羊水粪染对新生儿的影响

对１９９１年１月－１９９６年住院分娩产妇的羊水胎粪污染的相关因素及其对新生儿的影响进行了分析研究，发现，羊水粪染（ＭＳＦ）发生率为１４．２％，ＭＳＦ与产科高危因素（妊上、过期产、羊水过少、脐带因素、早破水、产程延长等）有密切关系，合并相关高危因素者，ＭＳＦ发生率明显高于无相关高危因素者，ＭＳＦ越重对新生儿危害越大。     

新生儿窒息与羊水粪染的临床研究

将 8 2例孕龄在 37～ 42周新生儿窒息及其羊水情况、电脑胎儿胎心监护进行分析 ,研究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。新生儿轻度窒息组羊水粪染为Ⅰ～Ⅱ度的比例高 ,而新生儿重度窒息组羊水粪染为Ⅲ度的比例高 (P <0 .0 5 ) ;Ⅲ度羊水粪染者胎心监护的异常发生率明显高于羊水清亮或Ⅰ度羊水粪染者 (P <0 .0 1) ;电脑胎心监护对新生儿窒息的预测准确率为 46 .34 %。结论 :新生儿窒息的发生与羊水粪染的程度有关。一旦出现羊水粪染Ⅲ度应立即结束分娩 ,出现羊水粪染Ⅰ～Ⅱ度时 ,要在胎心监护下密切观察产程的进展 ,一旦出现异常尽快结束分娩 ,以便降低新生儿窒息的发生率 ,减少围产儿死亡率     

羊水过少不同分娩方式对围生儿的影响

目的探讨足月妊娠羊水过少不同分娩方式对围生儿的影响,寻找较好分娩方式,降低围生儿病死率。方法回顾性分析2006年1月至2008年1月在我院住院分娩的184例羊水过少孕妇的围生儿情况;比较羊水过少阴道分娩、急诊剖宫产、计划剖宫产3种分娩方式的围生儿结局。结果妊娠晚期羊水过少的围生儿病率及病死率高;羊水过少分娩过程中新生儿窒息、吸入性肺炎、HIE发生率以计划剖宫产组最低;急诊剖宫产组与阴道分娩组之间比较,新生儿窒息率两组差异具有统计学意义(P<0.05),HIE发生率无统计学意义(P>0.05);急诊剖宫产组与计划剖宫产组之间比较,急诊剖宫产组的新生儿窒息、吸入性肺炎、HIE的发生率均明显大于计划剖宫产组,两组比较具有统计学意义(P<0.05)。结论妊娠晚期羊水过少的围生儿病率及病死率明显增加;妊娠晚期羊水过少急诊剖宫产者和阴道分娩者的新生儿结局较差,不失时机的选择剖宫产是改善围生儿预后的关键。     

尿低分子量蛋白联合检测在新生儿羊水粪染肾损害中的预警作用

目的探讨尿低分子量蛋白联合检测在新生儿羊水粪染肾损害中的临床意义。方法采用病例对照研究的方法,选择120例足月新生儿,其中90例羊水粪染新生儿为研究组,按污染程度分为3组,30名正常羊水新生儿为对照组。测定血气分析、血清尿素氮（BUN）、肌酐（Cr）、尿β2-微球蛋白（β2-MG）、尿α1-微球蛋白（α1-MG）及尿微量白蛋白（MALB）水平。结果随着羊水粪染程度加重,BUN、Cr、尿β2-MG、尿α1-MG及尿MALB水平逐渐增高。研究组和对照组中的BUN和Cr水平比较差异均无统计学意义（P〉0.05）。脐带血pH值（血气分析）、尿β2-MG、尿α1-MG及尿MALB在羊水Ⅲ度粪染组中的含量明显高于对照组,差异有统计学意义（P〈0.05）,而在Ⅰ、Ⅱ度粪染组与对照组比较差异无统计学意义（P〉0.05）。结论尿低分子量蛋白联合检测对羊水粪染引起的肾功能损害早期发现及评估其程度有一定的意义。     

晚期妊娠羊水过少分娩方式的比较分析

羊水过少可发生于妊娠各期，但以晚期妊娠最常见。妊娠晚期羊水量少于300ml者称羊水过少。羊水过少是胎儿危险的重要信号，严重影响围生儿结局，随着超声技术的提高检出率明显增加，日益受到产科工作者的重视。现将我院2003年1月至2006年8月羊水过少185例进行分析。     

羊水过少对围产儿的影响及分娩方式选择浅析

目的研究羊水过少对围产儿的影响及分娩方式的选择.方法收治羊水过少102例,与随机抽取同期分娩102例羊水量正常病例,就妊娠并发症、围产儿情况、分娩方式进行比较.结果羊水过少组合并妊高征、过期妊娠、IUGR明显增高,合并羊水Ⅲ*浊、胎儿宫内窘迫明显高于羊水量正常组,剖宫产机会也明显增高[1].结论应用B超诊断,羊水过少合并妊高征、过期妊娠、IUGR以计划剖宫产为宜,对降低围产儿死亡率有重要意义.     

羊水胎粪污染与新生儿神经行为测定关系的临床分析

目的了解羊水胎粪污染对新生儿行为能力的影响,早期发现脑功能损害引起的新生儿行为神经异常,充分利用早期神经系统可塑性强的时机进行早期干预,促进新生儿脑代偿性康复。方法对108例羊水胎粪污染的足月新生儿进行新生儿20项行为神经能力测定（NBNA）。结果Ⅰ度羊水胎粪污染新生儿与正常新生儿出生3~7天做20项NBNA评分对照,有显著差异（P〈0.05）,生后12~14d和26~28d复测与正常新生儿比较无明显差异（P〉0.05）。Ⅱ度、Ⅲ度羊水胎粪污染新生儿与正常新生儿生后三次20项NBNA评分对照,均有显著差异（P〈0.05,P〈0.01）。结论羊水胎粪污染影响新生儿行为神经能力测定,要及早发现羊水Ⅱ度、Ⅲ度胎粪污染,及时处理,降低围产儿的脑损伤。     

羊水过少与围产儿预后的临床研究

目的 探讨羊水过少与围产儿预后的关系.方法 收集我院2007年1月～2009年12月住院治疗羊水过少孕妇78例,作为观察组,随机抽取同期住院85例羊水量正常孕妇作为对照组,两组病例就其分娩方式、围产儿预后方面进行比较.结果 观察组胎儿窘迫发生率、羊水粪染发生率、新生儿窒息发生率、剖宫产率明显高于对照组.结论 羊水过少是胎儿宫内慢性缺氧最敏感的特异性指标,严重威胁围产儿的生命安全,一经确诊羊水过少,应积极终止妊娠,增加了母亲手术的创伤与风险.     

胎儿纤维连接蛋白与支原体宫颈炎和羊水胎粪污染关系的研究

目的通过检测胎儿纤维连接蛋白（FFN）,研究支原体宫颈炎和羊水胎粪污染的关系,为预测胎儿窘迫提供新方法。方法采用酶联免疫吸附法（ELISA）对支原体宫颈炎患者120例（研究组）,健康孕妇81例（对照组）进行宫颈阴道分泌物FFN检测,以FFN≥50ng／mL为判断阳性标准。结果研究组FFN阳性患者75例,阳性率62．5％（75／120）,对照组FFN阳性患者31例,阳性率38．2％（31／81）;研究组羊水胎粪污染18例,阳性率24％（18／75）,对照组羊水胎粪污染2例,阳性率畅（2／50）。两组比较均有显著性差异（P〈0．05）。结论FFN与支原体宫颈炎有关系,对预测羊水胎粪污染及早期治疗胎儿窘迫有价值。     

Amniotic fluid cell culture for prenatal diagnosis of some metabolic diseases

Primary cultures of amniotic fluid cells were obtained. Optimal conditions of culture were determined and the mean incubation period was 17.9 days. Normal values for the activity of eight glycosidases, deficiency of which causes the development of inborn errors of metabolism, were obtained. On the basis of the results it is concluded that glycolipidoses (Tay-Sachs', Fabry's, and Gaucher's diseases, etc.) can be diagnosed prenatally. Data on the prenatal diagnosis of Tay-Sachs' disease are presented.Department of Medical Genetics, All-Union Research Institute of Obstetrics and Gynecology, Ministry of Health of the USSR, Moscow. Laboratory of Biochemistry and Pathochemistry of Carbohydrate Metabolism, Institute of Biological and Medical Chemistry, Academy of Medical Sciences of the USSR, Moscow. (Presented by Academician of the Academy of Medical Sciences of the USSR L. S. Persianinov.) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 89, No. 3, pp. 344–346, March, 1980.     

羊水栓塞的病理诊断

目的探讨羊水栓塞病人病理诊断的有关问题。方法通过HE染色、胆色素和黏液组织化学染色以及CD34、cytokeratin(H)、HCG-β免疫组化染色，对死于围产期的13例尸检资料及1例抢救成功的外检资料进行回顾性分析。结果尸检中明确诊断为羊水栓塞的5例，在其HE染色的肺组织切片中小血管及毛细血管内都看到了长梭形，三五成团或散在分布的鳞状上皮，其中4例观察到胎粪小体的存在，经胆色素染色证实，3例观察到黏液，2例经黏液染色证实。1例外检诊断为羊水栓塞抢救成功的病例在子宫小血管及毛细血管内也看到了鳞状上皮，并经免疫组化标记证实。其他8例病例，无1例观察到明确羊水成分，其中6例在肺小血管内发现红染、丝状细胞团，但量少且无其他羊水成分证据，cytokeratin(H)全部阴性，CD34染色有3例阳性，3例在肺血管或子宫血管内看到了大细胞，HCG染色均为阴性。结论羊水栓塞的病理诊断应该以HE切片结合病史及临床表现为主，特殊染色及免疫组化染色可以辅助诊断，但不应完全依赖于特殊染色及免疫组化染色。     

Chorionic plate vessels as an origin of amniotic fluid neutrophils

The present study was conducted to investigate the potential anatomical source of amniotic fluid neutrophils. Microdissection of neutrophils from the chorioamnion of the fetal membranes and the amnion of the chorionic plates of 10 preterm placentas with acute chorioamnionitis was performed and the genotypes of the neutrophils were compared with those of the mother and fetus using polymerase chain reaction of nine autosomal STR loci. In separate analyses, we reviewed eight cases of fetal autopsies with increased amniotic fluid neutrophils for the presence of neutrophils in the alveoli, and also analyzed the relationship between the amniotic fluid white blood cell (WBC) count and the histological pattern of placental inflammation. The genotypes of all of the neutrophils found in the chorioamnion of the fetal membrane matched those of the mother (n = 10). The genotypes of neutrophils found in the chorionic plate were of mixed maternal and fetal origin (n = 4). In the autopsy series of the fetuses with amniotic fluid WBC (n = 8), only five cases showed neutrophils in the alveolar space, while all the placentas had chorioamnionitis. There was no significant difference in amniotic fluid WBC count between the cases with or without acute membranitis, while among the cases with placental inflammation, those with inflammation of the chorionic plate had a significantly higher amniotic fluid WBC count than both the membranitis-only cases (P < 0.001) and the membranitis and funisitis cases (P < 0.05). These results imply that fetal vasculature at the chorionic plate is the main source of amniotic fluid neutrophils, especially in the cases without funisitis.     

Enhancement of amniotic fluid cell growth for genetic amniocentesis

The last two decades have witnessed a logarithmic growth in demand for prenatal diagnosis of human disease through amniocentesis. Consequently, culture turn-around-time has become the major concern of all those who are primary care providers for patients seeking help. We report a rapid method for obtaining cytogenetic results from amniocytes as early as 5 days. Early tapping and reducing the turn-around-time during cytogenetic analysis may provide an alternative to chorionic villi sampling.     

提高羊水细胞培养成功率的方法

目的提高羊水培养的成功率。方法正常羊水保留换液标本,以备复查;异常羊水采用细胞分离技术提取羊水中的有效细胞成分;及时发现污染羊水并进行抗菌处理。结果提高了羊水培养的成功率（99.4%）并缩短异常羊水的培养时间,解决了部分污染羊水的污染问题（2/3）。结论保留换液标本可有效解决因收集不当而导致无法诊断的问题;细胞分离技术可提高异常羊水细胞培养的成功率并缩短培养时间,污染的羊水也可抗菌后培养成功。     

孕中期羊水中细胞研究进展

孕中期羊水中细胞培养和核型鉴定广泛应用于产前诊断领域,可以发现一系列胎儿发育异常。近来,许多研究表明羊水中含有胎儿的干细胞,这些细胞能否应用于干细胞和组织工程学领域成为研究热点。综述了羊水中细胞的组成、来源、生物学特性、干细胞特性及组织工程学应用等方面的内容,并对研究前景进行展望。     

母体循环血找羊水有形成分的方法探讨

目的提高显微镜检查母体循环血中羊水有形成分的检出率,以便辅助临床早期快速确诊羊水栓塞。方法将足月产妇羊水与健康产妇静脉血按不同比例混合,在不同速度离心后取血浆层镜检,找出其羊水有形成分的最低检出限,然后吸取血浆层再以不同速度离心,观察其羊水有形成分最低检出限的变化。同理将24份羊水栓塞产妇的静脉血经两次不同速度离心后镜检羊水有形成分,比较其检出率差异。结果第一次以1000rpm离心5min后镜检出羊水有形成分的羊水／血液比例最低,为1：64;然后取1000rpm离心5min后的血浆层再经4000rpm离心3min,羊水有形成分最低检测限降低至羊水／血液为1：256。羊水栓塞患者血液标本经1000rpm离心5min后镜检检出率最高为33．3％,然后取1000rpm离心5min后的血浆层再行4000rpm离心3min,可将羊水有形成分检出率提高至66．6％,其差异具有统计学意义（χ^2=6．125,P〈0．05）。结论羊水栓塞母体循环血找羊水有形成分时应进行二次离心,第一次1000rpm 5min,取血浆再4000rpm 3min,然后取沉淀物镜检找羊水有形成分。     

Chronic chorioamnionitis displays distinct alterations of the amniotic fluid proteome

Acute chorioamnionitis of infectious origin and chronic chorioamnionitis of immunological origin are two major placental lesions of spontaneous preterm birth with elevated amniotic fluid interleukin-6 and CXCL10 concentrations, respectively. The changes in the amniotic fluid proteome associated with intra-amniotic infection and acute chorioamnionitis are well defined, yet alterations unique to chronic chorioamnionitis remain to be elucidated. This study was conducted to determine those amniotic fluid proteins changing specifically in the presence of chronic chorioamnionitis. Amniotic fluid obtained from acute chorioamnionitis, chronic chorioamnionitis and gestational age-matched controls were analysed by two-dimensional (2D) difference in gel electrophoresis and MALDI-TOF analyses. The type of histological inflammation was used to define each condition in preterm labour cases (n = 125) and term not in labour cases (n = 22), and the amniotic fluid concentrations of interleukin-6, CXCL8, CXCL10 and prostaglandin F(2α) were also measured by specific immunoassays. Among preterm labour cases, 31 differentially expressed proteins were identified in chronic chorioamnionitis cases as compared to both acute chorioamnionitis and control cases. Importantly, glycodelin-A, which maintains maternal tolerance against an allogeneic fetus, was decreased in chronic chorioamnionitis, while haptoglobin was increased. We report the amniotic fluid proteome of chronic chorioamnionitis for the first time, and the findings herein strongly suggest that there is a pathophysiological association between the changes of immunomodulatory proteins in the amniotic fluid and chronic chorioamnionitis, a histological manifestation of maternal anti-fetal allograft rejection.     

羊水来源胎儿间充质干细胞定向诱导为脂肪细胞的研究

目的:研究体外诱导孕中期羊水来源胎儿间质干细胞(M SCs)分化为脂肪细胞。方法:机械手段挑取孕中期羊水细胞培养体系中的胎儿M SCs集落,培养扩增后,通过流式细胞仪检测表面抗原表达进行鉴定。取第3代胎儿M SCs,IBM X、胰岛素、氢化考的松等诱导其向脂肪细胞分化。倒置相差显微镜观察诱导后细胞形态的变化。诱导20 d后,油红O染色检测胞内中性脂肪并计算阳性细胞率,W estern Blot蛋白印记法检测PPA Rγ的表达。结果:机械手段分离出的胎儿M SCs为CD 44阳性,CD 34、CD 45、H LA-D R阴性,符合M SCs特点。诱导72 h后,细胞内有脂滴出现,随着时间延长,脂滴逐渐增加并融合为脂泡,细胞由梭形转变为圆形或多角性。20 d后85%以上胎儿M SCs变为油红O染色阳性,W estern Blot显示诱导20 d后,诱导组细胞PPA Rγ的表达量明显高于未诱导组。结论:经上述方法诱导20 d后,羊水来源胎儿M SCs可以分化为脂肪细胞。