应用超声评估脐带旋转指数与脐带附着部位的关系

目的观察脐带较少螺旋状盘绕与脐带在胎盘附着部异常是否相关.方法超声检测303位中晚期妊娠的胎儿脐带盘绕情况,1与脐动脉螺旋行走一周脐静脉的长度(A)的比值,定义为脐带旋转指数,1/A小于0.1考虑为少旋转.分娩后测量脐带附着点到胎盘边缘的距离,将结果分为正常附着、边缘性附着和帆状附着.结果少旋转的胎儿脐带约68%为异常附着,仅有1.4%的旋转指数≥0.1(P＜0.05).结论脐带少旋转与脐带异常附着有高度相关性,如存在脐带少旋转则可提示存在脐带异常附着,并为产科处理提供有利帮助.     

彩超诊断胎儿脐带异常附着的临床应用

目的:探讨对于脐带异常附着采取彩超检查诊断的临床应用价值。方法:回顾性分析了我院于2019年1—12月内收治的35例胎儿脐带异常附着产妇的临床资料,所有产妇在产前均接受了彩超检查,并以最终的妊娠结局为准,分析彩超诊断结果的准确性。结果:35例胎儿脐带异常附着,其中边缘性附着例数为25例,帆状附着例数为10例。彩超检查结果显示边缘性附着例数为22例(62.86%),帆状附着例数为9例(25.71%),漏诊率为11.43%(4/35),彩超检查的诊断符合率为88.57%(31/35)。35例产妇中,2例(5.71%)胎儿宫内发育迟缓,6例(17.14%)产后大出血,1例(2.86%)胎儿宫内死亡,26例(74.29%)产妇正常妊娠。结论:产前彩超检查可以准确的判断胎儿脐带异常附着,诊断符合率高,可以为产妇后续的治疗提供可靠的依据,进一步保障了母婴安全,改善了母婴结局。因此,可在临床大力推广。     

妊娠早期绒毛膜下出血与胎盘脐带附着异常的相关性研究

【】 目的 研究通过超声检测分析妊娠早期绒毛膜下出血程度对与妊娠中期胎盘形态脐带附着部位的影响之间的相关性,提高对脐带附着异常发病机制的认识。方法 以2017年25月-2018年117月经超声诊断妊娠早期绒毛膜下出血的7979例孕妇为研究对象,按照有无血肿和出血面积与孕囊面积的比值分为三四组：正常组、少量出血组、中等量出血组,大量出血组,同时收集早孕超声检查正常、无任何并发症的妊娠孕妇102例为对照组,超声随访记录胎儿结构筛查期二维超声及彩色多普勒超声记录脐带附着部位,孕期严密随访至分娩,并于分娩或剖宫产后检查胎盘,观察是否存在胎盘、脐带异常妊娠中期胎盘厚度、胎盘附着面积大小、胎盘实质有无血池及有无脐带附着部位异常等观察指标,并进行χ2检验或Fisher’s 确切概率法检验。结果 7979例妊娠早期绒毛膜下出血,结构筛查期妊娠中期胎盘增厚、胎盘附着面积局限,胎盘实质内血池,以及脐带异常附着的发生率分别为64.56% 、46.84% 、53.16%、13.92%,其结果明显高于正常组,差异有统计学意义(P＜0.05);脐带附着胎盘形态异常的发生率随妊娠早期绒毛膜下出血程度的加重而增加,少量出血自行吸收快,对胎盘形态的影响脐带附着位置影响较小,胎盘增厚、胎盘附着面积局限,胎盘实质内血池,脐带异常附着发生率依次为30.30%、9.09%、27.27%、为3.03%,中等量出血发生率分别为：95.45%、72.73%、68.18%、13.64%,大量出血发生率分别为：83.33%、75.00%、75.00%、29.17%,差异具有统计学意义(P＜0.05)。结论 妊娠早期发生不同程度的绒毛膜下出血与,妊娠过程中脐带异常附着具有相关性,了解绒毛膜下出血对脐带附着位置的影响,进一步明确脐带附着异常的发病机制,胎盘形态更容易发生改变,超声监测妊娠早期血肿大小能间接反映胎盘功能,从而指导妊娠,最大限度减少不良妊娠的发生。     

妊娠早期绒毛膜下出血与胎盘脐带附着异常的关系研究

目的探讨妊娠早期绒毛膜下出血与脐带附着部位之间的关系,提高超声对脐带附着部位异常的检出率。方法选取我院经超声诊断为妊娠早期绒毛膜下出血的79例单胎妊娠孕妇(病例组),按照出血面积与孕囊面积的比值分为少量出血亚组33例、中等量出血亚组22例及大量出血亚组24例;另选同期妊娠早期超声检查正常且无任何并发症的102例单胎妊娠孕妇(对照组)。各组均于结构筛查期采用二维超声及彩色多普勒超声观察脐带附着部位,记录两组脐带附着部位情况及病例组不同亚组间脐带附着部位情况;分析不同亚组与脐带附着部位异常的关系。结果病例组脐带异常附着的发生率为13.92%,明显高于对照组(2.94%),差异有统计学意义(P0.05);病例组中,少量出血亚组、中等量出血亚组、大量出血亚组脐带附着部位异常发生率分别为3.03%、13.64%、29.17%,组间比较差异有统计学意义(P0.05);相关性分析显示,妊娠早期绒毛膜下出血程度与结构筛查期脐带附着部位异常呈正相关性(r=0.32,P0.05)。结论妊娠早期发生绒毛膜下出血会对脐带附着部位产生影响,两者呈正相关,即出血程度越高,脐带附着部位异常的发生率越高。     

彩色多普勒超声检测脐带螺旋指数与围产结局的相关性研究

目的探讨彩色多普勒超声检测脐带螺旋指数(UCI)与围产结局的关系。方法使用彩色多普勒超声对330例晚孕期孕妇自脐带胎盘端到胎儿脐部行多切面扫查,记录脐带扭转的图像特征,检测UCI。根据UCI测值将其分为3组:A组18例(UCI﹤0.07),B组284例(0.07﹤UCI﹤0.30),C组28例(UCI﹥0.30),分别计算胎儿窘迫、Apgar评分、宫内发育迟缓(IUGR)及脐动脉收缩压与舒张压比值(S/D)增高的发生率。对检测值范围内的病例于分娩后测量脐带长度,并计算旋转周数。结果所有孕妇UCI均值为(0.22±0.07)周/cm,第90百分位数为0.30周/cm,第10百分位数为0.07周/cm。B组脐动脐S/D、IUGR、胎儿窘迫和Apgar≤7分的发生率与A、C组比较差异有统计学意义(P﹤0.01),但A、C组比较差异无统计学意义。结论超声检测UCI结合脐动脉血流参数可为临床妊娠结局提供参考依据。彩色多普勒超声计算UCI为临床了解脐血管扭转情况提供了一种方便、快速、直观、准确的方法。     

彩超诊断胎儿脐带异常附着的临床意义

目的：探讨超声诊断脐带附着异常的临床意义。方法：收集我院经彩超诊断或产后证实胎儿脐带异常附着105例,并探讨其临床意义。结果：105例胎儿脐带异常附着,其中包括92例球拍胎盘,13例帆状胎盘,合并血管前置4例。临床上合并宫内发育迟缓2例,产前出血15例,胎儿宫内死亡3例。结论：彩超是诊断脐带异常附着重要检查方法,产前诊断能降低胎儿死亡率。     

彩超诊断胎儿脐带脱垂1例

病例 女，32岁，孕31周，破水、腹痛2小时，胎心率120-160次／分。     

孕早期脐带附着部位与围产期并发症间的相关性研究

目的应用超声筛查孕早期胎盘及脐带发育情况,探讨脐带附着部位与围产期并发症间的关系。方法选取于孕11～13﹢6周在我院行胎儿颈项透明层检查并分娩的孕妇400例,应用彩色多普勒超声于孕早期对脐带入口进行检查,根据脐带入口位置进行分组:脐带入口位于子宫下1/3段者为低入口组(80例),位于子宫中上2/3段者为正常入口组(320例)。分别于孕中期行超声检查是否存在前置胎盘、帆状胎盘、前置血管等胎盘、脐带异常,并随访至分娩,记录并比较两组分娩方式和围产期并发症、新生儿并发症发生情况,分析孕早期脐带低入口与围产期并发症间的相对危险度。结果两组脐带附着异常、前置胎盘、胎盘畸形、胎盘早剥、脐带脱垂发生率比较,差异均有统计学意义(均P0.05);两组分娩方式比较,差异无统计学意义。低入口组的新生儿低Apgar评分和产时胎心异常比例与正常入口组比较,差异均有统计学意义(均P0.05)。孕早期脐带低入口与脐带附着异常、前置胎盘、胎盘畸形、胎盘早剥和脐带脱垂的相对危险度分别为:5.12、7.29、2.04、8.81和10.10(均P0.05)。结论孕早期脐带附着于子宫下1/3段与胎盘及脐带发育异常相关,于孕早期进行脐带入口超声筛查对预测围产期并发症具有重要的意义。     

超声孕早期筛查脐带附着部位的相关性研究

【】目的：探究超声孕早期筛查胎盘及脐带发育异常可行性。方法：选取在孕11-13﹢6周在我院进行颈后透明带检查并在我院进行分娩的孕妇400例作为观察对象,采用彩色多普勒仪器对脐带入口进行检查,其中超声医师根据超声结果判断脐带入口位置进行分组,其中脐带入口位于子宫下1/3段的为低入口组,而脐带入口位于子宫中上1/3的归为正常入口组。分别在孕中期进行再次超声确认是否存在前置胎盘、帆状胎盘、前置血管等胎盘、脐带异常等不良情况,同时对孕妇进行严密的随访工作至分娩结束,并于分娩后对胎盘和脐带的情况进行观察记录。结果：低入口组的围产期并发症中除了胎盘与正常入口组不存在统计学差异之外,其他相关并发症(脐带附着异常、前置胎盘、胎盘异常表现、胎盘早剥、脐带脱垂)均存在统计学差异(χ2分别为：12.132、13.256、7.251、6.789、7.894, P值均<0.05);两组患者的分娩方式之间不存在统计学差异(P>0.05);在新生儿并发症比较中低入口组的新生儿低Apgar评分和产时胎心异常与正常入口组存在显著的统计学差异(χ2分别为：9.786和6.751,P值均<0.05);孕早期脐带低入口与脐带附着异常、前置胎盘、胎盘异常表现、胎盘早剥和脐带脱垂的相对危险度分别为：5.12、7.29、2.04、8.81与10.1, P值均<0.05;结论：孕早期的异常脐带入口超声筛查结果与脐带的发育结果具有相关性,同时在孕早期进行脐带入口超声筛查异常胎盘和脐带具有重要的意义,具有较好的可行性。     

脐带附着异常49例临床分析

脐带一般附着于胎盘中央和侧方,球拍状胎盘和帆状胎盘属脐带附着异常,当二者中有血管前置破裂,可造成胎儿短时间内失血死亡.作者收集本院12年49例脐带附着异常的病例,分析其临床经过和围产儿结局;现报道如下.     

Absence of a relationship between umbilical cord thickness and coiling patterns.

OBJECTIVE: The purpose of this study was to evaluate a relationship between the umbilical cord thickness and cord coiling patterns during the fetal sonographic anatomic survey in the second trimester of pregnancy. METHODS: This was a prospective study of 470 patients with singleton pregnancies who had a fetal anatomic survey with recorded umbilical coiling patterns between 18 and 23 weeks' gestation. The umbilical cord thickness was assessed as an umbilical diameter at the level of the fetal abdominal cord insertion and compared with the antenatal umbilical coiling index (aUCI), calculated as a reciprocal value of the distance between a pair of umbilical cord coils. RESULTS: Three hundred twenty-one patients had adequate sonographic umbilical cord images and maternal demographic, antenatal, and labor data to meet inclusion criteria. The mean aUCI was 0.41 with 10th and 90th percentiles of 0.21 and 0.60, respectively. A total of 10.6% (34/321) and 9.3% (30/321) of patients were categorized as having hypocoiled and hypercoiled umbilical cords, respectively. The mean cord diameter +/- SD was 9.48 +/- 0.97 mm (range 7.0-12.5 mm). There was no statistically significant correlation between aUCI and umbilical cord thickness (P = .1164). CONCLUSIONS: An aUCI, or umbilical coiling pattern, does not correlate with umbilical cord thickness. It appears that a lesser amount of the umbilical supportive tissue, mainly Wharton jelly, is not related to an increased umbilical cord coiling pattern.     

Assessment of umbilical cord coiling during the routine fetal sonographic anatomic survey in the second trimester.

OBJECTIVE: The purpose of this study was to evaluate the sonographic accuracy to determine the umbilical coiling index (UCI) during the routine fetal anatomic survey in the second trimester. METHODS: In 300 consecutive women with singleton pregnancies and absence of gross fetal anomalies who had a routine second-trimester fetal anatomic survey, a distance between 2 pairs of coils was measured from the longitudinal images of the umbilical cord, and the antenatal UCI (aUCI) was calculated. The aUCI was compared with true UCI results obtained after birth. RESULTS: Two hundred thirty-six patients had adequate sonographic umbilical cord images, and all required demographic, antenatal, and labor data collection to meet the inclusion criteria. A statistically significant correlation between aUCI and true UCI was found (P < .0001; r = 0.643). The mean aUCI was 0.402 (80% confidence interval, 0.382), and the true UCI at birth was 0.203 (80% confidence interval, 0.176). The sonographic evaluation showed 12.3% and 8.9% of hypocoiled and hypercoiled cords, whereas evaluation at birth found 10.6% and 8.1% hypocoiled and hypercoiled umbilical cords, respectively. The sensitivity values of sonography to predict hypocoiling and hypercoiling at birth were 78.9% and 25.4%, respectively. CONCLUSIONS: A sonographic evaluation of umbilical cord coiling in the second trimester correlates with the true UCI at birth, although the sensitivity in predicting coiling patterns as hypocoiled and hypercoiled cords is less accurate. A difference between the aUCI and matched UCI at birth could be explained by a sonographic error in the sampling of different umbilical cord segments with discordant coiling patterns or the possibility of a dynamically evolving UCI with advancing gestational age.     

Sonographic evaluation of umbilical cord insertion with umbilical coiling index.

PURPOSE: The aim of this study was to investigate the association between umbilical cord hypocoiling and abnormal placental insertion of the umbilical cord. METHODS: Umbilical coiling was measured by sonography in 253 pregnant women in their second or third trimester. An umbilical coiling index, defined here as the reciprocal of the length of 1 umbilical vascular coil, of less than 0.1 was considered hypocoiled. The distance from the placental edge to the insertion of the umbilical cord was measured after delivery, and the results were used to classify cord insertion as normal, marginal, or velamentous. RESULTS: Cord insertion was abnormal in 66.7% of the fetuses with umbilical hypocoiling but in only 1.3% of those whose coiling index was > or = 0.1 (p < 0.05). CONCLUSIONS: Hypocoiling of the umbilical cord was highly associated with abnormal cord insertion. The presence of a hypocoiled umbilical cord may indicate the presence of abnormal cord insertion and thus may be useful for obstetric management.     

超声评价脐带螺旋异常与不良围生结局的研究进展

脐带的发展对胎儿的健康和生存至关重要。近年来,临床医师已注意到脐带螺旋异常与多种不良围生结局相关,产前超声检查对诊断脐带螺旋异常有重要意义。本文就脐带螺旋的发生及判断、螺旋异常对妊娠和围生结局的影响、超声评价螺旋异常的价值做一综述。     

Velamentous insertion of the umbilical cord: a first-trimester sonographic screening study.

OBJECTIVE: The purpose of this study was to determine the feasibility of prenatal sonography for detecting velamentous insertion of the umbilical cord in singleton pregnancies at the 11- to 14-week scan. METHODS: The placental umbilical cord insertion site was prospectively examined at the time of the routine first-trimester scan between 11 and 14 weeks as part of ongoing first-trimester sonographic screening for chromosomal abnormalities. RESULTS: Over a 1-year period, 533 consecutive singleton pregnancies were examined by a fetal medicine specialist at a median gestational age of 12 weeks. In 5 cases, a velamentous umbilical cord insertion was diagnosed, with a prevalence rate of 1 (0.9%) per 107. The diagnosis was further confirmed at the second-trimester scan and at the time of delivery in all cases. CONCLUSIONS: The placental umbilical cord insertion site can be readily determined by sonography at the time of the 11- to 14-week scan. Sonographic examination at this early gestational age provides the opportunity for screening for velamentous insertion of the umbilical cord in the first trimester, allowing close surveillance of the pregnancy for potential complications associated with this condition.     

Prenatal color Doppler sonographic evaluation of nuchal encirclement by the umbilical cord

PURPOSE: The aim of this study was to assess whether Doppler flow velocimetry of the fetal middle cerebral and umbilical arteries is affected by nuchal encirclement by the umbilical cord (nuchal cord) in the prenatal period. PATIENTS AND METHODS: The position of the fetal umbilical cord was assessed on color Doppler sonography in pregnant women who were referred to our radiology department between September 14, 1998, and January 14, 2000. Pulsatility and resistance indices and the ratio of peak systolic blood flow velocity to diastolic velocity of the umbilical arteries and middle cerebral arteries of all fetuses were prospectively obtained with Doppler flow velocimetry. The fetuses were categorized into 2 groups: group 1 consisted of fetuses without sonographic evidence of nuchal cord and group 2 of fetuses with sonographic evidence of nuchal cord. The results were statistically analyzed with independent-groups t test. A p value of less than 0.05 was considered significant. RESULTS: During the study period, 230 pregnant women underwent sonographic examination of the fetus, and 68 fetuses were delivered. The sonographic examinations were performed at 24-41 weeks' menstrual age. Of the 46 fetuses in group 1, 1 fetus had nuchal cord at delivery; of the 22 fetuses in group 2, 4 did not have nuchal cord at delivery. The sensitivity of color Doppler sonography in detecting nuchal cord was 95% (18 of 19 fetuses), the specificity was 92% (45 of 49), the negative predictive value was 98% (45 of 46), and the positive predictive value was 82% (18 of 22). No statistically significant differences in middle cerebral artery or umbilical artery Doppler flow velocimetry values were detected between the 2 groups. CONCLUSIONS: Color Doppler sonography is a sensitive and specific method of diagnosing nuchal cord, but fetal middle cerebral artery and umbilical artery Doppler flow velocimetry values are not affected by the presence of nuchal cord in the prenatal period.     

人脐血单个核细胞和脐带间充质干细胞移植用于大鼠脊髓损伤的实验研究

目的:探讨人脐血单个核细胞和脐带间充质干细胞(MSCs)移植对脊髓损伤功能恢复的影响,寻找一种更适合治疗脊髓损伤的细胞源。方法:采集新鲜人脐带血和脐带,分离培养单个核细胞和MSCs。将脊髓损伤模型随机分成3组:单个核细胞移植组、MSCs移植组和低糖必需培养基(L-DMEM)培养组。采用免疫组化和免疫荧光检测细胞移植后1—4周细胞在脊髓内的存活情况和迁移情况,使用BBB行为学评分评估大鼠脊髓功能恢复情况。结果:L-DMEM培养液组在术后各时间点观察评分无明显差异,而细胞移植组脊髓功能处于逐渐恢复过程,与L-DMEM培养液比较,差异有显著性意义。单个核细胞移植组对损伤脊髓功能的修复作用较MSCs移植组显著,且差异有显著性意义。结论:与MSCs相比较,人脐血单个核细胞更适合作为治疗脊髓损伤的细胞源。     

人脐带和骨髓源间充质干细胞对脐血单个核细胞增殖能力的影响

目的：探讨人脐带间充质干细胞（UCMSCs）与骨髓间充质干细胞（BMMSCs）在体外对造血干细胞的支持作用。方法分别从人脐带和骨髓中分离、培养间充质干细胞,通过免疫细胞化学染色等方法对其进行表型鉴定;采用流式细胞仪测定脐血单个核细胞的周期分布,采用甲基纤维素法测定脐血单个核细胞混合集落形成单位（CFU-Mix）,比较 UCMSCs和BMMSCs对脐血单个核细胞细胞周期、CFU-Mix形成能力的影响。结果成功培养获得 UCMSCs和BMMSCs,鉴定结果符合预期;与非共培养组细胞相比,UCMSCs和 BMMSCs共培养均能促进脐血单个核细胞进入增殖周期,并增加其形成CFU-Mix的能力（P＜0．05）,但UCMSCs和BMMSCs共培养组之间比较差异无统计学意义（P＞0．05）。结论成功从人脐带和骨髓组织中培养获得间充质干细胞,两种来源的间充质干细胞均能提高脐血单个核细胞的体外增殖能力及 CFU-Mix形成能力,均具有造血支持作用。     

新生儿脐带结扎方法的研究进展

描述新生儿脐带结扎的历史进展,总结棉线结扎、脐带夹结扎与气门芯结扎的优缺点。