妊娠晚期羊水过少对妊娠结局及围生儿的影响

目的探讨妊娠晚期羊水过少与妊娠结局及对围生儿的影响。方法收集北京世纪坛医院2009年11月至2010年11月住院的妊娠晚期羊水过少孕妇116例为观察组,随机抽取同期本院羊水量正常的分娩孕妇110例作为对照组,两组病例就妊娠结局和围生儿情况进行比较。结果观察组中阴道助产和剖宫产率均高于对照组,差异有统计学意义P〈0.05）;观察组中围生儿并发症的发生率也较对照组高,差异有统计学意义（P〈0.05）。结论羊水过少是妊娠晚期的危险信号,可反映胎儿宫内状况,结合有无高危因素及宫颈条件选择合理的分娩方式,需要在临床上高度重视,积极处理。妊娠晚期羊水过少与妊娠结局相关,威胁围生儿生命。羊水过少不是剖宫产的绝对指征。     

Antenatal oligohydramnios of renal origin: long-term outcome.

BACKGROUND: Prognosis of fetuses with renal oligohydramnios (ROH) is often still regarded as poor. Neonatal complications and the long-term follow-up of fetuses with ROH in two pediatric centres are described. Method. 23 fetuses (16 males, 7 females) were included as patients. Primary diseases included congenital anomalies of the kidney and urinary tract (n = 16), autosomal recessive polycystic kidney disease (n = 4) and renal tubular dysgenesis (n = 3). The analysis includes retrospective chart review. RESULTS: Seven children died (30%), the majority (n = 4, 17%) within the neonatal period due to pulmonary hypoplasia and renal insufficiency. Fourteen patients (61%) required postnatal mechanical ventilation for a median of 4 (range 1-60) days; 11 infants had an associated pneumothorax. All 16 surviving children have chronic kidney disease (CKD) at a current median age of 5.7 years (range 0.5-14.5), managed conservatively in eight patients [median glomerular filtration rate 51 (range 20-78) ml/min/1.73 m(2)]. Eight patients reached end-stage renal disease at a median age of 0.3 years (range 2 days to 8.3 years), including one patient with pre-emptive kidney transplantation. Five of the patients requiring dialysis underwent successful renal transplantation at a median age of 3.5 years (range 2.5-4). Growth was impaired in seven children requiring growth hormone treatment. Cognitive and motor development was normal in 12 (75%) of the 16 patients and showed a delay in four children, including two with associated syndromal features. CONCLUSION: ROH is not always associated with a poor prognosis and long-term outcome in survivors is encouraging. The high incidence of neonatal complications and long-term morbidity due to CKD requires a multidisciplinary management of these children.     

多模式超声诊断孕晚期羊水过少的准确率及其对围产预后的判断价值

羊水过少(oligohydramnios)即羊水量少于300 ml,是产科常见并发症之一,可发生在妊娠各期,但以晚期妊娠为常见,妊娠早、中期的羊水过少大都以流产告终\[1-4\]。随着B型超声技术在妇产科临床得到广泛的应用,羊水过少的检出率显著增加,羊水过少对围生儿的不良影响也日益受到产科临床医护人员的高度重视\[5-7\]。但目前仍缺乏对B型超声技术诊断效果的全面分析。 彩色多普勒超声仪包括B型成像、彩色多普勒及多普勒流速曲线,既能判断羊水量,又能评价有无脐带缠绕及其血流动力学情况,目前被广泛应用于临床,但对其有效性及应用价值的评价仍很缺乏。因此,本研究对2006年1月至2008年5月我院采用彩色多普勒超声仪诊断为羊水过少的106例孕晚期孕妇的围产情况进行了分析,探讨彩色多普勒技术的诊断效果,并评价其对围产预后的判断价值,为临床应用提供指导价值。     

Pulmonary hypoplasia with an unusual prenatal history

We describe a monochorionic, diamniotic twin with renal agenesis who received amniotic fluid from his normal co-twin by spontaneous rupture of the amniotic septum between them. By 16 weeks of gestation the presence of severe oligohydramnios in one twin had resulted in renal agenesis, but not in the other twin, who did not have oligohydramnios. By 20 weeks of gestation, the two amniotic fluid volumes had become the same in both twins. At 33 weeks, the twins were delivered by cesarean section. Despite intensive respiratory care, the twin with renal agenesis died from severe pneumomediastinum on day 3. At autopsy, pulmonary hypoplasia was demonstrated in that twin. This experiment of nature demonstrates that oligohydramnios during the early canalicular stage of pulmonary development (gestational age, 16-20 weeks) may be pathogenically important in pulmonary hypoplasia.     

Familial Renal Tubular Dysgenesis: A Disorder Not Isolated to Proximal Convoluted Tubules

The autopsy findings of a newborn with renal tubular dysgenesis, born to first cousins of Moslim Arob descent, are described. Hypocalvaria and hyperflexible joints were noted in addition to the renal lesion. A microdissection study demonstrated marked shortening of all the nephron segments from the glomeruli to the collecting tubules, rather than an isolated abnormality of the proximal convoluted tubules.     

Congenital Hypernephronic Nephromegaly with Tubular Dysgenesis: A Distinctive Inherited Renal Anomaly

This paper describes a distinct, apparently inherited renal disorder we call congenital hypernephronic nephromegaly with tubular dysgenesis. The disorder is characterized by oligohydramnios, the Potter phenotype, and enlarged nonfunctional kidneys. Light microscopy demonstrates increased numbers of glomeruli, undifferentiated tubules, and interstitial fibrosis. Microdissection reveals short, immature nephrons that lack proximal convolutions, and abnormal vascularization of the glomerulus. Morphomet-ric analysis demonstrates increased glomerular mass, primarily in the region of the corticomedullary junction, increased interstitial mass, and decreased tuOular mass. The parameters that define this anomaly are presented, and the possible mechanisms of pathogenesis are discussed in relation to pathologic observations and current concepts concerning renal embryogenesis and differentiation. The recurrence of this anomaly in the male children of a consanguineous couple suggests an X-linked recessive mode of inheritance, although an autosomal-recessive mode of inheritance cannot be ruled out. This condition indicates that not all cases of the Potter phenotype can be considered to be sporadic.     

Nitric oxide inhalation therapy in very low-birthweight infants with hypoplastic lung due to oligohydramnios

BACKGROUND: Although nitric oxide inhalation (iNO) therapy improves arterial oxygenation and reduces the rate of extracorporeal membrane oxygenation in term neonates, the efficacy of this therapy in premature infants is controversial. The objective of the present study was to determine whether iNO therapy improves the survival of very low-birthweight infants with pulmonary hypoplasia due to prolonged rupture of membrane. METHODS: A retrospective comparative study of very low-birthweight infants with pulmonary hypoplasia due to oligohydramnios who had or had not been treated with iNO therapy, was performed (iNO-treated group, eight infants; control group, 10 infants). A neonate was considered to have pulmonary hypoplasia due to oligohydramnios if the following conditions were satisfied: (i) artificial surfactant treatment did not improve the respiratory distress; (ii) prolonged rupture of membrane (PROM) continued for more than 5 days with oligohydramnios; and (iii) sufficient arterial oxygenation did not occur even after giving 100% oxygen, and more than 8 cm H(2)O of mean airway pressure was needed to maintain arterial oxygenation. RESULTS: Nitric oxide inhalation improved arterial oxygenation rapidly and consistently in all eight infants with pulmonary hypoplasia. All eight iNO-treated infants survived longer than 28 days, while five of the 10 control infants died within 24 h of birth (P < 0.05). Before starting iNO, seven of the eight treated infants had shown persistent pulmonary hypertension, which was confirmed by echocardiography. No iNO-treated infant had IVH greater than grade 1, while one control infant had grade 2 IVH. All six long-term survivors in the iNO-treated group are developing normally, while only two of the control infants are developing normally as of February 2002. CONCLUSIONS: The majority of the infants with pulmonary hypoplasia due to oligohydramnios had persistent pulmonary hypertension. iNO improved the arterial oxygenation and significantly improved the survival rate. A controlled study to determine whether iNO therapy improves the survival rate of preterm infants with pulmonary hypoplasia due to oligohydramnios is necessary.     

羊水指数预测羊水过少的价值分析

目的评价产前B超测定羊水指数对羊水过少的诊断价值.方法研究2004年1月～2005年10月在我院剖宫产、术前1周行羊水指数测定的584例孕妇,以羊水指数≤5.0cm、≤8.0cm分别为羊水过少标准,与剖宫产时实际测量羊水量进行对照分析,评价不同羊水指数在羊水过少中的诊断意义.结果羊水指数≤5.0cm与羊水指数≤8.0cm诊断羊水过少灵敏度分别为12.20%、56.10%,特异性分别为99.55%、92.36%,有显著性差异(P《0.01).结论与羊水指数≤5.0cm相比,以羊水指数≤8.0cm诊断羊水过少更为合理.     

羊水过少202例临床分析

回顾分析了１９８８ 年１ 月至１９９８ 年７ 月２０２ 例羊水过少病例。发现：羊水过少发病率为１ ．４７ ％ ,其中延期及过期妊娠占５２ ．４８ ％ ,胎儿宫内生长迟缓（ Ｉ Ｕ Ｇ Ｒ） 、妊娠高血压综合征及过期妊娠是其常见并发症。 Ｂ 超诊断羊水过少符合率为７２ ．７７ ％ 。羊水过少组围生儿死亡率为０ ．９９ ％ ,剖宫产率为９２ ．０８ ％ 。羊水过少组的胎儿宫内窘迫发生率为４４ ．５５ ％ ,显著高于羊水正常组（２１ ．０３ ％ , Ｐ＜ ０ ．０１） ,新生儿窒息发生率为２ ．４８ ％ ,与羊水正常组（１ ．１９ ％ ） 相比无显著性差异（ Ｐ＞ ０ ．０５） 。并发现随着羊水量的减少,胎儿宫内窘迫的发生率有增高的趋势,当羊水量≤５０ ｍ Ｌ时,胎儿宫内窘迫发生率高达８６ ．００ ％ （ Ｐ＜ ０ ．０１） 。结果提示： Ｂ 超是产前诊断羊水过少的简单而有效的方法,早期诊断、尽快剖宫产是改善围生儿预后的关键。