～Ⅲ度粪染的初产妇 2 2 0例为研究组 ,产程中羊水清亮的 2 10例初产妇作为对照组。两组产妇年龄 ,孕周 ,实验室检查无明显差异。1.2　处理　在人工破膜或自然破膜时发现羊水Ⅱ～Ⅲ度粪染者 ,在第一产程时给予吸氧、电子胎心监护 ,严密观察产程进展。估计短期内不能经阴分娩、胎儿监护异常及产…     

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...     

胎儿窘迫行剖宫产70例分析

目的 掌握胎儿窘迫的手术指征。方法 将我院70例因胎儿窘迫行剖宫产患者，依胎儿心外监护，羊水情况分为3组。1组胎心重度异常，2组胎心中度异常，同时可伴有羊水11度感染，3组单纯羊水11度感染，并与术中所见及新生儿Apgar评分对照。结果 三组新生儿低评分（Apgar≤7分）占40分，胎儿窘迫相关因素发病率（80％）明显高于2、3组。表明1组胎儿存在潜在缺氧情况，应及时娩出。结论 严格观察下按胎儿窘迫处理，有好转者，可待阴道分娩，否则以剖宫产为宜。     

第一产程异常胎心监护图形的分析

目的:探讨第一产程异常胎心监护图形的临床意义。方法:选自第一产程胎心监护图形异常的患者348例为观察组,367例第一产程胎心监护正常者为对照组。观察并比较两组间孕妇并发症及胎儿合并症的情况。结果:①电子胎心监护显示早期减速(ED)所占比例最高,为55.2%,然后依次为变异减速(VD)、晚期减速(LD)、心动过速、心动过缓、基线变异减弱及延长减速(PD)。②观察组中,伴有脐带绕颈及羊水量异常的患者分别占28.4%和10.3%,其比例均明显高于对照组,两组之间均有统计学差异(P<0.05)。③观察组中羊水粪染(Ⅱ-Ⅲ度),Apgar评分≤7分(出生1min),胎儿窘迫及剖宫产的比例均明显高于对照组,两组之间均有统计学差异(P<0.05)。结论:不同电子胎心监护异常图形有不同的临床意义,应该结合临床资料综合分析。     

羊水粪染的危害及其监测

羊水粪染的危害及其监测刘维超，顾美礼正常情况下，羊水透明无色，并可见胎脂。当胎粪排入羊水并使其变得混浊时称为羊水粪染或羊水胎粪污染。临床上按进人羊水中的胎粪量引起羊水性状改变的程度分为Ⅲ度。Ⅰ皮：羊水呈黄绿色，质薄；Ⅱ度：羊水里淡绿色，质较厚；Ⅲ度：...     

Spontaneous Resolution of Second Trimester Fetal Pleural Effusion

A case of pleural effusion, diagnosed by ultrasound in the second trimester, underwent spontaneous resolution without adverse effect on lung development. Optimal management has not been defined; because the natural history of fetal pleural effusion is unknown, observation with serial ultrasound is an alternative to in utero therapy.     

产程中胎儿血氧饱和度监测的临床研究

目的:研究产程中监测胎儿血氧饱和度(FSaO2)诊断胎儿窘迫的准确性及安全性,以及联合应用胎心电子外监护监测胎儿的合理途径。方法:对108例产妇在第一产程活跃期及第二产程中同时行胎心监护和胎儿血氧饱和度监测,动态观察胎儿血氧饱和度的变化,确定诊断胎儿窘迫的标准,依据分娩后Apgar评分及脐血血气分析结果,验证监测方法的敏感性、特异性、阳性预期值、阴性预期值与准确率。结果:(1)以胎儿血氧饱和度≤30%作为诊断胎儿窘迫的标准,对脐动脉血pH≤7.15预测的敏感性91.6%,特异性97.9%,阳性预期值84.6%,阴性预期值98.9%;(2)胎儿血氧饱和度≤30%持续5min以上预示胎儿有缺氧及酸中毒的可能;(3)胎心监护和胎儿血氧饱和度测定联合应用,可提高胎儿窘迫诊断的准确性。结论:胎儿血氧饱和度监测是一种理想的内监护方法;产程中常规应用胎心电子外监护,发现异常时可进一步进行胎儿血氧饱和度监测,是理想的监测方法。     

Benefits and risks of MRI in pregnancy

Ultrasound remains the modality of choice in imaging the fetus due to its availability, safety, and low cost. With advances in technology, however, magnetic resonance imaging (MRI) has become an important adjuvant in the evaluation of the fetus. MRI is not limited by fetal lie, oligohydramnios, overlying bone, or obesity. MRI can image the fetus in any plane, providing a large field of view of the fetus and placenta with excellent soft tissue resolution of the brain, airway, lungs, and abdomen. Advanced techniques are being developed that provide volumetric data, spectroscopy, and functional images. MRI has its own set of challenges with a lack of consensus regarding its utility and safety. Artifact from the moving fetus and breathing mother limits the sequences available. While there is currently no evidence that fetal MRI produces harmful effects, long-term safety regarding radiofrequency fields and the loud acoustic environment continues to be studied. In this review, the benefits and potential risks of fetal MRI will be discussed.     

影响脐血促红细胞生成素水平的多因素分析

目的　研究不同孕期脐血促红细胞生成素 (EPO)水平 ,并分析其影响因素。　方法　收集不同孕期脐血共 10 6例 ,分为四组 :正常足月儿组 (足月儿组 )、母患高血压组 (高血压组 )、母患糖尿病组 (糖尿病组 )、宫内窘迫或生后窒息组 (窒息组 )。用放射免疫法测定其EPO水平 ,并分析EPO与胎龄、分娩方式、不同妊娠合并症的关系。以EPO为因变量 ,以新生儿胎龄、性别、分娩方式、母患高血压、母患糖尿病、宫内窘迫或生后窒息为自变量 ,进行多元线性逐步回归。　结果　母患高血压、母患糖尿病、宫内窘迫或生后窒息是影响脐血EPO水平的重要因素 (P均 <0 .0 1) ,胎龄、性别、分娩方式均为非重要的影响因素。分析四组EPO水平 ,结果显示 :足月儿组脐血EPO值为 (1.0 73± 0 .495 ) μg/L ,高血压组、糖尿病组、窒息组脐血EPO值分别为 (1.994± 1.467)、(2 .0 87± 1.14 6)、(1.93 8± 1.5 0 4) μg/L ,与足月儿组比较差异均有显著性 (P均 <0 .0 5 )。　结论　缺氧是影响EPO水平的一个重要因素 ,脐血EPO水平可作为胎儿急、慢性缺氧的一个指标。     

Aortic isthmus and cardiac monitoring of the growth-restricted fetus

Aortic isthmus acts as an arterial watershed between the cerebral and placental circulations, connecting 2 parallel fetal ventricular pumps. It plays a crucial role in the fetal circulatory dynamics. Information about aortic isthmus blood flow may improve the management of sick fetuses. However, perceived technical difficulties limit the clinical use of aortic isthmus Doppler for fetal hemodynamic monitoring. Changes in aortic isthmus blood flow pattern seem to reflect fetal cardiovascular status accurately and predict perinatal and long-term neurodevelopmental outcome in intrauterine growth restriction. This review evaluates the available scientific information and discusses the role of aortic isthmus in fetal circulation.     

Physiological adaptation of the growth-restricted fetus

The growth-restricted fetus in utero is exposed to a hostile environment and suffers undernutrition and hypoxia. To cope with the stress, the fetus changes its physiological functions. These adaptive changes aid intrauterine survival; however, they can lead to permanent functional and structural changes that can contribute to the development of serious chronic diseases later in life. Epigenetic mechanisms are an important part of the pathophysiological processes behind this “developmental origin of adult diseases.” The dominant cardiovascular adaptive change is the redistribution of blood flow in hypoxic fetuses, with preferential supply of blood to the fetal brain, myocardium, and adrenal glands. The proportion of blood from the umbilical vein to the ductus venosus and foramen ovale increases, which increases the cardiac output of the left heart ventricle. The increased perfusion of fetal brain can be followed with Doppler ultrasound as increased diastolic velocities and decreased pulsatility index in the middle cerebral artery.     

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。     

Decreased fetal activity and fetal heart rate changes after amniocentesis complicated by fetal hemorrhage

A case is described in which amniocentesis caused placental injury, abruptic placenta, and fetal hemorrhage which caused fetal distress. This was primarily manifested by reduction of fetal movements and later by fetal heart rate deceleration. Emergency cesarean section was performed of monitoring the fetus after amniocentesis by assessment of fetal movements is stressed.