妊娠合并单脐动脉的产科临床意义(附47例报道)

目的通过对47例产前超声检查时发现胎儿单脐动脉病例的临床情况及妊娠结局进行追踪，分析产前发现单脐动脉对妊娠的影响及其产科临床意义。方法回顾2003年6月至2006年2月间，在我院行产前超声检查发现合并单脐动脉的47例妊娠，追踪其相关临床情况、妊娠结局。结果在47个胎儿单脐动脉病例中，合并其他系统胎儿发育异常的有28例，其中发现染色体异常的有3例，继续妊娠的病例中，有10例在孕程和产程中出现各种异常，余15例胎儿妊娠进程顺利，随访无明显异常发现。结论产前发现胎儿单脐动脉，需多角度动态观察，在排除胎儿合并其他畸形或染色体异常时，可以考虑继续妊娠，但尚需密切注意胎儿发育情况和产程。     

超声诊断胎儿单脐动脉的临床价值

目的探讨超声诊断胎儿单脐动脉的临床价值。方法回顾分析我院近6年来111例胎儿单脐动脉及合并其它畸形的声像特征,并与产后及尸检、病理解剖进行对照比较。结果超声诊断111例胎儿单脐动脉,其中20例伴发胎儿先天畸形,分别为单心腔11例,后颅窝积液1例,三尖瓣下移1例,膈疝伴法洛氏四联症1例,唇裂3例,其它多发畸形3例。结论超声能够准确诊断胎儿单脐动脉,并引起足够重视,进一步仔细检查排除其它合并畸形,特别是心脏畸形,为临床及孕妇妊娠与否提供确切依据,有利于优生优育。     

妊娠合并单脐动脉525例临床分析

目的对妊娠合并单脐动脉的患者围产期结局进行探讨,为今后临床对单脐动脉孕产期咨询和临床处理以及胎儿宫内监测提供可靠依据。方法回顾分析2010年10月～2013年10月,在我院诊断的525例妊娠合并单脐动脉的诊断方法、分娩方式和妊娠结局。结果 525例病例中,合并胎儿畸形89例,合并胎儿生长受限53例,宫内死胎6例,合并胎心监护异常31例,新生儿窒息10例,早产72例,足月分娩366例。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。单纯性单脐动脉胎儿妊娠结局良好,对于同时合并有其他超声异常,建议行胎儿染色体核型分析。     

脐动脉血流速度监测的临床意义-附118例异常分析

目的利用脐动脉血流速度监测孕晚期及分娩期胎儿的脐动脉阻力,通过对脐动脉血流速度波形分析,结合胎心监护,间接判断胎盘血流,脐带血流速度有无异常,决定正确的分娩方式,有效降低胎儿宫内窘迫及新生儿窒息的发生率,具有重要的临床意义.方法检测842例孕妇,其中S/D、PI、RI增高者118例(异常组),随机选择正常者100例(正常组),配合NST监护,将两组进行比较.结果合并IUGR及妊高症时S/D,RI值变化最大,分别为S/D6.47 ± 0.45、4.14±0.18,RI0.97±0.33、1.01 ± 0.65,监护阳性行剖宫产者25例,与正常组比较,P＜0.005,但两组新生儿Apgar平分比较P＞0.01.结论说明通过胎儿脐动脉血流监测能及时发现并处理胎儿宫内异常,新生儿预后良好.     

产前超声诊断单脐动脉的临床价值

目的探讨单脐动脉的产前超声诊断及其临床价值。方法对产前超声检查中发现的40例单脐动脉胎儿进一步进行全面筛查,并行脐血染色体检查,对妊娠结局进行随访。结果 40例单脐动脉中,单纯性单脐动脉28例(70%),合并其他畸形12例(30%),其中心血管系统畸形3例,中枢神经系统畸形2例,泌尿系统畸形2例,多发性畸形2例,消化系统畸形、桡骨发育不良及膈疝各1例;接受脐血染色体检查7例,染色体核型异常3例;单纯性单脐动脉预后良好。结论产前超声可以明确诊断单脐动脉。单脐动脉合并其他畸形的发生率高于正常,合并畸形时染色体异常发生率增高。当超声检查发现单脐动脉时,应进一步作系统筛查及染色体检查,并对单脐动脉胎儿生长发育指标进行监测评估,均具有重要的临床意义。     

单脐动脉合并其他异常情况的超声诊断意义

目的探讨超声在诊断胎儿单脐动脉以及伴发胎儿其他异常情况的意义。方法回顾性分析2010年1月至2011年1月在我院超声检查发现出的59例胎儿单脐动脉的超声资料,同时分析合并胎儿其他异常情况关系,并追踪其妊娠结局。结果 59例超声均诊断为胎儿单脐动脉,其中单纯性脐动脉28例(46.7%),合并胎儿其他异常情况31例(53.3%),且类型多样,达10种之多。而在这些异常情况中,羊水异常最多,共9例(15%),其次为心血管系统畸形为7例(11.6%)。结论通过彩色多普勒超声能仔细准确的诊断出单脐动脉及是否合并胎儿其他异常情况的存在,具有重大的临床意义。     

单脐动脉在产前超声诊断的意义

目的通过分析单脐动脉的临床特点及胎儿出生后情况,探讨单脐动脉在产前诊断超声的意义。方法自2006年3月至2009年9月,应用产前诊断超声检查孕妇胎儿脐带19264例,观察单脐动脉的形态结构、彩色多普勒特征、类型及伴发畸形的类型,分析胎儿染色体异常及出生后情况。结果超声检查诊断单脐动脉99例,61例合并其他系统异常,余38例为单纯单脐动脉。共行染色体检查27例,其中合并其他异常的单脐动脉中4例染色体异常中,2例21-三体,2例18-三体,单纯单脐动脉中1例为18-三体。引产65例,活产30例,死胎1例,3例妊娠尚未终止。结论超声可以有效检出单脐动脉,同时要排除其他系统异常及染色体异常。建议临床行染色体检查,重视宫内胎儿监护,必要时及时终止妊娠。     

单脐动脉合并胎儿先天性结构畸形的诊断及临床意义

目的探讨单脐动脉合并胎儿先天性结构畸形的诊断,为临床诊治病人提供依据。方法回顾性分析2008年1月1日～2010年6月1日在我科产前筛查诊断的297例单脐动脉及91例单脐动脉合并胎儿先天性结构畸形的超声特点,追踪其妊娠结局,并于产后新生儿特殊检查、或引产后尸体解剖及病理检查结果相对照。结果本研究43572例中孕胎儿中单脐动脉297例发生频率是0.68%,单脐动脉中合并胎儿先天性结构畸形91例,发生率30.64%。合并畸形中居前三位的分别为心血管系统、泌尿系统、中枢神经系统。同时发现单脐动脉合并多发畸形较单发畸形多见。结论单脐带动脉可引起较高畸形发生率,准确诊断单脐动脉合并胎儿先天性结构畸形具有重要的临床意义。     

超声诊断胎儿单脐动脉的临床意义

目的通过对单脐动脉胎儿的检查与随访,探讨单脐动脉的临床意义。方法进行产前超声检查的胎儿24018例,超声检查胎儿各系统结构及胎盘羊水情况,观察脐带的腹腔段、游离段及胎盘附着部。结果 24018例胎儿中检出单脐动脉胎儿47例,检出率为0.2%,其中单纯的单脐动脉23例,合并其它系统结构畸形者24例。5例单脐动脉胎儿进行了染色体核型分析,其中2例有染色体异常,3例未见异常。结论单脐动脉与胎儿先天性畸形有密切关系,单脐动脉可做为胎儿先天异常的一个软标记,超声医生应重视其重要性。     

单脐动脉及其合并胎儿异常的相关研究进展

单脐动脉（SUA）被认为是胎儿先天性畸形、早产及出生低体质量的软标志物。SUA属于脐带发育和结构异常,可以通过产前超声检出。SUA可能构成胎儿循环的严重障碍,引起胎儿缺氧而致发育不良,甚至可能发生胎儿畸形。SUA合并畸形系与胎儿的染色体异常有关,最常见为18-三体综合征。SUA可通过影响早期胚胎血液供应而扰乱胚胎血流动力学．引起胎儿中枢神经系统畸形、心血管畸形、泌尿系统畸形及肢体发育畸形等。双胎合并SUA的发生率比单胎的要高,且胎儿畸形率也高。SUA更可引起发育不良、胎儿生长受限、低体质量儿和围生儿死亡率增高等。     

彩色多普勒超声诊断胎儿单脐动脉的临床价值

目的探讨超声对胎儿单脐动脉的诊断意义。方法应用彩色多普勒超声连续观察21405例中晚孕期孕妇单脐动脉的发生情况并测量其脐动脉血流频谱（PI、RI及S/D比值）。结果共发现单脐动脉胎儿140例,99例单纯性单脐动脉,41例合并畸形,它们分别与正常胎儿的PI、RI、S/D值比较均无显著性差异（P〉0.05）。结论应用彩色多普勒超声可准确诊断胎儿单脐动脉的发生情况,为遗传生殖提供临床价值。     

Single umbilical artery in fetopathological investigations

Single umbilical artery (SUA) is a relatively common malformation that may call attention to the possibility of associated malformations (often chromosome aberrations). The current study aimed at surveying malformations associated with SUA on the basis of fetopathological investigations, analyzing the role of history, summarizing the clinically important factors emerging together with this malformation. In this study, we processed the details of 204 cases in which SUA was confirmed fetopathologically after miscarriage or induced abortion between 1990 and 2007. In our sample, SUA occurred in 7.38% of the cases. The history was positive in almost 30% of the cases. The majority of the cases had a positive obstetric and the minority of them a positive genetic history. The highest association of SUA with other malformations was found for craniospinal ones, but an association with cardiovascular malformations should also be mentioned. Regarding the individual types of malformation, SUA was most commonly associated with hydrocephalus, but Potter's sequence, trisomy 21, and atrioventricular septal defect also reached a higher rate in associated SUA. Previously published articles dealing with associated malformations found that urogenital malformations were most commonly associated with SUA. 'Itemizing' the different non-chromosomal malformations in association with SUA, we found that hydrocephalus, Potter's sequence, and atrioventricular septal defect were the most frequent malformations, while in earlier studies, the association with non-chromosomal malformations such as vertebral malformations, imperforated anus, cheilognathopalatoschisis, and renal agenesis occurred more frequently than usual.     

Incidence and associations of single umbilical artery in prenatally diagnosed malformed,midtrimester fetuses: A review of 62 cases

The absence of one umbilical artery (SUA) is the most common malformation of the umbilical cord. It may accompany other abnormalities or occur as an isolated defect. We examined 885 fetuses, terminated following the prenatal diagnosis of serious or lethal malformations between April 1977 and March 1989, for the presence of SUA. We found 62 cases of SUA. This represents an incidence of 7.01% (62/885). The most common abnormalities found in association with SUA were: (1) multiple malformations (8/11 cases, SUA incidence = 72.7%), (2) ADAM complex (7/14 cases, SUA incidence = 50.%), (3) multicystic renal dysplasia (5/20 cases, SUA incidence = 25.%), and (4) Potter sequence (5/21 cases, SUA incidence = 23.8%). These associations have not been documented previously. In 6 fetuses the Meckel syndrome was diagnosed, and SUA was present in 2 of these. Therefore, SUA may represent an additional anomaly in Meckel syndrome that has not been reported previously. © 1992 Wiley-Liss, Inc.     

188例脐血流S/D异常的临床分析

目的探讨应用彩色多普勒脐血流分析仪在监护胎儿宫内安危的临床价值。方法检测1789例妊娠28 ~42 w孕妇的胎儿脐动脉血流频谱,测定收缩期峰值与舒张期低值之比(S/D)。分析异常组(S/D≥3)188例及正常组(S/D<3=1601例其胎儿的妊娠结局。结果异常组的脐带绕颈,中重度妊高征,胎儿窘迫及IUGR的发生率均明显高于正常组(P<0.05~0.01=。结论高危胎儿其脐带血流缓慢,影响供血,表现S/D异常,提示S/D异常与胎儿宫内缺氧呈明显正常关系。     

Abnormal direct entry of the umbilical vein into the right atrium: antenatal detection,embryologic aspects

Summary Abnormal direct umbilical venous return into the right atrium was detected at obstetric ultrasonography in a 23 week fetus. This was an isolated anomaly; the growth of the fetus and size of the liver were normal, and the child was normal on examination at birth. Exclusion of the umbilico-placental circulation brought about closure of the umbilical vein. Growth and development of the child were normal 6 months after birth. Five other cases of abnormal umbilical venous entry into the right atrium have been reported in the literature, but associated with severe malformations, with situs ambiguous and heterotaxy. These cases have been grouped under the heading: persistence of the right umbilical vein. In view of recent findings relating to the organogenesis of the veins of the human liver, it seems preferable to label this anomaly: direct umbilical venous return into the right atrium.

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Retour veineux ombilical anormal direct dans l'atrium droit: découverte anténatale, interprétation embryologique

Résumé Un retour veineux ombilical anormal direct dans l'atrium droit a été reconnu à l'échographie obstétricale chez un ftus de 23 semaines. Cette anomalie était isolée, la croissance du ftus et la taille du foie étaient normales. A la naissance, l'examen de l'enfant était normal. L'exclusion de la circulation ombilico-placentaire a entraîné la fermeture de la veine ombilicale. La croissance et le développement de l'enfant sont normaux six mois après la naissance. Cinq autres cas de retour veineux ombilical anormal dans l'atrium droit ont déjà été rapportés dans la littérature mais associés à des malformations sévères, avec situs ambigu et hétérotaxie. Ces observations sont regroupées sous la dénomination: «persistance de la veine ombilicale droite». Compte tenu de données récentes concernant l'organogénèse des veines du foie humain, il semble préférable de dénommer cette anomalie: retour veineux ombilical direct dans l'atrium droit.