足月妊娠脐动脉血流S/D值介于2.5～3.0间的围产儿结局研究

目的　研究足月妊娠脐动脉血流 S/ D值介于 2 .5～ 3.0间的围产儿结局。　方法　将2 77例足月妊娠妇女根据分娩前脐动脉血流 S/ D值分成两组 ,即 S/ D值介于 2 .5～ 3.0的 35例为研究组 ,S/ D值 <2 .5的 2 42例为对照组 ,分别跟踪分娩结局 :出生时采集脐血进行血气分析 ,记录新生儿 Apgar评分 ,羊水粪染及新生儿体重等指标。　结果　研究组 5 7.14% (2 0 / 35 )的新生儿脐血 p H值异常 ,而对照组仅 10 .74% (2 6 / 2 42 )的脐血气异常 ,两组比较差异有显著性 (χ2 =47.5 3,P<0 .0 0 5 ) ,其它不良结局 (羊水 度以上 ,Apgar评分低于 7分 ,低出生体重 )发生率 ,研究组 6 5 .7% (2 3/ 35 ) ,对照组 2 7.2 7% (6 6 / 2 42 ) ,两组比较差异有显著性 (χ2 =2 0 .72 ,P<0 .0 0 5 ) ;研究组的新生儿出生体重 (310 5± 5 78) g显著低于对照组 (3 35 0± 475 ) ,(t=2 .84,P<0 .0 0 5 )。　结论　对于足月妊娠脐动脉血流S/ D值介于 2 .5～ 3.0的胎儿 ,要加强监护 ,避免严重的围产儿不良结局的发生。     

脐动脉血流阻力与一氧化氮含量的关系

本研究通过测定脐动脉血流阻力与脐血一氧化氮（ｎｉｔｒｉｃｏｘｉｄｅ,ＮＯ）含量及胎盘组织一氧化氮合酶（ｎｉｔｒｉｃｏｘｉｄｅｓｙｎｔｈａｓｅ,ＮＯＳ）的活性,探讨胎儿胎盘局部循环状况及ＮＯ含量与胎儿生长发育的关系及临床意义。一、资料与方法１分组：Ａ...     

妊娠期亚临床甲状腺功能减退症对脐动脉血流动力学指标与妊娠结局的影响

目的 探讨妊娠期亚临床甲状腺功能减退症（SCH）对脐动脉血流动力学指标与妊娠结局的影响。方法 选取本院1000名建档并分娩的孕妇为研究对象,依据甲状腺功能检查结果分为SCH组（n=150）和非SCH组（n=850）。比较两组不良妊娠结局发生情况及脐动脉血流动力学指标。结果 SCH组不良妊娠结局发生率为76.67%,显著高于非SCH组的21.65%(P<0.05);孕晚期SCH组脐动脉阻力指数、搏动指数、收缩末期峰值与舒张末期峰值比值明显高于非SCH组（P<0.05）。结论 妊娠期SCH的脐动脉血流动力学指标明显升高,容易影响母胎血流循环状态,导致不良妊娠结局,临床上应加强检测脐动脉血流动力学指标,以改善预后。     

肝素改善妊娠中晚期脐动脉血流异常的临床效果

目的评价肝素对改善妊娠中晚期脐动脉收缩期最大血流速度(S)与舒张末期血流速度(D)的比值异常的临床效果。方法将脐动脉血流S/D比值大于相应孕周的第95百分位以上的67例妊娠中晚期妇女共72例胎儿(5例双胎)分为研究组35例孕妇(38例胎儿),对照组32例孕妇(34例胎儿),知情同意后,研究组用肝素6250U或12500U+5%葡萄糖500ml、静脉滴注,4~6h内滴完,每天1次,平均治疗(37±21)d,范围1~10d;对照组应用低分子右旋糖酐500ml,丹参30ml+10%葡萄糖500ml,东莨菪碱20mg+10%葡萄糖500ml,静脉滴注,每天1次,平均治疗(67±28)d,范围3~14d。定期复查脐动脉血流S/D比值(3~5d1次,严重者每天1次)。结果研究组平均每天脐动脉血流S/D比值下降037,对照组平均每天脐动脉血流S/D比值下降014,两组研究结果比较,差异有统计学意义(P<005)。研究组所需治疗时间显著短于对照组,两组比较,差异也有统计学意义(P<001)。对照组中有10例胎儿脐动脉血流S/D比值进行性升高,2例胎儿脐动脉血流S/D比值出现无穷大,即舒张末期缺如而致胎儿死亡。结论肝素治疗妊娠中晚期脐动脉血流S/D比值异常升高,效果显著,疗程更短。     

脐带真结的产科因素及妊娠结局

目的:探讨脐带真结的危险因素及其妊娠结局。方法:回顾性分析2000年1月至2005年7月间分娩的脐带真结孕妇17例。结果:脐带真结的发生率为0.24%。Logistic回归相关分析发现脐带真结的发生与男性胎儿、羊水过多、脐带绕颈、脐带过长有关。脐带真结胎儿发生死胎、胎儿窘迫、剖宫产的风险较无脐带真结者明显增加(P<0.01)。结论:怀有男性胎儿、脐带过长、脐带绕颈、羊水过多的孕妇发生脐带真结的风险增加,应仔细地进行B超和彩色多普勒检查以排除脐带真结可能。     

胎儿脐动脉血流异常波形与围产儿结局的关系

胎儿脐动脉血流异常波形与围产儿结局的关系杨玉英江森郝素媛戴笙张慧琴张薇张运王淑琨应用彩色多普勒超声技术，可以从胎儿血流动力学的角度预测胎儿宫内发育状况。我们应用彩色多普勒超声，监测胎儿脐动脉血流，现将脐动脉血流异常波形与围产儿结局的关系分析如下。一...     

脐带螺旋指数和脐动脉血流S/D值与胎儿窘迫的相关研究

目的探讨脐带螺旋指数(umbilical coiling index,UCI)和脐动脉血流S/D比值与胎儿窘迫的相关性。方法回顾性分析420例胎儿窘迫者和对照组临产前S/D比值、分娩15min后脐带螺旋周数、长度及UCI。结果胎儿窘迫组平均脐带螺旋指数为(0.29±0.04)周/cm,其中脐带螺旋过少占40.0%(168/420),脐带螺旋过多占45.2%(190/420),与对照组(9.4%,45/480;9.8%,47/480)比较,差异均有统计学意义(P0.05);脐带螺旋过少和正常者脐动脉血流S/D比值明显低于脐带螺旋过多者(P0.05)。结论脐带螺旋指数异常与胎儿窘迫有密切的相关性,脐带螺旋过多者脐动脉血流S/D比值也明显升高。     

不同体重指数孕妇与妊娠结局的关系探讨

近年来国内外学者日益重视孕期妇女体重的变化与新生儿体重的关系 ,发现孕妇孕期的体重增加与新生儿出生体重有一定的关系 ,重视用母亲孕期体重的改变来预测巨大儿的发生 [1 ] 。本研究主要探讨不同体重指数孕妇的妊娠结局及与新生儿体重的关系。一、资料和方法1.对象 :自 1997     

脐动脉血流速度测定对高危妊娠及胎儿预后的预测价值

目前，脐动脉血流速度指数测定已成为产科监护的一项主要手段，通过对S／D值测定，能较准确地判断胎儿宫内状态，具有重复性、无损伤等优点，笔者对孕晚期单胎孕妇进行胎儿脐动脉血流测定及围产儿结局分析，现报告如下。     

正常妊娠脐动脉血流测定与胎盘病理及生化改变

应用多普勒超声，对妊娠２０－４２周的１１９例常妊娠妇女脐动脉血流进行测定，以收缩期血流速度峰值Ｓ与舒张末期血流速度峰值Ｄ的比值为测定参数，并将１１９例，妊娠３６－４２周的７０例，以Ｓ／Ｄ值＜３（为正常值）及Ｓ／Ｄ值≥３组比较，胎盘第三级绒毛干内小动脉计数显著减少，合体滋养细胞结节及出芽、绒毛间质纤维化显著增加；胎盘第三级绒毛干内小动脉计数显著减少，合体滋养细胞结节及出芽、绒毛间质纤维化显著增加；胎     

The umbilical coiling index in complicated pregnancy

OBJECTIVE: To evaluate umbilical cord coiling in pregnancies with adverse outcome. STUDY DESIGN: Umbilical cords and hospital records of 565 consecutive cases with an indication for histological examination of the placenta were studied. The umbilical coiling index (UCI) was determined as the number of complete coils divided by the length of the cord in centimeters, by an observer blinded for pregnancy outcome. Data on obstetric history and pregnancy outcome of each case were obtained from the hospital records. We calculated odds ratios and their 95% confidence interval to evaluate the strength of associations between pregnancy outcome and abnormal cord coiling. RESULTS: Fetal death (OR 4.09, 95% CI 2.22-7.55), chorioamnionitis (OR 1.77, 95% CI 1.09-2.88), fetal structural or chromosomal abnormalities (OR 1.78, 95% CI 1.08-2.95), and lower Apgar score at 5 min (p=0.03) were associated with undercoiling (UCI below the 10th percentile, using reference values from uncomplicated pregnancies). Fetal death (OR 3.74, 95% CI 1.89-7.40), iatrogenic preterm delivery (OR 1.91, 95% CI 1.04-3.49), umbilical arterial pH<7.05 (OR 3.63, 95% CI 1.44-9.17), fetal structural or chromosomal abnormalities (OR 1.79, 95% CI 1.01-3.16), thrombosis in fetal placental vessels (OR 2.64, 95% CI 1.37-5.06), chronic fetal hypoxia/ischemia (OR 1.82, 95% CI 1.09-3.05), and lower weight for gestational age (p=0.01) were associated with overcoiling (UCI above the 90th percentile). CONCLUSIONS: Our findings confirm that adverse perinatal outcome is associated with both undercoiling and overcoiling of the umbilical cord.     

The umbilical coiling index and adverse perinatal outcome.

OBJECTIVE: Evaluation of the relationship between umbilical coiling index (UCI) and adverse perinatal outcome. METHOD: A prospective study was performed on 699 pregnant women who were 37-40 weeks. UCI was determined by dividing the total number of the complete vascular coiling by the total umbilical cord length in centimeters. Then the relationship between UCI and neonatal weight, amniotic fluid index, meconium, Apgar score, and fetal distress were evaluated. RESULTS: There was a significant difference between normo- and hypocoiled groups according to the Apgar score less than 7 in minute 5, AFI相似文献   

Ultrasound evaluation of abnormal umbilical cord coiling in second trimester of gestation in association with adverse pregnancy outcome

OBJECTIVE: The purpose of this study was to evaluate the antenatal umbilical cord coiling index obtained during the fetal anatomic survey in the second trimester as a predictor of adverse pregnancy outcome. STUDY DESIGN: Four hundred twenty-five consecutive women who had a fetal anatomic survey between 18 to 23 weeks of gestation were evaluated for umbilical cord coiling. The antenatal umbilical cord coiling index was calculated as a reciprocal value of the distance between a pair of coils (antenatal umbilical cord coiling index = 1/distance in cm) and was correlated with the following adverse pregnancy outcomes: (1) small for gestational age, (2) mode of delivery, (3) presence of meconium-stained amniotic fluid, (4) presence of nonreassuring fetal status in labor, and (5) Apgar scores at 1 and 5 minutes. RESULTS: A total of 294 patients had adequate ultrasound images and all antenatal and labor data to meet the study inclusion criteria. Abnormal coiling was associated significantly with small for gestational age neonates at birth (P = .043) and non-reassuring fetal status in labor (P = .007). Nine of 58 neonates (15.5%) with abnormal umbilical coiling were small for gestational age infants compared with 15 of 236 small for gestational age neonates (6.4%) who had normal cord coiling. A non-reassuring fetal status in labor was observed in 25.7% of fetuses (15/58 fetuses) with abnormal umbilical coiling compared with 11.0% of fetuses (26/236 fetuses) with normal cord coiling. In contrast, no statistical difference for Apgar scores at 1 and 5 minutes or higher prevalence of interventional deliveries and meconium-stained amniotic fluid in labor between the groups with normal and abnormal umbilical cord coiling was observed. CONCLUSION: Abnormal umbilical cord coiling that is detected at the fetal ultrasound anatomic survey in the second trimester is associated with a higher prevalence of small for gestational age neonates and non-reassuring fetal status in labor. This observation can be used potentially as a predictor of adverse antenatal or perinatal events in future studies.     

Investigation of possible maternal and fetal factors which affect umbilical coiling index

Aim: The aim of this study was to investigate the possible maternal and fetal factors, which affect the Umbilical Coiling Index (UCI).

Methods: This prospective, observational, analytic study was conducted using the data of 380 women with term pregnancy and newborns who presented at a University Hospital. Hemoglobin (Hb), ferritin, iron, and the total iron binding capacity (TIBC) of the maternal blood were measured, and transferrin saturation was estimated based on the ratio between serum iron and TIBC. Blood gases, ferritin, iron, and TIBC of the umbilical cord were also measured, and the transferrin saturation was calculated. The length and thickness of the umbilical cord, numbers of coilings, weight of placenta, neonatal weight were registered. The UCI was calculated dividing the total number of coils by the length of the umbilical cord (in cm).

Results: A positive, linear, and statistically significant relationship was found between the UCI scores and the umbilical cord blood transferrin saturation, umbilical cord thickness, and the first- and fifth-min APGAR scores (p?=?.044, p?p?=?.008, p?=?.022, respectively). No statistically significant relationship was found between the maternal Hb values and the UCI scores (p?=?.472). In addition, there was no statistically significant relationship between the UCI scores and maternal ferritin, maternal transferrin saturation and umbilical cordon ferritin levels (p?=?.940, p?=?.681, and p?=?.975, respectively).

Conclusions: A positive correlation was found between the UCI and umbilical cord transferrin saturation and between the newborn APGAR scores. However, this finding is not sufficient to explain the relationship of the umbilical cord dynamics with the newborn wellbeing and coiling.     

The relationship between an aortic isthmus blood flow velocity index and the postnatal neurodevelopmental status of fetuses with placental circulatory insufficiency

OBJECTIVE: The purpose of this study was to evaluate the association between an abnormal aortic isthmus blood flow index and postnatal neurodevelopmental outcome in fetuses with placental circulatory insufficiency. STUDY DESIGN Forty-eight children who were born between 1991 and 1999 were included in this study on the basis of abnormal umbilical artery Doppler velocimetry. Prenatal isthmus blood flow index was obtained by dividing the sum of the systolic and diastolic Doppler blood flow velocity integrals by the systolic blood flow integrals. Neurodevelopmental outcome between 2 and 5 years was classified as optimal, when neurologic assessment and developmental quotient were within normal limits and as nonoptimal when abnormal neurologic findings and/or a nonoptimal developmental quotient was present. Neurodevelopmental outcome was analyzed in relation to isthmus flow index and pulsatility indices in the umbilical artery. RESULTS: The mean gestational age at delivery was 33.0 +/- 2 weeks. Nonoptimal neurodevelopmental outcome was found in 60.4% of the children (29/48). An inverse correlation was found between the isthmus blood flow index and postnatal neurodevelopmental outcome. All 13 children with an isthmus blood flow index of <0.5 were in the nonoptimal group. All 19 children with an optimal outcome had an isthmus blood flow index of >0.5, but this was also the case for 16 other children with nonoptimal neurodevelopmental outcome. An isthmus blood flow index cut-off value of 0.70 was associated with the highest overall positive and negative predictive values. The pulsatility index in the umbilical artery did not provide any significant contribution in the explanation of the outcome. CONCLUSION: The isthmic blood flow index can help to identify a subgroup of fetuses with placental circulatory insufficiency that might benefit from early delivery.     

Antenatal umbilical coiling index in gestational diabetes mellitus and non-gestational diabetes pregnancy

Objective

Umbilical cord abnormalities increase fetal morbidity and mortality. This study was designed to compare antenatal umbilical coiling index (aUCI) in gestational diabetes mellitus (GDM) and non-gestational diabetes mellitus (non-GDM) pregnancy, considering uncertainties about the best time to perform antenatal ultrasonography scan.

妊高征患者血液流变学与脐血流动力学的相关性研究

目的探讨妊高征患者血液流变学与胎儿脐动脉血流阻力指标的相关性和对围产儿结局的影响。方法用粘度仪检测妊高征孕妇全血比粘度高切（ＢＶＨ）、全血比粘度低切（ＢＶＬ）、全血还原比粘度、血浆粘度（ＰＶ）;用离心机检测红细胞压积（ＨＣＴ）;应用彩色多普勒检测胎儿脐动脉血流阻力指标,比较妊高征患者血液流变学各值与胎儿脐动脉血流阻力指标各值相关关系。结果妊高征患者血液流变学各值与胎儿脐动脉血流阻力指标各值呈正相关性;ＨＣＴ、ＢＶＨ、ＢＶＬ、ＰＶ对妊高征的发生、发展及严重程度及脐动脉血流阻力指标有重要影响,导致胎儿胎盘循环障碍,脐动脉血流阻力指标升高。围产儿结局不良发生率,中、重度妊高征高于轻度妊高征（Ｐ＜０．０１）。结论多项指标监测妊高征血液流变学及胎儿脐血流动力学,可提高预测妊高征发生、发展及严重程度和对围产儿预后影响的准确性。     

胎儿电子监护和脐血流与胎儿窘迫的关系

目的探讨胎儿电子监护和脐血流指标与胎儿缺氧和酸中毒的关系.方法妊娠晚期孕妇547例,分娩前1周内检测脐血流,记录S/D比值(收缩期末 最大的血流速度/舒张期末最大的血流速度),临产前1天或临产后行胎心监护.分娩后记录 新生儿Apgar评分,抽取脐带动脉血作血气分析,测定乳酸和超氧化物歧化酶(SOD)值.[ HTH〗结果 547例产妇均行血气分析, 407例检测乳酸和SOD值,285例检测脐血流 ;239例行产前胎心监护, 317例行产时胎心监护.经阴道分娩组NST无反应者的pH明显升高 (P《0.01),PCO2和乳酸明显降低(P《0.05);剖宫产组NST有反应与NST 无反应之间的HCO3-、TCO2有显著差异(P《0.05).产时监护阴性与阳性者的PO 2、HCO3-、TCO2、ABE和乳酸均有显著差异(P《0.05).S/D比值与P O2密切相关(P《0.01).S/D《2.6者和S/D≥2.6者两组其SOD值有显著差异(P 《0.05).Apgar评分》7分和Apgar评分≤7分两组其HCO3-、TCO2、ABE ( P《0.01),pH、PCO2、乳酸均有显著差异(P《0.05).结论 在临产前胎心监护发现胎动减少或无胎心加速时,提示胎儿缺氧存在,发展为代谢性酸中毒 尚需一定时间,如及时终止妊娠则不发展为酸中毒;临产后OCT或CST出现重度变异减速或晚 期减速提示缺氧酸中毒的存在.S/D比值以2.6为标准能预测子宫胎盘血流动力学改变,提示胎儿慢性缺氧.     

静脉导管、脐静脉和脐动脉及大脑中动脉血流检测对子痫前期胎儿预后分析

目的:探讨子痫前期(PE)胎儿静脉导管(DV)、脐静脉(UV)和脐动脉(UA)及大脑中动脉(MCA)血流检测对围生儿预后分析。方法:应用彩色多普勒超声检测PE胎儿的DV、UV和UA及MCA血流参数,并与相应孕周正常妊娠胎儿的血流测值进行对照分析,研究分析其与胎儿不良结局的关系。结果:28~31+6周及36周~分娩前,重度PE胎儿的DV、UV血流测值较正常、轻度PE胎儿升高(P0.05),轻度PE与正常胎儿比较差异无统计学意义(P0.05)。32周~35+6周,PE胎儿的DV血流参数测值PLI、PVIV、PIV及Qdv/Quv随着PE严重程度呈上升趋势(P0.05)。28周~分娩前,重度PE胎儿UA血流测值较正常、轻度PE胎儿升高(P0.05),轻度PE胎儿UA血流测值RI、PI、S/D与正常胎儿比较差异无统计学意义(P0.05),28~36周PE胎儿的MCA血流测值RI、PI、S/D与正常胎儿比较差异有统计学意义(P0.05)。PE胎儿DV、UV、UA血流测值与新生儿的出生体重、Apgar评分、脐动脉血氧饱和度、脐静脉p H值呈负相关。PE胎儿DV的PVIV、PIV,UV的Qdv/Quv,UA的PI、S/D和MCA的RI值与新生儿出生结局相关(P0.05)。结论:DV、UV血流频谱变化可反映PE胎儿宫内状况及预测出生不良结局,若结合UA、MCA血流频谱进行联合分析,将能更准确地评估胎儿的宫内状况。     

孕期体重增加与妊娠并发症及妊娠结局的相关性研究

目的:探讨孕期体重增加与妊娠并发症及妊娠结局的相关性。方法:收集2010年6月至2010年12月在我院进行正规产前检查并分娩的孕妇423例进行研究,分析孕期体重增加与妊娠并发症及妊娠结局的关系。结果:C组妊娠期糖尿病与妊娠期高血压疾病的发病率高于A组和B组,两者比较差异均具有统计学意义(P<0.05);C组剖宫产率及巨大儿的发生率高于A组和B组,C组及B组产后出血的发生率高于A组,两者比较差异均具有显著性(P<0.05)。C组胎儿窘迫及新生儿窒息的发生率明显高于A组(P<0.05)。结论:孕期体重增加过高可导致妊娠并发症及不良妊娠结局的发生,适当控制孕期体重增加可改善母婴妊娠结局,提高产科质量。