直接胎儿穿刺取血法及并发症的研究

目的　探讨 B超引导下直接胎儿穿刺取血的适应证、胎儿血判定方法、穿刺方法与并发症的关系。　方法　对 90例宫内妊娠 16～ 36周、有医疗穿刺指征的孕妇 ,在 B超引导下进行直接胎儿血穿刺。穿刺前后分别进行胎心监护 ,穿刺后 2 h及 2 4h B超了解胎盘情况。　结果　 90例穿刺病例中无胎儿丢失及胎盘早剥等严重母儿并发症。穿刺过程中胎心变化发生率为 35 .6 % (32 / 90 ) ,均在 6 0 s内恢复 ;穿刺后 4h内出现胎心变化发生率为 2 .2 % (2 / 90 ) ;胎心变化与取血量及穿刺部位正相关 r分别为 0 .2 7及 0 .36。穿刺后 2 h及 2 4h出现胎盘变化 1例 ,发生率为 1.1%。 90例无因穿刺并发症需紧急终止妊娠者 ;胎儿娩出后脐带未见特殊异常。　结论　在高分辨度彩超定位下 ,直接胎儿穿刺取血是安全可靠的。由胎儿血直接提供的有关胎儿染色体、宫内感染、代谢状况、内分泌状况及血液病学等相关因素的资料 ,是进行准确的胎儿宫内诊断不可替代的重要依据

Method and Complications of Direct Fetal Blood Sampling

Objective To study the indications of percutaneous ultrasound-guided direct fetal blood sampling; the methods of fetal blood assessment; and the relationship between the different puncture techniques and the complications. Methods Direct fetal blood sampling were performed on 90 pregnant women whose gestational age were from 16 to 36 weeks for medical indications under the guide of ultrasound. None stress test were performed before and after the puncture. Ulrtrasonographies were done at 2 hours and 24 hours after the procedure. Results There were no severe maternal or fetal complications such as fetal loss and placental abruption. The incidence of bradycardia was 35.6%(32/90), all recovered within 60 seconds; the incidence of bradycardia happened within 4 hours after the puncture was 2.25(2/90). There was a positive relationship among the incidence of bradycardia, the volume of blood taken and the place of punctures,r=0.27 and 0.36 respectively. There was one case with placental changing happened after 2 hours of the puncture, the placenta changing incidence was 1.1%. No emergency cesarean section was done due to the complications of the procedure. All the umbilical cord were normal when the babies were born. Conclusions Direct fetal blood sampling is a safe technique for both fetus and the mother under the guide of real time ultrasound. The data come from fetal blood analysis give reliable informations about chromosome, congenital infections, the status of fetal metabolism, endocrine system and hematologic system directly, which make this technique unreplacable for intrauterine diagnosis.