流动人口与本居人口孕妇产前检查和妊娠结局的对照分析研究

目的探讨流动人口与本居人口孕妇产前检查的特点、差别，分析流动人口与本居人口孕妇的妊娠结局的差异。方法回顾性分析2009年1～5月在周浦医院产科住院分娩的孕产妇共610例，其中本居人口231例，流动人口379例，分析其产次的特．最、首次产检时间、产检的次数、妊娠结局的差异以及分娩新生儿性别的差异。结果本居人口组产前检查覆盖率远高于流动人口组，流动人口组首次产栓的孕周远晚于本居人口组，产检次数明显少于本居人口组，分娩的新生儿性别中：出生性别比与产次有显著关系，流动人口顺产者比本居人口组多，差异有统计学意义。结论应加强对流动人口计划生育流出地和流入地的严格管理，同时各级行政及妇幼保健机构应加强对流动人口的管理和宣教，坚决取缔、处罚非法性别鉴定，减少妊娠并发症和出生婴儿性别比例失调。     

流动人口孕产妇产前检查次数与不良妊娠结局的调查分析及对策

目的 探讨流动人口孕产妇产前检查次数与不良妊娠结局的相关性。 方法 选取2009年1月—2010年12月在我院住院分娩的流动人口孕妇2000例的临床资料,按产前检查次数分为观察组和对照组,观察组产前检查次数为0-4次,对照组产前检查次数为≥5次。结果 观察组的产后出血率、围产儿死亡率、过期妊娠发生率、未消毒产率均高于对照组(P<0.05)。结论 加强流动人口孕妇管理,提高产前检查率以降低孕产妇及围产儿死亡率。     

流动人口妊高征的发生状况分析

目的:探讨流动人口中妊高征发生的状况。方法:采用回顾性研究方法,对2004～2005年在杭州市二院住院分娩时发生妊高征的孕产妇进行比较分析,了解人口流动对妊高征发生的影响。结果:(1)常住人口和流动人口孕产妇妊高征的发生率无显著差异,P>0.05。(2)流动人口子痫发生率明显高于常住人口,P<0.05。(3)流动孕产妇中计划外分娩的有33人,占76.7%,明显高于对照组,P<0.05。(4)常住孕产妇平均文化程度为初中,平均产检次数7.8次,明显高于流动人口,P<0.05。结论:流动人口孕产妇由于经济条件、文化教育的限制,存在对计划生育政策及围产期检查重要性认识的差异。为降低子痫的发生,应该制定并采取相应措施,对流动人口孕产妇进行妥善管理。     

孕晚期血脂水平与妊娠糖尿病患者围产结局相关的分析

目的探讨妊娠期糖尿病患者晚期血脂水平与围产结局的关系。方法以我院2011年4月～2013年1月接收的67例妊娠期糖尿病产妇为研究对象,与同期正常妊娠的孕产妇48例做对比,测定两组血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL-C)、及低密度脂蛋白(LDL-C)等血脂指标水平,并详细记录两组产妇分娩前年龄、孕w、体重、治疗方法、并发症等临床资料,对妊娠期糖尿病产妇血脂水平与围产结局进行分析。结果血脂指标:观察组孕产妇TC、LDL-C、及TG水平显著高于对照组(P<0.05),HDL-C无显著性差异(P>0.05);并发症发生情况:观察组孕产妇及新生儿各项并发症发生率均显著高于对照组(P<0.05或P<0.01)。结论娠期糖尿病患者血脂水平与母婴围产结局密切相关,应做实时监测,以控制"三高",维持正常血糖值为预测和预防母婴并发症,提高其围产期健康水平的主要措施。     

妊娠糖尿病不良结局的影响因素与预测模型的构建及验证

目的 分析妊娠糖尿病不良结局的影响因素,根据影响因素创建预测模型。方法 选取2021年3月至2022年3月入同济大学附属第一妇婴保健院产科门诊产前检查并住院分娩的诊断为妊娠糖尿病的孕产妇370例,根据妊娠糖尿病患者孕期或者产后是否发生不良结局,将建模的对象分为两组,正常结局组(n=228)和不良结局组(n=142)。采用单因素分析和多因素Logistic回归分析妊娠糖尿病不良结局的危险因素,并建立预测模型。绘制受试者工作特征(ROC)曲线对预测妊娠糖尿病患者不良结局风险预测模型进行预测效能评价,以敏感度和特异度、总正确率验证模型的实际应用效能。结果 单因素分析和多因素Logistic回归分析结果显示,年龄≥35岁、妊娠史≥2次、孕前体重指数>28 kg/m²、有糖尿病家族史、分娩方式为剖宫产、流产次数2次以上和糖耐量试验(OGTT)血糖3项异常指标是影响妊娠糖尿病患者发生不良结局的危险因素,并据此构建预测模型。列线图模型可以较好地预测妊娠糖尿病患者发生的不良结局,曲线下面积为0.938(95%CI:0.897～0.975),敏感度为0.873,特异度为0.7...     

流动人口孕产妇围产期保健质量影响因素分析和对策

目的了解流动人口孕产妇围产期保健质量,为采取有效的干预措施提供依据。方法对浙江省长兴县5年来26838例孕产妇的临产资料进行回顾性分析,并对本地孕产妇与流动孕妇的系统管理人数、孕产妇死亡数等资料分别统计后进行对比分析。结果本地孕产妇和流动人口孕产妇在系统保健和分娩结局方面有显著差异;流动人口孕产妇围产期保健质量显著提高。结论通过建立流动人口孕妇围产期保健网络和管理考核制度、降低检查和分娩费用、取缔家庭接生、加强健康教育等干预措施,我县流动人口孕妇系统管理率、高危孕妇筛选率、住院分娩率明显升高,孕产妇和围产期儿病死率、新生儿发生率明显降低。     

不同孕周给予胰岛素治疗妊娠期糖尿病的临床疗效观察

目的:探讨不同孕周给予胰岛素治疗妊娠期糖尿病(GDM)的临床疗效。方法:选取2015年10月~2016年9月我院收治的GDM孕产妇90例,根据首次使用胰岛素孕周分为对照组(孕周>32周)和观察组(孕周<32周)各45例。在饮食控制和适量运动的基础上给予胰岛素治疗,比较两组孕产妇血糖变化、不良妊娠结局及新生儿并发症发生情况。结果:两组孕产妇初诊时餐后2 h及空腹血糖比较无显著性差异(P>0.05);分娩前1周,观察组餐后2 h及空腹血糖水平明显低于对照组(P<0.05);观察组不良妊娠结局及新生儿并发症发生情况明显低于对照组(P<0.05)。结论:孕32周前及时给予胰岛素可有效控制孕产妇血糖水平,改善母婴结局。     

年龄因素对孕妇妊娠结局影响分析

目的探讨年龄因素对孕妇妊娠结局的影响。方法 2007年1月至2008年12月在本院定期产前检查并在本院分娩的高龄孕产妇316例(观察组),与同期在本院接受定期产前检查并在本院分娩的非高龄孕产妇344例(对照组),两组除基础产检外,均加强孕前、孕期保健及健康教育,比较两组妊娠并发症、母儿结局。结果观察组并发妊娠高血压、糖尿病、剖宫产率及产后出血发生率均明显高于对照组差异有统计学意义(P0.05),两组胎膜早破、早产、足月低体质量儿、新生儿窒息的发生率比较差异无统计学意义(P0.05)。结论对高龄孕妇应加强围产保健,积极预防和治疗并发症以改变妊娠母儿结局。     

TRUST滴度与孕产妇不良妊娠结局的相关性分析

探讨TRUST滴度与孕产妇不良妊娠结局的相关性。收治的孕产妇1301例,依据TRUST滴度分为阳性组和阴性组,所有孕产妇均给予TRUST试验检查,采用logistic回归分析法分析TRUST滴度对不良妊娠结局的危险度,分析所有孕产妇TRUST滴度和妊娠结局。TRUST试验检查显示阳性8例,阳性率为0.61%;阴性1293例,阴性率为99.39%,阳性组孕产妇不良妊娠结果发生率明显高于阴性组,差异显著(P<0.05);logistic回归分析结果显示,TRUST滴度阳性是孕产妇不良妊娠结局的独立危险因素(P<0.05)。TRUST滴度与孕产妇自然流产、死胎、死产等不良妊娠结局有关,是不良妊娠结局的独立危险因素,提示临床应重点关注妊娠合并梅毒孕产妇,以避免不良妊娠结局的发生。     

产前检查对妊娠结局的影响

目的探讨产前检查对妊娠结局的影响。方法回顾性分析2012-01—2013-12于重庆市沙坪坝区妇幼保健院住院分娩的856例孕产妇资料,按产前检查次数分为对照组(5次,n=420)和观察组(≥5次,n=436),分析产前检查次数与学历、户籍构成关系及对妊娠结局的影响。结果观察组大学本科及以上学历、本地户口比例明显高于对照组,比较差异都有统计学意义(P均0.05)。与对照组相比,观察组早产、过期妊娠、剖宫产、前置胎盘、胎盘早剥、妊娠高血压疾病、产后出血、新生儿窒息、低体质量儿、早产儿及新生儿出生缺陷发生率均明显降低,比较差异都有统计学意义(P均0.05)。结论加强产前检查,增加产前检查次数对妊娠结局有良好的影响,可以有效降低妊娠不良结局的发生率。     

Fetal growth rate and adverse perinatal events.

OBJECTIVE: To study fetal weight gain and its association with adverse perinatal events in a serially scanned high-risk population. SUBJECTS AND METHODS: A total of 200 pregnant women considered at increased risk of uteroplacental insufficiency had a total of 1140 scans in the third trimester, with a median of six scans in each pregnancy. The average fetal growth rate was retrospectively calculated for the last 6 weeks to birth, and expressed as daily weight gain in grams per day. Adverse pregnancy outcome was defined as operative delivery for fetal distress, acidotic umbilical artery pH (< 7.15), or admission to the neonatal intensive care unit (NICU). RESULTS: Fetuses with normal outcome in this high-risk pregnancy population had an average antenatal growth rate of 24.2 g/day. Compared to pregnancies with normal outcome, the growth rate was slower in those that required operative delivery for fetal distress (20.9 g/day, p < 0.05) and those that required admission to the NICU (20.3 g/day, p < 0.05). The growth rate in pregnancies resulting in acidotic umbilical artery pH also seemed lower, but this did not reach statistical significance. CONCLUSIONS: Impaired fetal weight gain prior to birth is associated with adverse perinatal events suggestive of growth failure.     

Uterine and fetal cerebral Doppler predict the outcome of third-trimester small-for-gestational age fetuses with normal umbilical artery Doppler.

OBJECTIVE: To assess the value of different admission tests in predicting the outcome of small-for-gestational age (SGA) fetuses with normal Doppler waveforms in the umbilical artery. METHODS: Criteria for admission into this retrospective study included: singleton pregnancy with a birth weight < 10th centile; absence of severe maternal complications; no evidence of fetal anomalies on the sonogram; normal umbilical artery Doppler; and availability of complete follow-up. At the first antenatal sonogram classifying the fetus as SGA, Doppler analysis of the uterine and middle cerebral arteries was performed and amniotic fluid volume was assessed. Outcome variables included adverse perinatal outcome (perinatal death, severe morbidity) and emergency Cesarean section for fetal distress. RESULTS: Two hundred and thirty-one pregnancies were included in the study. The mean +/- standard deviation birth weight and gestational age at delivery were 2222 +/- 502 g and 37.3 +/- 2.9 weeks, respectively. In 37 cases (16%), an emergency Cesarean section was performed. There was one intrauterine death and three fetuses delivered by emergency Cesarean section developed severe morbidity. Logistic regression demonstrated that abnormal velocimetry of the uterine arteries and fetal middle cerebral artery were independently correlated with the occurrence of Cesarean section. CONCLUSIONS: SGA fetuses with normal umbilical artery Doppler waveforms and abnormal uterine arteries and fetal middle cerebral artery waveforms have an increased risk of developing distress and being delivered by emergency Cesarean section. Particularly when both uterine and fetal cerebral waveforms are altered at the same time, the risk is exceedingly high (86%) and delivery as soon as fetal maturity is achieved seems advisable. On the other hand, when both vessels have normal waveforms, the chances of fetal distress are small (4%) and expectant management is the most reasonable choice.     

Assessment of fetal cerebral arterial and venous blood flow before and after vaginal delivery or Cesarean section.

OBJECTIVES: To compare perinatal intracranial arterial and venous blood velocity changes between healthy term neonates delivered vaginally or by Cesarean section and to correlate these changes with cord blood gases and pH values at birth. METHODS: The study involved 43 healthy term neonates who were delivered vaginally (n = 20) or by Cesarean section (n = 23). All fetuses/neonates were examined by Doppler ultrasound to obtain middle cerebral artery (MCA) and cerebral transverse sinus (Tsin) Doppler waveforms on three occasions (before delivery, and 1 h and 24 h after birth). Pulsatility index (PI) and peak systolic velocity (PSV) for MCA and Tsin were measured and compared between neonates who were delivered vaginally or by Cesarean section. Umbilical cord blood samples were analyzed for umbilical artery and vein pH, pO(2) and pCO(2) and values were correlated with MCA and Tsin Doppler indices. RESULTS: MCA-PI increased and MCA-PSV decreased at 1 h after birth, and Doppler measurements returned to predelivery values at 24 h after birth. Tsin Doppler measurements remained unchanged at 1 h and 24 h when compared to predelivery values in both the Cesarean and vaginal delivery groups. There was a negative correlation between Tsin-PI before birth and umbilical venous pH. There was a positive correlation between Tsin-PSV at 1 h after birth and umbilical vein pCO(2). CONCLUSIONS: Cerebral arterial blood velocity decreases immediately after birth and increases within 24 h, probably as part of neonatal adaptation. Cerebral venous blood velocity remains constant during the perinatal period and is likely to be regulated in a different and more complex manner than that of arterial blood velocity. Mode of delivery does not affect cerebral blood velocity.     

Doppler velocimetry, placental morphology and outcome in insulin-dependent diabetes.

The purpose of this study was to determine the underlying cause of abnormal umbilical artery Doppler velocimetry in pregnancies complicated by insulin-dependent diabetes, by evaluating placental morphology and correlating Doppler results with pregnancy outcome. Our study population consisted of 14 pregnancies with normal Doppler results and 11 pregnancies with abnormal Doppler results. Quantitative placental examinations were performed. Maternal and perinatal characteristics were analyzed. Infants from the abnormal Doppler group had a statistically significantly higher incidence than those from the normal Doppler group of hyperbilirubinemia, Cesarean delivery for fetal distress, and neonatal intensive care stay of 2 or more days. Women with abnormal Doppler results delivered earlier (36 vs. 38 weeks) and had infants of lower birth weight (3079 vs. 3629 g). They were also three times more likely to have poor glycemic control (relative risk = 3.2; p = 0.0067). The placentae of both groups showed no statistically significant differences in placental weight, number of tertiary stem villi, number of small muscular arteries, or mean arterial width. Our findings suggest a functional rather than structural placental process as the cause of the abnormal Doppler results in pregnancies complicated by diabetes. An association between glycemic control and Doppler velocimetry is suggested.     

脐带过度扭转产前检查及妊娠结局分析

目的探讨脐带过度扭转对母婴结局的影响。方法对照组（n=215）为正常足月分娩产妇,观察组（n=105）为产后确定为脐带过度扭转的产妇,比较两组的产前胎心监护检查、彩超检查、分娩方式、围产儿结局。结果观察组彩超检查具有特征声像图的发生率、胎心监护异常率高于对照组,观察组脐动脉S／D值高于对照组,差异均有显著性（P〈0．05）;观察组剖宫产率、围产儿并发症发生率显著高于对照组（P〈0．05）。结论产前胎监、彩超检查可为诊断脐带过度扭转提供参考,适时终止妊娠有望改善母婴结局。     

Endoscopic laser coagulation of umbilical cord vessels in twin reversed arterial perfusion sequence.

In monozygotic twin pregnancies with reversed arterial perfusion (TRAP) sequence, the donor twin is ut high risk of perinatal death. This paper describes the use of endoscopic surgery in the management of this condition. In four cases of TRAP sequence presenting at 17, 20, 26 and 28 weeks' gestation, respectively, an endoscope was introduced into the uterus under local anesthesia and a Nd-YAG laser was used to coagulate the umbilical cord vessels of the acardiac twin. Laser coagulation was successful in arresting blood flow to the acardiac fetus in the cases treated at 17 and 20 weeks, and healthy infants were delivered at term. In the pregnancies treated at 26 and 28 weeks, the umbilical cords were very edematous and laser coagulation failed to arrest blood flow; healthy infants were delivered after spontaneous labor at 29 weeks. These findings suggest that, during mid-gestation, endoscopic laser coagulation of the umbilical cord vessels of the acardiac twin is an effective method of treating TRAP sequence. In later pregnancy, alternative methods of treatment are needed.     

Erythroblastosis in birth asphyxia.

The pH and erythroblast count in umbilical venous blood were measured in 27 term neonates with normal birth weights. In seven cases, infants were admitted to the neonatal intensive care unit because of birth asphyxia, and the findings in these cases were compared to the values of the 20 non-asphyxiated neonates that were delivered either vaginally (n = 10) or by elective Cesarean section (n = 10). The umbilical venous blood pH in the asphyxiated group was significantly lower than that in the control group of infants that were delivered by Cesarean section, but not significantly different from the controls that were delivered vaginally. In contrast, the erythroblast count in the asphyxiated group was significantly higher than that in the controls, irrespective of the mode of delivery. These findings suggest that cord blood erythroblast count at delivery may provide a better measure of fetal tissue hypoxia than umbilical venous pH.     

Contraction stress test versus ductus venosus Doppler evaluation for the prediction of adverse perinatal outcome in growth-restricted fetuses with non-reassuring non-stress test.

OBJECTIVE: To compare Doppler evaluation of the ductus venosus and contraction stress test (CST) in the prediction of adverse perinatal outcome in growth-restricted fetuses with evidence of hemodynamic redistribution and a non-reactive non-stress test (NST). METHODS: Data were collected from all singleton pregnancies seen in our Fetal Surveillance Unit who underwent antenatal monitoring for fetal growth restriction, non-reactive NST and arterial redistribution beyond 26 weeks of pregnancy. Patients were divided into four groups based on their CST and ductus venosus waveform results. Perinatal outcome was evaluated by means of four variables: the need for admission to the neonatal intensive care unit (NICU), need for neonatal intubation, an umbilical artery pH < 7.10 and significant neonatal morbidity. Outcome was compared among fetuses delivered within 3 days of their antenatal test. Logistic regression analysis was used to analyze the relation between predictive and outcome variables. RESULTS: Sixty-eight women met the inclusion criteria for the study. The positive predictive value of the CST was 45% for admission to the NICU, 13% for significant neonatal morbidity, 26% for need of neonatal intubation and 29% for umbilical artery pH < 7.10. The positive predictive values of abnormal ductus venosus waveform (ADVW) were 81.5%, 26%, 48% and 55%. Groups with ADVW showed significantly poorer neonatal outcome. No significant differences were observed when CST results were compared. Logistic regression analysis showed that both gestational age at delivery and ADVW significantly predict the occurrence of adverse perinatal outcome. CONCLUSION: In growth-restricted fetuses with hemodynamic redistribution and a non-reassuring NST, Doppler assessment of the ductus venosus correlates with adverse perinatal outcome. In this clinical situation there is no benefit of CST in terms of prediction.     

Acceleration time in normal fetal umbilical artery at term and its relationship to the cord blood hematocrit

The purpose of this study was to test the hypothesis that the acceleration time (AT) of the fetal umbilical artery remains constant at term for normal pregnancies. In addition, we also examined whether the AT has any correlation with umbilical cord blood hematocrit (Hct). In total, 539 normal-term fetuses with menstrual ages (MA) ranging from 37 weeks to 42 weeks were enrolled in a cross-sectional design. The AT of the fetal umbilical artery was measured prior to delivery using a high-resolution, real-time Doppler scanner. All were delivered within 2 days of the ultrasound examination. At parturition, blood from the umbilical vein was collected and the red cell indices, including the Hct, were determined. The results indicated that the mean values of AT of the umbilical artery remained constant during normal-term pregnancies from 37 weeks to 42 weeks, menstrual age (mean: 0.104 sec, SE: 0.001 sec, n = 539). Although the AT was thought to be affected by the Hct, the AT had no correlation with umbilical venous Hct (n = 539, r = 0.002, p > 0.05). This constant value of the AT may be used as a reference for fetal physiology and perinatal medicine. © 1995 John Wiley & Sons, Inc.     

B型超声诊断胎儿宫内窘迫的临床价值

利用Ｂ超超声探讨胎儿宫内窘迫的原因,判断胎儿宫内生理病理状态和预后。方法：通过观察胎儿心率、脐带、羊水、胎动,做出超声诊断。结果胎儿心率、胎动异常是判定胎和有无缺氧和缺氧程度的主要指标;而脐带、羊水异常是造成胎儿宫内窘迫的主要原因。超声诊断与产后符合率１００％。