三种指标产前筛查出胎儿生长迟缓23例

方法利用姐妹染色单体互换频率、B型超声、宫高及腹围三种指标综合判断产前诊断胎儿生长迟缓.目的以提高产前诊断率及建立新的早期诊断方法.结果姐妹染色单体互换频率产前诊断率为61.76%,B型超声为52.94%,宫高腹围为26.09%,姐妹染色单体互换频率阳性检出率为75%,孕20周前阳性检出率为76.19%,三种指标综合判断可使产前诊断率提高到82.19%.结论多种指标判断可以提高产前诊断率,姐妹染色单体互换频率可以作为一项产前诊断胎儿宫内生长迟缓的新指标.     

妊娠期母体／胎儿皮质醇的代谢及调节

皮质醇是妊娠期母体代谢与胎儿发育代谢不可缺少的物质。母体内与胎体内的皮质醇浓度梯度提示,胎盘是阻止母体皮质醇到达胎儿的屏障,11β-羟基类固醇脱氢酶（11β—HSD）在这个屏障中起主导作用。在妊娠不同阶段,皮质醇代谢与调节存在差异。母体的皮质醇能在妊娠中晚期通过胎盘。多种因素会影响11β—HSD的活性,进而影响皮质醇在母体与胎儿问的代谢调节。     

Nitric oxide-mediated vascular tone in the fetal placental circulation of patients with type 1 diabetes mellitus

Endothelium-derived nitric oxide (NO) plays a key role in the regulation of vascular tone in health and disease. The present study addresses the contribution of NO to the baseline vascular tone in the fetal placental circulation of type 1 diabetic women. To this end, we performed ex-vivo dual perfusions of isolated cotyledons from seven women with type 1 diabetes mellitus and 24 healthy women. The fetal arterial pressure was considered to be a measure of fetal vascular resistance. The contribution of NO to the baseline vascular tone of the fetal placental circulation was quantified by addition of the NO-synthase inhibitor N(G)-nitro-arginine-methylester (L-NAME). Apart from the diabetic state, we studied the influence of exogenous insulin on the response to L-NAME. Mean (+/-SEM) baseline fetal arterial pressure was higher in diabetes (25.7+/-3.4 mm Hg vs 18.0+/-1.7 mm Hg, P<0.05). Maximum perfusion pressure after L-NAME was 87.9+/-7.1 mm Hg in diabetes vs 58.9+/-4.5 mm Hg in controls (P<0.01). The net L-NAME-induced increase in fetal arterial pressure was higher in diabetes (62.2+/-9.1 mm Hg vs 40.9+/-3.5 mm Hg, P<0.05). Although insulin induced a shift to the left of the L-NAME-curve, the net L-NAME-induced increase in fetal arterial pressure was not affected. We conclude that diabetes is associated with an increased baseline vascular tone of the fetal placental vascular bed. This can not be explained by attenuated NO-mediated effects. In contrast, the activity of the NO-pathway seems to be increased in diabetes. The latter observation seems not to be caused by high insulin levels.     

日常胎动记录图预测和评估脐带绕颈胎儿宫内安危的价值研究

背景 胎动(FM)是唯一依赖孕妇自我评估的主观性指标,却可客观反映胎儿宫内安全情况;如何将FM量化并使其成为一个相对客观的评价指标一直是产科医师研究和关注的焦点.目的 通过应用日常胎动记录图(DFMC)预测和评估脐带绕颈胎儿的宫内安危.方法 回顾性选取2010年1月—2016年1月在浙江衢化医院住院分娩的足月孕妇100...     

促性腺激素释放激素激动剂降调节激素替代治疗周期在冻融胚胎移植中的研究进展

冻融胚胎移植（frozen-thawed embryo transfer,FET）技术因具有提高累积妊娠率和降低卵巢过度刺激风险等优点被广泛应用于临床,移植胚胎质量、子宫内膜以及两者同步性是FET成功的关键因素。临床常见的子宫内膜准备方案包括自然周期、控制性卵巢刺激周期、激素替代治疗（hormone replacement treatment,HRT）周期以及降调节HRT周期。大多数妇女采用常规方案进行FET子宫内膜准备,但多囊卵巢综合征、子宫内膜异位症、子宫腺肌病、反复着床失败以及薄型子宫内膜等特殊人群,采用常规方案临床效果欠佳。垂体降调节方法是在促性腺激素释放激素激动剂（gonadotropin-releasing hormone agonist,GnRHa）垂体降调节基础上应用HRT准备子宫内膜,即降调节HRT周期较常规方案可有效改善上述特殊人群的妊娠结局。综述GnRHa降调节HRT周期的相关机制及其适宜人群。     

Fetal stroke and cerebrovascular disease: Advances in understanding from lenticulostriate and venous imaging,alloimmune thrombocytopaenia and monochorionic twins

Fetal stroke is an important cause of cerebral palsy but is difficult to diagnose unless imaging is undertaken in pregnancies at risk because of known maternal or fetal disorders. Fetal ultrasound or magnetic resonance imaging may show haemorrhage or ischaemic lesions including multicystic encephalomalacia and focal porencephaly. Serial imaging has shown the development of malformations including schizencephaly and polymicrogyra after ischaemic and haemorrhagic stroke. Recognised causes of haemorrhagic fetal stroke include alloimmune and autoimmune thrombocytopaenia, maternal and fetal clotting disorders and trauma but these are relatively rare. It is likely that a significant proportion of periventricular and intraventricular haemorrhages are of venous origin. Recent evidence highlights the importance of arterial endothelial dysfunction, rather than thrombocytopaenia, in the intraparenchymal haemorrhage of alloimmune thrombocytopaenia. In the context of placental anastomoses, monochorionic diamniotic twins are at risk of twin twin transfusion syndrome (TTTS), or partial forms including Twin Oligohydramnios Polyhydramnios Sequence (TOPS), differences in estimated weight (selective Intrauterine growth Retardation; sIUGR), or in fetal haemoglobin (Twin Anaemia Polycythaemia Sequence; TAPS). There is a very wide range of ischaemic and haemorrhagic injury in a focal as well as a global distribution. Acute twin twin transfusion may account for intraventricular haemorrhage in recipients and periventricular leukomalacia in donors but there are additional risk factors for focal embolism and cerebrovascular disease. The recipient has circulatory overload, with effects on systemic and pulmonary circulations which probably lead to systemic and pulmonary hypertension and even right ventricular outflow tract obstruction as well as the polycythaemia which is a risk factor for thrombosis and vasculopathy. The donor is hypovolaemic and has a reticulocytosis in response to the anaemia while maternal hypertension and diabetes may influence stroke risk. Understanding of the mechanisms, including the role of vasculopathy, in well studied conditions such as alloimmune thrombocytopaenia and monochorionic diamniotic twinning may lead to reduction of the burden of antenatally sustained cerebral palsy.     

产前补充牛磺酸调节Rho家族因子活性促进生长受限新生大鼠神经干细胞增殖的研究

目的 探讨产前补充牛磺酸通过调节Rho家族因子活性促进生长受限 （FGR）新生大鼠神经干细胞增殖的可能性,为产前补充牛磺酸促进生长受限患儿脑发育提供实验依据。方法 将24只Sprague-Dawley孕鼠随机分为对照组、FGR组、牛磺酸组 （n=8）,通过全程饥饿法建立FGR模型。采用逆转录-聚合酶链反应法、免疫组化及免疫印迹法检测各组新生鼠脑组织神经干细胞特异性胞内标记物脂肪酸结合蛋白7 （FABP7）、Rho相关螺旋卷曲蛋白激酶2 （ROCK2）、ras同源基因家族成员A （RhoA）、Ras相关的C3肉毒素底物 （rac）表达水平。结果 FGR组FABP7阳性细胞OD值、FABP7mRNA及蛋白的表达低于对照组,牛磺酸组FABP7阳性细胞OD值、FABP7mRNA及蛋白的表达高于FGR组 （P < 0.05）。FGR组中RhoA、ROCK2mRNA的表达高于对照组,牛磺酸组中RhoA、ROCK2mRNA表达高于对照组但低于FGR组 （P < 0.05）;FGR组中racmRNA的表达低于对照组,牛磺酸组中racmRNA表达高于FGR组及对照组 （P < 0.05）;FGR组中RhoA、ROCK2蛋白表达水平高于对照组,牛磺酸组中RhoA、ROCK2蛋白表达水平低于FGR组 （P < 0.05）。结论 产前补充牛磺酸可促进FGR新生大鼠神经干细胞增殖,其机制可能与调控Rho家族因子的活性有关。     

Calcified tissue of fetal origin in utero

Hysteroscopic examination in a woman with secondary infertility revealed calcified tissue in the uterine cavity. Histopathological examination demonstrated mature bone. Genetic analysis supports its fetal origin.     

Proliferative responses in the placenta after endotoxin exposure in preterm fetal sheep

OBJECTIVES: Antenatal infections are associated with an increased risk of perinatal morbidity and mortality. Systemic application of endotoxins to the fetus results in an increase in placental vascular resistance and chronic reduction in umbilical blood flow. We studied morphological alterations of the placenta in response to fetal inflammation in the preterm sheep. STUDY DESIGN: Therefore, 14 fetal sheep were chronically instrumented at a mean gestational age of 107+/-1 days (term is 147 days). Four days after surgery fetuses received 100 ng lipopolysaccharide (LPS; n=8) or saline (control; n=6) intravenously. Fetal heart rate and arterial blood pressure were monitored continuously while blood gases and acid-base balance were measured at time points 0, +1, +3, +6, +12, +24, +48 and +72 h. Three days after LPS application placental cotyledons were analyzed by immunohistochemistry and morphometry. Different primary antibodies like AE 1 and AE 3 against cytokeratins were used. Secondary antibodies were visualized with 3-amino-9-ethylcarbazole (AEC) or using the Vectastain kit (Vector Laboratories, Burlingame, CA). Double staining was carried out first by utilizing Vectastain kit (black), followed by AEC staining (red). Counterstaining was performed with haematoxylin. RESULTS: Fetal tachycardia and hypertension were induced transiently during the first 12h after LPS application. Fetuses suffered from mild hypoxaemia while acidemia was absent. Morphometry revealed a non-significant shift in the relation of maternal and fetal placental compartments towards the maternal parts in response to LPS treatment. Endotoxin induced an increased proliferation in both compartments of the placenta with a 3.2-fold increase on the maternal and a 1.8-fold increase on the fetal side. CONCLUSIONS: Systemic endotoxin exposure of the preterm fetal sheep leads to a change in the gross organization of the placenta and changes in the proliferation patterns in both placental compartments. These rearrangements inside the placenta may disturb its organ function and subsequently lead to fetal morbidity associated with the fetal inflammatory response syndrome and chronic placental dysfunction, respectively.     

The risk of shoulder dystocia related permanent fetal injury in relation to birth weight

OBJECTIVE: To examine birth weight related risks of fetal injury in connection with shoulder dystocia. STUDY DESIGN: The investigation was based on a retrospective analysis of 316 fetal neurological injuries associated with deliveries complicated by arrest of the shoulders that occurred across the United States. RESULTS: The study revealed that the distribution of birthweights for the high risk shoulder dystocia population differs from the standard birthweight distribution. The relative difference per birthweight interval is used to adjust an assumed 1:1000 baseline risk of injury due to shoulder dystocia following vaginal deliveries. These adjusted risks show a need to consider new thresholds for elective cesarean delivery. CONCLUSIONS: Current North American and British guidelines, that set 5000 g as minimum estimated fetal weight limit for elective cesarean section in non-diabetic and 4500 g for diabetic gravidas, may expose some macrosomic fetuses to a high risk of permanent neurological damage. The authors present the opinion that the mother, having been informed of the risks of vaginal versus abdominal delivery, should be allowed to play an active role in the critical management decisions.