新生儿窒息与羊水粪染的关系

对８７ 例孕龄３７ ～４２ 周新生儿窒息及其羊水状况、胎心电子监护进行分析, 探讨新生儿窒息与羊水粪染的关系。结果：新生儿窒息与羊水粪染有关。新生儿重度窒息组为Ⅲ度羊水粪染比例高,而新生儿轻度窒息组为Ⅰ、Ⅱ度羊水粪染比例高（ Ｐ＜ ０ ．０５） ; Ⅲ度羊水粪染者胎心电子监护的异常发生率显著高于Ⅰ、Ⅱ度羊水粪染者（ Ｐ ＜ ０ ．０１） ;胎心电子监护对新生儿窒息的阳性预测率为２９ ．０９ ％ （１６／５５） 。结论：新生儿窒息的发生与羊水粪染程度密切相关。出现Ⅲ度羊水粪染应立即结束分娩, 出现Ⅰ、Ⅱ度羊水粪染时必须在胎心电子监护下密切观察产程进展, 一旦出现异常尽快结束分娩,以降低新生儿窒息的发生率。     

羊水乳酸水平对羊水粪染病例胎儿窘迫的诊断价值

目的探讨羊水乳酸水平在羊水粪染病例中诊断胎儿窘迫的临床价值。方法2003年8月至2004年12月暨南大学第二临床医学院测定72例第一产程活跃期出现羊水粪染(观察组)和52例羊水清、胎儿监护图形正常且有良好新生儿结局(对照组)的羊水及新生儿脐动脉血乳酸水平。结果对照组羊水乳酸值近似正态分布,其95%参考值为5.4~8.9mmol/L。对照组活跃期和分娩时羊水乳酸水平差异无显著性意义(P>0.05)。羊水Ⅲ度粪染的羊水乳酸水平明显高于对照组(P<0.01)。羊水Ⅰ度及Ⅱ度粪染而胎儿监护正常的病例羊水乳酸值与对照组比较,差异无显著性意义(P>0.05)。但羊水Ⅱ度粪染合并胎心基线异常或(和)重度变异减速病例的羊水乳酸水平明显升高(P<0.01)。观察组发生胎儿窘迫及新生儿窒息的病例,其活跃期羊水乳酸水平均明显高于对照组(P<0.01)。以活跃期羊水乳酸值>8.9mmol/L为异常值来诊断胎儿窘迫发生的敏感性、特异性、阳性预测值及阴性预测值分别为61.9%、88.2%、68.4%和84.9%。结论羊水乳酸值测定对提高羊水粪染病例胎儿窘迫的诊断准确性有一定临床价值。     

羊水过少177例临床分析

目的 探讨羊水过少的病因及其相关因素,寻找正确的处理方法,降低围生儿病死率。方法 对羊水过少１１７例临床资料进行分析。结果 羊水过少高发于４０周后;Ｂ超对羊水量的估计准确率可达９５％;羊水过少出现嘬多的妊娠并发症为妊高征和胎儿宫内生长 缓（ＩＵＧＲ）;羊水过少脐带缠绕及脐带过短发生率明显高于对照组,有显著差异（Ｐ〈０．０１）;羊水量越少,羊水粪染率及胎儿窘迫发生率越高,羊水过少组新生儿窒息率明显高     

B超诊断羊水偏少孕妇阴道试产196例分析

目的分析足月妊娠妇女Ｂ超检查示羊水偏少时,阴道试产对围产期结局的影响。方法应用羊水指数（ＡＦＩ）法估测羊水量,并测定脐动脉收缩期最大血流速度（Ｓ）和舒张末期血流速度（Ｄ）的比值（Ｓ／Ｄ值）及２４小时尿雌三醇与肌酐的比值,比较分析１９６例Ｂ超诊断羊水偏少者（观察组）和２００例羊水量正常的足月妊娠妇女（对照组）阴道试产后的分娩结局。结果两组新生儿重度窒息发生率和新产儿死亡率差异无显著性（Ｐ＞０．０５）,观察组急诊剖宫产率明显升高（Ｐ＜０．０５）。结论Ｂ超诊断羊水偏少的足月妊娠妇女,在严密监护下可行阴道试产。     

羊水胎粪污染与新生儿结局

我院１９９２年１～１２月头位生产羊水胎粪污染４１６例，发生率２１．９％，早产及过期妊娠羊水粪染发生率显著高于足月产（Ｐ＜０．００５）．羊术Ⅲ度粪染者胎心电子监护异常及新生儿不良结局的发生率均显著高于Ⅰ度与Ⅱ度粪染者（Ｐ＜０．００５）．９例胎粪吸入综合征，有７例为羊水Ⅲ度粪染．脑心电子监护异常组新生儿不良结局发生率明显高于胎业正常和仅有胎心基线变异减少或消失组（Ｐ＜０．００５），阳性预测率６７．０３％．本研究结果提示，羊水Ⅲ度粪染有明确的胎儿宫内窘迫，应尽快娩出胎几，Ｉ度与Ⅱ度羊水粪染，应加强胎心电子监护，不必过早干预．早产羊水粪染发生率高不支持“胎粪排出乃胎儿肠道成熟标志”的理论．     

应用羊水置换术治疗产时羊水Ⅱ、Ⅲ度胎粪污染

目的 :研究产时应用羊水置换技术对治疗羊水Ⅱ、Ⅲ度胎粪污染的疗效。方法 :选择产时羊水Ⅱ、Ⅲ度胎粪污染的足月单胎头位分娩孕妇 88例 ,其中的 4 4例进行羊水置换术的作为研究组 (A组 ) ;未进行羊水置换操作的另外 4 4例作为对照组 (B组 ) ;另选羊水无胎粪污染的 4 4例孕妇作为实验研究的空白对照组 (C组 )。观察其VD波缓解率、剖宫产率、新生儿血气分析及Apgar评分。结果 :A组变异减速 (VD)波的缓解率高于B组 (6 4.0 0 % ,2 9.17% ,P <0 .0 5 ) ;A组新生儿出生后 1分钟的脐血血气的pH值较B组高 (P <0 .0 5 ) ;A组的剖宫产率 (45 .4 5 % )低于B组(6 8.18% )。结论 :羊水置换对产时羊水Ⅱ、Ⅲ度胎粪污染有显著的疗效 ,可以明显改善新生儿的酸中毒与预后 ,且可以降低剖宫产率。     

花生四烯酸的代谢产物在兔羊水栓塞中的作用

目的：研究不同性质的羊水注入兔血循环后血中花生四烯酸的代谢产物血栓素Ａ２（ＴＸＡ２）、前列环素Ｉ２（ＰＧＩ２）和白三烯Ｃ４（ＬＴＣ４）的变化。方法：新西兰孕兔２９只,随机分为４组：兔原羊水、胎粪液、胎盘组织提取液和生理盐水,分别在注入前、注入后５ｍｉｎ,、４５ｍｉｎ从兔耳动脉抽血２ｍｌ,用放射免疫分析（ＲＩＡ）检测血中ＴＸＡ２和ＰＧＩ２的代谢物６－酮前列腺素（６－Ｋｅｔｏ－ＰＧＦ１α）和血栓素Ｂ２（ＴＸＢ２）,用酶联免疫法（ＥＩＡ）检测ＬＴＣ４。结果：注入胎粪液、胎盘组织提取液后６－Ｋｅｔｏ－ＰＧＦ１α明显增加（Ｐ＜０．０１）,兔原羊水组轻度增加,但差异无显著性（Ｐ＞０．０５）;生理盐水组无明显变化（Ｐ＞０．０５）;除生理盐水组外,其余各组的ＴＸＢ２和ＬＴＣ４在注入后增加显著（Ｐ＜０．０１）;ＴＸＢ２、６－Ｋｅｔｏ－ＰＧＦ１α和ＬＴＣ４的组间对比以胎盘组织提取液组增加显著（Ｐ＜０．０１）。结论：羊水进入兔血循环能刺激机体产生ＴＸＡ２、ＬＴＣ４和ＰＧＩ２等花生四烯酸的代谢产物,在羊水栓塞的发生、发展过程中起重要作用。     

胎膜破裂前后羊水及脐血厌氧菌培养68例分析

对６８例胎膜早破、临产后破膜及胎膜未破的孕产妇，在剖宫产术中取羊水及脐血作厌氧菌培养。结果：普通培养（＋）１５例次，厌氧培养（＋）２０例次，阳性结果在胎膜早破组和临产破膜组比较无明显差异（Ｐ〉０．０５）；两破膜组与胎膜未破组比较有显著差异（Ｐ〈０．００１）；感染组与非感染组比较，前者破膜距手术时间较后者明显延长（Ｐ〈０．００１）。胎膜未破组也有阳性结果出现。认为：①产科感染中厌氧菌感染占半数以上；     

羊膜腔输注药物治疗羊水过少并发胎儿窘迫的临床效果观察

目的探讨羊膜腔输液、羊水置换及羊膜腔输注碱性药物治疗胎儿窘迫酸中毒的临床效果。方法对40例羊水过少、产程中胎心监护出现胎心律异常波形、Ⅱ度以上羊水胎粪污染产妇,在持续内监护下行羊膜腔输液、羊水置换治疗,其中20例分娩前行羊膜腔输入5%NaHCO3150ml(研究组),20例分娩前行静脉注射5%NaHCO3150ml(对照组),分娩后立即抽取两组新生儿脐动脉血行血气分析,并对两组新生儿行Apgar评分比较。结果(1)羊膜腔输液治疗:两组40例产妇中胎心律异常波形消失27例(27/40,68%),胎心律异常波形明显减少8例(8/40,20%),治疗有效率为88%(35/40);无变化或加重5例(5/40,13%)。(2)羊水置换治疗:两组40例产妇平均每例羊水置换Ⅱ~Ⅲ度胎类污染羊水900ml,最少700ml,最多1200ml。经羊水置换后抽出羊水清亮者21例(21/40,53%),羊水Ⅰ度污染者13例(13/40,33%),有效率为85%(34/40);仍有羊水Ⅱ度污染6例(6/40,15%)。(3)研究组脐动脉血二氧化碳分压(PCO2)、氧分压(PO2)、碳酸氢盐(HCO3-)、剩余碱(ABE)、标准碱(SBE)等指标明显好于对照组,两组比较,差异均有统计学意义(P<0·05,P<0·01)。(4)研究组新生儿出生后1分钟Apgar评分平均为(9·2±1·1)分,对照组平均为(8·7±1·7)分,两组比较,差异有统计学意义(P<0·05)。结论羊膜腔输液及羊水置换是治疗因胎儿窘迫及预防新生儿胎粪吸入综合征的有效方法,羊膜腔输注碱性药物能有效纠正胎儿酸中毒。     

经腹羊膜腔输液治疗小于34孕周羊水过少的疗效观察

目的：探讨产前经腹羊膜腔输液在临床应用的可行性。方法：以３２ 例（早破膜及未破膜者）＜ ３４ 孕周羊水过少的患者作为研究对象，在Ｂ超引导下，经腹壁行羊膜腔穿刺，留置导管，向羊膜腔内输３７℃复方氯化钠溶液３００～５００ｍ ｌ／ｄ，滴速２ｍ ｌ／ｍ ｉｎ，羊水指数＞ ８ｃｍ 为停止输液指标。辅以抑制宫缩及促胎肺成熟、防治感染等综合治疗，观察延长孕龄的时间及母婴预后。取３２例未开展本研究之前孕周相同的羊水过少患者作为对照。结果：研究组孕龄延长最短３ｄ，最长３８ｄ。剖宫产率、产后出血率及产褥病率均无明显增加。研究组早产儿Ａｐｇａｒ评分１、５ｍ ｉｎ 均高于对照组（Ｐ＜ ０．０５，Ｐ＜ ０．０１），研究组围产儿存活率明显高于对照组（Ｐ＜ ０．０１）。结论：产前经腹羊膜腔内输液是治疗＜ ３４孕周羊水过少的简便、有效措施之一。     

Significance of assay of nucleated RBCs in umbilical cord blood in neonates with meconium-stained amniotic fluid

Background: Approximately 8–15% of all infants are born with evidence of meconium-stained amniotic fluid (MSAF). MSAF is a potentially serious sign of fetal compromise and may indicate fetal hypoxia

Objectives and aim of the work: The present study was designed to evaluate the relationship between meconium stained amniotic fluid and fetal nucleated red blood cell counts. As well, we aim to evaluate the relationship between the presence of meconium in amniotic fluid and Apgar scores in neonates.

Subjects and methods: A prospectively case-controlled study was performed on 40 women with clear amniotic fluid as control and 40 women with meconium-stained amniotic fluid as the study group. At delivery, 2?ml of umbilical cord blood was collected and analyzed for nucleated red blood cell (NRBC).

Results: The mean NRBC counts in meconium-stained amniotic fluid was significantly higher than the control group (18.35?±?7.7 and 9.6?±?4.96), respectively (p?p?Conclusion: Our results support previous studies which indicate the presence of meconium can be associated with chronic fetal hypoxia as demonstrated by elevated fetal NRBC levels.     

孕羊羊水栓塞后血液动力学、呼吸的改变

目的:研究羊水栓塞对血液动力学、呼吸的影响。方法:健康孕晚期山羊16只,根据注入液体性质不同随机分为4组:原羊水组(AF组),胎粪污染羊水组(MAF组),过滤羊水组(FAF组),生理盐水对照组(NS组),每组4只。于液体注入前、注入后即刻、10、30、60、90、180min采集血液动力学、呼吸指标及心电图检查,呼吸频率由专人用听诊器听取获得。结果:注入生理盐水后血液动力学指标有一过性改变,但无统计学意义(P>0.05)。注入羊水后,孕羊动脉收缩压、舒张压、平均动脉压下降,肺动脉压、肺毛细血管楔压、中心静脉压升高,胎粪组改变最明显(P<0.05),原羊水组与过滤羊水组无显著差异,血压改变以羊水注入后10min最明显,多数30min内恢复正常,部分肺动脉压在60min后恢复。孕羊心率和呼吸增快,但与生理盐水组的差异无统计学意义(P>0.05)。胎粪组中有两只孕羊出现左心衰,其余组未见左心衰。结论:注入羊水后,体循环血压明显下降,肺循环压及中心静脉压明显升高,且是一过性的。注入的羊水是否过滤处理,对孕羊血液动力学的影响无明显差异。     

L-arginine pathway in neonates with meconium-stained amniotic fluid

Objective

To study the arginase, nitric oxide synthase and nitric oxide pathways associated with passage of meconium.

Study design

Cord blood samples were collected from 20 newborns with meconium-stained amniotic fluid (MSAF) and from 23 newborns with clear amniotic fluid. Cord blood pH, arginase, nitric oxide synthase and nitric oxide levels were compared between the groups.

Result

The differences between the arginase and nitric oxide measurements of the newborns with MSAF and those with clear amniotic fluid were significant. In the MSAF group arginase levels were significantly lower (p = 0.007) and nitric oxide levels were significantly higher (p = 0.032) than the clear amniotic fluid group.

Conclusion

Hypoxia may be involved in the pathogenesis of meconium passage due to decreased arginase and increased nitric oxide levels.     

Meconium in the amniotic fluid and fetal acid-base status

Of 323 pregnancies with meconium-stained amniotic fluid at 36-42 weeks' gestation, 68 (21%) had a pH less than 7.20 in umbilical arterial blood, 21 (7%) had a pH less than 7.15, and only three newborns (0.9%) had true metabolic acidemia. At birth, of the 74 newborns with normal electronic fetal heart rate (FHR) tracings, eight (11%) had an umbilical arterial pH less than 7.20. There was a significantly higher frequency of acidemia (defined as pH less than 7.20) in newborns with both baseline and periodic FHR abnormalities. Although there was a significant difference (P less than .05) in the frequency of meconium found below the cords in these neonates with an umbilical artery pH less than 7.20 compared with those with values exceeding 7.20, there was no significant difference in the frequency of clinical meconium aspiration syndrome. We conclude that meconium-stained amniotic fluid correlates poorly with infant condition at birth as reflected by umbilical cord acid-base measurements.     

羊膜腔输液治疗在产时应用的临床分析

目的 :分析羊膜腔输液 (amnioinfusion,AI)治疗产时羊水过少、胎膜早破和胎粪性羊水的临床意义。方法 :选择产程中发生胎心异常合并羊水过少、胎膜早破和羊水胎粪污染的孕产妇 1 0 1例 ,随机分为治疗组 51例 ,对照组 50例。治疗组在胎心监护下行羊膜腔输液或羊水置换 ;对照组给予吸氧 ,改变体位 ,静滴 5% Na HCO3等治疗。结果 :治疗组经羊膜腔输液 50 0～ 1 0 0 0 ml,胎心可变减速 (variable deceleration,VD)和长时减速 (period long deceleration,PL D)消失或明显改善 44例 ,有效率占 86 .3% ,明显高于对照组 (2 2 % ) ,两组比较差异有显著性 (P<0 .0 1 )。治疗组 1 9例胎粪性羊水行羊水置换 ,有 1 7例羊水转为清亮或 度混浊。治疗组产程时间比对照组缩短 ,治疗组和对照组剖宫产率分别为 1 3.7%和 34.0 % ,新生儿窒息率分别为 3.9%和 42 .0 % ;对照组胎粪吸入性肺炎 9例 ,新生儿死亡 3例 ,治疗组仅一例发生胎粪吸入性肺炎 ,无新生儿死亡。产褥病率两组比较 ,差异无显著性 (P>0 .0 5)。结论 :羊膜腔输液是治疗产时羊水过少、胎膜早破、胎粪性羊水的有效方法     

产程中持续内监护下行羊膜腔输液及羊水置换治疗胎儿窘迫

目的 探讨产程中持续内监护下行羊膜腔输及羊水置换,对治疗胎儿窘迫的意义。方法 对产程中出现频发可变减速合并羊水胎粪污染者１３６例,随机分为观察组与对照组各６８例,观察组在持续内监护下行羊膜腔输液或羊水置换。对照组给予吸氧、改变体位、静脉输液等治疗。结果观察组经羊膜腔输液５００￣１０００ｍｌ,ＶＤ波消失或明显改善者占９１．２％,同时对观察组中４８例羊水Ⅱ度以上粪染者行羊水置换,其中３９例羊水国 清亮     

Prolonged in utero meconium exposure impairs spatial learning in the adult rat. Central Prize Award

OBJECTIVE: The purpose of this study was to examine the effects of prolonged in utero meconium exposure on adult learning and memory, as measured by the Morris water maze. STUDY DESIGN: Timed pregnant Long-Evans rats were studied. On gestational day 20 (term, 21 days of gestation), laparotomy was performed, and each maternal animal received an injection of clear amniotic fluid or meconium-stained amniotic fluid into each gestational sac. The laparotomy incision was closed, and the animals received postoperative monitoring through delivery. On postnatal days 145 to 148, the offspring underwent Morris water maze testing. The mean (+/-SEM) for the latency time was reported for each day's trial and compared between groups. RESULTS: There were significant differences between meconium-stained amniotic fluid group and clear amniotic fluid group in the mean time to platform on day 1 (82.7 +/- 1.8 seconds vs 75.9 +/- 3.0 seconds; P=.04), day 2 (60.5 +/- 3.5 seconds vs 47. 8 +/- 4.6 seconds; P=.03), and day 3 (56.5 +/- 4.5 seconds vs 34.7 +/- 4.4 seconds; P=.001). However, there were no differences on days 4 and 5. There were also no differences between recall and response learning trials that were done after a 12-day retention period. CONCLUSION: In the absence of hypoxia or infection, prolonged in utero meconium exposure is associated with a delay of spatial learning in the adult rat.     

Prolonged in utero meconium exposure impairs spatial learning in the adult rat : Central Prize Award

Objective

The purpose of this study was to examine the effects of prolonged in utero meconium exposure on adult learning and memory, as measured by the Morris water maze.

Study design

Timed pregnant Long-Evans rats were studied. On gestational day 20 (term, 21 days of gestation), laparotomy was performed, and each maternal animal received an injection of clear amniotic fluid or meconium-stained amniotic fluid into each gestational sac. The laparotomy incision was closed, and the animals received postoperative monitoring through delivery. On postnatal days 145 to 148, the offspring underwent Morris water maze testing. The mean (±SEM) for the latency time was reported for each day's trial and compared between groups.

Results

There were significant differences between meconium-stained amniotic fluid group and clear amniotic fluid group in the mean time to platform on day 1 (82.7 ± 1.8 seconds vs 75.9 ± 3.0 seconds; P = .04), day 2 (60.5 ± 3.5 seconds vs 47. 8 ± 4.6 seconds; P = .03), and day 3 (56.5 ± 4.5 seconds vs 34.7 ± 4.4 seconds; P = .001). However, there were no differences on days 4 and 5. There were also no differences between recall and response learning trials that were done after a 12-day retention period.

Conclusion

In the absence of hypoxia or infection, prolonged in utero meconium exposure is associated with a delay of spatial learning in the adult rat.     

Use of maternal plasma level of Zinc-Coproporphyrin in the prediction of intrauterine passage of meconium: A pilot study

Objective: To evaluate the usefulness of maternal plasma zinc-coproporphyrin (ZCP) level as a marker for intrauterine passage of meconium.

Methods: A pilot study consisting of 10 pregnancies with meconium-stained amniotic fluid and 10 pregnancies with clear amniotic fluid was used. The corresponding plasma and amniotic fluid levels of ZCP were measured using spectrofluorometry. ZCP levels in plasma and amniotic fluid were compared between the two groups and the relation between plasma and amniotic fluid ZCP levels in the clear and meconium-stained groups was assessed using Spearman rank-order correlation.

Results: Mean amniotic fluid ZCP was significantly higher in the meconium-stained amniotic fluid as compared to the clear amniotic fluid group. Although mean plasma ZCP levels were higher in the meconium-stained amniotic fluid group, this difference was not statistically significant. There was no significant correlation between plasma ZCP levels and amniotic fluid ZCP, but we could categorize patients according to plasma ZCP levels into four categories with different risks for having meconium-stained amniotic fluid.

Conclusions: Plasma ZCP might be a promising test for prediction of intrauterine passage of meconium in high-risk patients if confirmed by larger studies. The implications of this prediction on management remain unknown.