胎盘早剥漏诊原因分析

目的　了解不典型胎盘早剥产前漏诊的原因。　方法　用回顾性分析方法对１０ 年间胎盘早剥产前未确诊的２１３ 例（ 观察组） 进行分析,并与同期产前确诊为胎盘早剥的１６９ 例（对照组）比较。　结果　观察组发病诱因以催产素等方法引产或催产为最多,临床表现主要为产程中胎心率或胎心监护异常,早剥面积及总出血量均明显低于对照组,总产程＜ ５ 小时为１０３ 例占５１－７６ ％ ,围产儿死亡率１１０－６ ‰,其中死产及新生儿死亡１５ 例（７－５４ ％ ）。　结论　催产素使用不当是胎盘早剥的诱因,症状不典型、产程活跃期进展过快是早剥漏诊的主要原因,对围产儿仍有较大影响     

胎盘早剥漏诊31例临床分析

目的探讨胎盘早剥漏诊的相关因素,提高对不典型病例的认识,减少胎盘早剥的漏诊或误诊。方法回顾性分析1999年1月至2008年9月在上海浦东新区人民医院住院分娩的67例胎盘早剥患者的临床资料,将产前漏诊的31例作为漏诊组,产前确诊的36例作为对照组,比较漏诊的危险因素、临床特征和母儿结局。结果胎盘早剥发生率0.27%(67/24848),其中漏诊率46.27%(31/67),围生儿死亡率22.39%(15/67)。漏诊组发生阴道出血、子宫张力增高、重度胎盘早剥发生率低于对照组(P分别0.001,0.01和0.05)。漏诊组胎儿窘迫发生率高于对照组(P0.05)。两组腹痛、血性羊水、子宫卒中发生率比较,差异无统计学意义(P0.05)。漏诊组B超检出率10%,明显低于对照组的76.92%(P0.01)。两组患者的休克、凝血功能障碍、子宫切除、新生儿重度窒息比较,差异无统计学意义(P0.05)。漏诊组早产、围生儿死亡、死胎低于对照组(P0.05)。结论早期识别胎盘早剥的不典型征象,注意动态观察,可降低母婴危险。     

胎盘早剥胎心监护的图形分析

目的分析胎盘早剥异常胎心监护图形特征，总结图像规律，以提高早期诊治胎盘早剥的能力。 方法选取2015年1月至2019年11月中山大学附属第一医院产科收治的胎盘早剥且胎心监护异常的56例病例，按出现胎心监护异常时临产情况分为已临产组(25例)和未临产组(31例)，并对其胎心监护图形等资料进行分析；按胎盘早剥产前诊断与漏诊分为产前诊断组(30例)和产前漏诊组(26例)，对其胎心监护异常的类型进行比较。 结果胎盘早剥常见的胎心监护异常类型为无加速、微小变异、变异减速及宫缩波异常。微小变异在胎盘早剥未临产组胎监异常类型所占比例(51.6%)明显高于临产组(8%)，两组差异有统计学意义(χ²＝12.07，P<0.01)；延长减速在未临产组胎监异常类型所占比例(6.5%)明显低于临产组(48%)，两组差异有统计学意义(χ²＝12.74，P<0.01)。宫缩波异常在产前诊断组胎监异常类型所占比例(50%)明显高于产前漏诊组(3.8%)，两组差异有统计学意义(χ²＝14.54，P<0.01)；变异减速在产前漏诊组胎监异常类型所占比例(46.2%)明显高于产前诊断组(16.7%)，两组差异有统计学意义(χ²＝5.73，P＝0.02)。 结论准确判读胎心监护图形，有助于早期发现胎盘早剥。当胎心监护出现微小变异、延长减速或宫缩波异常时，需警惕胎盘早剥的发生。     

早期游泳和抚摸护理对新生儿病理性黄疸53例干预的疗效观察

目的早期游泳和抚摸护理对新生儿病理性黄疸干预的影响。方法 105例病理性黄疸新生儿随机分为观察组53例和对照组52例。对照组给予常规新生儿护理干预,观察组在对照组基础上给予早期游泳和抚摸护理,观察新生儿黄疸出现/消退时间、首次排便时间和胎便转黄时间,护理干预5d内经皮黄疸指数。结果观察组与对照组比较,黄疸出现时间晚、黄疸消退时间早、首次排便时间早和胎便转黄时间短,差异有统计学意义（P〈0.01）;观察组在护理干预第2、3、4、5天末黄疸指数明显低于对照组,差异均有统计学意义（P〈0.01）。结论早期游泳和抚摸护理能够缩短新生儿病理性黄疸患儿黄疸持续时间和胎便转黄时间,降低黄疸指数,在阻碍黄疸进行性加重和促进患儿早期康复等方面具有非常重要的意义。     

辅助生殖技术后双胎妊娠自然减胎对妊娠结局的影响

目的比较辅助生殖技术双胎妊娠自然减胎与单胎的妊娠结局。方法回顾2008年1月1日至2017年12月31日北京大学第一医院辅助生殖技术双胎妊娠自然减胎121例,早期减胎95例(早期减胎组)及中期减胎26例(中期减胎组),同期320例单胎纳入对照组。对3组进行一般情况、早产及产科结局比较。结果中期减胎组新生儿出生体重低于早期减胎组及对照组[(2361.54±724.07)g、(3144.42±506.73)g、(3332.23±493.32)g],差异有统计学意义(P0.05),而早产、新生儿窒息、转入NICU、低出生体重、胎儿生长受限及胎盘早剥发生率高于早期减胎组及对照组(P0.05)。早期减胎组新生儿出生体重低于对照组,而早产率高于对照组(P0.05)。3组凝血指标比较,差异无统计学意义(P0.05)。结论辅助生殖技术自然减胎会导致新生儿出生体重下降及早产增加,中期自然减胎增加不良妊娠结局。     

胎粪吸入综合征患儿血清肌钙蛋白Ⅰ和肌酸激酶同工酶检测45例分析

目的探讨胎粪吸入综合征（MAS）对血清肌钙蛋白Ⅰ（cTnⅠ）和肌酸激酶同工酶（CK-MB）的影响。方法取确诊MAS的新生儿45例为观察组,同期出生的健康新生儿40例为对照组,分别测定血清cTnⅠ和CK-MB水平,并将结果进行统计分析。结果观察组cTnⅠ和CK-MB分别为（0.31±0.24）μg/L、（85.1±18.3）U/L,均高于对照组（0.03±0.19）μg/L、（34.2±12.5）U/L,两组比较差异有统计学意义（P〈0.01）。观察组中血清cTnⅠ的异常率68.89%（31/45）,高于对照组5.00%（2/40）,两组比较差异有统计学意义（P〈0.01）;观察组中血清CK-MB的异常率66.67%（30/45）,高于对照组50.00%（20/40）,但两组比较差异无统计学意义（P〉0.05）。结论 MAS新生儿血清cTnⅠ和CK-MB水平较正常高,应常规对MAS患儿进行血清cTnⅠ和CK-MB检测,可以早期发现心肌损害,及时干预和治疗。     

子痫并发不同程度肝损害对母胎结局的影响

目的:探讨子痫并发轻、中、重度肝功能损害的临床特点及对母胎结局的影响。方法:回顾分析2009年1月1日至2014年12月30日广州医科大学附属第三医院收治的79例子痫且合并肝功能损害患者的临床资料,按肝功能损害程度分为轻、中、重度3组,比较各组的临床特征及对母胎结局的影响。结果:子痫并发肝损害的发病率为0.24%(79/33084)。轻、中、重度肝功能损害患者的最高收缩压及舒张压比较,差异均有统计学意义(P0.05);轻度与中、重度组的定期产检率比较,差异有统计学意义(P0.05),但后两组比较差异无统计学意义(P0.05);3组的抽搐次数比较,差异无统计学意义(P0.05)。重度并发HELLP综合征与轻度与中度组比较,差异有统计学意义(P0.05),后两组比较差异无统计学意义(P0.05)。3组的入住ICU时间比较,差异有统计学意义(P0.05),但并发胎盘早剥、心功能不全、产后出血率比较差异无统计学意义(P0.05)。3组的新生儿窒息、胎儿生长受限、早产、转新生儿重症监护室率、围产儿死亡差异比较,差异均无统计学意义(P0.05)。结论:血压控制不良加重肝脏损害;随着肝损害程度加重,HELLP综合征发生率及转重症监护室风险明显增加,但与围产儿结局无明显相关性。     

不典型胎盘早剥的诊断与分析

目的分析不典型胎盘早剥的临床特点及诊疗方法。方法回顾性分析我院2010年1月~2014年12月收治的胎盘早剥患者78例的临床资料,将其分为典型组42例和不典型组36例。比较两组患者的误诊率、实验室指标及母婴结局。结果典型组患者经B超检查确诊37例,漏诊6例,漏诊率为11.90%;不典型组患者经B超检查确诊24例,漏诊12例,漏诊率为33.33%。不典型组的血纤维蛋白原进行性下降率、血红蛋白进行性下降率及血小板进行性下降率等指标均显著低于典型组,差异有统计学意义(P0.05)。典型组的剖宫产率、产后出血率、胎儿窘迫率及早产低体质量等指标均显著低于不典型组,差异有统计学意义(P0.05)。结论不典型胎盘早剥具有症状、体征不明显的特点,易出现漏诊、误诊,因此要多种诊断方法联合应用予以确认,提高早期诊断率。临床上要加强胎盘早剥的预防工作,积极治疗各类合并症及并发症,改善母婴结局。     

上海市母产前发热与早期新生儿败血症临床多中心研究

目的探讨母产前发热与早期新生儿败血症之间的关系,以降低围产儿死亡率.方法采用回顾性分析方法,对有母产前发热的新生儿103例与无产前发热的新生儿311例临床资料进行对比分析,同时分析103例有产前发热的新生儿的有关因素.结果母产前发热组较无母产前发热组在早期新生儿败血症发生率方面有极显著的差异（4.9%和0.3%,P＜0.01）,母产前发热≥39℃,产后连续发热数天提示新生儿发生宫内感染性败血症的可能性较高.结论对于母亲产前高热、产后又继续发热的新生儿,要注意作好母宫腔分泌物培养及新生儿血培养,完善实验室检查,密切观察临床表现,必要时予抗生素应用,积极治疗,降低围产儿死亡率.     

妊娠期糖尿病新生儿脐血血气分析影响的研究

目的：探讨妊娠期糖尿病（gestational diabetes mellitus,GDM）新生儿脐血血气分析情况及可能影响因素。方法：选择2015年6-8月同济大学附属第一妇婴保健院分娩的单胎GDM孕妇（GDM组）152例和单胎正常孕妇（对照组）152例。152例GDM孕妇中,阴道分娩组69例,剖宫产组83例;非胰岛素治疗组141例,胰岛素治疗组11例。比较2组新生儿脐血血气分析和结局,以及不同分娩方式和治疗方式对GDM新生儿各项指标的影响。结果：GDM组脐静脉血碱剩余（BE）值较正常对照组低,差异有统计学意义（t=2.702,P=0.007）。不同分娩方式GDM新生儿脐动脉血pH值、脐静脉血pH值、脐动脉血BE值、脐静脉血BE值、脐静脉二氧化碳分压[p（CO2）]比较,差异有统计学意义（均P＜0.05）;但2组新生儿结局差异无统计学意义（均P＞0.05）。是否采用胰岛素治疗的GDM新生儿脐血血气分析和结局比较差异无统计学意义（均P＞0.05）。结论：血糖控制良好的GDM新生儿脐血血气分析与正常妊娠者类似,分娩方式及是否采用胰岛素治疗均不影响GDM新生儿结局。     

119例胎盘早剥的临床分析

目的:分析胎盘早剥漏诊、误诊原因,提高早期确诊率,降低母儿并发症。方法:回顾性分析我院10余年胎盘早剥患者的临床资料。结果:我院胎盘早剥发生率0.52%。急诊入院患者占46.2%,有明确发病诱因51例(42.9%),以妊娠期高血压疾病、胎膜早破、外伤性因素为主。临床表现主要为腰腹胀或腹痛、阴道流血、血性羊水。B超检出率66.4%。轻型胎盘早剥52例(43.7%),重型胎盘早剥67例(56.3%),出现症状到就诊及处理时间重型早剥组均长于轻型早剥组(P<0.01)。子宫胎盘卒中6例,弥散性血管内凝血(DIC)1例。剖宫产85例(71.4%),阴道分娩33例(27.7%),子宫次全切除1例。死胎19例,转新生儿重症监护室29例。结论:临床发病到临床处理时间是影响胎盘早剥轻重程度的重要因素;胎盘早剥临床表现易与先兆临产、临产或胎儿窘迫等混淆;后壁胎盘、发育异常的胎盘等发生胎盘早剥时,超声容易漏诊。     

妊娠晚期子宫扭转一例并文献复习

目的探讨妊娠期子宫扭转病因、扭转程度和扭转时间与母儿结局的关系。 方法回顾性分析龙岩人民医院收治的1例及从中国知网和万方数据库检索的2003年以来报道的71例(39篇)妊娠期子宫扭转患者的临床资料。 结果72例妊娠期子宫扭转中子宫畸形34例(47.22%)，子宫肌瘤12例(16.67%)，其他原因11例(15.28%)，不明原因15例(20.83%)。临床症状有腹痛59例(81.94%)，失血性休克34例(47.22%)，恶心呕吐等消化系统症状25例(34.72%)，排尿困难11例(15.28%)。72例患者中有7例双胎，入院时胎心消失40例(50.63%)，胎心正常32例(40.51%)，胎儿窘迫7例(8.86%)，其中1例胎心正常和4例胎窘的胎儿在分娩前胎心消失，1例停经20周入院时胎心正常利凡诺引产后胎儿死亡，故胎儿总丢失数为46例。因利凡诺引产胎儿死亡1例，所以在计算因子宫扭转引起的胎儿丢失时胎儿数为45例。母儿不良结局依次为胎儿丢失45例(57.69%)、胎盘早剥36例(50%)、失血性休克34例(47.22%)、子宫切除31例(43.06%)，孕产妇死亡1例(1.39%)。 结论妊娠期子宫扭转多有子宫畸形、子宫肌瘤等病因，临床特征主要为腹痛，伴有恶心呕吐，严重者出现排气、排便、排尿困难，胎儿窘迫，休克甚至母儿死亡，母儿预后与子宫扭转严重程度相关。     

胎盘早剥的早期临床诊断

目的探讨胎盘早剥临床漏诊的原因,提高胎盘早剥的早期诊断。方法对近5年在我院产科发生的40例胎盘早剥的临床资料进行回顾性分析。结果胎盘早剥的发生率为0.60%。19例合并妊娠高血压疾病（47.5%）,16例孕妇没有任何胎盘早剥的高危因素（40%）。大部分孕妇临床表现不典型。前壁胎盘B超诊断率高于后壁胎盘（P〈0.05）,重度胎盘早剥B超诊断率高于轻度胎盘早剥（P〈0.05）。结论识别胎盘早剥的高危因素,根据病史、临床症状和体征,结合B超以及电子胎心监护,进行综合分析判断是提高胎盘早剥诊断的有效手段。     

胎盘血管瘤的临床特点及病理分析

目的　探讨胎盘血管瘤的临床特点及病理大体观特征。方法　对我院收治的 12例胎盘血管瘤患者的临床资料作回顾性分析。结果　 ( 1)在 12例病理诊断为胎盘血管瘤的患者中 ,5例临床诊断为胎盘血管瘤 ;2例临床误诊为胎盘早剥血肿 ;1例误诊为脂肪瘤 ;1例误诊为胎盘囊肿 ;3例分娩后漏诊 ,直至胎盘病理检查时发现而诊断。 4例产前曾行彩色多普勒超声检查 ,2例获得诊断 ,2例漏诊。 ( 2 ) 12例患者中 ,3例发生早产 ,其中 2例并发羊水过多 ;2例并发妊娠高血压综合征 ;2例死胎 ;1例胎儿畸形。新生儿 3例苍白窒息 ,1例青紫窒息。 ( 3)胎盘病理大体观检查 ,肿瘤大小 2cm×2cm× 2cm至 11cm× 8cm× 8cm ;9例患者肿瘤为单个 ,2例患者为 2个 ;6例肿瘤颜色为暗红色 ,3例灰红色 ,1例淡黄色 ,1例部分暗红、部分灰白 ,1例部分暗红、部分淡黄。结论　 ( 1)胎盘血管瘤可引起孕妇早产、羊水过多、死胎及新生儿窒息等并发症。 ( 2 )胎盘血管瘤在产前不易诊断 ,彩色多普勒超声是产前诊断胎盘血管瘤的惟一辅助手段。 ( 3)胎盘血管瘤大体观肿瘤体积大小不一 ,颜色大多为暗红色 ;也可因夹杂不同组织或供血不足而呈黄色或灰白色     

Vorgehen bei plazentaren Blutungen

Peripartum hemorrhage is associated with a high maternal and fetal morbidity and mortality and is one of the leading causes of maternal death worldwide (25%). The major causes of hemorrhage are placenta previa, premature abruption of the placenta and uterine atony. In cases with placental abruption or bleeding from the vasa previa there is an extremely high risk for the fetus as well as for the mother. The diagnosis of hemorrhage is suspected from the clinical manifestations and confirmed by ultrasonography. The prognosis for both mother and child can be markedly improved if the risk factors for hemorrhage are recognized early and the problem is treated rapidly and appropriately.     

彩色超声对胎盘早剥的诊断及临床价值

目的:评价彩色多普勒超声(CDFI)及彩色多普勒能量超声(CDE)对胎盘早剥的诊断价值及临床意义。方法:回顾分析2000年1月至2003年12月本院收治的71例胎盘早剥声像特征及母儿结局。结果:彩色超声诊断胎盘早剥63例,符合率89%,漏误诊8例(占11%),71例胎盘早剥孕妇剖宫产63例,阴道分娩8例。活婴59例,其中早产儿家属放弃治疗1例,死胎12例伴子宫卒中3例。结论:CDE及CDFI对胎盘早剥的诊断准确率较高,能减少母儿并发症,降低围生儿死亡率,可作为胎盘早剥的首选检查方法。     

Placental abruption and placenta praevia

Antepartum haemorrhage is defined as bleeding from the genital tract from 24 weeks of gestation onwards. The incidence is around 2–5% of all pregnancies progressing beyond 24 weeks. Placenta praevia and placental abruption are of great clinical importance as causes of antepartum haemorrhage. Placenta praevia occurs when the placenta is totally or partly inserted in the lower uterine segment. The aetiology of placenta praevia may merely represent an accident of nature but is associated with advanced maternal age, multiparity and previous uterine damage such as in a previous caesarean section. Usually, the initial bleed is painless and mild, but it may be severe. Screening and diagnosis are normally by ultrasound. A dilemma exists as to whether hospitalisation should be offered to women with an asymptomatic placenta praevia. Caesarean section is the recommended mode of delivery for major placenta praevia. Haemorrhage arising from premature separation of a normally situated placenta is known as abruptio placentae. Risk factors include placental abruption in a previous pregnancy, pre-eclampsia, cigarette smoking, and trauma. The patient typically develops pain over the uterus, and this may not be associated with apparent bleeding at first. The diagnosis is mainly clinical and confirmed by the demonstration of a retroplacental clot after delivery. In the obvious case of abruption, early delivery is of crucial importance. If the baby is still alive and the gestation compatible with survival upon delivery, it is recommended that urgent caesarean section should be performed. However, if the fetus is dead, one should expedite vaginal delivery. Complications of antepartum haemorrhage include maternal shock, especially due to the increased risk of postpartum bleeding. There is a greater risk of premature delivery, fetal hypoxia and sudden fetal death.     

Placental abruption,offspring sex,and birth outcomes in a large cohort of mothers

Objective.?To investigate stillbirth, neonatal, and perinatal death outcomes in pregnancies complicated by placental abruption, according to fetal sex.

Methods.?We utilized maternally linked cohort data files of singleton live births to mothers diagnosed with placental abruption during the period 1989 through 2005 (n?=?10,014). Logistic regression models were employed to generate adjusted odd ratios and their 95% confidence intervals. Male babies served as the referent category.

Results.?The sex ratio at birth was 1.18. The overall prevalence of stillbirth, neonatal mortality, and perinatal mortality was 7.2%, 4.5%, and 11.8%, respectively. Placental abruption was less likely to occur in mothers carrying female pregnancies than mothers of male infants (adjusted odds ratio [95% confidence interval]?=?0.89 [0.86–0.93]). There were no significant sex differences with regards to stillbirth, neonatal mortality, and perinatal mortality. Similar findings were observed for preterm and term infants.

Conclusions.?Although a preponderance of male infants was discernable among mothers with placental abruption, no sex difference in fetal survival was observed among the offspring of the mothers affected by placental abruption.     

Fetal body movement monitoring

Recording fetal activity serves as an indirect measure of central nervous system integrity and function. The coordination of whole body movement, which requires complex neurologic control, is likely similar to that of the newborn infant. Short-term observations of the fetus are best performed using real-time ultrasound imaging. Monitoring fetal motion has been shown to be clinically worthwhile in predicting impending death or compromise, especially when placental insufficiency is longstanding. The presence of a vigorous fetus is reassuring. Perceived inactivity requires a reassessment of any underlying antepartum complication and a more precise evaluation by fetal heart rate testing or real-time ultrasonography before delivery is contemplated.     

Fetal habituation to vibroacoustic stimulation in uncomplicated term pregnancies.

The use of transabdominal vibroacoustic stimulation has been shown to improve the efficiency of antepartum fetal surveillance. The ability of the fetus to habituate to such a stimulus has also been suggested as a means of assessing the function of the central nervous system. The purpose of this blinded prospective investigation was to evaluate fetal habituation in a group of low-risk pregnancies anticipated to deliver within 1 week. One hundred sixteen uncomplicated pregnancies underwent repetitive vibroacoustic stimulation using a Corometrics Model 146 fetal acoustic stimulator. Fetal habituation was defined as a sustained elevation of the heart rate baseline for more than 15 minutes or a failure to produce an adequate acceleration of the fetal heart rate after an initial response. Habituation was present in 106 (91.4%) cases, whereas 10 (8.6%) failed to habituate to the stimulus. All infants failing to habituate in utero ultimately did well after delivery. Their birthweights, Apgar scores, umbilical artery blood gas determinations, and courses in the newborn nursery were similar to those of infants who responded to in utero sound stimulation. However, cesarean delivery for fetal distress and gross placental abnormalities (such as infarction and abruption) occurred more commonly in those fetuses failing to habituate. Additional investigations of fetal habituation to a vibroacoustic stimulus may be helpful in the intrapartum risk assessment of uncomplicated term pregnancies.