B超引导下的脐静脉穿刺术在产前诊断应用中的安全性研究

目的探讨B超引导下的脐静脉穿刺术在产前诊断中的成功率和安全性。方法回顾性分析1990年3月～2003年6月对2403例因各种原因在B超引导下的脐静脉穿刺术进行产前诊断的孕妇临床资料,观察穿刺手术的成功率和并发症。结果一次性穿刺成功为2368例(98．5％),二次穿刺成功为2384例(99．2%)。75．5％的孕妇可在5min内完成穿刺术,93．0％的孕妇在10min内完成穿刺术。手术并发症包括：脐带或胎盘渗血315例(13．1％),胎儿心动过缓125例(5．2％),一次性穿刺失败35例(1．5％),流产18例(0．8％),早产4例(0．2e%),绒毛膜羊膜炎2例(0．1％)。结论脐静脉穿刺术是一项较为安全而简单易行的产前诊断取材技术。     

超声引导下脐静脉穿刺术在先天畸形胎儿产前诊断中的应用

目的:探讨超声引导下脐静脉穿刺术在先天畸形胎儿产前诊断中的应用价值及安全性。方法:产前检查中B超提示胎儿畸形的孕妇27例,进行超声引导下脐静脉穿刺术,对所抽取的脐静脉血进行核型分析。结果:超声引导下脐静脉穿刺术穿刺成功率为96.3%(26/27),1例穿刺失败,在26例成功病例中一次性穿刺成功率为80.8%(21/26)。27例穿刺术中发生一过性并发症1例,为脐血管穿刺点渗漏;所有患者均未发生流产、早产、胎死宫内、宫内感染等严重并发症。26例终止妊娠,病理检查20例为单发畸形,6例为多发畸形,1例足月分娩一侧腋下畸胎瘤患儿,术后患儿恢复良好。染色体核型分析成功24例,其中6例为染色体异常,阳性率为25%。结论:超声引导下脐静脉穿刺术操作简单、成功率高、安全性高,在先天畸形胎儿产前诊断中有较高的应用价值。     

脐静脉穿刺用于产前诊断230例分析

目的：探讨B超引导下游离脐带穿刺术成功率和安全性。方法：对230例因各种原因行产前诊断的孕妇进行B超引导下游离脐静脉穿刺术。结果：102例18－21周孕妇穿刺成功率为90．5％，72例22－28周孕妇成功率97．8％，56例28周以上的成功率为100．0％，总成功率96．1％；169例穿刺经过胎盘，胎盘渗血29．2％（49／168），脐带穿刺后渗血17．8％（41／230）。胎心过缓者占5．2％（12／230）。术后未出现早产、宫内感染等并发症。结论：B超引导下脐带穿刺术用于产前诊断是一项成功率高且安全的方法。     

自由手技术行脐静脉穿刺在产前诊断中的应用价值

目的探讨应用超声引导自由手技术行脐静脉穿刺在产前诊断中的可行性、成功率及临床价值。方法 2008年9月至2010年3月于上海交通大学医学院附属国际和平妇幼保健院,应用超声引导自由手技术对134例有产前诊断指征的中晚孕孕妇行脐静脉穿刺术(自由手组),明确界定穿刺1次成功的评判标准,并与81例经穿刺架引导行脐静脉穿刺者(穿刺架组)进行对照研究,分析应用自由手技术的优势、影响其一次穿刺成功的因素以及穿刺并发症。结果自由手组与穿刺架组总穿刺成功率及一次进针成功率差异无统计学意义(96.3%、95.1%;64.3%、61.0%),当1次进针穿刺失败,需再次穿刺时,自由手技术可明显减少经皮肤穿刺的次数。穿刺熟练程度、脐静脉直径、前壁胎盘、穿刺路径的长短是影响自由手一次穿刺成功的主要因素,穿刺次数与并发症明显相关。结论超声引导自由手技术经严格训练后可有效提高脐静脉穿刺质量,值得临床推广。     

超声引导下经皮脐静脉穿刺术的应用

超声引导下经皮脐静脉穿刺术 (percutaneousumbilicalbloodsampling,PUBS)为胎儿的宫内诊断和治疗提供了新的方法 ,是目前产前诊断的主要技术之一 ,本文对我院应用此项技术 872例进行分析 ,探讨其应用的安全性。1　资料和方法1 1　研究对象　 1998年 10月至 2 0 0 1年 12月 ,我院产前诊断时需做胎儿脐血检查的孕妇 86 8例 ,其中 4例为双胎妊娠 ,穿刺例数为 872例 ,年龄 2 3～ 44岁 ,孕龄 16～ 38周。1 2　仪器　采用Aloka SSD 6 30型实时超声显像仪及其配套的腹部穿刺探头 ,探头频率 3 5MHz,2 2G一次性穿刺针。1 3　方法1 3 1　术前嘱…     

多胎妊娠早期选择性减胎术的临床研究

目的 研究多胎妊娠早期选择性减胎术的技术可靠性、安全性及其对妊娠结局的影响。方法 以超声引导下穿刺,少量氯化钾胚囊注射方法实施多胎妊娠早期选择性产硬盘减胎术患者２５例,其中１例经腹穿刺术,其中余２４例经阴穿刺术。结果 ２５例患者减胎术后,获得足月分娩者１５例,两个阶段中,初期减胎术１０例,成功率仅为３０．０％;第二阶段为临床应用期,实施１５例,分娩率达８０．０％,流产率降至６．７％。结论技术成熟的     

婴幼儿股静脉采血两种穿刺方法的效果比较

目的：较婴幼儿股静脉采血两种穿刺方法的效果。方法：180例行股静脉采血的婴幼儿随机分成试验组90例和对照组90例。试验组用斜面进针法（斜剌法）进行穿刺，对照组用垂直进针法（直刺法）进行穿刺。比较两组的穿刺效果。结果：试验组一次穿刺成功率为98．9％，明显高于对照组的80．0％，差异有统计学意义（P〈0．05）。结论：婴幼儿股静脉采血用斜刺法能明显提高一次穿刺成功率，减少并发症的发生，减轻患儿痛苦，优于直剌法，值得临床推广应用。     

B超在引导困难性宫控操作中的应用

目的：研究B超在引导困难性宫控操作中的有效性和成功率。方法：用B超观察子宫形态、位置、大小,确定子宫内容物的性质、大小、部位以及与子宫壁的关系。一般取纵切面相对固定探头,引导施术者完成手术。术后常规应用抗菌素预防感染。结果：本组95例中94例手术均在B超引导下一次完成,成功率98．95％。结论：运用超声引导困难性宫腔操作,能缩短手术时间,减少受术者的痛苦,避免手术并发症的发生,提高手术一次性成功率。     

经皮肾镜钬激光碎石术治疗肾结石76例报告

目的：探讨经皮肾镜钬激光碎石术（minimallyinvasivepercutaneousnephrolithotripsy,MPCNL）治疗肾结石的有效性与安全性。方法：回顾分析2010年8月-2012年9月该院经皮肾镜钬激光碎石术的76例肾结石患者的临床资料,并对手术的安全性、并发症及防治措施进行分析和讨论。结果：76例患者,共行80例次手术。一例穿刺失败,改开放手术,无死亡,成功率98．7％。一例肾出血,未输血,经保守治疗后治愈,两例残余结石堵塞输尿管,行体外超声波碎石后,结石排出,并发症发生率3．9％。一期单通道取石73例,二期取石两例,三期取石一例,总结石清除率为97．4％。结论：经皮肾镜钬激光碎石术具有疗效好、创伤小、安全性高、结石取净率高、并发症少等特点。     

经皮取脐血检查在产前诊断中的应用

近十余年来随着优生研究工作的深入,对胎儿质量的预测,越来越受到临床医生、社会及家庭成员的重视,通过广大科技工作者的辛勤努力和探索,新的产前诊断方法不断涌现,提高了胎儿遗传性疾病和胎儿先天畸形诊断的水平.如何安全、有效、简便地获取纯胎血标本,是产前诊断极待研究和推广的一项课题.经皮脐静脉穿刺术国外1983年已有报道,我院自1985年开始在B 超下实施脐静脉穿刺术,取胎血用于临床研究.通过实践建立了该项检查的方法,取得了点滴经验和体会.     

Percutaneous ultrasound-guided fetal blood sampling in the management of nonimmune hydrops fetalis

Nonimmune hydrops fetalis can be caused by fetal chromosomal, hematologic, cardiac, or infectious conditions. A fetal blood sample obtained from percutaneous ultrasound-guided fetal blood sampling can offer vital information about the underlying cause of nonimmune hydrops fetalis, and perinatal management can be planned accordingly. Ten cases of nonimmune hydrops fetalis were investigated with percutaneous ultrasound-guided fetal blood sampling and subsequent fetal blood analysis. Nine were proved to be Bart's hemoglobin hydrops fetalis, with 78.2% to 99% of Bart's hemoglobin in the fetal blood. Terminations of pregnancy were undertaken immediately, resulting in a lowered maternal morbidity rate. Free cord loops or an intra-abdominal portion of the dilated umbilical vein can be used for percutaneous fetal blood sampling in nonimmune hydrops fetalis when the placental cord insertion is difficult to visualize. Percutaneous ultrasound-guided fetal blood sampling and subsequent fetal blood analysis will eventually play a key role in the management of the puzzling nonimmune hydrops fetalis if the safety of ultrasound-guided fetal blood sampling can be verified by further clinical studies.     

直接胎儿穿刺取血法及并发症的研究

目的　探讨 B超引导下直接胎儿穿刺取血的适应证、胎儿血判定方法、穿刺方法与并发症的关系。　方法　对 90例宫内妊娠 16～ 36周、有医疗穿刺指征的孕妇 ,在 B超引导下进行直接胎儿血穿刺。穿刺前后分别进行胎心监护 ,穿刺后 2 h及 2 4h B超了解胎盘情况。　结果　 90例穿刺病例中无胎儿丢失及胎盘早剥等严重母儿并发症。穿刺过程中胎心变化发生率为 35 .6 % (32 / 90 ) ,均在 6 0 s内恢复 ;穿刺后 4h内出现胎心变化发生率为 2 .2 % (2 / 90 ) ;胎心变化与取血量及穿刺部位正相关 r分别为 0 .2 7及 0 .36。穿刺后 2 h及 2 4h出现胎盘变化 1例 ,发生率为 1.1%。 90例无因穿刺并发症需紧急终止妊娠者 ;胎儿娩出后脐带未见特殊异常。　结论　在高分辨度彩超定位下 ,直接胎儿穿刺取血是安全可靠的。由胎儿血直接提供的有关胎儿染色体、宫内感染、代谢状况、内分泌状况及血液病学等相关因素的资料 ,是进行准确的胎儿宫内诊断不可替代的重要依据     

Risks of funipuncture in fetuses with single umbilical arteries

OBJECTIVE: To estimate procedure-related risks of funipuncture in fetuses with single umbilical arteries (UAs). METHODS: We identified fetuses that had blood samples collected by funipuncture and in which single UAs were detected, prenatally or postnatally. We also recorded maternal demographics, prenatal sonographic findings, gestational age at the time of the procedure, procedure-related complications, and perinatal outcomes. RESULTS: Over 2 years, 14 fetuses identified as having single UAs had funipuncture for prenatal karyotyping at a median gestational age of 29 weeks (range 20-34 weeks). Each had additional abnormal prenatal sonographic findings. The approach to the cord was transplacental in six cases and transamniotic in eight. There were no failed procedures, and 13 of 14 funipunctures were successful on the first attempt. Three fetuses (21%) had complications (bradycardia in two cases and bleeding in one case), a complication rate not greater than that reported in large series of fetuses that had fetal blood sampling. All three complications were associated with the transamniotic approach. There were no procedure-related pregnancy losses within 2 weeks of the procedure in this series. CONCLUSION: Funipuncture does not seem to be associated with increased risk of procedure-related complications or pregnancy losses in fetuses with single UAs, although the risk could be greater with transamniotic than with transplacental sampling.     

Percutaneous fetal umbilical blood sampling: procedure safety and normal fetal hematologic indices

Percutaneous umbilical blood sampling allows direct access to the fetal circulation. We describe our experience with the procedure in the first 100 patients whose fetuses were at risk for hemolytic anemia, chromosomal abnormalities, coagulopathy, or intrauterine infection. Hematologic indices, including hemoglobin, hematocrit, red blood cell count, white blood cell count, and platelet count, were analyzed from 50 of the fetuses who were normal at delivery. Normal values and gestational age regression curves (from 17 to 37 weeks' gestation) are presented. The technique and complications of the procedure are described. Percutaneous umbilical blood sampling affords useful information in prenatal diagnosis and entails a low rate of complications.     

Hematologic evaluation of growth retarded fetus by cordocentesis

Fetal blood sampling by ultrasound-guided cordocentesis was performed in 22 IUGR fetuses in order to evaluate the fetal condition. All patients were referred to our hospital for further examination and management. In addition to hematological assessment we measured the velocity profiles of the umbilical artery with pulse-gated Doppler equipment. On the whole, pH and pO2 in the umbilical vein of IUGR fetuses were significantly lower and pCO2 higher, respectively, the corresponding values in controls. In particular, IUGR fetuses which had an etiology of maternal pre-eclampsia had fallen into hypoxemia. However, other laboratory values in IUGR did not differ from those of the controls except for the platelet count, which was low in the IUGR fetuses. Five fetuses with chromosomal abnormalities were found by analyzing the fetal blood. Since there are different etiologies inducing IUGR, fetus and umbilical artery velocimetry is not always predictive of the state of the IUGR fetus, hematological assessment is considered indispensable for further management.     

Preliminary experience in fetal blood obtainment through cord punction

Seven umbilical cord punctures where done in viable fetuses. The procedure was successful in all cases, the fetuses had anomalies or non immune hydrops fetalis. There was one case in which the indication was autoimmune thrombocytopenic purpura. There is high risk in the punction, but the prenatal diagnostic studies is necessary and useful. The authors comment advantages and complications in this procedure.     

Acute fetal distress associated with percutaneous umbilical blood sampling

Percutaneous umbilical blood sampling is emerging as an important procedure in the armamentarium of the obstetrician involved with prenatal diagnosis. It has apparent low morbidity and can be accomplished with relative ease by the experienced operator. We report a series of 42 successful percutaneous umbilical blood sampling procedures in 22 patients and describe the indications and gestational ages of the fetuses undergoing the blood-sampling procedures. Nine of the procedures involved intravascular transfusions. In one of our 42 cases, acute fetal distress developed in a manner similar to that of a previously reported case that was likewise associated with a compromised fetus and ended in death. Because of prompt and immediate delivery, the infant described in this series survived and, although this procedure appears to be relatively safe in experienced hands, it is imperative that the associated complications be duly recorded.     

Safety of fetal blood sampling by cordocentesis in fetuses with single umbilical arteries

OBJECTIVES: To examine the safety of cordocentesis in fetuses with single umbilical arteries. METHODS: Retrospective analysis of all cases of cordocenteses in fetuses with single umbilical arteries over a five-year period at one centre. We analysed the records for pregnancy details, outcomes, and procedure-related complications, and compared these to similar data for cordocenteses procedures performed, during the same period, for similar indications in fetuses with three-vessel cords. RESULTS: Twenty-nine eligible cases were identified. All procedures were performed for the indication of fetal structural abnormalities, and seven fetuses (24%) had abnormal karyotypes. The median gestational age at the time of the procedure was 21 weeks (range 19-34 weeks). There were no procedure-related fetal losses but the umbilical artery was inadvertently punctured in one case, resulting in prolonged bradycardia with spontaneous recovery. These outcomes compare favourably to those of a total of 134 cordocenteses procedures in fetuses with three-vessel cords. CONCLUSION: Cordocentesis in cases with single umbilical arteries does not appear to carry more risk than in cases with three-vessel cord, and should continue to be performed by adequately trained specialists when indicated. Extra care should be undertaken to avoid puncturing the umbilical artery.     

Ultrasound-guided umbilical cord occlusion using bipolar diathermy for Stage III/IV twin-twin transfusion syndrome.

OBJECTIVES: To evaluate bipolar diathermy as a technique for selective fetocide in the treatment of advanced (Stage III/IV) twin-twin transfusion syndrome (TTTS). METHODS: A prospective observational study in two tertiary referral fetal medicine centres: Queen Charlotte's Hospital, London, UK and Haemek Hospital, Afula, Israel. Fifteen cases of TTTS (14 twins and one triplet pregnancy) were treated by selective occlusion of either the donor (n=8) or recipient's (n=7) umbilical cord using ultrasound-guided bipolar diathermy. Following each procedure, patients were scanned serially for fetal growth, liquor volume and umbilical Doppler measurements. Procedural complications and obstetric outcome were recorded. Postnatal placental injection studies were performed. RESULTS: Overall co-twin survival in Stage III/IV TTTS was 13/14 (93%). There were no treatment failures. The incidence of preterm prelabour rupture of membranes (PPROM) within 3 weeks of the procedure was 3/15 (20%). In those cases where pre-procedure umbilical artery Dopplers were abnormal, the Doppler findings normalised post-procedure in all non-cord-occluded fetuses. Growth velocities of surviving donors were similar to those of surviving recipients. CONCLUSIONS: Bipolar diathermy appears an effective technique for the selective reduction of monochorionic twins complicated by severe as well as preterminal TTTS, with recipient and donor fetuses being equally appropriate choices for fetocide. We suggest that for advanced-stage disease where the parents can contemplate this option, cord occlusion as a single preemptive procedure maximises the opportunity for intact survival of a single survivor.