545例新生儿窒息回顾性分析

目的 了解新生儿窒息的发生率，高危因素及其并发症发生情况，为防治新生儿窒息提供经验。方法 回顾性分析45337例活产新生儿中545例窒息新生儿的临床资料，分析新生儿窒息发生率及其影响因素。结果 从2001年至2006年，新生儿窒息发生率从2．13％（113／5298）降至0．35％（37／10466）（χ^2=97．560，P〈0．01）。男婴窒息发生率为1．43％（503／33723），明显高于女婴的0．95％（208／21834），差异有统计学意义（χ^2=22．070，P〈0．01）。产钳助产组的窒息发生率明显高于剖官产组及自然分娩组，差异有统计学意义（χ^2=114．835，P〈0．01）。早产儿窒息发生率为3．46％（70／2023），明显高于足月儿窒息发生率（1．09％，475／43314），差异有统计学意义（χ^2=90．911，P〈0．01）。自然分娩活婴中应用无痛分娩者窒息发生率为1．61％（111／6895），明显高于非无痛分娩儿的窒息发生率（1．09％，216／19749），差异有统计学意义（χ^2=11．231，P〈0．01）。在545例窒息新生儿中，引起窒息的前七位影响因素依次为胎儿窘迫、脐带异常、胎膜早破、母妊娠及内科合并症、早产、巨大儿及胎盘异常。新生儿并发症依次为肝功能受损、代谢及电解质紊乱、呼吸系统并发症、中枢神经系统损害、心肌损害、肾功能异常。结论重视新生儿窒息相关高危因素，选择合适的分娩方式，积极防治窒息后的器官功能损伤，加强新生儿窒息复苏培训及产儿合作，是降低新生儿窒息发生率和病死率的有效手段。     

新生儿缺氧缺血性脑病心肌损害与出生状况的相关性研究

目的分析新生儿缺氧缺血性脑病（HIE）心肌损害发生与出生状况的相关关系。方法采用回顾性临床观察研究方法,对224例HIE患儿发生心肌损害与其出生时胎龄、体质量、性别、分娩方式及有无窒息史等状况的关系进行相关性分析。结果 224例患儿中心肌损害发生率为51.8%（116/224）,48例早产儿心肌损害发生率为81.3%（39/48）,显著高于足月儿45.8%（76/166）,早产与HIE心肌损害的发生有显著的正相关性（r=0.286,P〈0.05）;58例低出生体重儿心肌损害发生率为69.0%（40/58）,显著高于正常体重儿45.8%（76/166）,低出生体质量与HIE心肌损害的发生有正相关性（r=0.198,P〈0.05）;70例窒息新生儿心肌损害发生率为84.3%（59/70）,显著高于无窒息新生儿37.0%（57/154）,窒息与HIE心肌损害的发生有显著的正相关性（r=0.436,P〈0.05）;不同性别及分娩方式对新生儿心肌损害的发生率无影响。结论早产、低体质量、窒息是HIE发生心肌损害的3个高危因素,对于这些新生儿发生HIE时更要关注其心肌损害的发生,以降低病死率。     

远程胎儿监护在高危妊娠中的临床应用

目的:探讨远程胎儿监护在高危妊娠中的临床应用。方法:2004年3月至2005年6月在产科门诊诊断为高危妊娠的孕妇57例作为研究组,并于孕35周以后用远程胎儿监护终端部分(以远程胎儿监护结合胎动计数进行家庭自我监护),随机选择同期高危妊娠孕妇58例,在家中以胎动计数结合门诊常规NST检查作自我监护,作为对照组,比较两组的NST异常和围生儿不良预后发生率。结果:研究组57例孕妇中,NST异常21例,检出率为37%,对照组58例,NST异常11例,检出率为19%,两组比较差异有显著性(P<0.05),对照组58例中,发生围生儿不良预后27例,发生率为47%,研究组57例中发生围生儿不良预后12例,发生率为21%,两组比较差异有显著性(P<0.05)。结论:应用远程胎儿监护对高危妊娠的监测,可降低新生儿窒息等围生儿预后不良的发生率,为高危妊娠孕妇的自我监护和管理开辟了一条有效、实用、可行的途径。     

第二产程胎心监护异常的处理及临床意义

目的 探讨第二产程胎心监护异常者的分娩方式,及其与产妇并发症和围产儿结局的关系。方法 回顾性分析我院足月单胎头位分娩产妇第二产程中胎心率（FHR）正常的111例（对照组）和胎心率异常的121例（观察组）的资料。结果 FHR异常的发生率为52.2%（121／232）,异常胎心率类型包知中、重度变异减速（VD）81例,占66.9%;晚期减速（LD）27例,占22.3%,其中仅1例发生连续LD;延长减速（PD）4例,占3.3%;VD合并LD2例,占1.7%;VD合并PD3例,占2.5%;基线变异减弱4例,占3.3%。对照组中,阴道助产13例（11.7%）,顺产98例（88.3%）;观察组中,顺产86例（71.1%）,阴道助产35例（28.9%）,其中29例（82.9%）为FHR异常而施术者,两组间比较,差异有显著性（P＜0.05）。观察组、对照组新生儿窒息的发生率（分别为5.0%、1.8%）及产伤的发生率（14.3%、15.4%）比较,差异均无显著性（P＞0.05）;观察组中有1例产妇会阴Ⅲ度撕伤。结论 第二产程中FHR异常的发生率高,多为产程中胎头受压或脐带受压而引起的迷走神经反射或暂时性子宫胎盘血流减少,并非缺氧所致,不必急于干预,以免造成母、儿损伤。     

远程胎儿监护在脐带绕颈孕妇产前自我保健中的作用

目的　探讨远程胎儿监护对提高脐带绕颈孕妇产前保健质量的作用。方法　根据家庭自我监护方式的不同 ,将脐带绕颈的孕妇分为试验组和对照组 ,试验组 (896例 )为远程胎儿监护和胎动计数者 ;对照组 (1914例 )为单纯胎动计数者。分别统计两组无负荷试验 (NST)、胎儿宫内窘迫、新生儿窒息、医院内外死胎、死产的资料。结果　试验组远程NST为反应型、无反应型和变异减速频繁发生的百分率 (分别为 2 5 6 %、16 1%、5 9 1% )与试验组常规NST(分别为 33 7%、11 5 %、33 4 % )和对照组常规NST(分别为 30 8%、12 1%、31 8% )比较 ,差异均有显著性 (P <0 0 5 ) ;试验组和对照组常规NST比较 ,差异无显著性 (P >0 0 5 )。试验组胎儿宫内窘迫检出率 (35 0 % )较对照组 (30 9% )明显升高 (P <0 0 5 ) ;试验组新生儿窒息的发生率 (3 5 % )较对照组 (5 6 % )明显降低 (P <0 0 5 )。医院外试验组死胎发生率 (0 1% )较对照组 (0 8% )明显降低 (P <0 0 1) ;两组医院内死胎发生率比较 ,差异无显著性 (P >0 0 5 ) ;两组间分娩方式比较 ,差异无显著性 (P >0 0 5 )。结论　远程胎儿监护可降低脐带绕颈孕妇新生儿窒息的发生率 ,减少医院外死胎的发生率 ;对手术产率无明显影响。远程胎儿监护为脐带绕颈孕妇家庭自     

远程胎儿心率监护网络在高危妊娠中的临床应用

目的　探讨远程胎儿心率监护网络作为高危妊娠围生期孕妇家庭自我监护方法的临床应用价值。方法　 2 0 0 1年 1月至 2 0 0 4年 7月深圳市第二人民医院选择 1 36例高危妊娠孕妇 ,采用远程胎儿心率监护网络进行无负荷试验 (NST)监测 (研究组 ) ,选择同期进行常规胎儿心率监护的高危孕妇 1 4 0例作为对照 (对照组 ) ,分析两组胎儿心率监护的监测结果和围生儿结局。结果　研究组NST异常检出率 (36 6 %)较对照组 (2 8 3%)明显增高 (P <0 0 5 )。研究组NST异常图形为变异减速、基线变异减少或胎儿心率 (FHR)过缓 ,与对照组比较 ,差异均有显著性 (P <0 0 5 )。研究组新生儿窒息和早产儿的发生率低于对照组 (P <0 0 5 )。两组剖宫产率的差异无显著性 (P >0 0 5 )。结论　应用远程胎儿心率监护网络进行高危妊娠的监测 ,可改善围生儿预后 ,是高危妊娠孕妇自我监护的新选择。     

胎儿脐带绕颈产时连续胎心监护132例体会

目的 探讨超声提示胎儿脐带绕颈孕妇临产后连续胎心监护对围生儿预后的影响。方法 对2004年12月至2005年4月辽宁盘锦市第四人民医院产前诊断脐带绕颈的132例孕妇，入产房后，常规采用外监测法进行连续性产时胎心监护。结果 132例超声提示脐带绕颈孕妇中发现重度变异减速及频发晚期减速不祥图形30例（占22．7％），发生在潜伏期者6例（占20％），活跃期21例（占70％），第2产程3例（10％），均及时改行急诊剖宫产。无重度新生儿窒息，轻度新生儿窒息3例，全部复苏成功，无围生儿死亡。结论 对产前超声提示脐带绕颈孕妇进行全产程胎心监护，有助于及时发现胎儿窘迫并及早处理，可有效避免新生儿重度窒息和围生儿死亡。     

羊水过少对围生儿的影响分析

目的探讨羊水过少对围生儿的影响，寻求改善围生儿预后的措施。方法对150例羊水过少的产妇与同期200例羊水量正常者进行对比分析。结果羊水过少对胎儿的影响有胎儿窘迫、新生儿窒息、足月低体重儿及胎儿畸形和围生儿死亡；阴道分娩的新生儿窒息发生率显著高于剖宫产（P〈0．01）。结论羊水过少严重影响围生儿的预后，对羊水过少的产妇，应加强监护，适时选择剖宫产结束分娩。     

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。     

远程胎儿监护网络用于高危妊娠监测的临床价值

目的　探讨远程胎儿监护网络监测高危妊娠的价值。方法　选择 116例高危妊娠孕妇 ,采用远程胎儿监护网络进行无负荷试验 (NST)监测 (研究组 ) ,选择同期进行常规胎儿监护 (胎动计数和定期到医院进行NST监测 )的高危孕妇 12 0例作为对照 (对照组 ) ,分析两组胎儿监护的监测结果、新生儿预后和剖宫产情况。结果　研究组孕期胎儿监护次数为 (9 2± 4 9)次 ,明显高于对照组的(2 6± 1 3)次 (P <0 0 0 1) ,而两组监护费用相当。研究组新生儿窒息和早产发生率分别为 10 3%和12 6 % ,低于对照组的 2 0 8%和 2 4 5 % ,差异有显著性 (P <0 0 5 )。研究组NST异常者新生儿预后不良的发生率为 6 4 8% ,NST正常者新生儿预后不良的发生率为 17 7% ,两者比较 ,差异有显著性 (P<0 0 5 )。研究组行剖宫产和NST异常行剖宫产者的新生儿预后不良发生率分别为 75 9%和 71 7% ,与对照组 (75 0 %和 6 0 6 % )比较 ,差异均无显著性 (P >0 0 5 )。结论　应用远程胎儿监护网络进行高危妊娠的监测 ,可减少新生儿窒息和早产的发生 ,而对剖宫产率无影响 ,为高危妊娠的自我监护提供了一种可靠的新手段     

羊膜腔灌注治疗产时频发可变减速142例分析

目的：探讨羊膜腔灌注（AI）对产时出现的频发可变减速（RVD）治疗作用，方法：将276例产时出现RVD的产妇，随机分为灌注组（142例）用灌注仪行AI或羊水置换；对照组（134例）给予改变体位等常规治疗，结果：两组相比较，灌注组的剖宫产率，1分钟Apgar评分≤7分百分率，胎粪吸入综合征（MAS）发生率，产褥病率的发生率均低于对照组（P＜0．05）。结论：AI是处理产时出现的RVD的有效手段，可降低剖宫产率，减少母婴并发症。     

Spontaneous fetal heart rate deceleration: an ominous sign for fetal outcome

Background The aim of this study was to establish the prognostic import of spontaneous fetal heart-rate deceleration, a sign of fetal distress.Methods This retrospective study enrolled 169 patients with fetal heart-rate deceleration treated at Shin-Kong Wu Ho Su Memorial Hospital from 1 January 1998 to 24 November 2000. Reviewed variables included type of fetal heart-rate irregularity (including early, variable, late, and spontaneous variants), neonatal outcome, Doppler results, gestational age and weight at birth, and amniotic fluid index.Results The spontaneous form of fetal heart-rate deceleration was determined for 11 of the 169 patients (6.5%) diagnosed with fetal heart-rate deceleration, with a 5-min Apgar score below 7 observed for 5 (45.5%) of these subjects, and neonatal complications for 9 (81.8%). Mean gestational age was 32.2±3.8 weeks; mean birth weight was 1,560±723.9 g. Spontaneous deceleration has a sensitivity of 29%, specificity of 99%, positive predictive value of 81.8%, and negative predictive value of 86.1%.Conclusion Although of the different fetal heart-rate deceleration types the spontaneous variant has the lowest incidence rate, the complication and mortality rates are highest and it is also associated with lower birth weight and higher incidence of pre-term labor. Failure of the fetus to cope with the compromised placental flow and uterine compression resulting from oligohydramnios may be fundamental to the etiology of spontaneous fetal-heart rate deceleration. Once diagnosed, Doppler ultrasound may be used to assess placental-vessel flow. Emergency treatment may be mandatory if deterioration is noted.Abbreviations AFI Amniotic fluid index - ITP Idiopathic thrombocytopenic purpura - GDM Gestational diabetes mellitus - SGA Small for gestational age restriction - PPV Positive predictive value - NPV Negative predictive value - S/D ratio Systolic/diastolic ratio - bpm Beats per minute - IUGR Intrauterine growth - IUFD Intrauterine fetal death - PPROM Pre-term premature rupture of membrane - RDS Respiratory distress syndrome     

Spontaneous Resolution of Second Trimester Fetal Pleural Effusion

A case of pleural effusion, diagnosed by ultrasound in the second trimester, underwent spontaneous resolution without adverse effect on lung development. Optimal management has not been defined; because the natural history of fetal pleural effusion is unknown, observation with serial ultrasound is an alternative to in utero therapy.     

产程中胎儿血氧饱和度监测的临床研究

目的:研究产程中监测胎儿血氧饱和度(FSaO2)诊断胎儿窘迫的准确性及安全性,以及联合应用胎心电子外监护监测胎儿的合理途径。方法:对108例产妇在第一产程活跃期及第二产程中同时行胎心监护和胎儿血氧饱和度监测,动态观察胎儿血氧饱和度的变化,确定诊断胎儿窘迫的标准,依据分娩后Apgar评分及脐血血气分析结果,验证监测方法的敏感性、特异性、阳性预期值、阴性预期值与准确率。结果:(1)以胎儿血氧饱和度≤30%作为诊断胎儿窘迫的标准,对脐动脉血pH≤7.15预测的敏感性91.6%,特异性97.9%,阳性预期值84.6%,阴性预期值98.9%;(2)胎儿血氧饱和度≤30%持续5min以上预示胎儿有缺氧及酸中毒的可能;(3)胎心监护和胎儿血氧饱和度测定联合应用,可提高胎儿窘迫诊断的准确性。结论:胎儿血氧饱和度监测是一种理想的内监护方法;产程中常规应用胎心电子外监护,发现异常时可进一步进行胎儿血氧饱和度监测,是理想的监测方法。     

Fetal hiccups; characteristics and relation to fetal heart rate

In 35 two-hour recordings of fetal heart rate and fetal movements, 14 periods of fetal hiccups were present (1.2% of the recording time) with a median duration of 3.5 min (range 1 to 8 min). No specific relation to behavioural states or movement patterns could be identified. The hiccupping frequency varied from 10 to 21 per min. Within a hiccupping spell, the mean frequency decreased from 20 ± 11 to 12 ± 6.2 per min. A small but evident increase in baseline frequency was present during the hiccupping spells, independent from other movements performed by the fetus.     

Decreased fetal activity and fetal heart rate changes after amniocentesis complicated by fetal hemorrhage

A case is described in which amniocentesis caused placental injury, abruptic placenta, and fetal hemorrhage which caused fetal distress. This was primarily manifested by reduction of fetal movements and later by fetal heart rate deceleration. Emergency cesarean section was performed of monitoring the fetus after amniocentesis by assessment of fetal movements is stressed.     

Benefits and risks of MRI in pregnancy

Ultrasound remains the modality of choice in imaging the fetus due to its availability, safety, and low cost. With advances in technology, however, magnetic resonance imaging (MRI) has become an important adjuvant in the evaluation of the fetus. MRI is not limited by fetal lie, oligohydramnios, overlying bone, or obesity. MRI can image the fetus in any plane, providing a large field of view of the fetus and placenta with excellent soft tissue resolution of the brain, airway, lungs, and abdomen. Advanced techniques are being developed that provide volumetric data, spectroscopy, and functional images. MRI has its own set of challenges with a lack of consensus regarding its utility and safety. Artifact from the moving fetus and breathing mother limits the sequences available. While there is currently no evidence that fetal MRI produces harmful effects, long-term safety regarding radiofrequency fields and the loud acoustic environment continues to be studied. In this review, the benefits and potential risks of fetal MRI will be discussed.     

Relationship Between Combined Fetal Biophysical Activities,Oligohydramnios, and Fetal Acid–Base Status

The purpose of this study was to determine the relationship between combined fetal biophysical activities, oligohydramnios, and fetal acid-base status at the time of testing. In a prospective study of 101 patients undergoing cesarean section before the onset of labor, a fetal biophysical profile was performed within 3 h before the cesarean section. Different combinations of fetal biophysical activities (fetal heart rate reactivity, fetal breathing movements, fetal body movements, and fetal tone) and oligohydramnios were correlated with umbilical cord blood gas and acid-base measurements (artery and vein). Fetal acidemia was defined as umbilical arterial blood pH <7.20. The group of fetuses with reactive nonstress test (NST) and/or fetal breathing present had significantly higher pH, pO₂, bicarbonate, and base excess and significantly lower pCO₂ levels compared with fetuses who had nonreactive NST, absent fetal breathing, and compromised or absent body movements and tone. These blood gas and acid-base differences were observed in both umbilical cord artery and vein. There was a significant relationship between oligohydramnios and fetal acidemia. Seven of 15 (46.6%) fetuses with oligohydramnios were acidemic and 7 of 15 (46.6%) acidemic fetuses had oligohydramnios (P = 0.0008). Fetuses with compromised or absent movements and tone had the highest incidence of acidemia (10 of 11 or 91%) and oligohydramnios (4 or 11 or 36%). The presence of oligohydramnios was associated with increased frequency of acidemia in every combination of biophysical activities. However, when all biophysical activities were absent, the frequency of acidemia was 100% regardless of the presence or absence of oligohydramnios. In conclusion, progressive loss of fetal biophysical activities is associated with increasing frequency and severity of fetal acidemia and oligohydramnios.