胎儿畸形与羊水过多的超声相关性研究

目的探讨胎儿畸形与羊水过多之间的相关性,并对造成羊水过多的常见胎儿畸形进行排序。方法分析13351例16～40孕周的胎儿资料,比较羊水正常组胎儿畸形发生率与羊水过多组中畸形发生率,并对羊水过多组中胎儿畸形种类进行统计排序。结果超声检出羊水过多103例,发现胎儿畸形26例,畸形发生率约25.2%;正常羊水量组13248例,其中胎儿畸形31例,胎儿畸形发生率约2.3%。羊水过多组中最常见胎儿畸形依次为:中枢神经系统畸形(26.9%)、骨骼畸形(23.1%)、消化系统畸形(15.4%)。结论超声检查是判断羊水过多的首选方法,羊水过多合并胎儿畸形的发生率明显高于正常羊水量组。其常见的畸形种类依次为中枢神经系统畸形、骨骼畸形和消化系统畸形。     

超声诊断羊水过多与胎儿畸形的探讨

目的分析超声诊断羊水过多与胎儿畸形的关系。方法回顾性分析2004年8月~2005年7月在我院作超声产前常规检查的16~40周的3292例孕妇资料。发现羊水最大深度≥8cm时,为羊水过多。结果检出羊水过多的19例,检出率为0.58%。其胎儿未见明显异常的12例,占63%,胎儿畸形7例,占37%。结论羊水最深平面≥11cm时,致死性畸形发生率明显增高。     

羊水过多与胎儿畸形的关系及诊断

目的：胎儿畸形是指胎儿在子宫腔内发生结构和染色体异常的一种出生缺陷,有数据表明我国胎儿畸形发生率为5.6%,胎儿畸形严重地影响了人口的出生质量。避免胎儿畸形的发生是提高国民素质的一项非常重要的举措,减少胎儿畸形的发生率以及畸形胎儿的出生刻不容缓。方法：通过查阅图书期刊上的资料,将每个问题的各个方面加以总结,深入研究分析。结果：胎儿畸形与羊水过多有着密不可分的关系,与羊水过多有关的胎儿畸形中,中枢神经系统和消化系统畸形常见。结论：羊水越多,胎儿畸形的发生率越高。     

羊水过多分度与新生儿结构畸形的关系及预后分析

目的 探讨羊水过多的分度与新生儿结构畸形的发生率及预后相关性。方法 回顾性分析2017年3月至2019年3月在浙江大学医学院附属妇产科医院住院分娩的羊水过多患者198例,根据最高羊水指数(AFI)水平分为轻度羊水过多组(138例)、中度羊水过多组(41例)和重度羊水过多组(19例),比较三组新生儿的结构畸形发生率及预后结局。结果 198例羊水过多病例中,胎儿结构畸形总发生率为17.7%。重度羊水过多组羊水过多的发现孕周与分娩孕周均明显早于轻/中度羊水过多组,差异有统计学意义(P<0.001)。轻、中、重度羊水过多组的新生儿结构畸形率分别为10.9%、26.8%、7.4%,新生儿死亡率分别为0、12.2%、36.8%,三组的新生儿结构畸形率及死亡率比较,差异均有统计学意义(P<0.001)。Spearman秩相关分析结果显示,新生儿结构畸形发生率及新生儿死亡率均与羊水过多的分度呈正相关(r_s1=0.290、r_s2=0.424,P_均<0.001)。结论 临床上可根据AFI水平预测羊水过多的新生儿结局,一旦诊断中/重度羊水过多,...     

7月孕羊水过多合并腹腔畸形1例

患者，26岁，农民，B超示7月孕畸形，建议终止妊娠于2003年5月7日入院。孕期无感冒及否认服药史。妊娠的前3个月有规律月经，量较平时少，无早孕反应；自觉腹部膨隆，B超示4月孕大小，未见胎儿异常发育，数日后有胎动；妊娠呕吐不剧，数日后自行消失；腹部膨隆明显，5月孕双足浮肿10余天，未经     

羊水指数分级预测羊水过多孕妇妊娠结局的相关性研究

目的 探讨分析羊水过多与妊娠结局的相关性,为产前咨询及临床干预提供更多有价值的信息。方法 选取产前超声检查发现羊水过多[羊水指数(AFI)≥20 cm或羊水深度(DVP)≥8 cm]的单胎妊娠孕妇,根据羊水增多的程度将所有病例进行分组,a组：AFI 20～24.9 cm, b组：AFI 25～29.9 cm或DVP 8～11 cm, c组：AFI≥30 cm或DVP>11 cm,总结不同羊水分段与妊娠结局的关系。结果 本研究中3组病例分别为a组285例(61%)、b组154例(33%)、c组27例(6%)。特发性羊水过多363例,非特发性羊水过多103例。AFI增加与早产发生率及5分钟Apgar评分<7分发生率之间存在统计学显著正相关(P<0.05)。3组中新生儿或胎儿结构异常a组32例(11.2%)、b组30例(19.5%)、c组15例(55.6%),较高的AFI与产前检测到的先天性畸形发生率增加相关。其中一些相对严重的胎儿,如消化道梗阻、胸腔病变、泌尿系统异常、胎儿贫血/水肿性疾病及帆状胎盘的发生率在3组间存在统计学显著正相关(P<0.05)。结论 按照羊水...     

羊水过多对胎儿的影响

羊水过多是妊娠期常见病症,其围产期发病率和死亡率均增高[1],常有胎儿畸形、胎盘早剥、产后出血等并发症,是临床上较为棘手的问题。为寻找正确的处置方法,笔者对本站45例羊水过多患者进行了分析研究。1资料与方法1.1一般资料选择2004年1月至2006年1月在我站门诊及收治住院分娩     

羊水过多与妊娠结局的关系分析──附137例报告

目的: 探讨羊水过多与妊娠结局的关系.方法: 以137例羊水过多孕妇为观察组,另选择同期559名羊水量正常的孕妇为对照组.记录观察组的妊娠结局,包括剖宫产率,新生儿的性别比例、胎儿畸形以及巨大胎儿的发生情况,并与对照组进行比较.结果: 观察组的剖宫产率为44.5%,对照组的剖宫产率为17.4%.观察组分娩新生儿146名,其中女性81名(55.5%),胎儿畸形16例(11.0%,其中羊水过多发生于孕30周以前12例),双胎9例(12.3%),巨大胎儿36例(24.7%,其羊水过多均发生于孕30周以后).对照组分娩新生儿560名,其中女性251名(44.8%);无发生胎儿畸形,双胎1例,巨大胎儿30例(5.4%).观察组的剖宫产率、胎儿女性比例、胎儿畸形及巨大胎儿的发生率均比对照组高(P<0.05～0.01).结论: 羊水过多与胎儿畸形、巨大胎儿及胎儿性别有关,孕妇在孕30周以前出现羊水过多应高度警惕胎儿畸形,而在孕30周以后出现羊水过多应考虑巨大胎儿,并进一步行相关检查以采取必要的措施改善胎儿预后.     

羊水过多胎儿血流变化的临床研究

目的探讨羊水过多胎儿血流的变化。方法对１３例足月妊娠羊水过多应用彩色多普勒显像技术（ＣＤＦＩ）检测胎儿肾动脉,大脑中动脉的搏动指数（ＰＩ）、阻力指数（ＲＩ）以及脐动脉Ｓ／Ｄ。结果羊水过多胎儿肾动脉ＰＩ、ＲＩ明显高于正常羊水量对照组（Ｐ＜０．０５）;大脑中动脉ＰＩ、ＲＩ,脐动脉Ｓ／Ｄ值两组比较无显差异（Ｐ＞０．０５）。结论羊水过多与胎儿肾动脉血流有明显相关性,其胎儿肾动脉血流阻力改变在羊水过多中的     

羊水过多与胎儿性别的关系--附482例报告

目的:探讨羊水过多与胎儿性别的关系。方法:回顾性研究羊水过多孕妇482例,其中单胎羊水过多440例,双胎羊水过多42例,并随机选取同期单胎羊水正常孕妇1697名和双胎羊水正常孕妇699名作为对照组,对各组婴儿性别与羊水过多的关系进行研究。结果:单胎羊水过多组和双胎羊水过多组中女婴所占比例分别高于单胎羊水正常组和双胎羊水正常组中女婴所占比例,两组分别比较有统计学差异,P<0.05和P<0.01。而且在羊水过多组中,双胎妊娠组中女婴所占比例又较单胎妊娠高,两组比较有统计学差异,P<0.05。结论:妊娠期羊水过多者胎儿性别以女性占优势。     

超声在先天性胎儿畸形诊断中的应用

目的：进一步探讨超声对先天性胎儿畸形的诊断范围及价值。方法：回顾性分析86例先天性胎儿畸形的超声图像。结果：超声诊断完全符合率88.37%(76/86),部分符合率4.65%(4/86),漏诊率6.98%（6/86）。结论：超声诊断先天性胎儿畸形的基础是胎儿形态上的改变,大多数先天性胎儿畸形均可以由超声诊断,超声是产前诊断的首选方法。     

Permanent Pacing in Ebstein's Anomaly

Patients with Ebstein's anomaly present unique challenges to permanent pacing due to anatomical variations and tricuspid valve replacement. We retrospectively reviewed our experience with permanent pacing in patients with Ebstein's anomaly between 1976 and 1993. We identified 401 patients with Ebstein's anomaly, of whom 15 (3.7%) required permanent pacing (1 of the 15 was implanted elsewhere). Of the 15, there were 8 females and 7 males (mean age 32 years [range 7-74]); the indications for pacing were AV block in 11 and sinus node dysfunction in 4. Eight patients were programmed with WI and seven with DDD. All VVI patients were paced epicardially. Two patients with DDD pacemakers had transvenous atrial and ventricular leads, 4 DDD patients had transvenous atrial leads and epicardial ventricular leads, and 1 patient had both epicardial and transvenous systems. Associated surgical procedures included tricuspid valve replacement in 14 of 15, atrial septal defect repair in 10 of 15, atrioplasty in 7 of 15, prior tricuspid annuloplasty in 4 of 15, pulmonary vein dilation in 1 of 15, and conduction system ablation in 2 of 15. Patients had a mean follow-up of 35 months (range 1-168 months). Complications requiring operative intervention occurred in four patients. One patient had displacement of a transvenous ventricular lead. A second patient had an epicardial lead failure. A third patient had a nonfunctioning atrial lead that displaced across the tricuspid valve, causing severe tricuspid regurgitation. The fourth patient had multiple epicardial and endocardial leads exit block with secondary diaphragmatic stimulation. Permanent pacemakers were required in 3.7% of patients with Ebstein's anomaly, with the indication being intrinsic conduction disease in the majority of patients. Ninety-three percent of patients required tricuspid valve replacement, suggesting more severe manifestation of Ebstein's anomaly. Twenty-seven percent had complications requiring surgical intervention. Thus, permanent pacing in patients with Ebstein's anomaly can be challenging and should be approached by an experienced physician. (PACE 1997;20[Pt. I]:1243-1246)     

Fetus In Fetu and Fetaform Teratoma in 2 Neonates

OBJECTIVE: The purpose of this study was to describe the imaging and pathologic findings of 2 cases of complex neonatal abdominal masses and to discuss the probable common embryologic etiology of fetus in fetu (FIF) and fetaform teratomas. METHODS: Two male neonates had complex cystic abdominal masses, 1 of which was diagnosed prenatally, and both had abdominal sonography. One patient also had abdominal computed tomography. Both patients subsequently underwent surgical resection, with pathologic and genetic analysis of these masses. RESULTS: One patient had typical imaging, pathologic, and genetic findings of FIF. The second patient had a well-formed mass that was diagnosed pathologically as a teratoma yet had most of the criteria for FIF that have been set forth in recent embryologic literature. CONCLUSIONS: Recent concepts regarding the origin of FIF suggest that it is part of a spectrum of monozygotic twinning gone awry, ranging from conjoined twins at one end to fetaform teratomas at the other. The imaging and pathologic features of these 2 cases serve to reinforce this concept.     

Clinical Findings of Multiple Pregnancy With a Complete Hydatidiform Mole and Coexisting Fetus

Objective. The aim of this series was to evaluate the clinical features, management, and outcomes of multiple pregnancy with a complete hydatidiform mole and coexisting fetus (CHMCF). Methods. Between 1998 and 2008, we investigated 6 women with a diagnosis of a CHMCF. The gestational age at diagnosis, symptoms, serum b‐human chorionic gonadotropin levels, cytogenetic and molecular analysis findings, complications, routes of delivery, and pregnancy outcomes were assessed. Results. All cases were diagnosed before 14 weeks' gestation by sonography. Only 1 ended with the delivery of a live‐born neonate, whereas the other 5 cases required termination of pregnancy (TOP) before 21 weeks' gestation because of severe maternal complications (eg, preeclampsia, thyrotoxicosis, lung metastasis, and heavy bleeding) or intrauterine fetal death. The pathologic diagnosis of a complete hydatidiform mole was confirmed in all cases. Two patients required methotrexate for treatment of persistent trophoblastic disease (PTD). Conclusions. On the basis of our experience, in cases with a normal karyotype and no gross fetal abnormalities on sonography, we carefully recommend continuation of pregnancy as long as maternal complications are absent or controllable. However, updated treatment criteria are still needed, and intensive maternal follow‐up is necessary in the postpartum period because maternal complications during pregnancy and PTD after TOP are not uncommon.     

临产前后胎心率监护预测产时胎儿情况的调查

目的 对孕妇临产前后行胎心率监护,预测胎儿在宫内的储备能力,以降低胎儿或新生儿的病死率.方法 对孕龄在37～41周的750例住院孕妇临产前后进行常规的胎心率监护,包括无应激试验(non-stress test,NST)、宫缩应激试验(contraction stress test,CST)和缩宫素应激试验(oxytocin challenge test,OCT)试验,并分析胎心监护与胎儿脐带绕颈、新生儿窒息和胎儿生长受限之间的关系.结果 胎心率监护750例中,出现频繁的变异减速与胎儿脐带绕颈关系显著;胎心率评分与新生儿窒息及胎儿生长受限关系显著(P＜0.01).结论 临产前后行NST、CST或OCT试验,可预测产时胎儿在宫内的储备能力并及时发现胎儿宫内缺氧等不良反应,从而尽快改善围产儿的预后.     

胎儿消化道畸形的二维超声诊断价值

目的:探讨二维超声诊断胎儿消化道畸形的价值。方法:回顾性分析2001-2005年我院超声检查“胎儿消化道异常”55例患者的超声影像特征。结果:55例患者中,胎儿腹腔内未见胃泡3例,小胃泡2例,胃泡呈“双泡征”7例,肝脏及脾脏近包膜处强回声1例,肝脏囊性占位1例,肝内实性占位2例,肝脏大1例,小肠扩张2例,结肠扩张11例,先天性无肛门1例,腹腔内囊性占位18例,腹腔内强回声6例。结论:二维超声能客观、动态观察胎儿消化道生理性变化及异常,强调“胎儿消化道异常”的动态及多次超声复查。     

Laboratory Monitoring of Mother,Fetus, and Newborn in Hemolytic Disease of Fetus and Newborn

BackgroundLaboratory monitoring of mother, fetus, and newborn in hemolytic disease of fetus and newborn (HDFN) aims to guide clinicians and the immunized women to focus on the most serious problems of alloimmunization and thus minimize the consequences of HDFN in general and of anti-D in particular. Here, we present the current approach of laboratory screening and testing for prevention and monitoring of HDFN at the Copenhagen University Hospital in Denmark.SummaryAll pregnant women are typed and screened in the 1st trimester. This serves to identify the RhD-negative pregnant women who at gestational age (GA) of 25 weeks are offered a second screen test and a non-invasive fetal RhD prediction. At GA 29 weeks, and again after delivery, non-immunized RhD-negative women carrying an RhD-positive fetus are offered Rh immunoglobulin. If the 1st trimester screen reveals an alloantibody, antenatal investigation is initiated. This also includes RhD-positive women with alloantibodies. Specificity and titer are determined, the fetal phenotype is predicted by non-invasive genotyping based on cell-free DNA (RhD, K, Rhc, RhC, RhE, ABO), and serial monitoring of titer commences. Based on titers and specificity, monitoring with serial peak systolic velocity measurements in the fetal middle cerebral artery to detect anemia will take place. Intrauterine transfusion is given when fetal anemia is suspected. Monitoring of the newborn by titer and survival of fetal red blood cells by flow cytometry will help predict the length of the recovery of the newborn.     

二维超声诊断胎儿消化系统畸形的价值

目的　探讨二维超声对胎儿消化系统畸形的诊断价值 ,为正确诊断胎儿消化系统畸形提供参考。方法　通过总结和分析胎儿各种肠道畸形的二维超声声像图特征 ,对 163 48例胎儿除常规检查外 ,着重观测胎儿肠道液性暗区的形态、位置及最大横径 ,对其横径 >3 .2cm并形成恒定形态者诊断为肠道畸形。结果　在 164 3 8例患者中有 2 0例产前B超诊断为肠道畸形 ,后来经引产、手术或X线检查最后诊断为十二指肠闭锁者 8例、回盲部闭锁 3例、巨结肠 5例、直肠闭锁和肛门闭锁各 2例。结论　二维超声可作为诊断胎儿消化系统畸型的首选方法。     

正常孕妇胎儿脐动脉血流的临床研究

目的:探讨胎儿脐动脉的S/D值与孕龄的关系,把东北与西南地区的S/D值对照,探讨两地的S/D值是否有差异。方法:将东北地区714例和西南地区642例末次月经明确、平时月经规律的正常妊娠的孕妇,孕龄为20周~42周,每4周为一组,将其脐动脉的S/D值加以记录,计算出每组孕龄的S/D值范围,得出孕龄与S/D值的对应关系,并将两地的S/D值范围对照,验证两地脐动脉S/D值是否具有差异。结果:随着孕龄的增加脐动脉的S/D值呈下降趋势,两地之间正常胎儿的S/D值无差异性,P>0·05。结论:脐动脉的S/D值不具有区域性的差异,是一个较客观的指标,对临床具有指导意义。     

胎儿畸形的产前超声诊断

目的:探讨超声在产前诊断胎儿畸形中的应用。方法:采用B型超声诊断仪或彩色多普勒超声诊断仪对15 000例孕妇行产前检查,并观察胎儿的情况。结果:15 000例孕妇产前检查中,检出胎儿畸形96例,其中无脑儿30例,脑膨出7例,脑积水5例,唇裂2例,开放性脊柱裂5例,单腔心2例,多指畸形2例,腹裂8例,脐膨出2例,胎儿胸、腹水14例,膈疝2例,单肾发育不全1例,单侧肾积水2例,双肾盂扩张8例,胃肠道畸形3例,致死性软骨1例,双胎连体畸形2例。结论:超声诊断仪对产前诊断胎儿畸形有重要价值,对降低围产期发病率和死亡率及提高出生人口素质和优生优育有重要意义。