早产儿及胎儿胼胝体超声测量比较

目的:比较不同方式测量胎儿及早产儿胼胝体前后径的差异。方法:282例孕28～36周胎儿及222例出生孕周为28～36周的早产儿,分为胎儿组及早产儿组,胎儿组使用超声经母体腹部测量胼胝体前后径,早产儿组在出生当天使用超声经新生儿颅脑测量胼胝体前后径。比较两种方式测量胼胝体前后径的差异。结果:孕28～36周胎儿胼胝体前后径分别为:(34.56±1.27)mm、(35.53±1.30)mm、(37.66±1.41)mm、(37.11±1.53)mm、(38.54±1.99)mm、(38.20±1.07)mm、(39.53±2.13)mm、(42.59±1.57)mm、(43.56±2.31)mm;出生孕周为28～36周的早产儿胼胝体前后径分别为(33.50±1.67)mm、(34.14±2.01)mm、(36.50±1.21)mm、(36.69±1.45)mm、(37.68±2.04)mm、(38.36±1.97)mm、(38.62±1.34)mm、(40.54±1.57)mm、(42.94±2.11)mm。胎儿组经母体腹部测量胼胝体前后径与相同孕周出生早产儿出生当天经颅脑超声测量胼胝体前后径差异无统计学意义(P>0.05)。结论:经母体腹部与经新生儿颅脑两种方式测量胼胝体前后径差异无统计学意义(P>0.05)。胎儿胼胝体生长发育数据可以作为早产儿宫外胼胝体生长发育的对照参考。     

超声测量不同孕周胎儿肾脏大小及其临床意义

目的:确立不同孕周正常胎儿肾脏大小指标,探讨产前超声检查胎儿肾脏生长指标与孕周的相关性,筛查肾脏和尿路的发育异常。方法:应用超声测量孕18~42周胎儿肾脏的长径、前后径和肾盂分离宽度,分析各孕周与胎肾长径、前后径的关系。结果:共收集625例孕18~42周单胎妊娠胎儿肾脏的测量值。胎儿左右肾脏测量的各参数差异无统计学意义,与孕周呈线性正相关,同时发现暂时性肾盂分离21例,短暂性肾盂分离11例,持续性肾盂分离9例,先天性泌尿系畸形5例。结论:测量胎儿肾脏长径、前后径、肾盂分离宽度,可作为判断不同孕周胎肾发育的可靠指标,能早期发现胎肾发育异常,进行临床干预和治疗。     

母体先兆子痫时胎儿胸腺的三维超声体积测量

目的通过对合并母体先兆子痫胎儿胸腺横径、前后径和体积进行超声测量,评估胎儿胸腺超声经线和孕妇先兆子痫的相关性。方法选取2014年7月-2017年7月在吉林大学第二医院诊断为先兆子痫的孕妇50例为观察组,同时随机选取同期在该院体检的50例孕23~40周孕妇为对照组,取两组胎儿三血管气管切面测量胎儿胸腺横径、前后径,三维超声成像QLAB技术测量胎儿胸腺体积,并比较两组的差异。结果对照组胎儿胸腺横径和孕周线性回归方程为Y=0.148X-1.756(R2=0.966,P<0.05),对照组胎儿胸腺前后径和孕周线性回归方程为Y=0.048X-0.150(R2=0.860,P<0.05),对照组胎儿胸腺体积和孕周线性回归方程为Y=0.822X-15.875(R2=0.938,P<0.05)。两组参数胎儿胸腺横径、前后径和体积均值比较,差异均有统计学意义(P<0.05)。结论孕妇发生先兆子痫时,胎儿胸腺超声测值均值小于相应孕周正常妊娠胎儿胸腺测值均值95%,两者差异显著,胎儿胸腺发育与孕妇先兆子痫具相关性。     

三维超声技术在测量胎儿肾脏体积中的应用(附116例临床资料)

目的:通过三维超声测量胎儿肾脏体积并用这些资料来建立用二维超声测量进行估算胎儿肾脏体积的公式。方法:包括20~40孕周的单胎。用三维超声测量胎儿双侧肾脏的体积。测量胎儿肾脏的三个径线(最大前后径、横径和纵径),并计算胎儿肾脏体积的公式,计算出每侧肾脏体积与三条径线的回归曲线和系数。结果:共做了116例胎儿,建立了以下胎儿肾脏体积的公式:胎儿肾脏体积=系数(R)×最大前后径(X)×最大横径(Y)×最大纵径(Z)。在右侧和左侧肾之间,体积、三条径线和系数有所不同,但无明显差异。结论:三维超声测量胎儿肾脏体积是有用的,胎儿肾脏体积公式使二维超声测量肾脏体积更为精确。     

利用三维超声C平面成像对胎儿小脑蚓部发育的监测

目的：评价利用三维超声C平面成像方法对小脑蚓部发育的监测价值。方法：利用三维超声C平面成像方法观察200例中孕期胎儿的小脑结构,显示小脑正中矢状切面,在小脑正中矢状切面上测量小脑蚓部前后径、上下径和切面面积,并分析其与孕周的关系。结果：利用三维超声C平面成像方法显示小脑蚓部的成功率较高,在该平面上测量的小脑蚓部前后径、上下径和最大切面面积与孕周呈正相关性。结论：三维超声C平面成像能够克服二维超声难以获取胎儿头颅正中矢状切面的不足,能得到满意的小脑矢状切面图像,从而使胎儿小脑蚓部发育的测量成为可能;小脑蚓部随孕周发育的变化规律及其正常测量数据为进一步判断病变提供了参考标准。     

二维超声检测孕7～13周胎儿羊水体积的研究

目的分析7~13周正常胎儿羊水体积及其头臀径的关系。方法选取孕7~13周头臀径为10~65mm的正常胎儿281例,利用二维超声测量其羊水体积和头臀径(CRL),并对头臀径与羊水体积进行相关性研究。结果胎儿羊水体积与头臀径呈正相关(r=0.913,P<0.001),回归方程为:羊水体积(cm3)=-12.41+1.25×头臀径(mm)。281例胎儿头臀径平均测值为(35.42±15.74)mm,中位数为32.00mm;羊水体积的平均体积为(31.692±21.458)cm3,中位数为29.029 cm3;中位数预测值从头臀径为10mm时的0.188 cm3(范围0.140~0.278 cm3)增加至头臀径为65mm时的65.236 cm3(范围58.660~74.723cm3)。结论孕7~13周正常胎儿羊水体积的变化规律及其正常测量数据可为临床早期评价胎儿的预后提供重要的依据。     

10~13孕周超声筛查颈部半透明层厚度的方法

目的:应用超声测量10~13孕周胎儿颈部半透明层厚度(Nuchal Translucency,NT)和头臀长(Crown Rump Length,CRL),前瞻性研究吉林省汉族人群中NT与CRL和孕周的关系。方法:分别对10~13孕周的胎儿超声测量CRL,确定“超声孕周”后,再测量胎儿的颈部半透明层厚度,回顾性分析3826例10~13孕周胎儿资料,绘制各孕周NT的正常曲线,制定出第10百分位、第50百分位、第90百分位。结果:经NT筛查的10~13孕周胎儿中出生后随访3884中正常胎儿有3826例,其中10孕周胎儿571例,NT平均厚度为1.18mm;孕11周胎儿1026例,NT的平均厚度为1.21mm;孕12周胎儿1514例,NT平均厚度为2.02mm;孕13周胎儿715例,NT平均厚度为2.05mm。孕10~13周平均NT厚度为1.78mm。结论:①10~13孕周正常胎儿的NT随CRL的增大而增大;②对10~13周孕妇进行产前NT无创筛查,是一种尽早发现异常胎儿的有效方法。     

胎儿股骨、肱骨长度随孕周增长变化趋势初探

<正> 为了解自孕12～40周胎儿在不同孕周股骨与肱骨发育特点,本文对我院不同孕龄胎儿股骨与肱骨的长度进行测量,以发现其发育速度的特点,更好的研究胎儿期肢体发育的异常。 资料与方法 1997～1998年不同孕周的孕妇共2757例,使用日本阿洛卡256B超声仪,探头频率为3.5MH_Z。孕妇仰卧位,B超对胎儿双顶径、脊柱、胎心、胎动、胎盘、羊水做全面扫查后,测量胎儿股骨、肱骨长度,计算平均值,得出胎儿股骨与肱骨长度在不同孕周     

B超测量胎肝右叶纵径监测胎儿生长受限

目的 建立不同孕周正常胎儿肝脏右叶纵径指标,观察胎儿生长受限、治疗前后胎儿肝脏右叶纵径的变化.方法 采用超声诊断仪分别测量妊娠18～42周的1 106例正常胎儿及64例胎儿生长受限的妊娠妇女治疗前后胎儿的肝脏右叶纵径长度.结果 ①正常妊娠胎儿肝脏右叶纵径与孕周密切相关,孕28周前胎儿肝脏右叶纵径增长速度为每周1.01mm,孕28周后增长速度为每周1.66mm,两者有显著性差异(P＜0.05);②胎儿生长受限治疗前后胎儿肝脏右叶纵径增长速度为每周1.21mm和1.52mm;③临产前LL和胎儿体重密切相关(r＝0.93,P＜0.05).胎儿肝脏右叶纵径对正常胎儿体重、胎儿发育受限诊断的敏感性分别是88%、87%,特异性分别是89%、91%.结论 胎儿肝脏右叶纵径变化可反映胎儿的宫内生长情况,动态测量可正确评价胎儿宫内生长情况.     

不同超声测量指标计算孕龄对唐氏综合征筛查结果影响的分析

目的探讨不同超声测量指标计算孕龄对中孕期唐氏综合征(DS)筛查效率的影响。 方法选择2012年1～12月在四川大学华西第二医院产前诊断中心于中孕期抽血行DS筛查的5 934例孕妇为研究对象,按照不同孕龄计算方法,将其分为顶臀长组(n＝2 967,采用早孕期胎儿顶臀长计算孕龄)和双顶径组(n＝2 967,采用中孕期胎儿双顶径计算孕龄)。对两组DS筛查阳性率及DS筛查效率进行对比分析。两组孕妇的年龄、体质量等一般临床资料比较,差异无统计学意义(P>0.05)。 结果①顶臀长组孕妇接受DS筛查主要集中于孕龄为15～17孕周,而双顶径组孕妇接受DS筛查的孕龄为15～20孕周。②双顶径组的DS筛查阳性率(9.80%)高于顶臀长组(6.20%),两组比较,差异有统计学意义(χ²＝26.641,P<0.000 1);双顶径组的DS筛查效率(1.03%)低于顶臀长组(2.17%),但两组比较,差异无统计学意义(χ²＝0.386,P>0.05)。 结论早孕期超声检查测量胎儿顶臀长计算孕龄用于中孕期DS筛查可能优于中孕期超声检查测量胎儿双顶径计算孕龄方法。     

早产儿与足月儿胼胝体大小及形状的对比研究

目的比较足月儿与发育至同龄的极低出生体重(very low birth weight,VLBW)早产儿胼胝体面积、偏心率和斜率的差异,为早期评价和改善早产儿脑发育提供参考。方法 55例胎龄为40周的足月儿于出生当日、80例VLBW早产儿于纠正胎龄40周时分别接受颅脑高场MRI检查,扫描序列为T1WI、T2WI和DWI,选择T1WI正中矢状位图像,共得到127例合格的颅脑MRI图像,其中足月儿组49例,VLBW早产儿组78例;由两名影像学医师于不同时间分别勾画两次胼胝体及大脑区域,使用MATLAB R2010a中的图像处理函数对所勾画的图像进行测量,计算得到胼胝体面积、前部斜率、后部斜率及偏心率。结果 VLBW早产儿组胼胝体面积和后部斜率均小于足月儿组,前部斜率大于足月儿组,两组间差异有统计学意义(P均0.05)。VLBW早产儿组胼胝体偏心率小于足月儿组,两组间差异无统计学意义(P0.05)。结论早产影响胼胝体的发育,VLBW早产儿发育至与足月儿同龄时胼胝体可能较小且较圆。     

Maternal smoking and fetal growth characteristics in different periods of pregnancy: the generation R study

The authors examined the associations of maternal smoking in pregnancy with various fetal growth characteristics among 7,098 pregnant women participating in the Generation R Study (2002-2006), a population-based prospective cohort study of pregnant women and their children in Rotterdam, the Netherlands. Maternal smoking was assessed by questionnaires administered in early, mid-, and late pregnancy. Fetal growth characteristics evaluated included head circumference, abdominal circumference, and femur length measured repeatedly in mid- and late pregnancy. Maternal smoking during pregnancy was associated with reduced growth in head circumference (-0.56 mm/week; 95% confidence interval (CI): -0.73, -0.40), abdominal circumference (-0.58 mm/week; 95% CI: -0.81, -0.34), and femur length (-0.19 mm/week; 95% CI: -0.23, -0.14). This reduced growth resulted in a smaller femur length from midpregnancy (gestational age 18-24 weeks) onwards and smaller head and abdominal circumferences from late pregnancy (gestational age > or =25 weeks) onwards. Analyses using standard deviation scores for the growth characteristics demonstrated the largest effect estimates for femur length. The authors concluded that maternal smoking during pregnancy is associated with reduced growth in fetal head circumference, abdominal circumference, and femur length. The larger effect on femur length suggests that smoking during pregnancy affects primarily peripheral tissues.     

胎儿生长受限高危因素的Logistic回归分析

目的:探讨胎儿生长受限(FGR)发生的高危因素。方法:采用1∶1配比的病例对照研究设计,对2011年在该院分娩的276例FGR新生儿(FGR组)及276例正常体重新生儿(正常组)及其产妇病历资料进行回顾性分析。结果:FGR组与正常组在产妇年龄、文化程度、家庭月收入、吸烟、饮茶、妊娠期感染史、妊娠期合并症、妊娠期并发症、新生儿胎龄等单因素方面比较存在差异,差异有统计学意义(P<0.05);以新生儿体重为因变量,其他因素为自变量,进行非条件性的Lo-gistic多因素分析,结果显示产妇年龄、文化程度、家庭月收入、吸烟、饮茶、妊娠期感染史、妊娠期合并症、妊娠期并发症、新生儿胎龄等因素差异有统计学意义(P<0.05)。结论:产妇高龄、文化程度低、家庭月收入低,有吸烟、饮茶、妊娠期感染史,存在妊娠期合并症、妊娠期并发症及新生儿低胎龄均是FGR发生的高危因素。在孕期应针对以上高危因素积极进行针对性预防,以减少FGR的发生。     

Familial aggregation of fetal growth restriction in a French cohort of 7,822 term births between 1971 and 1985

An association between fetal growth restriction and increased rates of metabolic and cardiovascular diseases in adulthood has been reported. This study evaluated familial aggregation of fetal growth restriction in term births. The population consisted of 3,505 sibships comprised of 7,822 full-term singleton infants born between 1971 and 1985 in Haguenau, France, and selected from a regional register of births. Sib-sib odds ratios were estimated for being born small for gestational age (SGA), defined as having a birth weight below the 10th percentile of the sex-specific curve of birth weight by week of gestation. SGA births were further stratified according to ponderal index (birth weight/length(3)). After adjustment for maternal factors, the sib-sib odds ratios were 4.8 (95% confidence interval (CI): 3.7, 6.3) for all SGA births, 7.7 (95% CI: 4.1, 14.7) for SGA births with a low ponderal index (<10th percentile), and 4.4 (95% CI: 2.3, 8.2) for SGA births with a normal ponderal index (25th-75th percentile). None of the maternal factors investigated significantly influenced the magnitude of these odds ratios. This strong residual sib-sib aggregation suggests a role for genetic and/or shared environmental factors in the etiology of fetal growth restriction, especially when associated with a low ponderal index.     

Individually customised fetal weight charts derived from ultrasound measurements: the Generation R Study

Maternal and fetal characteristics are important determinants of fetal growth potential, and should ideally be taken into consideration when evaluating fetal growth variation. We developed a model for individually customised growth charts for estimated fetal weight, which takes into account physiological maternal and fetal characteristics known at the start of pregnancy. We used fetal ultrasound data of 8,162 pregnant women participating in the Generation R Study, a prospective, population-based cohort study from early pregnancy onwards. A repeated measurements regression model was constructed, using backward selection procedures for identifying relevant maternal and fetal characteristics. The final model for estimating expected fetal weight included gestational age, fetal sex, parity, ethnicity, maternal age, height and weight. Using this model, we developed individually customised growth charts, and their corresponding standard deviations, for fetal weight from 18 weeks onwards. Of the total of 495 fetuses who were classified as small size for gestational age (<10th percentile) when fetal weight was evaluated using the normal population growth chart, 80 (16%) were in the normal range when individually customised growth charts were used. 550 fetuses were classified as small size for gestational age using individually customised growth charts, and 135 of them (25%) were classified as normal if the unadjusted reference chart was used. In conclusion, this is the first study using ultrasound measurements in a large population-based study to fit a model to construct individually customised growth charts, taking into account physiological maternal and fetal characteristics. These charts might be useful for use in epidemiological studies and in clinical practice.     

CORRELATES OF LOW BIRTH WEIGHT

Summary In order to provide a base line for long term follow-up, the background, methodology and major conclusions of a prospective study of low birth weight infants (≤2500 g) and their matched controls (> 2500 g) were studied and the results presented. The low birth weight babies were disadvantaged in respect of a number of bio-social parameters, had an excess of maternal and pregnancy disease conditions and a more unfavourable outcome in other pregnancies. The cohort was used to try and evolve a better definition of impaired fetal growth. The relative merits of using weight, head circumference, length, ratio of anthropometric measurements, relative merits position of anthropometric measurements in the same baby, cluster analysis techniques and clinical morbidity as estimates of impaired fetal growth were analysed: none defined impaired fetal growth more accurately than weight for gestational age. Methods of estimating gestational age and physical characteristics relating to growth and gestational age, as well as a number of biochemical and neonatal measurements, are described.