正常和胎儿窘迫新生儿脐血中8-异前列腺素F2α水平及临床意义

目的:探讨8-iso-PGF2α在正常和胎儿窘迫的新生几脐血中浓度;探讨羊水粪染与新生儿脐血中8-iso-PGF2α的关系.方法:选取2008年9月至2011年6月在我院分娩过程中出现胎儿窘迫者103例为实验组、同期随机选取正常对照新生儿73例为对照组;于分娩或剖宫产过程中断脐后采取脐带动脉中血液4mL.其中胎儿窘迫组根据分娩过程中或剖宫产术中羊水粪染新生儿共56例,羊水清亮47例、羊水Ⅰ度粪染5例、羊水Ⅱ度粪染19例、羊水Ⅲ度粪染32例.采用ELISA法测定新生儿脐血血清中8-iso-PGF2α含量.结果:胎儿窘迫新生儿脐血中8-iso-PGF2α较正常组明显升高,差异有显著性(P=0.001);通过对胎儿窘迫组新生儿8-异前列腺素F2α的比较发现Ⅱ、Ⅲ度羊水粪染新生儿脐血8-异前列腺素F2a浓度显著高于羊水Ⅰ度和羊水清组,比较差异有显著性(P=0.004).结论:胎儿窘迫的发生与脂质过氧化有关;羊水粪染(Ⅱ、Ⅲ度)存在8-异前列腺素F2α浓度升高,提示脐血8-异前列腺素F2α测定可作为羊水粪染新生儿预后早期预报的一个指标.     

分娩期羊水粪染与新生儿结局的分析

目的 探讨分娩期羊水粪染与新生儿结局的关系.方法 足月妊娠分娩期羊水Ⅱ-Ⅲ度粪染的孕妇54例作为研究组,羊水Ⅰ度污染的孕妇50例作为对照组,进行对比分析.结果 分娩期羊水Ⅱ-Ⅲ度粪染,胎儿监护异常;新生儿窒息及胎粪吸入综合征发生的比例高(P＜0.05).结论 羊水粪染的程度与新生儿窒息、胎粪吸入综合征的发生密切相关.     

羊水粪染在胎儿宫内窘迫诊断中的价值

胎儿宫内窘迫临床表现主要有胎心率异常 ,羊水粪染及胎动减少或消失。其中羊水粪染是胎儿宫内窘迫的危险信号 ,本文就羊水混胎粪与诊断胎儿窘迫问题分析如下。1　临床资料1.1　羊水混胎粪的诊断标准　正常晚期妊娠的羊水为白色半透明性液体 ,胎粪是胎儿的肠道分泌物、胆汁、咽下羊水中的胎毛 ,胎脂及脱落的皮肤上皮细胞的混合物 ,呈墨绿色。羊水粪染程度按羊水颜色及粘稠度分为三度 : 度羊水稀薄色淡绿 ; 度羊水稍粘稠色黄绿 ; 度羊水呈糊状 ,深绿或棕色。1.2　羊水混胎粪的发生率　我院 2 0 0 0 - 0 1～ 2 0 0 1- 12分娩总数为 186 2例 ,出…     

羊水粪染与新生儿窒息的相关性分析

目的 探讨羊水粪染与胎儿宫内窘迫、新生儿窒息的相关性.方法 对2009-01-2010-10 280例发生羊水粪染新生儿,根据羊水粪染程度、电子胎心监护和新生儿窒息情况进行了相关性分析.结果 羊水Ⅱ度、III度粪染的胎心监护异常率、新生儿窒息率明显高于羊水I度粪染者(P<0.01).结论 新生儿窒息的发生与羊水粪染程度有关;羊水粪染可作为胎儿宫内窘迫诊断标准之一,产程中一旦发现羊水粪染伴电子胎心监护异常者应尽快结束分娩,对羊水Ⅲ度粪染者即使胎心无异常也应尽快结束分娩,以减少缺氧对新生儿的损害,降低新生儿窒息的发生率,防止胎粪吸入综合征,降低围产儿病死率.     

脐血胃动素水平与胎粪排出关系的研究

目的:研究脐血胃动素(Motilin,MTL)水平与胎粪排出的关系.方法:用酶免疫分析法检测并比较足月分娩羊水性状正常(B组,122例)及中重度羊水粪染(A组,62例)的新生儿脐血及其孕母外周血血浆MTL水平.结果:A组新生儿脐血MTL值(343.69 ± 206.73)pmol/L高于B组(139.05 ± 80.06)pmol/L,差异有显著性意义(P ＜0.01),而两组孕妇外周血的MTL值无统计学差异(P ＞ 0.05).羊水中度和重度胎粪污染者的孕妇外周血及脐血的MTL差异均无显著性(P ＞ 0.05).结论:脐血MTL水平升高可能与胎粪排出有关.     

羊水粪染的临床意义

目的 探讨羊水粪染的临床意义并指导临床处理.方法 对溧水县人民医院4 564名孕妇进行前羊水观察、胎心监护及新生儿Apgar评分.结果 胎儿宫内窘迫率、新生儿窒息率随羊水粪染程度加重而升高.羊水粪染合并胎心异常者新生儿窒息率较高.结论 羊水粪染程度与胎儿宫内窘迫、新生儿窒息呈正相关.临床对羊水II、III度,尤其合并胎心异常者应尽快终止妊娠.     

足月妊娠羊水过少与围生儿结局

目的分析羊水过少足月妊娠孕妇围生儿结局,以降低妊娠不良结局。方法 227例足月妊娠羊水过少患者为观察组,同期羊水量正常孕妇100名为对照组,比较2组胎心电子监护结果及胎儿宫内窘迫、羊水Ⅲ度污染、新生儿窒息发生率。结果观察组剖宫产率、胎儿宫内窘迫及羊水Ⅲ度污染发生率、围生儿病死率均高于对照组(P<0.05)。结论对羊水过少产妇应加强胎儿宫内监护,以预防新生儿窒息等妊娠不良结局发生。     

羊水胎粪污染360例临床分析

笔者以近2年在本院发现的分娩中羊水胎粪污染（简称粪染）病例作研究对象，回顾性分析羊水粪染及其程度和其他相关因素在胎儿窘迫诊断中的价值。1资料与方法1．1资料1994～1996年在本院分娩的产妇4538例，其中有羊水粪染871例，占19．19％。本文选择单胎，头先露，胎龄≥37孕周，在产程中出现羊水粪染的产妇360例作为研究对象，占总羊水粪染的41．33％。选择同期在本院分娩的产妇在相同或类似条件下，但羊水清亮的730例作为对照组。1．2方法每例均做胎心监护比较研究组与对照组之间的异常发生率，新生儿APgar评分，以及胎儿窘迫相关因素出…     

羊水过少与围产儿预后相关分析

目的：探讨羊水过少对围产儿的影响。方法：采用回顾性分析方法,对足月妊娠分娩的孕产妇羊水正常组200例及羊水过少组239例进行对比分析。结果：羊水过少组中羊水Ⅱ度以上粪染,胎儿窘迫、新生儿窒息、胎儿生长受限率均显著高于羊水正常组。结论：羊水过少严重威胁围产儿生命,及时终止妊娠,可以明显改善围产儿预后。     

胎儿窘迫剖宫产125例分析

目的探讨胎心率异常、羊水胎粪污染与新生儿窒息的关系。方法回顾性分析125例因胎儿窘迫行剖宫产者的临床资料。结果胎心率较慢、产程的潜伏期或活跃期出现Ⅱ度至Ⅲ度羊水胎粪污染的新生儿窒息率高(均值P<0.01)。结论产程后期羊水胎粪污染率高,胎心率异常伴重度羊水胎粪污染者,新生儿窒息率高。     

Cocaine and metabolite concentrations in the fetal guinea pig after chronic maternal cocaine administration.

To determine the disposition of cocaine (COC) and metabolites after chronic COC exposure in the late gestation guinea pig, six time-bred Dunkin-Hartley guinea pigs were given 10 daily 6 mg/kg COC s.c. injections from day 50 of gestation. Maternal blood and urine, fetal cord blood, and brain and amniotic fluid were collected 1 hr after the last injection. There was no difference between maternal and fetal plasma COC concentrations. This may be due to the combined effect of lower protein binding and ion trapping of COC in the fetus. Benzoylecgonine was higher in maternal plasma, but benzoylnorecgonine was higher in fetal plasma. COC brain-to-plasma ratios were similar in the dam and fetus. Benzoylecgonine was the only metabolite that could be detected in the brain, but levels were too low to quantitate. COC accumulated 3 to 4 times plasma concentrations in the amniotic fluid and was directly proportional to fetal plasma COC concentrations. Benzoylnorecgonine in amniotic fluid accumulated to 2 times fetal plasma levels. The in vitro half-life of COC in amniotic fluid was 30 times longer than plasma elimination half-life in vivo. The high level and long duration of COC in amniotic fluid serve as a reservoir for prolonged fetal COC exposure.     

产前超声诊断三胎妊娠伴双胎无心脐动脉反向灌注序列征

目的总结三胎妊娠伴双胎无心脐动脉反向灌注序列征（TRAPS）胎儿产前超声图像特点。 方法对2001年4月至2017年4月经湖北省妇幼保健院产前超声诊断和生后检查确诊的6例三胎妊娠伴TRAPS胎儿超声与病理检查结果进行对照分析,总结TRAPS胎儿产前超声图像特点。 结果产前超声显示：（1）6例三胎妊娠伴TRAPS胎儿中无心畸胎均有发育不良的下肢（1例有发育不良上肢）,无胸腔、无心脏结构及心管搏动,5例无头颅结构,1例有发育不良头;4例有脊柱和腹腔结构;4例为单脐动脉,5例伴全身皮肤水肿;彩色多普勒示脐动脉反向灌注朝向胎儿体内,2例产前超声末显示脐动脉及胎儿体内血流。（2）6例泵血儿解剖结构均正常,羊水过多2例,羊水正常4例。胎儿期发生心功能不全3例（1例中孕早期好转存活,2例宫内死胎）。（3）6例第三胎儿中5例解剖结构正常,1例多发畸形。胎儿预后：6例三胎妊娠伴TRAPS胎儿中1例剖宫产产下2个正常男婴,1个死胎（无心畸胎）;其余5例三胎均预后不良（5例泵血儿中4例宫内死胎,1例早产死亡;5例第三胎儿中1例宫内死胎,2例早产死亡,2例引产;5例无心畸胎中4例宫内血流阻断,1例生后死胎）。产后病理检查显示6例均为三胎妊娠伴TRAPS,其中4例为双绒毛膜三羊膜三胎妊娠,1例为双绒毛膜双羊膜三胎妊娠;1例为单绒毛膜三羊膜三胎妊娠。 结论三胎妊娠伴TRAPS为罕见而严重的多胎妊娠并发症,产前超声有特有的声像图特点,彩色多普勒超声有较高的诊断价值。     

妊娠晚期羊水过少112例临床分析

目的:探讨羊水过少的相关因素及围产儿的预后。方法:采用回顾性分析方法,对妊娠晚期羊水过少112例与羊水正常100例进行对比分析。结果:羊水过少多发生在孕40周后,与胎儿宫内发育迟缓(IUGR)和延期、过期妊娠有关;羊水过少组围产儿不良预后明显高于羊水正常组(P<0.01)。结论:妊娠晚期羊水过少是胎儿宫内慢性缺氧的标志,对围产儿预后有严重影响,应加强产前监测。剖宫产是处理妊娠晚期羊水过少及降低围产儿死亡率的重要措施。     

Maternal Intravenous Administration of Azithromycin Results in Significant Fetal Uptake in a Sheep Model of Second Trimester Pregnancy

Treatment of intrauterine infection is likely key to preventing a significant proportion of preterm deliveries before 32 weeks of gestation. Azithromycin (AZ) may be an effective antimicrobial in pregnancy; however, few gestation age-approriate data are available to inform the design of AZ-based treatment regimens in early pregnancy. We aimed to determine whether a single intra-amniotic AZ dose or repeated maternal intravenous (i.v.) AZ doses would safely yield therapeutic levels of AZ in an 80-day-gestation (term is 150 days) ovine fetus. Fifty sheep carrying single pregnancies at 80 days gestation were randomized to receive either: (i) a single intra-amniotic AZ administration or (ii) maternal intravenous AZ administration every 12 h. Amniotic fluid, maternal plasma, and fetal AZ concentrations were determined over a 5-day treatment regimen. Markers of liver injury and amniotic fluid inflammation were measured to assess fetal injury in response to drug exposure. A single intra-amniotic administration yielded significant AZ accumulation in the amniotic fluid and fetal lung. In contrast, repeated maternal intravenous administrations achieved high levels of AZ accumulation in the fetal lung and liver and a statistically significant increase in the fetal plasma drug concentration at 120 h. There was no evidence of fetal injury in response to drug exposure. These data suggest that (i) repeated maternal i.v. AZ dosing yields substantial fetal tissue uptake, although fetal plasma drug levels remain low; (ii) transfer of AZ from the amniotic fluid is less than transplacental transfer; and (iii) exposure to high concentrations of AZ did not elicit overt changes in fetal white blood cell counts, amniotic fluid monocyte chemoattractant protein 1 concentrations, or hepatotoxicity, all consistent with an absence of fetal injury.     

Typing of Fetal Cells Obtained by Amniocentesis

In 38 of 287 amniocenteses done at the Mayo Clinic the amniotic fluid contained enough erythrocytes to permit blood typing with commercial sera. Simultaneous use of both an acid-elution technic and the direct Coombs test helped to establish three of the four possibilities for having erythrocytes in bloody amniotic fluid: 1) maternal and fetal erythrocytes of different blood types; 2) maternal erythrocytes only; 3) fetal erythrocytes only; and 4) maternal and fetal erythrocytes of the same blood type. Twenty of the 38 bloody amniotic fluids permitted fetal erythrocyte-typing that was later verified postnatally in the living newborns. Traumatic amniocentesis in an Rh_o(D)-negative mother with an Rh_o(D)-positive fetus increases the risk of anamnestic rise in maternal antibody levels. Amniotic epithelial cells from seven different nonbloody amniotic fluids were typed by mixed agglutination technic. Although the ABO groupings were accurate as shown by postnatal typing, Rh_o(D) typing was unreliable.     

Prostate-specific antigen in amniotic fluid of normal and abnormal pregnancies

Objective: To examine if prostate-specific antigen (PSA) is present in amniotic fluid or maternal serum during pregnancy and if its presence is associated with fetal abnormalities.

Methods: Samples tested included amniotic fluids from 853 pregnant women for whom amniocentesis was performed; 312 nonpregnant women who donated blood; 259 pregnant women who donated blood at various gestational ages. Amniotic fluid or serum PSA was measured with an ultrasensitive time-resolved immunofluorometric procedure. 372 pregnancies were studied for the presence of genotypic or phenotypic fetal abnormalities.

Results: PSA was present in most amniotic fluids; the median PSA concentration increased from gestational week 11 to 22 and stabilized thereafter until delivery. The most prominent PSA concentration change occurred during gestational weeks 13–14. Pregnant women had significantly higher serum PSA concentrations than nonpregnant women; the pattern of serum fSA concentration change during pregnancy was similar to that of amniotic fluid; however, serum PSA concentrations were lower by a factor of 20–40. No association existed between amniotic fluid F'SA and maternal age, gender of fetus, or length of abstinence of mother from sexual intercourse. After gestational week 15, fetuses with trisomy 21 or 18, anencephaly, or renal disorders were associated with low amniotic fluid PSA levels.

Conclusion: Our data suggest that PSA may play a role in fetal development, especially at gestational ages between 13–20 weeks. The diagnostic usefulness of PSA in identifying fetal abnormalities remains to be determined.     

A single intravenous high dose of cholic acid to a pregnant ewe does not affect fetal well-being

Cardiovascular variables of both mother and fetus and total bile acid levels were monitored in amniotic fluid and in maternal and fetal plasma after the administration of a single intravenous high dose (29 mg) of cholic acid to a pregnant ewe. We observed the diffusion of significant quantities of cholic acids from the mother to the fetus and amniotic fluid. Nevertheless, cardiovascular parameters (heart rate, blood pressure,PO₂,PCO₂ and pH) were not affected, neither did intra-amniotic pressure show significant changes compared with the initial experimental conditions. It is concluded that an acute increase in maternal plasma levels of bile acids does not produce important adverse effects in either the mother animal or the fetus and consequently, if bile acids should be deemed responsible for any deleterious effect observed in a preterm fetus in intrahepatic cholestasis, this should be considered as the consequence of a chronic process.     

Prenatal determination of human platelet antigen type 4 by DNA amplification of amniotic fluid cells

To predict a fetus at risk for neonatal alloimmune thrombocytopenia (NATP) caused by human platelet antigen (HPA)-4 incompatibility, we applied a sequence-specific polymerase chain reaction (PCR-SSP). We were able to determine the HPA-4 genotype of three infants at risk using amniotic fluid cells without the need for fetal blood sampling. The HPA-4 genotypes of amniotic fluid cells determined in this way were completely concordant with the genotype and phenotype of infants' venous blood samples obtained after delivery. Therefore, this technique is also convenient to a fetus at risk in the antenatal management of NATP induced by HPA-4 incompatibility.     

Variations of the concentrations of certain glycoproteins in maternal serum, fetal serum and amniotic fluid during pregnancy (author's transl)]

The authors investigated systematically the variations during normal pregnancies of the concentrations of alpha-1-antitrypsin, orosomucoid, transferrin and alpha-fetoprotein simultaneously in maternal serum, fetal serum and amniotic fluid. The role of certain factors such as the gestational age birth weight, placental weight and pairty were studied with regard to variations in the concentrations of each of these proteins. This research permitted the definition during pregnancy of the normal concentrations for these four proteins and allowed us to learn more about protein exchanges between fetal blood, maternal blood and amniotic fluid. There exists a difference between the concentrations of alpha-1-antitrypsin and of orosomucoid found for primigravidae and for multigravidae. The role of these glycoproteins in preventing the mother from rejecting the fetus (insofar as the fetus may be considered as an allograft) is discussed.     

Power Doppler imaging of the fetal upper aerodigestive tract using a 4-point standardized evaluation: preliminary report.

OBJECTIVE: Our investigation of fetal swallowing has identified potential limitations in the use of color Doppler imaging for detection of amniotic fluid flow and discrimination of respiratory from ingestive activity. The objective of this study was to evaluate an alternative imaging modality, power Doppler sonography, as a technique to enhance detection of amniotic fluid flow in the upper aerodigestive tract. METHODS: We applied a standardized 4-axis sonographic examination of upper aerodigestive structures and used power Doppler imaging to document amniotic fluid flow. Normal aerodigestive activities from 62 healthy control subjects were compared with 4 abnormal cases. RESULTS: Our longitudinal experience with 66 subjects showed that a directed evaluation of the fetal upper aerodigestive tract with power Doppler imaging provided a systematic approach for studying the physiologic development of this region in both healthy and at-risk fetuses. CONCLUSIONS: A standardized 4-axis examination with power Doppler imaging is a useful adjunct in addressing ingestive and respiratory functions in the developing fetus.