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...     

胎儿脐动脉血流速度与围产儿预后的关系

胎儿脐动脉血流速度与围产儿预后的关系李扬黄醒华胎儿脐动脉血流速度波形是反应胎儿胎盘循环状态的指标之一。当胎盘血管阻力增加时，脐动脉舒张期血流速度下降，血流速度波形表现异常。为探讨胎儿脐动脉血流与围产儿预后的关系，我们对１００例孕妇进行了脐动脉血流速度...     

脐带螺旋指数与脐动脉血流S/D比值及妊娠结局关系的研究

目的:探讨脐带螺旋指数(umbilical coiling index,UCI)与脐动脉血流收缩期最大血流速度(S)/舒张期末血流速度(D)比值(S/D比值)及妊娠结局之间的关系。方法:选择在我院住院分娩妊娠37~40周的孕产妇720例,计算UCI值,分析UCI与脐动脉血流S/D比值及胎儿窘迫、新生儿体重、新生儿窒息、围产儿死亡、羊水指数、产后出血及剖宫产率之间的关系。结果:UCI正常组与UCI不足组之间脐动脉血流S/D比值及羊水指数、产后出血、剖宫产率无显著差异,UCI不足组胎儿窘迫、新生儿窒息、围产儿死亡发生率显著高于UCI正常组。UCI过高组的脐动脉血流S/D比值、羊水过少发生率及剖宫产率明显高于UCI不足组,两组间胎儿窘迫、新生儿窒息、围产儿死亡发生率无显著差异。UCI过高组脐动脉血流S/D比值、胎儿窘迫、新生儿窒息、围产儿死亡、羊水过少发生率及剖宫产率明显高于UCI正常组,两组差异有统计学意义。结论:UCI异常可能与脐动脉血流S/D比值及妊娠结局相关。     

胎儿脑、肾及脐动脉血流速度波型与围产儿结局

目的 探讨胎儿血流速度波型与围产儿结局的关系及高危妊娠胎儿缺氧时血液动力学变化的特点.方法 采用超声多普勒检测了46例正常晚期妊娠和32例高危妊娠胎儿脐动脉(UmA)、大脑中动脉(CMA)及肾动脉(RA)的搏动指数(PI)、阻力指数(RI)、收缩末期和舒张末期血流速度峰值的比值(S/D)三项阻力指标,并与围产儿结局进行对比分析.结果 高危组UmA、RA的RI、PI及S/D均高于正常组;胎儿CMA与RA的搏动指数比值,即PICMA/PIRA与围产儿结局的符合率最高,PICMA/PIRA≥1者,无围产儿结局不良,而＜1者有83.33%出现围产儿结局不良.结论 高危妊娠胎儿缺氧时脏器血流量改变,表现为肾血管血流阻力明显增高,脑血管阻力明显降低,胎儿血管的血液动力学状况与缺氧有良好相关性.RA的阻力指标可敏感预测围产儿缺氧.     

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胎儿监护与围生儿预后关系分析

目的:探讨对妊娠期肝内胆汁淤积症(ICP)孕妇进行胎儿监护的临床价值。方法:对223例ICP孕妇进行无负荷试验(NST),其中89例进行缩宫素激惹试验(OCT),所有孕妇均进行超声脐动脉血流分析及肝功能检测。结果:OCT和超声脐血流分析结果异常者的围生儿预后不良发生率分别为63.89%和21.43%,明显高于正常者的16.98%和11.11%(P<0.05,P<0.05)。NST正常者和异常者的围生儿预后不良发生率无明显差异。ICP患者的胎儿窘迫、新生儿窒息、早产、胎儿电子监测异常及脐血流异常高于正常组。ICP组中总胆汁酸大于50μmol/L组的胎儿电子监护异常及脐血流S/D值异常的发生率,均高于其他两组。结论:OCT和超声脐动脉血流分析对了解ICP孕妇胎盘功能和预测围生儿预后具有较高的临床价值。     

脐动脉血流监测的临床应用

多普勒脐动脉血流测定是估计胎儿-胎盘循环动力学改变的一种有效、无创的方法,通过测定收缩期最大血流速度与舒张末期血流速度的比值(S/D)、脉动指数、阻力指数等指标预测胎儿发育的健康状况及围产儿预后。胎儿舒张末期脐动脉血流缺失和返流波的出现是一个危险信号,预示可能在数天内胎死宫内,围产儿死亡率高达50%。脐动脉血流分析作为一项胎盘功能试验,用于正常孕妇筛查时,其敏感性较低,但在高危妊娠(妊娠高血压、胎儿生长受限、妊娠糖尿病等)中有明显价值,为临床诊断和治疗提供重要依据。     

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...     

子痫前期及其高危因素对围产儿结局的不良影响

目的:探讨子痫前期(PE)及其高危因素对围产儿结局的影响.方法:根据国内外资料统计的PE高危因素,筛选2011年4月至2012年1月在上海交通大学医学院附属仁济医院妇产科产检和分娩的正常及存在高危因素的孕妇154例,最终发展为PE的孕妇50例,非PE孕妇104例.通过采集病史及实验室检查,追踪妊娠结局,分析PE及存在高危因素PE孕妇的围产儿结局.结果:(1)PE组的新生儿体重及分娩孕周显著小于非PE组(P＜0.05).(2)PE组的胎儿生长受限(FGR)、胎儿窘迫、早产、死胎、新生儿窒息发生率分别是非PE组的4.64倍、2.32倍、4.61倍、2.66倍、6.38倍.两组的FGR、胎儿窘迫、早产的发病率有显著差异(P＜0.05).(3)当MAP≥85 mmHg、蛋白尿、子宫/脐动脉血流异常、D-D＞0.246μg/ml、FDP＞4μg/ml、PAGT＞40％时,易发生围产儿不良结局(P均＜0.05).不同高危因素对围产儿结局的威胁程度不同,其中子宫/脐动脉血流异常时围产不良结局发生率均较高(P＜0.05).结论:PE对围产儿结局有不良影响.孕期可针对高危孕妇进行严格有效的筛查,严密监测围产儿生长发育,警惕PE及围产儿不良结局的发生.     

Fetal blood flow in diabetic pregnancy

Forty pregnant diabetic women were examined with combined Doppler and real-time ultrasound. The volume blood flow in the fetal aorta and umbilical vein was higher and the pulsatility index (PI) in the aorta lower in the early third trimester, as compared with a reference group. Near term, the umbilical artery PI was higher in diabetic than in non-diabetic pregnancies, indicating a higher placental vascular resistance in the former group. The high umbilical artery PI occurred in fetuses who later developed distress in labor. Therefore, a high umbilical artery PI cannot be considered characteristic of diabetic pregnancy, although fetal distress might be more common in diabetic pregnancy. In addition, a high aortic volume flow was found in those fetuses who later develop distress in labor. This might be an expression of an early compensatory mechanism for increased placental vascular resistance. No specific flow variation was observed for any White class, or in association with hypertension or non-optimally regulated diabetes. The blood flow variables in growth-accelerated fetuses were comparable to those found in fetuses with normal weight. Since fetal distress might be more common in diabetic pregnancy, ultrasonic fetal blood flow measurements are recommended for antenatal fetal surveillance.     

Fetal superior mesenteric artery blood flow velocimetry in normal and high-risk pregnancy

THE AIM: To record blood flow velocimetry in the fetal superior mesenteric artery in normal pregnancy and to evaluate if blood flow recordings in the vessel might predict adverse outcome in high-risk pregnancy. METHODS: The fetal superior mesenteric artery blood velocimetry was recorded in a cross sectional manner in 75 normal pregnancies between 27 and 41 weeks of gestation. Reference curves were performed for pulsatility and resistance indices. The superior mesenteric artery was also located in 48 singleton pregnancies complicated by pregnancy-induced hypertension and/or intra-uterine growth retardation. Middle cerebral artery, umbilical artery and vein and uterine artery velocimetry were also recorded. RESULTS: Superior mesenteric artery PI and RI values expressed an increase in resistance to blood flow with gestational age after 32 weeks of gestation. In all except eight high-risk pregnancies the fetal mesenteric artery PI values were within normal range. Among the pregnancies with absent or reversed blood flow in the umbilical artery, all had abnormal mesenteric artery pulsatility index (PI) (> 97.5th percentiles), one fetus died intrauterine and two others died after delivery due to prematurity, growth retardation and necrotizing enterocolitis. In the remaining fetuses with increased mesenteric artery PI, necrotizing enterocolitis was diagnosed in three cases. CONCLUSIONS: Increased vascular resistance in the mesenteric artery might be a late sign of fetal circulation redistribution and frequently related to necrotizing enterocolitis in the newborn.     

妊娠期肝内胆汁淤积症儿缺氧脑损伤的研究

目的:探讨妊娠期肝内胆汁淤积症(ICP)患者胆汁酸水平、胎儿缺氧与胎儿脑损伤的关系.方法:选择2006年3月至9月在我院诊治的ICP患者(ICP组)及正常孕妇(正常妊娠组)各30例.采用彩色多普勒超声检测胎儿大脑中动脉收缩期峰值流速/舒张末期流速(S/D)、阻力指数(RI);用全自动生化分析仪测定母血及新生儿脐动脉血清胆汁酸(BA)、乳酸、和pH值;采用酶联免疫吸附试验(ELISA法)测定新生儿脐动脉血清神经元特异性烯醇化酶(NSE)浓度,并对两组的结果进行分析和比较.结果:①ICP组母血及脐血BA水平均高于正常妊娠组(P<0.01),并且ICP组母血与脐血BA呈正相关关系(r=0.937,P<0.01).②ICP组脐血乳酸水平和NSE值均高于正常妊娠组(P<0.01);而ICP组脐血pH值、大脑中动脉血流S/D值、RI值均低于正常妊娠组(P<0.01);ICP组脐血NSE浓度分别与队、乳酸水平呈正相关(P<0.01);与砌值、大脑中动脉血流S/D值及脐血pH值呈负相关(P<0.01).结论:ICP胎儿存在缺氧和脑损伤,ICP胎儿脑损伤与胎儿缺氧及高浓度胆汁酸密切相关,对ICP患者胎儿大脑中动脉血流和脐动脉血pH值、乳酸浓度及NSE的联合检测,可早期诊断ICP胎儿缺氧,早期发现新生儿脑损伤.     

Fetal blood velocity waveforms in uncomplicated pregnancy

Umbilical artery velocity waves were measured in fetuses from 94 normal pregnant women. In all, 183 determinations were carried out from the 14th to the 40th week of gestation. A combination of pulsed echo and real-time scanning was used to obtain blood waveforms from the umbilical arteries. The umbilical artery velocity wave can be readily differentiated from other fetal signals by its pattern. The systolic peak of the velocity wave was divided by the end diastolic value, thereby giving an S/D ratio. The S/D ratio in normal pregnancy declined from 7.6 to 2.0 from 14 to 40 weeks. Analysis of these waveforms indicated that the placenta is an organ of low vascular resistance and that placental resistance to blood flow declines with advancing gestational age in normal pregnancy. The umbilical artery S/D ratio provides a new and non-invasive marker of fetoplacental blood flow resistance.     

血液动力学指标预测胎儿缺氧及酸中毒的价值

目的：评价血液动力学指标预测胎儿缺氧及酸中毒的价值。方法：用彩色多普勒超声检测了４６例正常晚期妊娠（正常组）和３２例高危妊娠（高危组）妇女子宫动脉（ＵｔＡ）和胎儿脐动脉（ＵｍＡ）、大脑中动脉（ＭＣＡ）、肾动脉（ＲＡ）的血流速度波型，并且测定高危组脐动脉血气。结果：高危组ＵｔＡ、ＵｍＡ、ＲＡ的阻力指数（ＲＩ）、搏动指数（ＰＩ）及收缩期最大血流速度（Ｓ）与舒张末期血流速度（Ｄ）的比值（Ｓ／Ｄ值）均高于正常组，而ＭＣＡ的ＰＩ及Ｓ／Ｄ值均明显低于正常组（Ｐ＜０．０５）。与ＵｍＡＰＯ２＞２．５ｋＰａ的高危妊娠病例比较，ＵｍＡＰＯ２≤２．５ｋＰａ者ＵｔＡ的Ｓ／Ｄ值、ＵｍＡ的ＰＩ、Ｓ／Ｄ值以及ＲＡ的ＲＩ、ＰＩ、Ｓ／Ｄ值均明显增高，ＭＣＡ的ＰＩ明显降低（Ｐ＜０．０５）。ＵｍＡ及ＲＡ的ＰＩ与ＵｍＡＰＯ２和ｐＨ值呈负相关，与ＰＣＯ２呈正相关；ＭＣＡ的ＰＩ与ＵｍＡ的ｐＨ、ＰＯ２呈正相关，与ＰＣＯ２呈负相关。结论：高危妊娠胎儿缺氧时ＭＣＡ血流阻力降低，而周围血管，特别是肾血管血流阻力明显升高；胎儿血液动力学变化与缺氧及酸碱平衡失调呈良好相关性，可预测胎儿缺氧及酸中毒的程度。     

Fetal middle-cerebral and umbilical artery flow assessments after glucose challenge test.

OBJECTIVE: To determine whether a change occurs in fetal middle-cerebral and umbilical artery flow after glucose challenge testing. METHOD: Fetal middle-cerebral and umbilical artery flow was assessed by Color Dopppler technology in 21 pregnant patients before and after the 50-g glucose challenge test. The resistance index (IR) was evaluated separately for each vessel. Statistical significance was determined by Chi-square test and repeated measurement analysis with two co-variates. RESULTS: After glucose ingestion the RI was significantly decreased in the middle-cerebral artery, but not in the umbilical artery. A significant increase in RI was recorded in the umbilical artery when maternal plasma glucose level exceeded 102 mg%. CONCLUSION: Maternal ingestion of glucose significantly alters blood flow velocimetry in the fetal middle-cerebral and umbilical arteries. These changes may lead to the misinterpretation of normal results. It is therefore recommended that sonographic flow velocimetry assessment not be performed early after concentrated glucose ingestion.     

Fetal and maternal hemodynamic responses to exercise in pregnancy assessed by Doppler ultrasonography

It is common for women to undertake vigorous exercise in the late phase of pregnancy. This may have detrimental effects on the blood flow to the uterus and placenta or from the fetus to the placenta. Fifteen pregnant women with no obstetric or medical complications were subjected to a 5-minute exercise period. The maternal heart rate and blood pressure were elevated after exercise. The uteroplacental and umbilical circulations were assessed with Doppler ultrasonography. The ratio of the systolic/diastolic velocity in the uterine artery was elevated, which suggests that uteroplacental vascular resistance increased. The fetal heart rate was elevated after exercise, whereas the systolic/diastolic velocity ratio in the umbilical artery was unaltered. We conclude that moderate maternal exercise causes increased resistance to blood flow in the uterine circulation, whereas the umbilical circulation remains unaltered.     

Fetal hypertension induced by norepinephrine infusion and umbilical artery flow velocity waveforms in fetal sheep

This study was designed to examine the effects of fetal hypertension on the umbilical artery pulsatility index. Fetal arterial blood pressure and umbilical venous pressure were measured in eight sheep, 3 to 5 days after surgery. Umbilical blood flow was measured with an electromagnetic flowmeter around the common umbilical vein. Umbilical artery flow velocity waveforms were obtained either by an indwelling 5 MHz pulsed Doppler device (n = 4) or transcutaneously by a 4 MHz continuous-wave Doppler device (n = 4). Fetal blood pressure was raised by intravenous infusion of norepinephrine 10 micrograms/min during 5 minutes. Norepinephrine infusion resulted in elevated arterial and umbilical venous pressures, accompanied by a bradycardia during the first 3 minutes. Umbilical blood flow, calculated placental vascular resistance, and umbilical artery pulsatility index did not change. After atropine administration, the norepinephrine-induced elevated arterial and umbilical venous pressures were accompanied by tachycardia, increased umbilical blood flow, and no change in placental vascular resistance and umbilical artery pulsatility index. It is concluded that fetal arterial hypertension provoked by norepinephrine infusion has no effect on placental vascular resistance, umbilical blood flow, and umbilical artery pulsatility index.     

Volumetric flow in the umbilical artery: normative data

OBJECTIVE: Provide normative data for the volumetric blood flow (cc/min and cc/min/kg) in the umbilical artery. METHODS: Flow was determined from an umbilical artery in 252 normal obstetrical patients from 18-40 weeks' gestation utilizing pulsed Doppler and color flow Doppler with an angle of insonation of 30-60 degrees. Simultaneous velocimetry studies (S/D ratio, resistance and pulsatility indices), fetal biometry, and an anatomic survey were obtained to further define the normal population. RESULTS: There was a steady increase in the flow (cc/min) in the umbilical artery as pregnancy progressed. Flow/kg showed a steady decline as fetal weight increased. Umbilical artery diameter increased until reaching a plateau at 32-34 weeks. Velocimetric results were consistent with known data. CONCLUSIONS: Volumetric blood flow in the umbilical artery can be determined with relative ease and normative data from 18-40 weeks is presented for the first time.     

Fetal and maternal Doppler blood flow parameters in postterm pregnancies

In this preliminary investigation, we sought evidence of increasing impedance to placental blood flow from both sides of the placenta and evidence of compromised fetal aortic blood flow in 35 human pregnancies exceeding 42 weeks' gestation. Fetal age was confirmed by biparietal diameter (BPD) measurements obtained before 21 weeks. Pourcelot's Index, calculated from Doppler sonograms recorded with a noninvasive technique from small arteries in the myometrium and from an umbilical cord artery, did not correlate with the duration of the pregnancy beyond term. However, this "resistance index" of Pourcelot was higher in the umbilical cord arteries of fetuses with a worse clinical outcome. Doppler blood cell velocity in the fetal descending aorta correlated significantly and negatively with the prolongation of gestation. Fetal aortic velocities appeared to be lower in fetuses who passed meconium before delivery. Our findings suggest that fetal compromise in prolonged pregnancy is more a fetal-placental problem than a uteroplacental problem.