脐带缠绕产程中持续胎心监护100例临床分析

目的：探讨胎儿脐带缠绕孕妇临产后连续胎心监护对围生儿预后的影响。方法：对2008年10月～2010年10月霍州市人民医院产前诊断脐带缠绕100例孕妇从规律宫缩至胎儿娩出前,常规采用外监测法进行连续性产时胎心监护。结果：本组100例孕妇中,胎心监护发现重度变异减速及频发晚期减速不详图形28例（28%）,发生在潜伏期6例（占6%）,活跃期20例（占20%）,第二产程2例（2%）,均改行急诊剖宫产,无重度新生儿窒息,无围生儿死亡。结论：临床对于脐带缠绕的孕妇应进行严密的产时胎心监护,以早期发现胎儿窘迫并及时处理,避免新生儿重度窒息及围生儿死亡。     

胎心早搏30例临床分析

目的：探讨胎心早搏的发病原因。方法：采用胎儿心电图仪描记胎儿心电图，捕捉胎心早搏，并追问相关病因。结果：本院2006～2009年共检出胎儿心律紊乱269例，其中，胎心早搏30例，经观察，胎心早搏多发生于妊娠中、晚期，与胎儿宫内窘迫密切相关。结论：胎心早搏的临床原因多为宫内缺氧、病毒感染。因此，定期产检，及时发现胎儿宫内窘迫及宫内感染者至关重要。     

胎儿脐带缠绕的超声诊断

脐带围绕胎儿颈部、四肢或躯干者称为脐带缠绕.约90%为脐带绕颈,以绕颈1周者居多,占分娩总数的20%左右.其发生原因和脐带过长、胎儿小、羊水过多及胎动过频有关.脐带绕颈对胎儿影响与脐带缠绕松紧、缠绕周数及脐带长短有关.由于脐带是母体与胎儿间氧及营养物质的输送传递通道.其功能障碍必然影响胎儿氧的供应,导致胎儿窒息,甚至死胎、死产及新生儿死亡.因此产前超声诊断脐带绕颈有着重要的临床意义.     

脐带异常临床进展

脐带是胎儿和母体物质交换的通路。脐带异常可影响胎儿-胎盘血液循环,导致IUGR、胎儿宫内窘迫、死胎,以往缺乏特异性诊断方法,故在产时常突然发生意外,导致死产、新生儿窒息及死亡,是围产儿死亡的重要原因。目前应用超声波及胎心率电子监护等新技术,对脐带异常的诊断及处理有了一定进步。现将脐带缠绕、脐带脱垂、脐带扭转综述如下。 1 脐带缠绕脐带缠绕胎儿颈部、躯体及四肢。发生率国内报道在20％-25％。日本高桥(1991)报     

脐带缠绕的风险因素及围产儿结局

目的探讨与脐带缠绕有关的危险因素,以及对围产儿结局的影响。方法回顾性分析5086例产后病例和56例围产儿死亡病例,以及孕产次、孕妇体重、社会职业、新生儿体重、分娩方式、羊水过少和围产儿死亡情况。结果脐带缠绕发生率为30%,其占围产儿死亡原因的27%,脐带缠绕的发生与有无社会职业有明显相关性,但多发生在体重小于3000克和大于4000克组,脐带缠绕合并羊水过少的发生例数明显增多,同时也使剖宫产率升高。结论脐带缠绕应引起产科医生的关注,但复杂性缠绕易引起胎儿猝死,且不宜在产前被发现。     

胎儿脐带缠绕围生期观察及临床处理

目的 探讨胎儿脐带缠绕孕妇临床特点及处理方法.方法 连续进行胎心宫缩监护,比较现察组(脐带缠绕组)和对照组的胎心率(FHR)改变、羊水Ⅰ～Ⅲ度粪染率、新生儿窒息率、分娩方式、脐带缠绕周数及脐带长度.结果 脐带缠绕组阴道胎吸助产率、剖宫产率、胎儿宫内窘迫及新生儿窒息发生率明显高于对照组(P＜0.05),但自然分娩率仍高于剖宫产率.结论 对脐带缠绕的孕产妇加强围生期保健,产时密切监护,适时产科处理是降低新生儿窒息、围生儿死亡的有效措施.同时说明脐带缠绕的孕产妇不能盲目首选剖宫产术,应密切观察产程,当出现胎儿宫内窘迫时才行剖宫产术,并且脐带缠绕2周或2周以上最好选择剖宫产术.     

脐带缠绕对分娩方式及围生儿的影响

目的探讨脐带缠绕对分娩方式及围生儿的影响。方法选择孕36～42周头位妊娠脐带缠绕215例作为观察组,随机抽取同期头位妊娠无脐带缠绕230例作为对照组,对两组孕妇的临床资料进行回顾性分析,比较分析缠绕及缠绕周数对围生儿的影响。结果观察组阴道助产、胎儿窘迫、新生儿窒息与对照组比较,差异有统计学意义（P〈0.05）,脐带缠绕周数越多,胎儿窘迫及新生儿窒息的发生率越高,缠绕2周及其以上和缠绕肢体者与缠绕1周者比较,差异有统计学意义（P〈0.05）。结论脐带缠绕是胎儿窘迫、新生儿窒息的主要原因;加强产前、产时监护,适宜的产科处理是降低围生儿死亡的有效措施。     

脐带绕颈,要不要紧

柯大夫:我现在怀孕7个月。最近一次产检时,B超发现我的宝宝脐带绕颈一周,胎心还正常。请问是否有危险?是否一定要剖腹生下来?广东朱×朱读者:脐带围绕胎儿的颈部、四肢或者躯干者,称为脐带缠绕。脐带绕颈是脐带缠绕中最常见的情况,以缠绕一圈者居多。发生脐带绕颈的原因,与脐带过长、胎儿小、羊水过多、胎儿在宫内活动过多有关。     

彩色多普勒超声诊断胎儿脐带绕颈缠绕程度的易变性研究及临床价值

目的：探讨运用彩色多普勒超声（CDFI）判断脐带绕颈缠绕程度的价值及其临床意义。方法：通过3个时点（孕32、36、40周）对342例CDFI初诊为胎儿脐带绕颈的晚期孕妇追踪观察,研究其易变性因素,并依据脐动脉血流参数判定其缠绕程度,评价胎儿预后并为分娩方式提供更多信息。结果：CDFI诊断脐带绕颈具有高度的易变性,羊水量、检查时段、胎方位等是主要的影响因素,因此须动态观察;脐动脉血流参数尤其是收缩期/舒张期比值（S/D）能较准确地评价胎儿预后,结合羊水中脐带的曲直状态、缠绕角度、胎心率,其准确率更高;经阴道分娩时羊水中脐带呈直线状新生儿窒息率较羊水中脐带呈曲线状增高（P〈0.01）,当脐动脉S/D值〉3.0,且胎心率明显异常或羊水中脐带呈直线状时,应及时行剖宫产结束分娩。结论：CDFI能较准确地诊断脐带绕颈,判断其缠绕程度,为分娩方式的选择提供更多的信息,是首选的辅助检查方法。     

胎心监护变异减速与脐带缠颈孕妇体位变化的相关研究

目的 探讨胎心监护变异减速与脐带缠颈孕妇体位变化的关系.方法 把我院孕36 w后胎心监护出现变异减速的316例孕妇随机分成两组,左侧卧位胎心监护有变异减速的166例孕妇,采取半卧位或右侧卧位,为观察组;单以左侧卧位进行胎心监护的150例孕妇为对照组.观察两组胎心监护曲线图、脐带缠颈例数、分娩方式及围产儿情况.结果 观察组与对照组相比,正常图形较多,轻度变化减速(MVD)、重变异减速(SVD)、脐带缠颈发生率较少,胎儿窘迫、新生儿窒息率减少,差异均有极显著性(P＜ 0.01);两组分娩方式无显著差异.结论 左侧卧位胎心监护有变异减速的孕妇,改变体位后,胎心监护曲线可恢复正常,脐带压迫解除,甚至使缠绕的脐带松脱,胎儿窘迫、新生儿窒息减少.     

胎儿宫内窘迫相关因素及与新生儿出生结局的临床关系研究

目的:分析胎儿宫内窘迫相关因素及与新生儿出生结局的临床关系。方法:选取某院2017年10月~2018年12月收住的孕妇2700例进行研究分析,其中胎儿宫内窘迫有200例(7.41%)。对全部孕妇临床资料采取回顾性分析,通过Logistic回归多因素分析胎儿窘迫相关因素。结果:通过分析单因素结果显示,分娩方式、孕周、分娩史、胎盘异常、胎膜早破、24h尿蛋白量、羊水异常、纤维蛋白原、妊娠期高血压病、胎位异常、胎儿出生体重以及脐带异常等均为导致新生胎儿窘迫的危险因素(P<0.05);经过Logistic多因素回归分析显示,羊水异常、阴道助产、纤维蛋白原、胎膜早破、24h尿蛋白、胎位异常、胎儿体重以及脐带异常等是胎儿窘迫的危险因素(P<0.05);而OR值较高的因素有阴道助产、胎位异常以及羊水异常等。结论:对于产前舒张压较高、存在分娩史、纤维蛋白原偏低以及24h尿蛋白偏高的孕产妇应加强监护,及时诊断,从而进行针对性干预治疗。     

颈椎病综合征心电图改变的临床意义

目的探讨颈椎病综合征心电图改变的临床意义。方法对112例颈椎病患者治疗前后的心电图改变进行分析。结果治疗前心电图异常88例,以ST-T改变（78.57%）、窦性心动过缓（16.96%）、期前收缩、传导阻滞多见,治疗后心电图正常80例（90.91%）,好转6例（6.82%）。结论颈椎病早期导致的心电图异常往往是可逆的,早期干预治疗,短期内形成的心电图异常是可以恢复的。     

健康教育对孕妇院前胎膜早破预防脐带脱垂的影响

目的探讨加强健康教育对院前胎膜早破、预防脐带脱垂的影响。方法将在本院孕妇学校接受胎膜早破相关知识学习、入院前发生胎膜早破的104例孕妇为观察组；未接受胎膜早破相关知识学习、入院前发生胎膜早破的92例孕妇为对照组．观察加强健康教育对院前胎膜早破、预防脐带脱垂的影响。结果观察组发生脐带脱垂2例（1．92％），新生儿死亡0例（0．00％），分别与对照组[9例（9．78％）、6例（6．52％）]比较，差异有统计学意义（P〈0．05）。结论加强健康教育，提高孕妇对院前发生胎膜早破、预防脐带脱垂的意识，对降低围产儿死亡率有着重要的临床意义。     

超声心动图检查胎儿心律失常的临床分析

目的探讨超声心动图检查对胎儿心律失常的诊断价值及临床意义。方法采用超声心动图对374例胎龄12⁴1周临床疑诊为心律失常的胎儿进行检查。结果共检出胎儿心律失常61例,其中心脏结构畸形4例,完全性房室传导阻滞4例,心动过缓4例,室性早搏8例,室上性心动过速12例,房性早搏29例。以胎儿心律失常的实际发生率为标准,超声心动图检查的实际准确率为93.75%(61/65),比较结果的差异不明显,不存在统计学意义(P>0.05)。结论胎儿超声心动图是产前检查胎儿心律失常的可靠的无创性影像技术,其应用有助于早期检出并指导心律失常胎儿的处理。     

动态心电图与常规心电图诊断孕妇心律失常的临床对比

目的比较常规心电图、动态心电图在诊断孕妇心律失常方面的价值。方法80例心律失常孕妇,均接受动态心电图和常规心电图检查,比较两种检查方法对各类心律失常的检出率。结果动态心电图对房性早搏成对、房性早搏二三联律、室性早搏成对、室性早搏二三联律、短阵室上性心动过速的检出率分别为11.25%、13.75%、33.75%、83.75%、11.25%,均高于常规心电图的2.50%、3.75%、3.75%、33.75%、2.50%,差异具有统计学意义(P<0.05)。两种检查方法对房室传导阻滞的检出率比较差异无统计学意义(P>0.05)。结论动态心电图在孕妇心律失常诊断中准确率更高,能很好的协助诊疗,临床应用价值高。     

功能性及器质性室性早搏的动态心电图特性探讨

目的通过动态心电图判定功能性及器质性室性早搏。方法选取300例临床资料完整且诊断明确的室性早搏病例,观察其动态心电图（DCG）室性早搏的发生频度、规律与各项活动、精神因素及病种的关系,并与临床资料对照,寻找功能性及器质性室性早搏的鉴别方法。结果①器质性早搏多为均匀或无周期性早搏,功能性早搏多呈典型的周期规律;②早搏发生频度在200～500次/d之间时多为散在、均匀发生的器质性早搏（P〈0.05）;③心肌病、心肌炎、冠心病、先心病患者在运动后器质性早搏数目增多（P〈0.05）;④VE发生频度与运动之间无显著相关性（P〉0.05）。结论依据DCG的表现并结合Lown氏和Schmroth氏的观点,强调早搏的周期性与非周期性特征是鉴别诊断的一个重要依据,可显著提高鉴别诊断的准确率。     

Fundamental and clinical evaluation of ceftazidime in perinatal studies

In a chemotherapy of perinatal infections, the safety of mothers and their neonates and the transfer of a drug to amniotic fluid and fetus as well as its bacteriological efficacy are some of the important factors. In the present study, the authors have carried out a pharmacokinetic evaluation on the transfer of ceftazidime (CAZ), a new cephalosporin, to amniotic fluid and umbilical cord serum, and also a clinical study on its efficacy and safety in 3 cases of perinatal infections. Transfer ratios of CAZ to umbilical serum and to amniotic fluid were 25.3-46.5% and 0.6-17.5% (of maternal serum), respectively, after 1 g of CAZ was administered by bolus intravenous injection, and 24.3-85.8% and 1.6-17.5% (of maternal serum), respectively, after 2 g of CAZ was administered by bolus intravenous injection. These levels were high enough to expect that CAZ is an effective antibiotic both for treatment and prophylaxis of intrauterine fetal infections. Out of the 3 cases treated with CAZ, clinical efficacy was good in 2 cases which did not respond to other antibiotics. CAZ was considered to be clinically effective, although the number of cases treated was small. No abnormalities were observed at all either in subjective symptoms or objective findings in laboratory findings such as hepatic and renal functions of mothers, or neonates. This confirmed the high safety of CAZ. As earlier reports indicate, CAZ has a broad-spectrum of antibacterial activity against various bacteria including Gram-negative organisms and anaerobes, and shows a good transfer into intrauterine tissues, and high clinical efficacy in the field of obstetrics and gynecology.(ABSTRACT TRUNCATED AT 250 WORDS)     

新生儿窒息167例产科原因分析

目的探讨新生儿窒息的产科原因,以求降低新生儿窒息的发生率和围生期新生儿死亡率。方法对167例新生儿窒息原因进行分析。结果新生儿窒息发生率6.75%。脐带因素43例,胎盘因素37例,羊水因素27例,宫缩过频过强21例,早产16例,胎膜早破13例,第二产程延长8例,其他2例。结论新生儿窒息的发生与脐带、胎盘、羊水、宫缩、早产、胎膜早破、第二产程延长等因素有关。     

Experimental and clinical studies on latamoxef during the perinatal period

Fundamental and clinical studies on the perinatal use of latamoxef (LMOX) were performed, with the following results. Concentration of LMOX was examined in maternal serum, umbilical cord serum and amniotic fluid after intravenous administration of 2 g dose. Data were analyzed by the simulation curves using the two-compartment model. The peak level of LMOX in maternal serum was 218.4 micrograms/ml and half-life of the beta-phase was 1.9 hours. The peak levels of LMOX in umbilical cord serum and amniotic fluid were 37.4 micrograms/ml (1.4 hours) and 27.5 micrograms/ml (8.9 hours) after administration. The concentration of LMOX in amniotic fluid decreased in amount after the peak, but it still remained 21.9 micrograms/ml (16 hours) after administration. Above these results, it was concluded that the transfer of LMOX to umbilical cord serum and to amniotic fluid was sufficient. In clinical use, LMOX was administered to 30 pregnant patients with premature rupture of membrane. It showed excellent efficacy in preventing perinatal infection. Seven patients with perinatal infections were treated with LMOX and all of them had excellent efficacy. No side effects were observed in any of the cases studied.     

Ceftazidime: placental transfer and pharmacokinetic parameters in the third trimester pregnancy

Ceftazidime (CAZ), a newly developed cephalosporin with very high stability to beta-lactamase, was evaluated for its transfer into fetus and amniotic fluid in the third trimester pregnancy, following a single bolus intravenous injection at a dose of 1 g. In subjects with various conditions (background factors) standardized, concentrations of CAZ in maternal venous blood, venous and arterial blood in umbilical cord, and amniotic fluid were determined. High concentration of CAZ (10 micrograms/ml or higher) was found to be maintained in fetal blood and amniotic fluid for ca. 4 hours and ca. 8 hours, respectively, after intravenous injection, showing good placental transfer of CAZ. In view of MICs of CAZ, satisfactory clinical efficacy is expected in perinatal infections.