超声实时显象诊断胎儿畸形(附125例分析)

产前应用B型超声诊断胎儿畸形125例,经临床观察,诊断符合率为97.6%,本文介绍了各种胎儿畸形的超声声象图的特点,认为精通胎儿解剖学,熟悉正常形态,超声检查全面、仔细观察,部分畸形产前多能做出诊断。     

Impact of maternal body mass index on neonatal outcome

Introduction

Maternal body mass index has an impact on maternal and fetal pregnancy outcome. An increased maternal BMI is known to be associated with admission of the newborn to a neonatal care unit. The reasons and impact of this admission on fetal outcome, however, are unknown so far.

Objective

The aim of our study was to investigate the impact of maternal BMI on maternal and fetal pregnancy outcome with special focus on the children admitted to a neonatal care unit.

Methods

A cohort of 2049 non-diabetic mothers giving birth in the Charite university hospital was prospectively studied. The impact of maternal BMI on maternal and fetal outcome parameters was tested using multivariate regression analysis. Outcome of children admitted to a neonatal ward (n = 505) was analysed.

Results

Increased maternal BMI was associated with an increased risk for hypertensive complications, peripheral edema, caesarean section, fetal macrosomia and admission of the newborn to a neonatal care unit, whereas decreased BMI was associated with preterm birth and lower birthweight. In the neonatal ward children from obese mothers are characterized by hypoglycaemia. They need less oxygen, and exhibit a shorter stay on the neonatal ward compared to children from normal weight mothers, whereas children from underweight mothers are characterized by lower umbilical blood pH and increased incidence of death corresponding to increased prevalence of preterm birth.

Conclusion

Pregnancy outcome is worst in babies from mothers with low body mass index as compared to healthy weight mothers with respect to increased incidence of preterm birth, lower birth weight and increased neonate mortality on the neonatal ward. We demonstrate that the increased risk for neonatal admission in children from obese mothers does not necessarily indicate severe fetal impairment.     

Low birth weight and incidence of first malaria episode and adherence to malaria treatment protocols in infants in Chikwawa district,Malawi

Background

In Malawi, malaria is a leading cause of infant morbidity and mortality. Low birthweight and fetal anaemia are also a common occurrence. The relationship between birthweight and fetal anaemia and malaria morbidity in infancy is not known.

Objectives

To investigate the relationship between incidence of first malaria episode and birthweight and fetal anaemia and to investigate adherence of health workers to Integrated Management of Childhood Illnesses (IMCI) malaria treatment protocol.

Design

A stratified sample of 561 infants was selected based on low birth weight (LBW, <2.5Kgs), fetal anaemia (FA, Hbcord <12g/dl) and matched controls with normal birth weight (NBW) and no fetal anaemia (NFA). Cases were defined as LBW FA, LBW NFA, and NBW FA.

Results

Cumulative incidence to first malaria episode did not significantly differ between the study groups and the controls. Sulphadoxine-pyrimethamine (SP) was prescribed to the majority of malaria cases (89.3%).

Conclusion

There is no relationship between birthweight and fetal anaemia and first malaria episode. There is good adherence to IMCI guidelines for malaria treatment.     

超声图产前诊断唇腭裂

采用超声诊断仪探查４９２８例胎儿口唇、口腔及颜面部位，共计唇裂±腭裂１０例，其中９例确诊，１例漏诊，无误诊。当探头达胎儿面部时，探头沿口、鼻、眼方向与胎儿呈横断切面移动，如发现口与鼻之间的较强回声孤形切面，即为上唇。孤形切面的连续性完好表示口唇正常；若连续性中断，即可视为唇裂。舌头运动的异常抬高有助于腭裂的诊断。     

活血化瘀方抗孕鼠红细胞脂质过氧化损伤的研究

采用紫外分光光度法和化学发光技术检测了自由基对被动吸烟所致宫内胎儿发育迟缓（ＩＵＧＲ）孕鼠红细胞膜脂质过氧化物（ＬＰＯ）和红细胞超氧化物歧化酶（ＳＯＤ）的影响，并在透射电镜下观察红细胞形态及超微结构．结果表明：模型组孕鼠红细胞丙二醛（ＭＤＡ）水平、异形红细胞出现率显著高于对照组和用药（活血化瘀方）组，模型组胎仔平均出生体重及红细胞ＳＯＤ水平均显著低于对照组和用药组，而用药组与对照组之间差异无显著意义；胎仔平均出生体重分别与ＳＯＤ水平呈显著正相关，而与ＭＤＡ水平呈显著负相关，表明红细胞脂质过氧化损伤是引起ＩＵＧＲ的一个重要因素．实验结果还提示活血化瘀方可抗脂质过氧化损伤，保护红细胞正常形态、结构和功能，从而改善胎盘循环，是其促进胎儿生长的机理之一．     

148例阴道产患者软产道损伤的相关因素分析

目的探讨148例阴道产患者软产道损伤的相关因素分析。方法通过正常产和胎头吸引术对软产道损伤的相关因素进行分析。结果胎头吸引术中软产道损伤率明显高于正常产组,差异有显著性。结论软产道损伤的并发症很多．我们既要对助产人员的助产技术与水平进行提高,使其最大限度的减少软产道损伤的发生率与正确的诊断和处理,产后通过严密的观察伤口感染及血液性状、生命体征变化、阴道出血量与否及肛门坠胀情况。     

1100例巨大儿临床分析

目的探讨预测巨大儿的相关因素及分娩方式,减少母儿并发症。方法选取经过进行产前检查并分娩的巨大儿1 100例作为观察组（巨大儿组）,选取同期分娩的正常体质量儿1 000例作为对照组（正常体质量儿组）,进行分析研究。结果观察组孕妇宫高、腹围、胎儿双顶径、股骨长及胎儿腹围均明显高于对照组,按宫高＋腹围＋双顶径＋股骨长＋胎儿腹围≥192 cm预测巨大儿的可信度达90%以上。观察组剖宫产率明显高于对照组,观察组中经阴道分娩的母婴并发症明显高于剖宫产组。结论产妇分娩时的宫高、腹围、超声检测胎儿的腹围、双顶径、股骨长对产前预测巨大儿有价值;巨大儿的分娩方式以剖宫产相对安全。     

体重指数对新生儿体重影响的临床价值分析

目的:分析体重指数(BMI)对新生儿体重影响的临床价值.方法:收集2008年6月至2011年6月在我院产科分娩的BMI≥28的孕妇359例作为产前肥胖组,同期分娩的BMI＜28的孕妇359例作为产前体重正常组,分析其分娩前BMI与新生儿体重的相关性.结果:产前肥胖组新生儿体重及巨大儿的发生率高于产前体重正常组,两者比较差异均具有显著性(P＜0.05).结论:分娩前BMI与新生儿体重密切相关,高BMI增加巨大儿的发生风险.     

单脐动脉在产前超声诊断中的意义

目的：探讨单脐动脉在产前超声诊断胎儿畸形及胎儿生长受限的意义。方法：回顾性分析太原市太航医院超声室2008年9月至2012年6月常规产前超声检查的7890例中36例单脐动脉孕妇的临床资料,分析单脐动脉胎儿合并结构畸形及生长受限的情况。结果：36例单脐动脉中,合并结构畸形的11例,生长受限的3例,单纯单脐动脉22例,出生后随访未见畸形。结论：单脐动脉合并胎儿结构畸形及生长受限的风险明显高于正常脐动脉的胎儿,发现单脐动脉的胎儿,应进行各个部位系统的产前检查,以降低胎儿出生缺陷的发生。     

Study on the Effects of ＂Foshousan＂ Plus Danshen in Preventing IUGR Rats with Passive Smoking from Peroxidation in Erythrocyt

ＳｔｕｄｙｏｎｔｈｅＥｆｆｅｃｔｓｏｆ＂Ｆｏｓｈｏｕｓａｎ＂ＰｌｕｓＤａｎｓｈｅｎｉｎＰｒｅｖｅｎｔｉｎｇＩＵＧＲＲａｔｓｗｉｔｈＰａｓｓｉｖｅＳｍｏｋｉｎｇｆｒｏｍＰｅｒｏｘｉｄａｔｉｏｎｉｎＥｒｙｔｈｒｏｃｙｔｅＬｉｐｉｄＨＡＮＱｉｎｇ－ｈｏｎｇ...     

妊娠期糖尿病胎儿相关指标与脂联素关系分析

目的：探讨妊娠期糖尿病胎儿脐血APN、新生儿体重、脐血糖化血红蛋白及脐血IR与脂联素的关系。方法回顾性分析2013年3-12月在我院住院足月分娩的孕妇91例,根据OGTT试验结果将患者分为两组,GDM组61例,NGT组30例,检测血清APN、FINS、FPG、HbA1C、脐血IR。结果 GDM组胎儿脐血APN水平与NGT组比较明显较低,新生儿体重及脐血IR水平与NGT组比较明显较高,两组有显著性差异（P〈0.05）;GDM组脐血糖化血红蛋白与NGT组比较稍高,但经统计学分析两组无显著性差异（P〉0.05）;脐血APN与新生儿体重及脐血IR水平呈明显负相关（P〈0.05）。结论 GDM孕妇胎儿脂联素水平低于正常胎儿,新生儿体重及脐血IR水平与胎儿脂联素水平有关,有效的糖尿病管理有利于新生儿体重及脐血IR水平降低。     

孕妇血清IGF-1、IGF-2、IGFBP-3水平与正常胎儿生长的相关性

 目的 探讨孕妇血清胰岛素样生长因子1(insulin like growth factor 1,IGF-1)、IGF-2、IGF结合蛋白3(IGF binding protein 3,IGFBP-3)与正常胎儿生长的关系。 方法 选择2010年1月至2011年5月于上海市浦东新区人民医院产前检查并分娩正常体重儿的初产妇66例,分为妊娠16～18周、妊娠26～28周、妊娠37～40周3个阶段进行纵向观察,放射免疫法测定孕妇各阶段血清中IGF-1、IGF-2、IGFBP-3水平并进行对比分析。 结果 孕期母血IGF-1水平随着孕周增加明显上升,其中IGF 1水平在妊娠37～40周高于妊娠26～28周,妊娠26～28周高于妊娠16～18周,差异均有显著统计学意义(P均＜0.01)。孕期母血IGF 2水平随孕周增加无明显改变,妊娠3阶段差异无统计学意义(P＞0.05)。母血IGFBP 3水平妊娠37～40周高于妊娠26～28周及妊娠16～18周期,差异有统计学意义(P＜0.05),而妊娠26～28周与妊娠16～18周无显著差异。妊娠16～18周、26～28周和37～40周3阶段母血IGF-1、IGF-2、IGFBP-3水平与正常新生儿出生体重无显著相关性。 结论 孕妇血清IGF-1、IGFBP-3水平与正常胎儿生长密切相关,IGF-1可作为临床评价不同阶段正常胎儿生长的指标,而IGFBP-3更多地反映了妊娠中晚期正常胎儿的生长。     

Doppler studies in the growth retarded fetus and prediction of neonatal necrotising enterocolitis, haemorrhage, and neonatal morbidity

In 82 consecutive cases of intrauterine growth retardation managed by established criteria fetal Doppler studies identified 29 fetuses with absence of end diastolic frequencies in the fetal aorta. These same fetuses were significantly more growth retarded (p less than 0.001) and had an earlier gestational age at delivery (p less than 0.001) than those with end diastolic frequencies present. A subgroup of these cases was analysed in more detail to examine the prognostic value of this phenomenon for the neonate. Two groups of neonates of equivalent gestational age and with a birth weight below 2000 g were compared. There were 26 neonates with absent end diastolic frequencies (group 1) and 20 with end diastolic frequencies (group 2) in the fetal aorta. Those in group 1 were more likely to suffer perinatal death (p less than 0.05), necrotising enterocolitis (p less than 0.01), and haemorrhage (p less than 0.05). Only 4 (15%) of the babies in group 1 had an uncomplicated neonatal period compared with 15 (75%) in group 2 (p less than 0.001). The circulatory changes identified in these cases may provide a more sensitive measure of critical fetal compromise than current techniques and thus allow the clinician to deliver the fetus before irreversible tissue damage has occurred.     

气囊助产对提高阴道分娩质量的临床研究--附胎头位置异常120例及臀位60例分析

目的　通过对胎头位置异常 12 0例及臀位 6 0例施行气囊助产术研究 ,可使多数按常规处理应行剖宫产术的胎头位置异常者转化为阴道分娩 ,还能顺利解决正常体质量之臀位经阴道分娩 .方法　运用气囊助产法扩张宫颈与软产道 ,等于提前模拟胎头作用 ,排除或减少胎儿通过软产道的阻力 ,为顺利分娩提前创造了良好条件 .结果　胎头位置异常组经阴道分娩率为 94.2 % ,剖宫产率为 5 .8% (对照组阴道分娩率为 8.3% ,剖宫产率为 91.7% ,P<0 .0 1) ,臀位经阴道分娩率为 10 0 % (对照组阴道分娩率为 11.7% ,剖宫产率为 88.3% ,P<0 .0 1) .结论　运用气囊助产不仅明显缩短产程 ,还能促进多数胎头位置异常者及正常体质量之臀位能自然经阴道分娩 ,故气囊助产术是提高阴道分娩质量并降低剖宫产率的新型助产方法     

超声心动图监测孕中晚期胎儿心室Tei指数变化及其与子痫前期的关系

目的 超声心动图监测孕中晚期胎儿心室Tei指数变化情况,探讨其与子痫前期的关系。 方法 选择2012年12月-2015年12月金华市中心医院产科重度子痫前期孕妇70例作为A组,轻度子痫前期孕妇70例作为B组,同期正常孕妇220例作为C组。对所有孕妇进行超声心动图检查,观察正常孕妇不同孕周胎儿心室Tei指数,各组孕妇新生儿出生情况、心室功能指标、心室Tei指数,子痫前期孕妇胎儿右心室Tei指数和胎儿出生情况的相关性。 结果 在正常孕妇中,各孕周右心室的Tei指数高于左心室的Tei指数,但两者之间比较差异没有统计学意义(P>0.05)。A组新生儿出生体重、出生孕周均小于B组和C组(P<0.05),A组新生儿出生1 min和5min Apgar评分均小于B组和C组(P<0.05)。A组左心室射血分数和右心室射血分数低于C组(P<0.05);A组和B组左心室等容时间和右心室等容时间高于C组(P<0.05)。A组左心室Tei指数和右心室Tei指数高于B组和C组(P<0.05);B组左心室Tei指数和右心室Tei指数高于C组(P<0.05)。子痫前期新生儿的右心室Tei指数和胎儿的出生体重、出生孕周、1 min Apgar评分、5 min Apgar评分均呈负相关(P<0.05)。 结论 心室Tei指数能够评价胎儿心脏功能,子痫前期胎儿心功能有一定程度的损害,影响胎儿的预后,Tei指数检测对预测子痫前期胎儿预后有一定价值。      

胎儿成骨发育不全的超声诊断价值

目的 探讨超声检查胎儿成骨发育不全的声像图特点及其诊断价值。方法 回顾分析28例胎儿成骨发育不全患者的声像图特点。结果 28例成骨发育不全患者，均有四肢短小并多发骨折．其中16例胎儿羊水在正常范围，12例羊水较多。结论 常规超声检查对胎儿成骨发育不全的筛检有着重要意义，为产前诊断胎儿骨骼发育异常的首选方法。     

Survival of neonates born below thirty-five weeks gestation in a developing country (Barbados, the West Indies)

A retrospective study of the survival of babies born below 35 weeks of gestation over a period of five years from 1987 to 1991 at Queen Elizabeth Hospital was analysed. The births of 433 were evaluated taking into consideration the birth weights, periods of gestation and mode of delivery. The fetal outcome in relation to these parameters were examined. Twin pregnancies were excluded. A poor outcome was noted in babies below 1000 g. Increasing survival rates were observed with increasing birth weight and increasing period of gestation. Babies below 30 weeks gestation had a poor survival rate. Caesarian section was found to be better than a vaginal delivery for a favourable outcome when all 425 births were considered.     

Netrin-1在急性胎儿宫内窘迫胎盘中的表达及其意义研究

目的急性胎儿宫内窘迫是导致围产儿死亡的主要原因,大多系胎盘及脐带因素导致胎儿缺氧所致。通过检测晚期正常妊娠及急性胎儿宫内窘迫的胎盘表达神经轴突导向因子．1（neurontowardsaxonguidancefactor．1,Netrin-1）水平、相应脐带情况及患者娩出新生儿出生状况,从而探讨Netrin-1在急性胎儿宫内窘迫中发病的可能机制。方法选取2012年10月1日—2013年9月30日间剖宫产终止妊娠孕妇共27例。其中15例正常足月妊娠孕妇为对照组,12例急性胎儿宫内窘迫患者为研究组。检测所有人选病例胎盘中Netrin．1表达水平,观察2组胎儿娩出时脐带情况,测定相应新生儿出生体重及出生后1minApgar评分。结果2组患者胎盘Netrin-1表达水平、新生儿出生体重及出生后1rainApgar评分差异均无统计学意义（P〉0．05）。对照组未见明显脐带异常。12例胎儿宫内窘迫10例存在脐带绕颈,1例脐带螺旋。10例脐带绕颈中3例脐带绕颈两周;7例脐带绕颈1周,脐带绕颈1周新生儿患者中3例存在脐带水肿。但所有娩出胎盘均未见明显异常。与对照组相比,急性胎儿宫内窘迫组脐带异常明显（P〈0．05）。结论Netrin-1在急性胎儿宫内窘迫胎盘维持功能过程中作用较小。孕晚期急性胎儿宫内窘迫发生多因脐带因素所致。     

胎儿期心律失常的诊断及其临床意义探讨

目的：探讨胎儿期心律失常的诊断方法、临床意义及对新生儿预后的影响。方法收集产前检查中发现胎儿心律失常的57例孕妇资料,分析孕妇病史、胎儿心电图、胎儿超声心动图、妊娠结局等。结果胎儿心律失常中胎儿心动过速、胎儿心动过缓和不规则胎儿心律的发生率分别为7.0%、3.5%和89.5%。经期待疗法,孕期胎儿心律恢复正常的有21例（36.8%）,出生后新生儿心律迅速恢复正常的有15例（26.3%）,产后7d新生儿心律恢复正常的有14例（24.6%）。4例胎儿（7.0%）发现心脏结构异常。结论大部分胎儿心律失常与胎儿的心脏调节功能尚未完善有关,约91.2%在分娩前或出生后心律恢复正常;胎儿期心律失常预后不良相关的因素为胎儿水肿、持续性心律失常。     

无负荷试验后1周内胎死宫内的分析

８年间行无负荷试验（ＮＳＴ）３７８９０人次。于监护１周内胎儿死亡者５１例，占死亡总数的２２．４％，占监护总数的０．１３％。其中ＮＳＴ反应型（ＮＳＴ Ｒ）占总数的９７．１％，无反应型（ＮＳＴ ＮＲ）占２．９％。ＮＳＴ Ｒ组死胎率０．０７％，显著低于ＮＳＴ ＮＲ组的２．２８％（Ｐ＜０．００１）。ＮＳＴ Ｒ组中７３．１％为足月适龄儿，其中５０％孕妇无高危因素。胎儿死亡原因为脐带或胎盘因素引起的急性意外情况。在ＮＳＴ ＮＲ组中９６％的死胎为早产和小于胎龄儿，８０％的孕妇为高危孕妇，包括妊娠高血压综合征（６４％）、胎儿宫内发育迟缓（１６％），所有ＮＳＴ ＮＲ病例均伴有其他检测的异常。结果提示：ＮＳＴ是预测胎儿预后的方法之一，如果ＮＳＴ无反应型并伴有胎盘检测结果的异常，将会严重影响围产儿尤其是早产儿的预后。