妊娠高血压综合征血液流变学与胎儿脑血流阻力指标相关性分析

目的 :产前预测胎儿窘迫 ,及时发现异常 ,及时处理 ,降低围产儿病残率和死亡率。方法 :测定妊高征孕妇全血及血浆粘度 ,包括全血比粘度高切 (BVH)、全血比粘度低切 (BVL)、全血还原比粘度、血浆粘度 (PV)、红细胞压积(HCT)、纤维蛋白原 (Fib) ;运用彩色多普勒测胎儿大脑中动脉 (MCA)血流阻力指标 (S/ D、PI、RI值的统称 )。结果 :妊高征孕妇血液流变学检测比较 ,重度妊高征大于中度妊高征、中度妊高征大于轻度妊高征。妊高征孕妇血液流变学各值与胎儿 MCA血流阻力指标各值呈负相关性。当孕妇血液流变学各值增高 :BVH≥ 4 .6 3、BVL≥ 6 .2 3、PV≥ 1.6 8、HCT≥0 .36时可预测妊高征的发生 ,及对围产儿有不良影响 ;当胎儿 MCA血流 S/ D≤ 4、PI≤ 1.6、RI≤ 0 .6时 ,预测胎儿窘迫的发生 ,以上各值可作为临界值 ,及时发现异常 ,及时处理。结论 :监测孕妇血液流变学及胎儿 MCA血流阻力指标各值 ,可提高预测胎儿窘迫的准确性 ,及时发现异常 ,及时处理 ,保障母婴健康 ,降低围产儿死亡率     

彩色多普勒监测脐血流预测胎儿宫内状况

运用彩色多普勒监测正常妊娠、好高征、合并ＩＵＧＲ的ｖ妊高征胎儿脐动脉血流，计测血流的Ｓ／Ｄ值、ＰＩ值、ＲＩ值。结果表明，妊高征（合并或不合并ＩＵＧＲ）胎儿脐动脉血流阻力指标明显大于正常妊娠组，经治疗后，妊高征胎儿脐动脉血流阻力指标降低者，临床表现好转，反之恶化。阻力指标异常升高，预示胎儿宫内状况差、胎儿窘迫或发生ＩＵＧＲ，有助于及时发现异常和处理，降低围产儿死亡率。     

妊娠期肝内胆汁淤积症患者脐血流检测与围产儿预后

目的 :探讨妊娠期肝内胆汁淤积症 (ICP)患者胎儿脐动脉血流阻抗特点及围产儿结局的影响。方法 :用胎儿脐血流检测仪检测 4 3例 ICP患者和 5 8例正常孕妇胎儿脐动脉血流阻力指标。结果 :ICP患者胎儿脐动脉血流阻力指标及围产儿结局不良的发生率均明显升高。结论 :ICP患者应常规进行胎儿脐动脉血流阻力检测 ,以便及时处理以改善ICP患者围产儿预后     

PGE2与胎儿胎盘循环

目的　探讨前列腺素Ｅ２（ＰＧＥ２ ）对正常妊娠及妊高征孕妇胎儿胎盘循环的调节作用。　方法　在５０例足月正常孕妇（对照组）及３７例妊高征合并ＩＵＧＲ孕妇（妊高征组）中,利用共焦点激光扫描显微镜测定了ＰＧＥ２对人脐静脉内皮细胞（ＨＵＶＥＣ）内游离钙离子（Ｃａ２＋ ）ｉ动态变化的影响,同时用放免法测定了其脐静脉血中ＰＧＥ２浓度。　结果　ＰＧＥ２ 使两组ＨＵＶＥＣ中（Ｃａ２＋ ）ｉ上升, 脐血中ＰＧＥ２ 值在妊高征组为５．４±０．６ ｐｇ／ｍ ｌ与对照组的１５．３±１．２ ｐｇ／ｍ ｌ相比,显示有意义的低值（Ｐ＜０．０５）。　结论　ＰＧＥ２ 可能为胎儿胎盘循环的血管扩张因子;妊高征组脐血中ＰＧＥ２ 浓度降低使胎儿胎盘血流阻力增加可能影响胎儿生长发育     

内皮素与妊高征血液流变学的相关性研究

目的：研究内皮素与妊高征血液流变学的关系及其在妊高征中的发病机制。方法：用放射免疫分析法测定30例妊高征患者（妊高征组），28例正常妊娠妇女（正常妊娠组）血浆内皮素（endothelin,ET)水平，并与其血液流变学参数红细胞压积（Het)，血沉（ESR），全血粘度（WBV），血浆粘度（PV）进行相关性分析。结果：妊高征组ET与红细胞压积、全血粘度呈显著正相关，与血沉、血浆粘度呈负相关；正常妊娠组与这4项指标无明显相关性。结论：ET参与了妊高征的发病过程，并与其血液粘滞度增高的变化相关。     

一氧化氮在妊高征发病及子宫-胎盘-胎儿循环中的调节作用

目的：探讨一氧化氮（ＮＯ）在妊高征发病及在子宫－胎盘－胎儿循环阻力中的调节作用和对胎儿生长发育的影响。方法：采用Ｇｒｅｉｓｓ法测定了４３例妊高征患者（妊高征组）分娩前后外周血及脐血血清ＮＯ的含量，以２５例正常晚孕妇（正常晚孕组）及１８例健康未孕妇（未孕组）作对照。应用彩色多普勒超声检测了部分病例子宫动脉及脐动脉血流阻力指标Ｓ／Ｄ值，并观察了部分病例胎盘绒毛血管的超微结构变化。结果：妊高征组产前外周血及脐血ＮＯ含量均低于正常晚孕组（Ｐ＜０．０１）。脐血ＮＯ含量高于母血（Ｐ＜０．０１）。妊高征组外周血及脐血血清ＮＯ含量均与脐动脉Ｓ／Ｄ值呈负相关（ｒ分别为－０．５２，Ｐ＜０．０５及－０．５８，Ｐ＜０．０１）。中、重度患者的胎盘绒毛血管均有不同程度的病变。结论：ＮＯ的合成减少可能是妊高征发病中的一个重要环节，妊高征患者ＮＯ合成减少与胎盘循环阻力增高及绒毛血管的超微结构改变可能互相影响、互为因果。     

胎儿脐动脉舒张末期血流缺失及返流的临床分析

目的　探讨胎儿脐动脉舒张末期血流缺失、返流（ＡＥＤＶ） 的产生因素及与围产儿结局的关系。方法　应用脉冲多普勒超声检测胎儿脐血流,对３３ 例出现ＡＥＤＶ（ＡＥＤＶ 组） 的母儿的临床资料进行分析,并与未发生ＡＥＤＶ的４２４ 例（ 对照组）进行比较。结果　（１）ＡＥＤＶ组９ 例（２７ ．３ ％） 胎儿有不同种类的形态异常,其中６ 例围产儿死亡。（２）ＡＥＤＶ 组中双胎６ 例,３ 例为双胎间输血综合征（ＴＴＴＳ）。６ 例双胎两胎儿间体重差异最低在２４．８％ 以上,其中４ 例围产儿死亡。（３）ＡＥＤＶ 组妊高征、羊水过少、胎儿宫内发育迟缓、胎儿窘迫及新生儿死亡的发生率均明显高于对照组。结论　胎儿脐血流检测中,出现ＡＥＤＶ改变,是母体胎盘、胎儿胎盘循环障碍的表现,提示胎儿预后不良,临床上应予以高度重视。     

用彩色超声仪与多功能多普勒仪监测胎儿脐血流S/D值的比较

胎儿脐动脉血流速度波形是反映胎儿－胎盘循环状态的指标之一,当胎儿脐动脉血流出现阻断或逆流的异常波形时,反映胎儿－胎盘循环血流量严重不足;血流阻力指标极度升高表明胎儿宫内缺血、缺氧严重,在胎儿脐动脉逆流波形出现时有４０％～５０％的围产儿死亡,及时终止妊...     

妊高征患者血清尿酸含量与围产期结局的分析

通过测定３０例正常孕产妇和６４例妊高征患者的血清尿酸（ＵＡ）、肌酐（Ｃｒ）和尿素氮（ＢＵＮ）的水平，以探讨尿酸对妊高征围产期结局的影响。结果表明：妊高征患者血清尿酸含量明显高于正常妊娠（Ｐ＜００１），而妊高征的围产儿病死率明显高于正常妊娠对照组（Ｐ＜００１），且重度妊高征患者较轻度妊高征产妇增加显著（Ｐ＜００１～００５）。认为妊高征患者血清尿酸的变化不仅可作为临床监测指标，而且对妊高征的诊断和治疗均具有参考价值     

妊娠期胆汁瘀积症患者脂质代谢及血液流变学变化

目的：探讨妊娠期胆汁瘀积症（ＩＣＰ）患者血清甘胆酸（ＣＧ）水平升高对脂质代谢及血液流变学的影响。方法：对６８例孕妇用放射免疫法测定血ＣＧ，酶法测定血总胆固醇（ＣＨ）、甘油三酯（ＴＧ）、高密度脂蛋－胆固醇（ＨＤＬ－Ｃ）、低密度脂蛋白－胆固醇ＬＤＬ－Ｃ及ＬＤＬ－Ｃ／ＨＤＬ－Ｃ比值，并测定全血比粘度高切（ＨＳ）、低切（ＬＳ）、血浆比粘度（ＰＶ）和红细胞压积（ＨＣＴ）。以血ＣＧ≥６μｍｏｌ／Ｌ为标准组成ＩＣＰ组（３５例）；血ＣＧ＜６μｍｏｌ／Ｌ为正常妊娠组（３３例）。另选取３０例非妊娠妇女作血ＣＧ及血脂水平检查的对照组。结果：除ＩＣＰ组ＨＤＬ－Ｃ外，两组ＣＧ及血脂水平均明显高于对照组（Ｐ＜０．０２～０．００１），ＩＣＰ组ＬＤＬ－Ｃ及ＬＤＬ－Ｃ／ＨＤＬ－Ｃ比值，以及血液Ｌ５、ＰＶ和ＨＣＴ均明显高于正常妊娠组（Ｐ＜０．０２～０．００１）。结论：ＩＣＰ患者脂质代谢和血液流变学均有明显变化，随着妊娠终止及血ＣＧ浓度降低，ＩＣＰ患者脂质代谢的病理生理改变得以改善，说明该病的病理生理变化与血清ＣＧ浓度增高有关。     

妊高征患者的胎儿血流速度波形改变特点研究

目的：研究妊高征患者的胎儿脐动脉、肾动脉以及大脑中动脉的血流速度波形的变化特点。方法：妊高征患者９６例，正常妊娠１４８例，于产前１周内行彩色多普勒超声检测胎儿脐动脉、肾动脉和大脑中动脉的搏动指数（ＰＩ），产后随访新生儿预后。结果：随着妊高征的加剧，胎儿脐动脉和肾动脉的ＰＩ上升，大脑中动脉的ＰＩ则改变不明显。在围产儿预后良好和不良的两组中，随着妊高征的加重，胎儿脐动脉、肾动脉和大脑中动脉的ＰＩ均有上升的趋势，但预后不良组的改变比对照组明显。按正常妊娠和轻度、中度、重度妊高征分成４组，胎儿窘迫者脐动脉和肾动脉的ＰＩ上升，大脑中动脉的ＰＩ下降。结论：妊高征和胎儿窘迫对胎儿脐动脉和肾动脉的血流波形改变有协同作用，对大脑中动脉的改变有阻抗作用     

胰岛素抵抗与妊高征发病及围产儿预后的关系

目的探讨胰岛素抵抗与妊高征发病及围产儿预后的关系。方法选择妊高征孕妇１１１例为妊高征组,正常妊娠妇女１５５例为对照组;分别于孕３２周前和３２周后取母血,分娩后取脐血,测定胰岛素和Ｃ肽浓度;比较新生儿出生体重、Ａｐｇａｒ评分和羊水状况。结果妊高征组Ｃ肽和胰岛素的浓度在孕３２周前、后均明显高于对照组（Ｐ＜０．００１和Ｐ＜０．０１）。在妊高征组,宫内发育迟缓、新生儿窒息和羊水异常时,母儿Ｃ肽和胰岛素浓度均有上升的趋势,并且发生在妊娠３２周之前;在对照组,宫内发育迟缓时,孕妇Ｃ肽和胰岛素浓度有下降的趋势。结论胰岛素抵抗在妊高征的发生、发展,以及围产儿预后不良等方面均有重要意义。     

妊高征患者胎儿脐动脉及大脑中动脉血流动力学研究

目的探讨妊娠高血压综合征(PHI)患者胎儿脐动脉(UA)及大脑中动脉(MCA)的血流动力学变化规律,评价彩色多普勒血流显像技术在PIH上的利用价值。方法 应用彩色多普勒血流显像术检测95例正常晚期妊娠和52例PHI患者胎儿UA的搏动指数(PI)、阻力指数(RI)及MCA的搏动指数(PI)、阻力指数(RI),计算MCA—PI/UA—PI、MCA—RI/UA—RI的比值,均取平均值比较。结果PIH组与正常组UA—PI值比较有明显增高(P<0.01),而UA—RI值二组比较差异无显著性(P>0.05);MCA—PI值与MCA—RI值仅在重度PIH组与正常组间比较有显著降低(P<0.01);MCA—PI/UA—PI及MCA—RI/UA—RI的比值与正常组比较均有明显降低(P<0.01);重度PIH组MCA—PI/UA—PI及MCA—RI/UA—RI的比值二者均小于1。预测围产儿结局方面,MCA—PI/UA—PI具有高的敏感性(88.89％)、特异性(97.06％)、阳性预测值(94.12％)及阴性预测值(94.28％),其诊断指数最高为0.86,且与单一血管比较差异有显著性(P<0.01)。结论妊高征患者胎儿的胎盘循环与颅脑循环的血流动力学变化规律不一致,二者结合在预测妊高征病情发展程度和预测围产儿结局方面有重要的临床价值。     

Structural changes in umbilical vessels in pregnancy induced hypertension

BACKGROUND: Pregnancy Induced Hypertension (PIH) is associated with placental morphological changes, alterations in the blood flow patterns in the umbilical vessels and adverse fetal and maternal outcome. Studies have demonstrated changes in the structure of the umbilical vessels but these have not been described across the length of the cord or correlated with the severity of disease. STUDY DESIGN: A case control study. SETTING: Kenyatta National Hospital. MATERIALS AND METHODS: Thirty six umbilical cords from newborns of women with and without PIH (18 cases, 18 controls) were obtained and studied with light microscopy. Of the cases 9 women had severe PIH and 9 had mild PIH. Means and standard deviations for the various parameters of the various groups were obtained. Student's t-test and ANOVA were used to compare means, a p value of <0.05 being significant. RESULTS: The structure of the umbilical vessels changes from the placental end to the fetal end. The umbilical vein in PIH had a greater wall thickness and a smaller luminal area than in the controls. The vein's wall-luminal ratio increased from the placental to the fetal end. Duplication of the elastic subintimal lamina (ESL) was higher in the cases. The ESL was more commonly duplicated in the fetal end. There were no structural differences between the umbilical arteries in PIH and in the controls. CONCLUSION: PIH is associated with structural changes in the umbilical vessels. These changes are more predominant in the vein than in the artery and in the vein, they are more obvious in the fetal end. The observed increase in wall-luminal ratio from the placental to the fetal end suggests that the fetal end of the umbilical vein has a more refined role in the regulation of blood flow to the fetus.     

脑胎盘率诊断胎儿宫内缺氧的研究进展

胎儿宫内缺氧是围生儿死亡的重要原因之一,产前有效预测胎儿宫内缺氧,对降低围生儿死亡率具有重大意义。联合检测胎儿各项多普勒血流参数,包括脐动脉、大脑中动脉、肾动脉、静脉导管、腹内脐静脉等,能够反映胎儿各个器官的异常状态,准确地评价胎儿宫内缺氧状况,提高胎儿窘迫的诊断率。脑胎盘率(CPR)利用大脑中动脉与脐动脉搏动指数的比值,消除了共同的干扰因素,排除了基数波动的影响,受血流灌注阻抗变化的影响小,比单一血管更能反映胎儿全身血流分布情况,用于早期评价胎盘胎儿血流循环变化,从而更全面地评价宫内缺氧程度,早期预测妊娠不良结局,及时快速准确地发现异常,及时干预,提高围生儿质量,具有临床应用价值,值得临床推广应用。     

脐动脉血流监测在产科的应用

脐动脉血流监测做为非侵入性的胎儿胎盘血流动力学评估方法,广泛应用于产科临床。脐动脉多普勒血流波形主要反映胎盘的血管阻力,受绒毛血管发育状况的影响。同时,胎龄、胎儿心率、胎儿呼吸和呃逆、胎动、脐带的采样位置、胎儿性别、胎盘重量及胎儿体重等也对其有一定的影响。循证医学证据推荐将脐动脉超声多普勒检测作为胎儿生长受限及双胎选择性生长受限的胎儿监测。在低危人群中,脐动脉血流监测的意义还存在很多争议。舒张末期血流缺失或反向与围产期结局显著不良相关,需注意排除胎儿先天性异常及非整倍体异常。脐动脉血流异常的产科处理取决于脐动脉多普勒检查结果异常的严重程度、基础产科并发症的严重程度以及孕周,应个体化处理。     

The clinical value of maternal and fetal Doppler parameters in low-risk postdates pregnancies – a prospective study

Objective: The objective of this study is to determine the clinical significance of maternal and fetal ultrasound Doppler flow indices in postdates pregnancies.

Methods: This prospective study comprised 120 low-risk pregnant women beyond 40 weeks of gestation. All participants underwent Doppler assessment including of fetal middle cerebral artery (MCA), umbilical, and uterine arteries. Perinatal outcomes were recorded and evaluated for possible associations with Doppler flow values. Adverse perinatal outcomes were defined as umbilical cord arterial pH <7.1, Apgar score <7 at 5?min, neonatal admission to a neonatal intensive care unit, and emergency cesarean section due to abnormal intrapartum cardiotocogram

Results: Adverse perinatal outcome rate was 17.5% (n?=?21). Doppler indices of umbilical artery, MCA, uterine artery and the cerebroplacental ratio (CPR) did not differ significantly between pregnant women with and without adverse perinatal outcomes. Neonatal birth weight was found to correlate negatively with umbilical artery Doppler indices, including the peak systolic to end diastolic ratio (p?=?.04), the resistance index (p?=?.02), and the pulsatility index (p?=?.01). Doppler values of the uterine artery, MCA and CPR did not correlate with neonatal birth weight.

Conclusions: The contribution of maternal and fetal ultrasound Doppler to the prediction of adverse perinatal outcomes in low-risk postdates pregnancies is low. Hence, performing routine Doppler examination as part of postdates pregnancy assessments is unlikely to yield significant clinical benefit.     

Platelet-binding immunoglobulins in pregnancy-induced hypertension II. Origin of circulating IgG and IgM antiplatelet antibodies in the umbilical cord serum

IgG and IgM have been identified on the surface of maternal platelets in both autoimmune thrombocytopenia (ATP) and pregnancy-induced hypertension (PIH). IgG is also found on the umbilical cord platelets of patients with ATP and PIH, whereas IgM is only found on the umbilical cord platelets of patients with PIH. The possible maternal or fetal origins of these umbilical cord blood immunoglobulins were investigated by immunoblot analysis of antibodies in paired maternal and umbilical cord blood sera of ATP and PIH patients. Maternal sera contained IgG and IgM antibodies which reacted with several platelet proteins, however, a large amount of patient-to-patient variation was observed in the specific antigens that were identified. Analysis of paired maternal and umbilical cord sera from patients with ATP or PIH showed identical patterns of antigen specificity, which suggested that the IgG antibodies in the fetal circulation were of maternal origin. Circulating IgM antibodies were not observed in the umbilical cord sera of ATP patients. The umbilical cord sera of PIH patients, however, contained IgM antibodies that reacted against a variety of platelet antigens. In addition, most umbilical cord sera from PIH patients had identical patterns and relative intensities of reactivity, which differed from the patterns observed in the paired maternal sera. Antiplatelet IgM in the umbilical cord blood of PIH patients, therefore, appears to be a product of the fetal immune system.     

胎儿脑及脐动脉血流检测的临床意义

应用彩色多普勒超声，检测正常妊娠妇女４８例（正常妊娠组），妊高征患者３４例（妊高征组），妊高征合并胎儿生长迟缓（ＩＵＧＲ）５４例（ＩＵＧＲ组）儿大脑中动脉及脐动脉血流速波，计算血流的收缩末期峰值与舒张末期峰值的比值、脉搏指数、阻力指数。