脐带缠绕3162例临床分析

１９９０～１９９６年（除１９９３年外）６年间分娩总数１７４１６例中，脐带缠绕３１６２例，脐带缠绕发生率为１８．１６％。经产妇脐带缠绕发生率较初产妇低，分别为１６．７％、１８．５％。孕周越大，脐带缠绕发生机率越高，过期妊娠发生率最高，为２０．５％。脐带缠绕以头位多见，臀位次之。在１９７０例电子胎儿监护（ＣＴＧ）中，脐带缠绕多以变异减速波型（ＶＤ）表现，占总监护例数的１７．０％。行胎心监护和未行胎心监护的病例在新生儿低评分与死胎死产中比较，行胎心监护的低评分显著高于未行胎心监护，而死胎死产的发生率却明显降低，脐带越长，缠绕周数越多，低评分危险越大，死胎死产率越高，羊水污染发生率越高。而随缠绕周数增加，ＣＴＧ中的ＶＤ的发生率不呈正相关改变，这与脐带缠绕的危害不仅与缠绕周数相关连，也与临产后宫缩强度及频率、羊水量多少等有关。脐带缠绕分娩方式仍以正常分娩多见，次为剖宫产分娩。而脐缠绕与非脐缠绕比较，脐缠绕者阴道手术产高于非脐带缠绕，但脐带缠绕在分娩中不增加剖宫产的危险。     

多普勒超声技术用于诊治5例母胎间输血所致胎儿贫血

目的 探讨多普勒超声技术用于诊治母胎间输血（FMH） 所致胎儿贫血的临床应用价值.方法 2002-08-2005-05暨南大学附属第一医院收治5例由孕妇主诉胎动减少或消失、怀疑FMH的病例, 孕周29～35周, 立即记录其胎心监护（CTG）图形, 分别在脐带穿刺或输血前后记录大脑中动脉收缩期血流峰值（MCA-PSV）和脐静脉最大血流速（UVmax）及大脑中动脉和脐动脉血流阻力指数（PI）, 胎儿血红蛋白（FHb） 和红细胞容积（HCT）也由脐带穿刺或输血前后获得.结果 所有病例CTG图形均表现为正弦曲线图形,所有病例MCA-PSV和 UVmax均明显升高,而FHb、HCT则降低,但PI正常.5例中例4为抢救胎儿生命进行了即刻宫内输血.FMH通过Kleihauer Test最后诊断.5例均即刻终止妊娠,胎儿预后均较好.结论 多普勒超声测量MCA-PSV、UVmax是及时诊治FMH所致急性胎儿贫血的最重要方法.     

脐带挤压与立即断脐对产时胎心率异常新生儿结局的临床分析

目的:比较脐带挤压与立即断脐对产时胎心率异常新生儿结局的影响。方法:采用前瞻性病例对照方法,选择2021年2月至2022年2月于中国人民解放军北部战区总医院产科分娩的单胎足月且发生产时胎心率异常的孕妇100例为研究对象,根据是否给予脐带挤压,选择脐带挤压组和立即断脐组各50例,再根据分娩方式的不同选择阴道分娩(各10例)、剖宫产(各30例)及阴道助产(各10例)。分析比较两组在同一分娩方式下的新生儿结局。结果:(1)在同一分娩方式下,脐带挤压组的新生儿脐血pH值均大于立即断脐组;脐带挤压组的新生儿窒息率(4.0%)低于立即断脐组(22.0%),差异均有统计学意义(P<0.05)。(2)同一分娩方式下脐带挤压组新生儿出生时血红蛋白(Hb)、血细胞比容(HCT)值均高于立即断脐组;脐带挤压组的新生儿贫血发生率(8.0%)低于立即断脐组(24.0%),差异均有统计学意义(P<0.05)。(3)同一分娩方式下,两组新生儿出生后经皮胆红素(TCB)峰值、病理性黄疸的发生率比较,差异均无统计学意义(P>0.05)。结论:对于发生产时胎心率异常者,脐带挤压比立即断脐可以有效改善新生...     

脐带缩窄导致胎儿死亡:附3例病例报道

自1758年Burdach首次报道脐带缩窄伴扭转的第一例病例以来,文献报道共有50例,均胎死宫内,于产后作出诊断。本又报道3例脐带缩窄致胎死宫内的病例。 例1,36岁,G_1P_0,高龄孕妇。于孕16周B超显示胎儿形态正常与孕周相符,在超声引导下行羊膜腔穿刺,抽出30ml清羊水,穿刺后发现胎儿心动过缓,几小时后胎死宫内。胎儿娩出后检查发现在胎儿脐根部1cm处脐带显著狭窄伴扭转,核型分析为正常女性46,XX。病理检查发现针穿刺点在胎盘上,脐带未受累,脐带胎盘无血肿,脐带长18.5cm 直径平均0.7cm。离脐根部3.4cm处有一长1cm、直径仅0.2cm的脐带缩窄伴扭转,在缩窄处可见三条通畅的血管,     

单脐动脉、脐带宫腔内断裂致新生儿重度窒息抢救成功一例

单脐动脉、脐带宫腔内断裂致新生儿重度窒息抢救成功一例张海萍患者，２５岁，因妊娠足月不规则腹痛６小时，于１９９４年３月２日入院，入院时各项检查正常。当日８时３０分开始规律宫缩，１０时宫口开大３ｃｍ，胎心１４０次，１０时３０分胎膜自然破裂，羊水Ｉ°污染，...     

脐带真结3例临床分析

一、病例摘要 脐带异常是威胁胎儿生长发育及生命安全的危险因素之一,其中脐带真结是脐带异常中较为少见的一种类型。现就本院发现的3例脐带真结报道如下。 病例1患者26岁,孕1产0。主因宫内孕6个月,胎动消失2 d于2002年2月4日收入院。患者平紊月经规律,停经40 d出现早孕反应,孕早期顺利,无药物及放射线接触史。停经4个月自觉胎动,2 d前自觉胎动消失。入院查体:血压16/10 kPa,心肺(-),宫底脐上一横指,无宫缩,胎心未闻及。B超提示:胎儿双顶径5.6 cm,头皮下及胸腹壁下可见带状低回声,未见胎心搏动。辅助检查:血糖正常及TORCH(一)。入院诊断:宫内孕6个月,胎死宫内。行卡孕栓引产,7 h后顺娩一男性死婴,外观发育未见异常。脐带直径约1cm,绕颈2周,距脐轮约25 cm处可见一脐带真结,较紧,脐带总长约48cm。     

脐带溃疡与肠闭锁

3例脐带溃疡合并肠闭锁病例,均系30～34孕周时以早产入院。例1及例2羊水过多,破膜或穿刺为显著血性羊水,因胎儿窘迫紧急剖宫产娩出两贫血男活婴,体重分别为1830g 及2020g,Apgar评分1、 5、 10分钟各为1、 3、 7及3、 4、 6分。例1脐带长17cm,棕染、附有许多黑色血凝块,脐带溃疡在螺旋状扩张的脐动脉之后,局部亦附有血块。例2脐带长22cm,距脐轮2cm 以上脐带有2cm×0. 2cm 线性溃疡,脐动脉显露并有坏死及血块附着。两例新生儿经输血、血浆及升压药等     

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。     

胎儿宫内窘迫155例剖宫产手术指征分析

目的探讨如何正确判断胎儿宫内窘迫，正确掌握手术指征。降低围产儿死亡率的同时降低剖官产率。方法对我院胎儿宫内窘迫155例剖宫产手术指征进行分析。结果155例病例中能找到胎儿窘迫相关因素的为135例，占87．09％，其中比例最高的为脐带因素52例，占38．51％，与文献报道相一致。其次为胎盘因素、产程异常、羊水过少，妊娠合并症等因素。围产儿死亡率6．45‰。新生儿窒息率24．5l％（38／155），单纯羊水Ⅱ～Ⅲ度污染，新生儿窒息率为25．00％。电子监测异常发生窒息率最低，仅为13．23％。当胎心监护与羊水粪染、胎动异常，胎动胎心均异常相结合时，新生儿窒息率、胎窘相关因素的百分率明显升高。结论在诊断胎儿宫内窘迫时，须综合判断来评价，对于那些存在高危因索的病例，应密切监护，积极预防，纠正缺氧。对于那些处理后症状仍未纠正，短时间不能经阴道分娩者，应果断行削宫产术以降低围产儿的并发症及死亡率。     

胎心率监测对产前诊断脐带位置异常的意义

对２６２８例脐带位置异常的胎心率监测结果进行分析，发现脐带位置异常者胎心率监测阳性率为８１．６６％，假阴性率为１８．３４％。阳性组中有１６８０例出现可变性减速，占６３．９３％。分析发现，Ｖ型、Ｕ型和Ｗ型波为多见，共１２０６例占４５．８９％，此类波型以脐带受压并伴有胎儿宫内缺氧时为多见。提出了脐带位置异常的特异性胎心率波型及诊断标准，并观察其分娩后胎儿发育情况、脐带位置、羊水是否污染及新生儿Ａｐｇａ     

Efficacy and safety of cordocentesis for prenatal diagnosis.

OBJECTIVE: To assess the efficacy and safety of diagnostic cordocentesis. METHODS: Between January 1991 and May 2004, 2,010 cordocentesis were performed in the outpatient setting in 2,010 women with singleton pregnancies. A fixed needle guide and a 22-gauge percutaneous needle were used and no more than 2 attempts were allowed at 1 visit. In most cases, the umbilical vein was the target vessel. The results of each procedure and pregnancy outcomes were recorded and analyzed. RESULTS: The most frequent indication for cordocentesis was risk of severe thalassemia (59.0%), followed by a need for rapid karyotyping (30.0%). Most of the procedures (97%) were performed in the free cord loop and the remaining at the cord insertion. The overall success rate was 98.4%, with 80.0% of the successful procedures performed at the first needle insertion and the remaining 20% at the second insertion. Transient bleeding was observed at the puncture site in 19.8% of cases and transient fetal bradycardia in 4.9% of cases. The total fetal loss and cordocentesis-related loss rates within 2 weeks of cordocentesis were 2.7% and 1.0%, respectively, before 24 weeks of gestation and 1.9% and 0.8% after 24 weeks. The other obstetric complications were unremarkable. CONCLUSIONS: Cordocentesis is a simple, safe, and reliable procedure for prenatal diagnosis.     

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。     

Fetal blood gas analysis from cordocentesis for abnormal fetal heart rate patterns

We present three cases with abnormal fetal heart rate patterns and cordocentesis umbilical venous blood gas analyses. Conflicting heart rate patterns and cordocentesis and postnatal blood gas analyses prompt questions with regard to abnormal fetal heart rate pattern interpretation and suggest that cordocentesis blood gas analysis aids perinatal management only as a reflection of fetal status at sampling time.     

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.     

Fetomaternal transfusion and pregnancy outcome after cordocentesis

OBJECTIVE: To study the extent of fetomaternal transfusion and the outcome of pregnancy after cordocentesis. MATERIAL AND METHODS: 268 women underwent percutaneous fetal umbilical cord blood sampling for fetal karyotyping between 15 and 26 gestations of weeks. Complete follow-up was available in 221 (82.5%) of the cases. Cordocentesis was performed under continuous real-time ultrasound guidance. The duration of the procedure and the post-procedural bleeding time was counted in seconds. Fetomaternal transfusion was calculated by using the measurements of the maternal serum levels of alpha-fetoprotein before and after the procedure. The data were analyzed by Student's t and multiple regression tests. RESULTS: The maximum and mean amounts of fetomaternal transfusion were 1.067 and 0.061 ml, respectively. Twenty percent or more alpha-fetoprotein elevation was in 35.4% of the cases. Positive correlation was found between bleeding time after cordocentesis and fetomaternal transfusion (r = 0.174, p < 0.0129) as well as between the duration of the procedure (r = 0.165, p < 0.0171) and the amount of fetomaternal transfusion. Comparing the cordocentesis at the placental insertion site and at the free cord loop, a smaller amount of fetomaternal transfusion was observed (p < 0.0123) in the latter. Transplacental passage was associated with a higher amount of fetomaternal transfusion (p < 0.0067). No association was found between the extent of fetomaternal transfusion and the outcome of pregnancy. The fetal loss related to the cordocentesis was 0.50%. CONCLUSIONS: The extent of fetomaternal transfusion was influenced by the subsequent four parameters: procedural time, bleeding time, puncture site and transplacental penetration. The lack of the association between the degree of fetomaternal transfusion and the outcome of pregnancy, along with the low (0.50%) post-procedural fetal loss rate, suggest that cordocentesis is clinically a safe procedure.     

Cordocentesis and evaluation of fetal wellbeing in a very high-risk population (a very reliable index)]

In a population of 57 very high-risk pregnant women (severe clinical history and/or compromised fetus). A total of 240 tests for antepartum fetal evaluation were performed: baseline cardiotocography (CTG), biophysical profile scoring (BPS), doppler-velocimetry of umbilical artery and determination of blood gas analysis in venous umbilical cord blood obtained by cordocentesis. The results of the CTG, BPS, and umbilical artery doppler velocimetry showed a significant relation with those of pH and pO2. The sensitivity, specificity, false-abnormal value, and false-normal value of the CTG, PBS, and doppler velocimetry, used for the diagnosis of fetal acidosis, hypoxia, and asphyxia were comparable. The rate of fetal (asphyxia) was high if present severe/terminal CTG (85.0%), abnormal (4) BPS (82.0%), or absent-end diastole in umbilical artery doppler velocimetry (74.0%). The immediate complication rate due to cordocentesis procedure was minimal.     

Pathologic aspects of the umbilical cord after percutaneous umbilical blood sampling

Percutaneous umbilical blood sampling (cordocentesis) appears to be a valuable new procedure for prenatal diagnosis. In order to evaluate whether focal injury of the umbilical vessels caused by the needle puncture is potentially harmful, we completely examined 50 umbilical cords collected between 1 hour and 20 weeks after cordocentesis. Macroscopic evidence of the needle entry was found in 37 cases, including one giant hematoma of the cord. Within 48 hours after the procedure, microscopic examination of transverse sections taken at the puncture site revealed distinct perforation of the vessel wall, associated in four cases with a small hematoma encircling the vessel. One week after cordocentesis, the vessel wall was partially reformed. There were no histologic differences between needle entry in a vein or in an artery. No thromboses of the umbilical vessels were found.     

Fetal heart rate response to cordocentesis and pregnancy outcome: a prospective cohort.

OBJECTIVE: To evaluate fetal cardiac response to cordocentesis and whether such changes may affect pregnancy outcome. METHODS: 117 singleton pregnant women requiring percutaneous trans-abdominal cordocentesis were prospectively included. Fetal heart rate was continuously evaluated by ultrasound for 1 min after completion of cordocentesis and intermittently for 20 min more. Fetal and pregnancy outcomes were analyzed by grouping fetal cardiac response to cordocentesis into bradycardia, normal heart rate and tachycardia groups. RESULTS: Women included in the study were 30.5+/-4.0 years old and had a gestational age of 23.7+/-2.0 weeks. Fetal blood sample obtained by cordocentesis was 3.1+/-0.8 ml. Fetal heart rate before cordocentesis was 149+/-8 beats per minute (bpm), ranging from 130 to 169 bpm. Fetal heart rate post-cordocentesis was 145+/-30 bpm (from 32 to 175 bpm). The incidence of bradycardia and tachycardia was 10.3% (n=12) and 6.0% (n=7), respectively. Fetal heart rate returned to normal levels in all cases at 相似文献   

Predisposing factors and effects of fetal bradycardia following cordocentesis at mid-pregnancy

Objectives: To identify predisposing factors of fetal bradycardia following cordocentesis at mid-pregnancy and to compare the pregnancy outcomes to those without bradycardia. Methods: All cordocenteses performed at 18–22 weeks of gestation were prospectively enrolled. The inclusion criteria consisted of: (i) singleton pregnancies; (ii) no fetal structural or chromosomal abnormalities; (iii) the procedures done by experienced operators. They were divided into two groups; procedures with fetal bradycardia (Group 1) and those without bradycardia (Group 2). Factors related to bradycardia were identified and pregnancy outcomes between the two groups were also compared. Results: Of 6147 cordocenteses recruited, 2829 met the inclusion criteria. Of these,152 had fetal bradycardia whereas the remaining 2677 did not. The procedures involving placenta penetration, and umbilical cord bleeding were significantly related to a higher rate of fetal bradycardia. On the other hand, cordocenteses with fetal bradycardia had a significantly higher rate of fetal loss (11.8 vs. 1.9%, respectively, p = 0.001) as well as a higher rate of low birth weight and preterm birth. Conclusions: Cordocentesis with placenta penetration and umbilical cord bleeding carries a higher risk for fetal bradycardia and fetal bradycardia was an independent factor for a higher rate of fetal loss, preterm birth and low birth weight.