妊娠肝内胆汁淤积症孕妇及其新生儿血清总胆酸水平变化对胎儿心脏功能的影响

目的 探讨妊娠肝内胆汁淤积症(ICP)孕妇及其新生儿脐动脉血(脐血)血清总胆酸(TBA)水平变化对胎儿心脏功能的影响.方法 应用循环酶法测定30例ICP孕妇(ICP组)及30例正常妊娠妇女(对照组)外周静脉血及其新生儿脐血TBA水平,单克隆夹心酶联免疫法测定新生儿脐血心肌肌钙蛋白I(cTnI)水平,用彩色多普勒超声诊断仪测定胎儿左心室Tei指数.结果 (1)TBA:ICP组孕妇血清TBA水平为(36.0±9.6)μmol/L,新生儿脐血TBA水平为(10.1±2.0)μmol/L;分别高于对照组的(3.8±0.9)、(5.5±0.4)μmol/L,差异均有统计学意义(P<0.01),且ICP组孕妇血清TBA水平明显高于其分娩的新生儿脐血TBA水平,两者比较,差异有统计学意义(P<0.01),对照组孕妇血清TBA水平明显低于其分娩的新生儿脐血TBA水平,两者比较,差异也有统计学意义(P<0.01).(2)Tei指数:ICP组胎儿左心室Tei指数为0.58±0.04,明显高于对照组的0.43±0.03,差异有统计学意义(P<0.01).(3)cTnI:ICP组新生儿脐血cTnI水平为(0.92±0.23)μg/L,明显高于对照组的(0.52±0.10)μg/L,差异也有统计学意义(P<0.01).(4)ICP组脐血TBA水平与孕妇血清TBA、脐血cTnI水平及胎儿左心室Tei指数均呈正相关关系(r=0.769、0.635、0.758,P<0.01);脐血cTnI水平与胎儿左心室Tei指数呈正相关关系(r=0.637,P<0.01).结论ICP胎儿存在左心室功能异常及心肌损伤,这种损伤可能与孕妇血TBA水平升高有密切关系;胎儿左心室Tei指数可作为监测ICP胎儿心脏功能及心肌损伤程度的指标.     

脐血乳酸水平、产时胎心监护不良图形和新生儿结局关系的研究

目的:研究脐动脉血乳酸水平与产时胎心监护不良图形及新生儿结局之间的关系。方法:229例足月妊娠、单胎、头位产妇根据产时胎心宫缩图(cardiotocography,CTG)分为两组,观察组:轻度变异减速(variable deceleration,VD)68例、不良CTG包括中、重度VD、不典型VD、胎心基线变异减弱或消失、延长减速、重度晚期减速及心动过缓84例。对照组:产时CTG无VD及不良图形、新生儿脐动脉血pH≥7.20的产妇77例,检测新生儿脐动脉血乳酸浓度及生后20项行为神经评分(neonatal behavioral neudogioal as-sessment,NBNA)。结果:对照组脐动脉血乳酸99%参考值范围为1.31~4.05mmol/L,不良CTG脐血乳酸水平明显高于对照组(P<0.01);pH、BE值显著低于对照组与轻度VD组(P<0.01,P<0.05),脐血乳酸水平与pH、BE呈显著负相关(P<0.01)。以对照组x-±2.58s为界值,观察组脐血乳酸超过界值者不良CTG占73.33%,其中不良结局儿占68.18%。结论:脐动脉乳酸水平与pH、BE值有较好的相关性。产时重度VD或VD并存其它异常CTG,胎心基线变异减弱,尤其伴发羊水粪染、脐带异常时与围生儿脐血高乳酸水平、不良结局有关。     

妊娠肝内胆汁淤积症孕妇胎儿总胆酸水平对胎儿胰腺内分泌功能及胎儿生长发育的影响

目的 探讨妊娠肝内胆汁淤积症(ICP)孕妇的胎儿总胆酸水平与胎儿胰腺内分泌功能变化的关系及其对胎儿生长发育的影响.方法 选择2007年3月至2008年2月在中南大学湘雅二医院妇产科行剖宫产分娩的30例单胎ICP孕妇为ICP组,同期行剖宫产分娩的30例正常单胎孕妇为对照组.采用放射免疫法测定两组新生儿脐动脉血中胰岛素、胰高糖素水平;循环酶法测定总胆酸水平;氧化酶-过氧化物法测定血糖水平.并测量两组新生儿出生体重、身长,计算肥胖指数(PI).结果 (1)ICP组新生儿脐动脉血中胰岛素水平为(9.0±3.3)mU/L、胰岛素/胰高糖素比值为0.048±0.028,分别低于对照组的(10.1±3.7)mU/L及0.050±0.020,差异有统计学意义(P<0.05);ICP组新生儿脐动脉血中总胆酸水平为(10.3±3.8)μmol/L、胰高糖素水平为(235±57)ns/L,分别高于对照组的(4.1±1.3)μmol/L及(205±34)ng/L,差异有统计学意义(P<0.05);ICP组新生儿脐动脉血中血糖水平为(3.4±1.1)mmol/L,对照组为(3.6±1.2)mmol/L,两组比较,差异无统计学意义(P>0.05).(2)ICP组新生儿出生体重及身长分别为(3163±478)g及(46.5±2.3)cm,对照组分别为(3498±393)g及(49.3±1.9)cm,两组分别比较,差异均有统计学意义(P<0.01);ICP组新生儿PI(3.13±0.23)明显高于对照组(2.92±0.29),差异有统计学意义(P<0.01).(3)ICP组新生儿总胆酸水平分别与胰岛素、胰高糖素水平及胰岛素/胰高糖素比值呈直线关系,且随着总胆酸水平的升高,胰岛素水平及胰岛素/胰高糖素比值均降低,胰高糖素水平升高(P<0.01);ICP组新生儿脐动脉血中胰岛素水平及胰岛素/胰高糖素比值分别与出生体重、身长呈正相关,与PI呈负相关(P均<0.01);而胰高糖素水平与出生体重、身长呈负相关,与PI呈正相关(P均<0.01).结论 ICP孕妇的胎儿存在胰岛素分泌不足,胰高糖素分泌增多,胰岛素/胰高糖素比值下降的情况,其变化与脐动脉血总胆酸水平密切相关;胎儿胰腺内分泌功能变化可能影响胎儿的生长发育.     

妊娠期肝内胆汁淤积症胎儿监护与围生儿预后关系分析

目的:探讨对妊娠期肝内胆汁淤积症(ICP)孕妇进行胎儿监护的临床价值。方法:对223例ICP孕妇进行无负荷试验(NST),其中89例进行缩宫素激惹试验(OCT),所有孕妇均进行超声脐动脉血流分析及肝功能检测。结果:OCT和超声脐血流分析结果异常者的围生儿预后不良发生率分别为63.89%和21.43%,明显高于正常者的16.98%和11.11%(P<0.05,P<0.05)。NST正常者和异常者的围生儿预后不良发生率无明显差异。ICP患者的胎儿窘迫、新生儿窒息、早产、胎儿电子监测异常及脐血流异常高于正常组。ICP组中总胆汁酸大于50μmol/L组的胎儿电子监护异常及脐血流S/D值异常的发生率,均高于其他两组。结论:OCT和超声脐动脉血流分析对了解ICP孕妇胎盘功能和预测围生儿预后具有较高的临床价值。     

妊娠肝内胆汁淤积症胎儿总胆汁酸浓度与肾上腺皮质功能变化的关系

目的　探讨妊娠肝内胆汁淤积症(ICP)胎儿总胆汁酸浓度与胎儿肾上腺皮质功能变化的关系。　方法　采用放射免疫法测定正常孕妇22例(对照组)及ICP孕妇20例(ICP组)胎儿脐血皮质醇及硫酸脱氢表雄酮(DHEA S)浓度;循环酶法测定两组母血及脐血总胆汁酸浓度。　结果　ICP组胎儿脐血总胆汁酸浓度(8.93±3.16) mmol/L高于对照组(4.33±1.51) mmol/L,两组比较有显著性差异(P<0. 05),且与母血胆汁酸浓度呈正相关。ICP 组脐血皮质醇浓度(99. 83±41. 34)ng/ml与对照组(74.93±29.58)ng/ml相比无明显差别(P>0.05)。ICP组脐血DHEA S浓度(24.62±8.89)μg/dl明显低于对照组(69.18±39.37)μg/dl,两组比较有显著性差异(P<0.05)。ICP组脐血DHEA S与皮质醇比值(0.29±0.09)亦明显低于对照组(0.87±0.31),两组比较有显著性差异(P<0.05)。ICP组脐血皮质醇、DHEA S浓度及DHEA S与皮质醇比值均与脐血胆汁酸浓度相关(相关系数分别为:r1= 0.87,r2=-0.88,r3=-0.84;P<0.05)。　结论　ICP孕妇的胎儿总胆汁酸浓度增高,与母血总胆汁酸浓度呈正相关;ICP孕妇的胎儿肾上腺皮质功能受损,其受损程度与脐血总胆汁酸浓度呈正相关。     

胎盘MDR3的表达及其与妊娠期肝内胆汁淤积症关系的研究

目的探讨妊娠期肝内胆汁淤积症(intrahepatic cholestasis of pregnancy,ICP)胎盘中胆盐载体磷脂输出泵(multidrug resistance p-plycoprotein,MDR3)的表达,以及母、胎血中总胆汁酸(total bile acids,TBA)和甘胆酸(cholylglycine,CG)水平的变化;进一步分析胎盘胆盐载体对胆汁酸水平的调节作用及其与ICP的关系。方法ICP(ICP组)及正常妊娠(对照组)孕妇各20例。母血、胎儿脐静脉血中TBA、CG水平的测定分别采用放射免疫法和速率法;胎盘组织中胆盐载体MDR3 mRNA的表达采用荧光定量PCR法。结果(1)ICP组母血、脐血中的TBA、CG水平均高于对照组(P<0.05)。ICP组母血TBA水平高于脐血(25.8±16.6和8.6±5.5)μmol/L,CG水平高于脐血(3416.1±1986.0和821.8±673.2)μg/dL(P<0.05);对照组母血和脐血TBA水平(3.4±2.5和4.4±3.3)μmol/L,CG水平(342.7±234.9和309.3±145.2)μg/dL比较,差异无统计学意义(P>0.05)。(2)ICP和正常妊娠各期胎盘组织中均有MDR3 mRNA的表达。ICP组MDR3 mRNA表达量低于对照组(0.80±0.67和162.63±334.33)拷贝/ng(P<0.05)。(3)ICP组、对照组胎盘中MDR3 mRNA表达量与母血、脐血中TBA和CG水平均无相关性(r=-0.60~0.165,P>0.05)。结论ICP胎盘胆盐载体MDR3 mRNA表达降低,可能引起ICP胎盘对胆汁酸的转运障碍、胎儿体内胆汁淤积,可能是引起ICP胎儿窘迫的原因。     

活跃期羊水乳酸水平对单纯胎心基线变异性降低胎儿窘迫的预测价值

目的探讨活跃期羊水乳酸水平对单纯胎心基线变异性降低胎儿窘迫预测价值。方法暨南大学第二附属医院2004年5月至2008年9月,选择162例在活跃期胎心电子监护中出现单纯胎心基线变异性降低的足月、单胎、头位的初产妇,随机分为研究组82例,胎心电子监护同时经阴道取羊水测定乳酸水平;对照组80例仅行胎心电子监护。比较两组的剖宫产率、胎儿窘迫发生率及研究组脐动脉血pH值与出生前1h内羊水乳酸值的相关性。结果研究组脐动脉血pH值与出生前1h内羊水乳酸水平具有明显的负相关性(r=-0.752,P<0.01)。研究组17例脐动脉血pH<7.20者羊水乳酸水平为(11.06±1.82)mmol/L,较脐动脉血pH≥7.20者羊水乳酸水平(7.45±1.19)mmol/L明显升高(P<0.05)。研究组剖宫产率为35.4%,明显低于对照组的52.5%,两者比较差异有统计学意义(P<0.05);研究组脐动脉血pH<7.20发生率较对照组明显降低(分别为20.7%和36.2%),差异有统计学意义(P<0.05);羊水乳酸值>8.9mmol/L为异常值诊断单纯胎心基线变异性降低胎儿窘迫的敏感度、特异度、阳性预测值及阴性预测值分别为82...     

母胎循环中PGE2浓度与慢性胎儿窘迫的相关性研究

目的探讨母胎循环中前列腺素E2浓度与慢性胎儿窘迫发生的相关性.方法以孕晚期(37～42孕周)未临产孕妇为研究对象,根据慢性胎儿窘迫诊断标准划分为窘迫组36例与对照组30例,分别采集产前母血及分娩时脐动脉血测定PGE2浓度,同时留取脐动脉血进行血气分析.结果胎儿窘迫组母血及脐血PGE2浓度在明显低于对照组(P＜0.01;P＜0.05);母血PGE2浓度与新生儿Apgar评分呈正相关(r=0.41;P＜0.05).结论母胎循环中的PGE2水平与胎儿窘迫的发生相关,晚孕期母血中PGE2低值可能有助于慢性胎儿窘迫的诊断.     

胎盘法尼醇X受体的表达及其与妊娠期肝内胆汁淤积症关系的研究

目的:探讨法尼醇X受体(FXR)在正常晚孕胎盘和妊娠期肝内胆汁淤积症(ICP)胎盘的表达,及其与母血、脐血总胆汁酸(TBA)水平的关系,分析胎盘FXR在ICP病理机制中的作用.方法:收集ICP患者(ICP组)及正常晚孕妇女(对照组)胎盘组织及母血、脐血各33例,并将ICP患者根据母血血清TBA是否≥40 μmoL/L将ICP组分为轻度ICP组和重度ICP组.并测定母血、脐血TBA水平和胎盘组织中FXR mRNA的相对表达量.结果:①羊水胎粪污染的发生率:ICP组羊水污染发生率高于对照组(χ~2:7.543,P=0.013);重度ICP组高于轻度ICP组(χ~2=7.637,P=0.013);②胎盘组织中FXR mRNA的表达情况:ICP组胎盘FXR mRNA表达量高于对照组(z=-2.391,P=0.017);重度ICP组胎盘FXR mRNA表达量高于轻度ICP组(z=-2.391,P=0.017);③ICP组胎盘FXR mRNA表达量与母血、脐血TBA呈正相关(r_s=0.348,P=0.047;r_s=0.284,P=0.027);对照组胎盘FXR mRNA表达量与母血、脐静脉血TBA无相关性(r_s=-0.068,P=0.716;r_s=0.010,P=0.959).结论:ICP时增高的胆汁酸水平上调胎盘FXRmRNA的表达,胎盘FXR表达增加可能为ICP时胎盘的一种对抗胎儿胆汁淤积的保护性机制.     

母血和脐血中HIF-1α、VEGF-A、PlGF的表达和胎儿生长受限的相关性分析

目的探讨母血和脐血中缺氧诱导因子-1α(HIF-1α)、血管内皮生长因子-A(VEGF-A)、胎盘生长因子(PlGF)的表达和胎儿生长受限的相关性分析。方法选择2017年7月至2019年7月广东省妇幼保健院接诊的80例产科住院分娩的生长受限的患儿为生长受限组,并选择同期接诊的80例住院分娩的正常胎儿作为对照组,比较两组新生儿生长发育指标、脐动脉血流指标、母血和脐血中血清HIF-1α、VEGF-A、PlGF的表达情况,分析其相关性。结果生长受限组新生儿的胎盘质量、出生体重、出生头围和出生身长均低于对照组(P 0.05);生长受限组脐动脉血流的RI、PI和S/D指标水平均高于对照组,母血和脐血中HIF-1α高于对照组,VEGF-A、PlGF均低于对照组(P 0.05);Spearman相关分析显示,血清HIF-1α和新生儿的出生体重、出生头围、出生身长、RI、PI、S/D均呈相关,和VEGF-A、PlGF均呈正相关(P 0.05)。结论生长受限胎儿的母血和脐血中HIF-1α表达升高,VEGF-A、PlGF的表达均降低,和出生体重、出生头围和出生身长、脐动脉血流之间密切相关。     

Doppler examinations of fetal and uteroplacental blood flow in AGA and IUGR fetuses before and after maternal physical exercise with the bicycle ergometer

OBJECTIVE: To study changes in uteroplacental and fetal circulation after maternal exercise in appropriate-for-gestational-age fetuses (AGA) and intrauterine-growth-retarded fetuses (IUGR). MATERIALS AND METHOD: 33 women with an uncomplicated course of pregnancy and ten women with IUGR were examined. Physical stress was caused through a bicycle ergometer with 1.25 W/kg maternal weight. Doppler examinations were performed in the umbilical artery, fetal aorta, middle cerebral and in the uterine artery. Fetal heart rate was documented by monitoring. Maternal lactate and glucose levels as well as maternal blood pressure and heart rate were recorded. RESULTS: No significant changes after cycling could be observed in umbilical and uterine vessels either in the normal pregnancies or in pregnancies with IUGR. In contrast, in the fetal aorta an increase of the RI was recorded in both groups (an increase of 16% [P<0.01] and 18% [P<0.05], respectively for AGA and IUGR cases). In cerebral arteries a decrease of the RI was observed after cycling in both groups (a decrease of 24% [P<0.01] and 13% [P<0.05], respectively for AGA and IUGR cases). In AGA fetuses the RI of the aorta and middle cerebral artery returned to pre-test level by the 18th minute of examination. In IUGR fetuses the RI of the aorta and middle cerebral artery did not return to pre-test levels at the end of the test. Fetal heart rate remained unchanged in both groups. Maternal blood pressure and heart rate increased during the exertion phase but returned to initial values at the end of the test. A 21% and 24% (for AGA and IUGR groups respectively) reduction of maternal glucose values after exercise was observed (P<0.001). Lactate values doubled in both groups after exercise (P<0.001). CONCLUSION: From the results obtained we conclude that maternal exercise does not significantly alter uterine and umbilical perfusion in AGA and IUGR pregnancies, suggesting an absence of change in the uterine vascular bed resistance. However, submaximal maternal exercise was followed by fetal cerebral vasodilatation and an increase of resistance in the fetal aorta that was more evident in IUGR fetuses. This might be due to slight fetal hemoglobin desaturation in those cases.     

血液动力学指标预测胎儿缺氧及酸中毒的价值

目的：评价血液动力学指标预测胎儿缺氧及酸中毒的价值。方法：用彩色多普勒超声检测了４６例正常晚期妊娠（正常组）和３２例高危妊娠（高危组）妇女子宫动脉（ＵｔＡ）和胎儿脐动脉（ＵｍＡ）、大脑中动脉（ＭＣＡ）、肾动脉（ＲＡ）的血流速度波型，并且测定高危组脐动脉血气。结果：高危组ＵｔＡ、ＵｍＡ、ＲＡ的阻力指数（ＲＩ）、搏动指数（ＰＩ）及收缩期最大血流速度（Ｓ）与舒张末期血流速度（Ｄ）的比值（Ｓ／Ｄ值）均高于正常组，而ＭＣＡ的ＰＩ及Ｓ／Ｄ值均明显低于正常组（Ｐ＜０．０５）。与ＵｍＡＰＯ２＞２．５ｋＰａ的高危妊娠病例比较，ＵｍＡＰＯ２≤２．５ｋＰａ者ＵｔＡ的Ｓ／Ｄ值、ＵｍＡ的ＰＩ、Ｓ／Ｄ值以及ＲＡ的ＲＩ、ＰＩ、Ｓ／Ｄ值均明显增高，ＭＣＡ的ＰＩ明显降低（Ｐ＜０．０５）。ＵｍＡ及ＲＡ的ＰＩ与ＵｍＡＰＯ２和ｐＨ值呈负相关，与ＰＣＯ２呈正相关；ＭＣＡ的ＰＩ与ＵｍＡ的ｐＨ、ＰＯ２呈正相关，与ＰＣＯ２呈负相关。结论：高危妊娠胎儿缺氧时ＭＣＡ血流阻力降低，而周围血管，特别是肾血管血流阻力明显升高；胎儿血液动力学变化与缺氧及酸碱平衡失调呈良好相关性，可预测胎儿缺氧及酸中毒的程度。     

硝酸甘油对高危妊娠胎儿—胎盘血流动力学的影响

应用Acuson-128彩色电脑声像仪监测12例高危妊娠孕妇应用硝酸甘油前后的脐动脉、胎儿大脑中动脉,胎儿腹主动脉的血流动力学变化。结果:用药后脐动脉的搏动指数(PI),阻力指数(RI)和S/D值均显著降低(P<0.001),胎儿大脑中动脉和胎儿腹主动脉的PI、RI和S/D值无显著改变,呈现良好的耐受性,表明应用硝酸甘油可明显降低脐-胎盘血管阻力,是改善胎儿血氧供应的简便、有效方法,并对硝酸甘油的作用机理进行了讨论。     

正常晚期妊娠胎儿脐动脉,大脑中动脉及腹主动脉血流速度波形与？…

目的 探讨正常妊娠胎儿血流速度波形与胎儿血气的相关性,方法 应用彩色多普勒超声对４５例正常晚期妊娠初孕妇女于剖宫产术时２４小时内进行胎儿脐动脉（ＵＡ）,大脑中动脉（ＭＣＡ）及腹主动脉（ＡｂＡｏ）的血流速度波形（ＦＶＷｓ）检查,计算搏动指数（ＰＩ）,阻力指数（ＲＩ）及收缩期最大血流速度（Ｓ）与舒张末期血流速度（Ｄ）的比值（Ｓ／Ｄ）,同时对剖宫产分娩的新生称立即进行脐动脉血气ｐＨ,二氧化碳分压（ＰＣＯ     

正常晚期妊娠胎儿脐动脉、大脑中动脉及腹主动脉血流速度波形与胎儿血气相关性探讨

目的探讨正常妊娠胎儿血流速度波形与胎儿血气的相关性。方法应用彩色多普勒超声对４５例正常晚期妊娠初孕妇女于剖宫产术前２４小时内进行胎儿脐动脉（ＵＡ）、大脑中动脉（ＭＣＡ）及腹主动脉（ＡｂＡｏ）的血流速度波形（ＦＶＷｓ）检查，计算搏动指数（ＰＩ）、阻力指数（ＲＩ）及收缩期最大血流速度（Ｓ）与舒张末期血流速度（Ｄ）的比值（Ｓ／Ｄ），同时对剖宫产分娩的新生儿立即进行脐动脉血气ｐＨ、二氧化碳分压（ＰＣＯ２）、氧分压（ＰＯ２）测定。结果ＵＡＲＩ与血ｐＨ、ＰＯ２呈明显负相关（Ｐ＜０．０１，Ｐ＜０．０５），与ＰＣＯ２呈正相关（Ｐ＜０．０５），ＭＣＡＲＩ与血ｐＨ、ＰＯ２呈明显正相关（Ｐ＜０．０１，Ｐ＜０．０５），与ＰＣＯ２呈负相关（Ｐ＜０．０５）。结论产前监测ＵＡ及ＭＣＡ的血流速度波形，可间接了解胎儿血气情况，及时判断胎儿宫内安危的状况。     

Fetal grasping of the umbilical cord and perinatal outcome

This study assessed perinatal outcome in pregnancies with accidentally diagnosed fetal grasping of the umbilical cord (FGUC) on ultrasonography (US) in late gestation as a possible cause of fetal hypoxia due to mechanical occlusion of umbilical circulation. In this retrospective clinical study, routine antenatal US examination revealed FGUC from 32 to 41 weeks of gestation in seven normal single pregnancies. Upon FGUC findings, fetal condition was followed up every second day by repeat US findings of FGUC, and then by Doppler parameters of fetoplacental circulation measurement of resistance index in umbilical artery (URI) and middle cerebral artery (CRI), and cardiotocography (CTG), and perinatal outcome (peripartal cardiotocography, 5-min Apgar score, umbilical arterial blood pH, occurrence of meconium amniotic fluid, need of additional treatment at neonatal intensive care unit (NICU), and mode of pregnancy termination (cesarean section, forceps or vacuum extraction-VE for hypoxia). After delivery, neonatal neurosonography and neonatal complications related to pregnancy or birth were evaluated. All URI values were increased, resulting from persistent FGUC and elevated umbilical arterial RI. CRI showed great oscillations in the values for gestational age and decreased CRI. In two cases, cerebral/umbilical ratio was less than 1, indicating initial vasocentralization as a fetal compensatory mechanism for hypoxia. In these cases, a pathological peripartal CTG and pH 7.23, indicative of preacidosis, were verified. All children were discharged from NICU as healthy, free from neurological lesions, with the exception of the latter, who had dystonia syndrome and mild motor deficit as a sign of peripartal hypoxia. Although it probably belongs to normal reflexes, intermittent FGUC should be US controlled. Persistent FGUC should be considered pathological for its possible hypoxic effect and umbilical circulation obstruction. These pregnant women should be hospitalized and closely monitored, as in part confirmed by the present study.     

Relationship between Doppler velocimetry at middle cerebral artery and umbilical artery and status of newborn

Aim of investigations was qualification of account between Doppler parameters in estimation of fetal state. Investigations one passed on 30 fetuses and newborn children in pregnancies brought. Doppler parameters one priced at use of sonographic device Toshiba SSH 140 A/G and searchers of type convex about working frequency 3.75 MHz. Following Doppler flow blood parameters were analyzed: maximum blood speed (V1) average blood speed (V2) and minimum blood speed (V3), systolic/diastolic ratio (S/D), resistance index (RI), pulsatile index (PI) and proper flow in umbilical cord vein (MF) in following dishes of feto-placental circulation: middle cerebral artery (MCA) and umbilical cord artery (UA). Acid-base equilibrium and gasometry of blood in umbilical cord dishes one marked at use of device Ciba-Corning 278 Blood Gas System and parameters of oxygenation of blood at use of device Ciba-Corning 270 CO-OXIMETER. At new-born children one priced pH-metry (pH) and gasometry (pO2, pCO2, BAA) in blood umbilical cord arterial and venous were measured. The newborn children were estimated by Apgar score. There were following essential statistical correlations between Doppler parameters of fetal blood flow and with parameters of acid-base equilibrium of new-born child: 1/ between V2 and V3 in UA and with supply of rules (BAA) in UV (p = 0.027; p = 0.009) and UA (p = 0.035; p = 0.003) and venous pH (p = 0.022; p = 0.009); 2/ between RI in UA and BAA in UV (p = 0.006) and UA (p = 0.010); 3/ between PI in UA and BAA in UV (p < 0.0001) and UA (p < 0.0001) and pH venous (p < 0.0001). We can conclude that Doppler investigations only by measure of parameters of blood flow in middle cerebral artery and umbilical artery in expectation of state of birth new-born child priced across parameters of acid-base equilibrium and Apgar score are not very useful, however they are helpful.     

Prognostic Doppler ultrasound examination of fetal arteries blood flow

Early detection of fetal risk is one of the main issues in today obstetrics. Ultrasound diagnostics plays a significant role, as the introduction of Doppler imaging method in the evaluation of blood flow has enabled non-invasive assessment of uteroplacental circulation. Therefore, we have analysed foetal three arteries: umbilical artery, middle cerebral artery and renal artery after determining the normal range for the analysed parameters. AIM OF WORK: 1. Comparison of the obtained blood flow indices (S/D, RI, PI) in the umbilical artery, middle cerebral artery and renal artery of foetuses from normal and complicated full-term pregnancies. 2. Determination of indices: umbilical-cerebral and renal-cerebral in normal and pathological pregnancy. 3. Evaluation of feasibility of the analysed flow parameters for the detection of intrauterine foetal hypoxia. MATERIAL AND METHODS: We have examined 151 women, who were divided into control group--101 pregnant women with normal pregnancy and study group--50 pregnant women with complicated pregnancy. All pregnant women underwent ultrasound examination using the Hitachi EUB 515 C (Japan) scanner with 3.5 MHz convex probe, connected to the colour pulsed Doppler. The study consisted of the biometric measurements and evaluation of the spectrum of blood flow in the umbilical artery, middle cerebral artery and renal artery. We have determined following indices: a) systolic-diastolic ratio S/D, resistance index RI, pulsatility index PI, b) umbilical-cerebral ratio P/M. (PI ua/PI mca), renal--cerebral ratio N/M (PI ra/PI mca). RESULTS: Statistically significant difference was found between the study and control groups for all the flow indices assessed (S/D, RI, PI) for the middle cerebral artery, for the indices P/M and N/M. (p < 0.001) and pulsatility index in the renal artery (p < 0.01). Similar, although slightly smaller difference (p < 0.05) was seen for the values of flow parameters in the umbilical artery. CONCLUSIONS: 1) Evaluation of blood flow in the middle cerebral artery, and in particular pulsatility index PI, reflects the risk to foetus. Umbilical-cerebral index and renal-cerebral index demonstrate the mechanisms of circulation centralization in case of fetal distress. For the umbilical-cerebral index, the cut-off value is 1.0 and for the renal-cerebral index it is 2.5, 2) Evaluation of the blood flow in foetal vessels is a significant element of prenatal diagnostics. Due to its low sensitivity, it should be compared with the results of other biophysical tests, to achieve complex evaluation of the condition of the foetus.