双胎输血综合征的超声诊断分析

目的 评价超声在双胎输血综合征(TTTS)中的作用.方法 回顾分析12例被确诊TTTS胎儿的超声检查结果.结果 12例胎儿中,孕20周确诊3倒,孕24～35周确诊8例,孕36周后确诊1例.其中有5例双胎之一为水肿儿,3例伴胸腹水,双胎之一为贴附儿2例.含死胎的有3例.结论 超声作为一种无创性的检查,在TTTS的早期诊断具有很高的应用价值,能为临床提供科学的诊治依据.     

双胎输血综合征产前超声诊断及分析

目的探讨双胎输血综合征(TTTS)的产前超声诊断及TTTS发现时间与围产儿结局的关系,目前采用的治疗方法,改善围产儿结局和降低围产儿死亡风险。方法采用回顾性分析的方法对1323对双胎的羊膜囊数目以及羊膜隔带厚度、胎盘位置、数目、两胎性别及早期超声绒毛膜囊数目进行分析判断为MCT193例,超声测量胎儿双顶径、头围、腹围、股骨长、羊水指数、膀胱、胎盘厚度、回声,脐动脉血流动力学参数等超声表现进行分析符合TTTS诊断的患者有21对。结果 TTTS是MCT胎儿宫内死亡的主要原因,TTTS发生越早围产儿生存的风险性越高,期别进展与围产儿结局有一定关系,分期系统在监测病情进展方面更为有效。结论 TTTS是双胎妊娠的一个严重并发症,围产儿发病率及病死率极高,超声技术作为一种无创、安全、简便、快捷、可靠的检查是目前诊断TTTS的重要手段。     

14例新生儿双胎输血综合征临床超声影像观察研究

目的评价超声诊断双胎输血综合征应用价值;探讨新生儿双胎输血综合征临床表现及合并症等问题。方法应用二维及多普勒超声测定14例22～36周的双胎妊娠胎儿生长指标及脐动脉血流PI值、RI值、S/D值,观察活产和死胎所产双胎婴儿供血儿和受血儿的各项指标。结果超声诊断双胎输血综合征14例,诊断准确率92.8%（13/14）,双胎输血综合征具有一般双胎的临床共性,其中受血儿出现病理临床表现及合并症较供血儿多且严重。结论二维联合多普勒超声诊断双胎输血综合征有较高的准确率,是快捷诊断双胎输血综合征手段之一。双胎输血综合征对受血儿危害更大,临床一旦确诊为双胎输血综合征,应对受血儿进行严密监护,若出现临床表现并发红细胞增多症,应积极采取治疗措施以减少严重并发症及后遗症的发生。     

双胎输血综合征宫内治疗的探讨

目的探讨双胎输血综合征（TTTS）的诊断、分期，评价宫内治疗的可行性及临床效果。方法对双胎输血综合征病例进行诊断分期，并且行系列羊水减量等宫内治疗。结果邢严重程度的分期是决定TTTs治疗效果和围产儿预后的重要因素。诊断时分期越高，围产儿死亡率越高。Ⅰ-Ⅱ期TTTs患者，经羊水减量术治疗后，孕龄延长，胎儿预后好。结论尽可能早地确立诊断和临床分期有助于评估预后和临床处理。羊水减量术治疗TTTs，可操作性强，有较好的治疗效果。     

左心发育不良综合征的产前超声诊断价值

目的探讨产前超声诊断胎儿左心发育不良综合征（HLHS）的诊断方法和价值。方法回顾性分析产前超声诊断为胎儿左心发育不良综合征的病例资料,对其超声特点进行分析,探讨其诊断要点。结果16例中经引产后尸检证实14例,2例失访。16例中四腔心切面均显示左、右心比例失常,左心狭小;三血管切面主、肺动脉内径比例失常,血流方向反向;主动脉弓切面显示主动脉弓内反向血流。结论产前超声对检出胎儿左心发育不良综合征具有极重要的价值。三血管切面主、肺动脉内径比例失常,血流方向反向;主动脉弓切面检出主动脉弓内反向血流对诊断HLHS具有重要的提示作用,四腔心切面是筛查HLHS的重要切面,多普勒超声是重要的和不可或缺的。     

超声软指标产前筛查唐氏综合征的临床策略研究

目的通过产前超声筛查胎儿染色体软指标,探讨染色体软指标筛查唐氏综合征的临床价值。方法 2014年2月至2017年2月在我院行系统超声检查的正常胎儿597例,同期在我院经产前诊断为DS的存活胎儿46例,孕周16~25w,超声筛查有无结构异常及染色体异常软指标,根据孕妇年龄、血清学筛查结果及超声检查综合评定,决定是否行胎儿染色体检查。染色体异常软指标主要包括:鼻前软组织增厚,鼻骨发育不良,颈项软组织增厚、轻度肾盂扩张、心室强回声、肠管回声增强,小指中节指骨发育不良等。结果 597例胎儿中,发现超声软指标异常共68例(11.4%),其中鼻部软指标异常25例(4.2%),其他软指标异常43例(7.2%)。46例DS胎儿中,合并结构畸形15例(32.6%),超声软指标异常44例(95.7%),多发软指标异常29例(63.0%),单发软指标异常5例(10.9%),鼻部软指标异常40例(87.0%),非鼻部软指标异常21例(45.7%)。DS组超声软指标异常发生率显著高于正常组,差异有统计学意义(P<0.001),DS组多发超声软指标异常发生率高于单发软指标异常,差异有统计学意义(P<0.001),DS胎儿鼻部软指标异常发生率高于非鼻部软指标异常,差异有统计学意义(P<0.001)。结论产前超声筛查中应当注重超声软指标的筛查,多发软指标异常筛查DS的敏感性较单发软指标异常明显提高,鼻部软指标的综合评价和筛查较常规染色体标志物更有助于DS胎儿的产前筛查。     

双胎输血综合征二例报道

一次妊娠同时有两个或两个以上胎儿妊娠称为多胎妊娠.因为多胎妊娠孕妇并发症围产期死亡率高,故临床作为异常妊娠对待.目前,所知多胎妊娠胎儿数目可达2～8个.以双胎妊娠最常见发生率11%左右.双胎妊娠分类:单卵双胎、双卵双胎两类.单卵双胎占20%～25%,双卵双胎占25%～80%.多胎妊娠孕产妇并发症多,围产儿死亡率明显升高.主要表现为早产,胎儿宫内发育迟缓、畸形,双胎输血综合征,脐带脱垂,胎头交锁,胎头碰撞等.本文介绍我院近10年来在多胎妊娠中,双羊膜囊,单绒毛膜、单卵双胎并发双胎输血综合征两例报道.     

12例双胎输血综合征供血患儿围生期的综合护理体会

目的：探讨施行围生期综合护理对双胎输血综合征供血患儿远期临床效果的影响。方法：按标准纳入对照组和实验组研究对象,进行围生期综合护理干预后,对比分析双胎输血综合征供血患儿出院时及1年后的贫血和脑损伤等并发症的护理效果。结果：进行围产期综合护理后,出院时和1年后双胎输血综合征供血患儿红细胞及血红蛋白含量与对照组无明显区别(P>0.05);《Bayley婴幼儿发育量表》分析结果显示,随访双胎输血综合征供血患儿1年后,其智力量表用智力发展指数(mental development index,MDI)和运动发展指数(psychomotor development index,PDI)的各个水平分布的比率与常模相比,并无明显差异(P>0.05)。结论：输血综合征供血患儿围生期的综合护理可以有效改善其远期并发症的产生。     

Maternal vascular endothelial growth factor receptor and interleukin levels in pregnant women with twin-twin transfusion syndrome

Twin-twin transfusion syndrome (TTTS) is an unusual and serious condition that occurs in twin pregnancies when identical twins share a placenta but develop discordant amniotic fluid volumes. TTTS is associated with an increased risk of fetal death and birth defects if untreated. This study investigated the soluble levels of biomarkers including growth factors and interleukins in pregnant women with and without TTTS during pregnancy. We quantified plasma levels of VEGF-R1, VEGF-R2, IL-1β, IL-6 and IL-8 in twin pregnant women with (n=53) and without TTTS (n=72) and in women with single pregnancy (n=30) by ELISA and analyzed the association of maternal circulating biomarker levels with TTTS. Our results showed that maternal VEGF-R1 levels were significantly higher in twins compared to single pregnancy (P<0.05) and were decreased in the second trimester compared to the first trimester (P = 0.065, 0.019 and 0.072 for twins with and without TTTS and single pregnancy, respectively). VEGF-R2 levels had a trend to be lower in twins compared to single pregnancy. In addition, soluble VEGF-R1 and VEGF-R2 levels were significantly decreased while IL-6 levels were increased after surgical treatment with laser in twin pregnant women with TTTS (P = 0.016, 0.041 and 0.04, respectively). These results suggest that IL-6, VEGF-R1 and VEGF-R2 are involved in vascular regulation and stabilization in twin pregnancies and may contribute to the pathogenesis of TTTS and thus play a prognostic role in the surgical treatment of TTTS.     

Endothelin concentrations in monochorionic twins with severe twin-twin transfusion syndrome.

The objective of this study was to determine endothelin (ET-1) concentrations in monochorionic twin fetuses with and without twin-twin transfusion syndrome (TTTS). Fourteen monochorionic twin pregnancies complicated by TTTS and six without TTTS were studied. Matched maternal and fetal blood samples were obtained both in utero and at birth. Amniotic fluid samples were also collected from twin pairs. ET-1 concentrations were measured by radio-immunoassay. ET-1 concentrations in recipient fetuses were higher than in the donors both in utero(P < 0.001) and at birth (P < 0.01). Fetal concentrations of ET-1 in donors were similar to non-TTTS twins. Plasma ET-1 concentrations were significantly higher (P < 0.01) in recipient fetuses with severe hydrops than those with mild/no hydrops. Maternal concentrations of ET-1 were comparable in the two groups. Endothelin concentrations in recipient twins were 2(1/2) times higher than in their co-twins and this was related to the severity of hydrops.     

应用分子生物学技术产前诊断Down综合征

目的 探讨应用PCR分子生物学方法产前诊断Down综合征（Down syndrome,DS)。方法 取产前诊断病例：羊水100例，绒毛16例。提取DNA，PCR扩增21号染色体的6个多态位点，电泳，膜转移，等位基因位点分析，诊断。结果 正常人为两种带型：杂合型显示两条带，纯合型一条带。Down综合征患者为三种带型：完全杂合型显示三条带，半杂合型两条带（信号增强的2：1带），纯合型一条带。100例羊水中2例阳性，16例绒毛标本中1例阳性，3例患者，至少有2个位点检出三个等 基因，患者为2个位点时，表现2：1带型；无一例正常检出三个等位基因。所有结果均与细胞染色体核型检查相符。结论 本分子生物学方法产前诊断DS简便、快速、可行，是一种值得推广的方法。     

唐氏综合征孕中期产前筛查及产前诊断的临床价值

目的探讨唐氏综合征的产前筛查和产前诊断在预防出生缺陷中的价值。方法对68813例孕15-20w的孕妇采用时间分辨荧光免疫方法检测血清AFP和B-HCG浓度,通过Maiticale软件计算危险系数,对唐氏高危和18-三体高危孕妇取羊水获脐血作染色体诊断,对神经管缺陷（NTD）高危孕妇行系统超声检查。结果筛查68813例孕妇,其中2632例为唐氏综合征或18-三体综合征高分险病例,占总筛查人数的3.82%;NTD高风险542例,占0.79%。接受羊水或脐血染色体检查1772例（占总阳性数的67.32%）,检出异常核型67例,占异常发生率3.78%;NTD高风险行超声检查证实胎儿畸形58例,占筛查高危孕妇的10.7%。结论孕中期产前筛查结合产前诊断可以有效预防出生缺陷的发生。     

Early prediction of severe twin-to-twin transfusion syndrome

This extended series of 303 monochorionic twin pregnancies examined at 10-14 weeks gestation explores the possible association of increased fetal nuchal translucency thickness (NT) in the early prediction of severe twin-to-twin transfusion syndrome (TTS). Of 303 pregnancies, there were 16 in which at least one fetus was structurally or chromosomally abnormal and in the remaining 287 ongoing pregnancies there were 43 (15%) which developed severe TTS. The median fetal NT was 1.0 multiples of the median (MOM) and NT was >95th centile in 47 (8.2%) fetuses and in at least one fetus in 37 (12.9%) pregnancies. The prevalence of increased NT in the pregnancies that developed TTS [17.4% (n = 15) of fetuses and 28% (n = 12) of pregnancies] was significantly higher than in the non-TTS group [6.6% (n = 32) and 10.2% (n = 25) respectively; Z: = -3.4, P: < 0.001 and Z: = 3.2, P: < 0.001 respectively], likelihood ratio of increased fetal NT for prediction of TTS = 3.5 [95% confidence interval (CI) 1.9-6.2]. In 153 of the pregnancies, an ultrasound examination was also performed at 15-17 weeks gestation and intertwin membrane folding was seen in 49 (32%) cases; 21 of these (43%) subsequently developed TTS compared to two (1.9%) of the 104 pregnancies without membrane folding (Z: = 6.6, P: < 0.001), likelihood ratio of membrane folding for prediction of TTS = 4.2 (95% CI 3.0-6.0).     

南京地区9453例孕妇唐氏综合征产前筛查结果分析

目的探讨孕中期双联法在产前筛查唐氏综合征中的价值。方法采用时间分辨免疫荧光技术检测9453名15w-20＋6w孕妇血清中AFP和f-βHCG的浓度,使用Multicalc软件评估风险。建议唐氏综合征或爱德华综合征高风险孕妇行胎儿羊水/脐带血染色体检查,神经管开放性缺损高风险者接受高分辨度超声检查,并对高风险妊娠跟踪随访至胎儿出生后。结果共筛查出高风险343例,其中经产前诊断确诊唐氏综合征2例、爱德华综合征3例、其他染色体异常1例。通过随访发现其他异常4例。结论使用孕中期母血清AFP/f-βHCG双联法筛查出唐氏综合征等高风险妊娠进而行产前诊断是减少患儿出生的有效方法。     

超声检查在胎儿产前筛查中的应用价值

目的探讨超声检查在产前筛查中的应用价值,为降低出生缺陷及产前干预措施提供依据。方法对我科行产前检查的11576例孕妇的超声检查结果进行回顾性分析;并进行畸形种类和比率分析。结果超声检查在孕早期可判定胚胎发育停止、葡萄胎、宫外孕;孕中晚期可判定胎儿畸形、前置胎盘、胎盘早剥、死胎;畸胎中以神经管畸形最多,超声检查对畸形胎儿的诊断符合率91%。结论产前超声检查十分必要和有效,是出生缺陷筛查的重要检查手段,具有方法简便,诊断迅速,对母体及胎儿无明显损害的优点,对妇女保健有较大的实用价值,值得推广。     

The role of three-dimensional ultrasonography in polycystic ovary syndrome

The 2003 Rotterdam diagnostic criteria for polycystic ovarysyndrome (PCOS) support the objective role of ultrasound indefining the appearance of the PCO, but there are significantlimitations of these new guidelines from an ultrasound perspectivethat must be considered. Three-dimensional (3D) ultrasound providesa new method for the objective quantitative assessment of folliclecount, ovarian volume, stromal volume and blood flow withinthe ovary as a whole. Since the introduction of 3D ultrasonography,there have been increasing publications on PCOS, each addressingdifferent areas and reporting different results. This reviewcritically examines these studies in an attempt to clarify theevidence to date and thereby establish the current role of 3Dultrasonography in PCOS.