产前超声鉴别诊断持续性左上腔静脉的临床意义

目的探讨产前超声鉴别诊断持续性左上腔静脉(PLSVC)的临床意义。方法对2018年1～12月在我院行产前检查并分娩的5612例孕妇的临床资料进行分析持续性左上腔静脉胎儿的超声心动图表现及相关疾病情况。结果检出PLSVC胎儿22例,发生率为0.39%,均为双上腔静脉。其中单纯型PLSVC 14例(63.64%),非单纯型PLSVC 8例(36.36%)。在非单纯型PLSVC中,合并心脏畸形2例,心外畸形1例,5例同时合并心脏及心外畸形。14例单纯型PLSVC均有良好的妊娠结局,而非单纯型妊娠结局不良5例(62.50%)(P0.05)。结论 PLSVC在胎儿中有一定发生率,合并心内外畸形居多;非单纯型预后较单纯型差。产前超声能够有效诊断PLSVC,为及时发现胎儿畸形及胎儿发育不良提供依据。     

产前超声诊断胎儿单脐动脉及其与胎儿异常的应用价值研究

目的:探究产前超声诊断在胎儿单脐动脉与胎儿异常中的应用价值。方法:回顾性分析自2014年12月~2016年8月于我院行超声检查且确诊为单脐动脉的胎儿58例,观察并记录其超声表现,并对其合并其它异常病症、脐动脉缺失的侧别进行分析。结果:所有入组孕妇中于20周前发现单脐动脉胎儿7例,于孕21~24周检测发现单脐动脉胎儿32例,于孕25~28周检测出单脐动脉胎儿13例,于孕28周发现单脐动脉胎儿6例。左侧脐动脉缺失36例,右侧脐动脉缺失22例,孤立型脐动脉缺失27例,合并其它组织器官畸形31例。27例孤立型脐动脉缺失胎儿仅存1例S/D值明显升高,其余均处于正常状态。胎儿染色体检测结果为27例孤立型单脐动脉中5例染色体表现为多态性,其他染色体结果均显示正常;31例合并其它组织结构异常的单脐动脉中8例染色体结果显示异常。58例单脐动脉胎儿中活产23例,引产30例,死于宫内5例。结论:单脐动脉与胎儿畸形异常密切相关,且经产前超声检查可有助于明确胎儿单脐动脉的发生发展,对改善孕妇妊娠结局具有重要意义。     

彩色多普勒超声检查对胎儿颅内畸形筛查的应用价值及染色体异常分析

摘要 目的：探讨彩色多普勒超声检查对胎儿颅内畸形筛查的应用价值,并进行染色体异常分析。方法：选择2016年2月至2019年5月本院收治的进行胎儿颅内畸形筛查的高危孕妇120例,所有孕妇都给予彩色多普勒二维超声与三维超声筛查,对超声筛查异常者进行染色体异常分析,记录预后情况。结果：在120例孕妇中,二维超声诊断为胎儿颅内畸形12例,三维超声诊断为13例(预后都确诊为胎儿颅内畸形)。染色体核型筛查检出胎儿颅内畸形12例,其中21-三体综合征8例,18-三体综合征3例,13-三体综合征1例。确诊为胎儿颅内畸形的孕妇超声NT值都显著高于非胎儿颅内畸形孕妇,差异都有统计学意义(P<0.05)。孕妇选择终止妊娠10例,选择继续妊娠3例,继续妊娠3例胎儿都最终死亡。结论：产前彩色多普勒超声结合染色体核型在胎儿颅内畸形筛查中具有很高的价值,两者可互相补充,共同发挥诊断与预后评估价值。     

产前超声诊断胎儿肢体畸形的效果观察

目的探讨产前超声诊断胎儿肢体畸形的效果。方法选择2015年4月~2016年4月在我院行产前检查的孕妇1180例,均采用彩色多普勒超声诊断仪进行产前超声检查,并观察产前超声诊断胎儿肢体畸形的临床应用效果。结果本组1180例孕妇中,检出肢体畸形胎儿38例,检测率为3.22%,其中脚缺失胎儿5例(13.16%),手畸形胎儿8例(21.05%),足内翻畸形胎儿6例(15.79%),股骨歪曲胎儿6例(15.79%),上肢畸形胎儿3例(7.89%),桡骨缺损胎儿8例(21.05%),六指畸形胎儿2例(5.26%)。超声诊断胎儿肢体畸形者均行引产手术,引产结果与超声诊断结果相符。结论产前超声检查在胎儿肢体畸形诊断中具有较高检测价值,能够有效检查出胎儿肢体发育情况,对提高人口质量具有重要意义。     

对比分析四维容积超声及彩色多普勒超声在胎儿肺静脉异位引流诊断中的应用

摘要 目的：对比分析四维容积超声及彩色多普勒超声在胎儿肺静脉异位引流（APVC）诊断中的应用价值。方法：采用回顾性分析方法,2019年1月到2022年1月选择在本院进行诊治的胎儿肺静脉异位引流孕妇60例作为研究对象,都给予四维容积超声及彩色多普勒超声,记录影像学特征并判断诊断价值。结果：在60例孕妇中,彩色多普勒超声检查判断为胎儿肺静脉异位引流51例,诊断敏感性为85.0 %;四维容积超声检查判断为胎儿肺静脉异位引流59例,诊断敏感性为98.3 %,四维容积超声检查对胎儿肺静脉异位引流的诊断敏感性明显高于彩色多普勒超声检查（P<0.05）。彩色多普勒超声检查与四维容积超声检查诊断的特异性都为100.0%。在60例孕妇中,判断为胎儿肺静脉异位引流心上型32例,心下型28例;心上型的肺静脉引流途径为肺静脉-垂直静脉-右上腔静脉22例、肺静脉-垂直静脉-左上腔静脉10例,心下型的肺静脉引流途径为肺静脉-垂直静脉-左头臂静脉-右上腔静脉6例、肺静脉-垂直静脉-门静脉22例。合并心脏畸形32例,合并畸形率为53.3 %;有51例孕妇终止妊娠,9例孕妇继续妊娠,其中8例未经治疗者新生儿期死亡,1例在3月龄死亡。结论：相对于彩色多普勒超声,四维容积超声在胎儿肺静脉异位引流诊断中的应用可提高诊断敏感性,可有效反映肺静脉回流情况,可指导临床进行早期干预。     

超声心动图检测胎儿心包积液的临床价值

目的:探讨超声心动图检测胎儿心包积液的临床意义。方法:2007-2010年在我院检查行超声心动图检查的高危孕妇473例,同时设对照组,检测孕龄在20-40周无明显高危妊娠因素的孕妇472例,并将产前超声检查结果和胎儿尸检或分娩后超声心动图检查结果进行对照。结果:1.高危组检出72例心包积液,检出率12.5%,对照组检出13例心包积液,检出率3%,两组胎儿心包积液检出率间差别有统计学意义(x2=39.57,P<0.05)。2.85例心包积液中,孤立性心包积液38例,伴其他心脏畸形或者其他系统畸形47例,其中孤立性心包积液预后良好。结论:超声心动图能够敏感地检出胎儿心包积液;心包积液程度并不是最重要的,其伴随心脏畸形或者其他畸形决定预后。     

胎儿迷走右锁骨下动脉175例临床分析

目的探讨提高迷走右侧锁骨下动脉(ARSA)的检出率,超声评估妊娠中期ARSA的可行性,ARSA在筛查21-三体及其与其他异常相关性中的表现。方法回顾性分析2013年1月～2017年12月在我院行产前超声筛查检出的ARSA 175例的临床资料,总结其检出方法并随访观察妊娠结局,观察产前超声诊断的ARSA胎儿有无合并其他畸形,并对出生后胎儿进行随访,记录其产后28天内各种生理指标、外观及Apgar评分。结果 175例ARSA均由彩色多普勒超声在三血管气管切面(Three vessels and tmchea view,3VT)检出,其中孤立ARSA 94例,合并其他畸形81例;除8例合并严重畸形胎儿引产外,65例出生儿均身体情况良好。结论 3VT是显示胎儿ARSA敏感且有效的切面,可显著提高其检出率;孤立的ARSA胎儿预后较好,若合并其他心内外畸形,则预后较差。     

妊娠期肝内胆汁淤积症合并妊娠期糖尿病的母儿结局分析

目的:探讨妊娠期肝内胆汁淤积症(ICP)合并妊娠期糖尿病(GDM)对母儿结局的影响。方法:选取2012年1月至2013年2月在我院住院分娩的13例ICP合并GDM孕妇为ICP+GDM组,将同期住院分娩的69例单纯ICP孕妇归为ICP组,对两组孕妇的母儿结局进行回顾性比较分析。结果:两组孕妇的子痫前期、胎膜早破、剖宫产、产后出血发生率比较,无明显差异(P0.05);ICP+GDM组孕妇围产儿Apgar小于7分、新生儿肺炎、早产发生率明显高于ICP组,差异有统计学意义(P均0.05);ICP+GDM组孕妇围产儿平均出生体重低于ICP组,差异有统计学意义(P0.05)。结论:妊娠期肝内胆汁淤积症合并妊娠期糖尿病将进一步加重围产儿不良结局,对于此类孕妇,应加强监护和管理,适时终止妊娠,以改善围产儿结局。     

超声心动图检测胎儿心包积液的临床价值

目的：探讨超声心动图检测胎儿心包积液的临床意义。方法：2007-2010年在我院检查行超声心动图检查的高危孕妇473例,同时设对照组,检测孕龄在20-40周无明显高危妊娠因素的孕妇472例,并将产前超声检查结果和胎儿尸检或分娩后超声心动图检查结果进行对照。结果：1.高危组检出72例心包积液,检出率12.5%,对照组检出13例心包积液,检出率3%,两组胎儿心包积液检出率间差别有统计学意义（x2=39.57,P〈0.05）。2.85例心包积液中,孤立性心包积液38例,伴其他心脏畸形或者其他系统畸形47例,其中孤立性心包积液预后良好。结论：超声心动图能够敏感地检出胎儿心包积液;心包积液程度并不是最重要的,其伴随心脏畸形或者其他畸形决定预后。     

胎儿唇裂与唇腭裂产前超声诊断分析

目的:探讨超声诊断胎儿唇裂与唇腭裂的图像特征,以提高胎儿唇裂及唇腭裂的确诊率。方法:选取我院2013年1月~2013年12月的2381例产前超声筛查检查出的17例唇腭裂胎儿,经二维三维超声检查后与出生后颜面部检查结果比较。结果:17例唇腭裂胎儿共检查出16例,漏检1例,检出准确率94.12%,其中1例完全唇裂伴完全腭裂仅检查出唇裂,误检率5.88%。其中未合并其他畸形胎儿16例(94.12%,16/17),完全唇裂伴完全腭裂13例(76.47%,13/17),单纯唇裂2例(11.76%,2/17),单纯腭裂1例(5.88%,1/17);唇腭裂合并其他畸形胎儿1例。结论:产前进行超声检查在胎儿唇裂和唇腭裂诊断中具有显著作用,发现唇裂或唇腭裂后可经多次反复检查确诊,对于部分胎儿可能存在患有唇裂或唇腭裂而漏检情况。     

Contribution of the umbilical and portal veins to the hepatic blood supply of guinea pig fetuses--an angiographic study.

The interlobular distribution of the umbilical and portal venous blood flow within the liver was examined in 35 guinea pig fetuses between 59 and 65 days of gestation. Contrast medium was injected into the umbilical or vitelline vein, and its passage through the liver was monitored by serial angiography. In four experiments, injections were made into both the umbilical and vitelline veins of the same fetus. To ease interpretation of the angiograms obtained in vivo, we also made a postmortem examination of livers in which the venous system had been filled with an aqueous suspension of barium sulphate in gelatin. These combined experiments demonstrated no passage of contrast medium from the placenta to the inferior vena cava, which is in accordance with independent evidence that the term guinea pig fetus lacks a functional ductus venosus. The area supplied by the umbilical and portal veins was clearly and consistently delineated. The umbilical vein supplied the left lobe and the left sublobe of the quadrate lobe. The portal vein supplied the right lobe, the smaller caudate lobe, and all or most of the right sublobe of the quadrate lobe. This pattern of distribution appears to be determined by flow and pressure gradients within the hepatic circulation.     

Umbilical vein variations: review of the literature and a case report of a persistent right umbilical vein

A case of a ligamentum teres formed from an obliterated right umbilical vein is described. It passed to the right branch of the portal vein. The quadrate and left lobes of the liver were not separated by the usual fissure. Very few cases of anomalous umbilical veins or persistent right umbilical veins have been recorded. Of these, several have been recorded only in the umbilical cord, while in others the persistent right umbilical vein has been found intra-abdominally, in an extrahepatic position, and passing directly to the right atrium or to the inferior vena cava. Its presence is generally associated with severe congenital abnormalities, in contrast with the present case. In view of the high incidence of congenital defects associated with aberrant or accessory umbilical veins, when these are detected either in the umbilical cord or in the abdomen by umbilical phlebography, it is suggested that the patient should be carefully investigated for other congenital abnormalities.     

Ultrasound-guided fetal intravenous transfusion for severe rhesus haemolytic disease.

Intrauterine, intraperitoneal transfusion is associated with a poor survival rate in fetuses with hydrops and low gestational age. A method of direct fetal intravenous transfusion was used in two fetuses. One fetus with severe rhesus haemolytic disease was given transfusions in the 29th and 30th weeks of gestation, using an ultrasound-guided needle through the hepatic part of the umbilical vein without fetoscopy. In another fetus, an experimental cannulation of the umbilical vein succeeded in the 23rd week of gestation. Ultrasound-guided fetal intravenous transfusion avoids the use of fetoscopy, which has limitations, and may improve the prognosis for rhesus-sensitised fetuses.     

Progesterone values in monkeys near term

The serum progesterone of peripheral, ovarian, uterine and umbilical blood from six Macaca mulatta and two M. fascicularis was determined by radioimmunoassay in late pregnancy. Peripheral progesterone values fell to lower levels the day after delivery, a decrease indicating placental progesterone secretion. The concentration of progesterone in the ovarian vein associated with the presence of a corpus luteum was greater than that in the contralateral vein, a difference denoting active progesterone secretion by the corpus luteum. In most cases the uterine vein on the side associated with the placement of the primary and secondary placentae contained more progesterone than its opposite counterpart, a condition that suggests some synthesis of progesterone by the placenta. The umbilical vein/artery progesterone ratio showed fetal metabolism of this steroid and also greater metabolism of progesterone by the female fetus. The progesterone concentration in the ovarian vein associated with the corpus luteum in mothers who bore female fetuses was greater than that of the same vein in those mothers who bore male fetuses. Peripheral progesterone levels were high the day before cesarean section and fell to lower levels the day after delivery. The decline was more rapid in mothers who bore male fetuses.     

Limb reduction defects in humans associated with prenatal isotretinoin exposure.

Retinoic acid has long been used to induce limb reductions defects in experimental animal studies. No limb malformations, however, have been reported among malformed retinoic acid-exposed human fetuses from case reports or epidemiologic studies. We report a child and a fetus with limb reduction malformations following maternal use of isotretinoin (13-cis-retinoic acid) during the first trimester of pregnancy. The child had a unilaterally absent clavicle and nearly absent scapula, with a short humerus and short, synostotic forearm bones. He also had ventriculomegaly and developmental delay, minor dysmorphic facial features, and a short sternum with a sterno-umbilical raphe. The fetus had a unilaterally absent thumb with normal proximal bony structures. Other findings included hydrocephalus, craniofacial anomalies, thymic agenesis, supracristal ventricular septal defect, single umbilical artery, anal and vaginal atresia, and urethral agenesis with dysplastic, multicystic kidneys. Although the limb malformations were quite dissimilar, a number of anomalies that are frequently found among isotretinoin-exposed fetuses/infants were present in both cases. This increases the probability that retinoic acid caused these limb defects, but a causal association cannot be conclusively drawn on the basis of these two retrospective case reports.     

Transplacental transfer of medetomidine and ketamine in pregnant ewes

The extent of placental transfer of medetomidine and ketamine is unknown in pregnant ewes. Date-mated singleton (n = 8) and twin (n = 8) pregnant merino cross ewes were anaesthetized for Caesarean delivery of preterm lamb fetuses. A combination of medetomidine (20 μg/kg) and ketamine (10 mg/kg) was administered by intravenous injection and surgery performed immediately thereafter. Blood samples were collected from the ewe at one, five and 10 min after intravenous injection and from the umbilical vein of the fetus at delivery. Non-pregnant ewes were also anaesthetized (n = 8). There was no difference in the plasma concentration of medetomidine or ketamine when comparing singleton and twin ewes or pregnant and non-pregnant ewes for the short duration of the study. Fetal plasma concentrations of each drug were comparable to the maternal concentrations at the same time. We conclude that both drugs cross the placenta readily and provide anaesthesia and analgesia for the fetus when it is delivered.     

Obstetric importance,diagnosis, and management of fetal tachycardias.

During 1980-7, 23 pregnancies of 22-38 weeks'' duration were investigated for fetal tachycardia. Twelve were cases of supraventricular tachycardia, eight of atrial flutter, and three cases in which the rhythm varied between supraventricular tachycardia and atrial flutter. In 11 cases the fetus had developed non-immune fetal hydrops before referral; 12 cases were non-hydropic at referral but one of this group of fetuses became hydropic during treatment. No relation was found between the rate or type of arrhythmia and the presence or absence of intrauterine heart failure. One non-hydropic infant was delivered electively prematurely. Maternal antiarrhythmic treatment was instituted in the remaining 22 cases. Conversion of the arrhythmia was achieved with digoxin alone in five cases and with a combination of digoxin and verapamil in nine. Control of the arrhythmia was achieved in seven of the 10 non-hydropic fetuses, and all were delivered at term with no deaths. Of the 12 hydropic fetuses, control was achieved in seven. Only three of the hydropic fetuses were delivered close to term. There were two deaths, both in the hydropic group. Of the whole group, five neonates suffered severe complications of prematurity. In this series the main benefit of treatment appeared to be in prolonging gestation of those hydropic fetuses in which conversion was achieved.     

Blood flow to the placenta and lower body in the growth-retarded guinea pig fetus

Blood flow to the placenta and lower body of control and growth retarded (IUGR) guinea pig fetuses was measured between 60-64 days of pregnancy by the microsphere technique. Further information about the hepatic blood supply and its interlobular distribution was obtained by injecting microspheres into the umbilical vein and a branch of the portal vein. Liver weight was reduced by 60% in IUGR fetuses from 5.0 +/- 0.2 to 2.0 +/- 0.1 g, compared to a decrease in body weight of 50% from 91.6 +/- 3.0 to 45.4 +/- 2.6 g. In addition, there was a proportionately greater reduction in the size of the right liver lobe. Umbilical blood flow was 10.8 +/- 1.0 ml min-1 in control fetuses and 4.9 +/- 1.2 ml.min-1 in IUGR fetuses, whilst blood flow in the portal vein was reduced from 1.4 +/- 0.1 to 0.8 +/- 0.3 ml min-1 and that in the hepatic artery from 0.6 +/- 0.1 to 0.3 +/- 0.1 ml.min-1. Since ductus venosus flow was absent or negligible, the umbilical venous return accounted for greater than 80% of the hepatic blood supply in both control and IUGR fetuses. Blood flows were, however, unequally distributed between the liver lobes. The right lobe was supplied mainly by the portal vein in IUGR fetuses as well as the controls, and received less than 6% of the umbilical venous return. No significant change occurred in total liver perfusion, which was 2.8 +/- 0.2 ml min-1 per g in control fetuses and 2.6 +/- 0.4 ml min-1 per g in IUGR fetuses. It is therefore suggested that a high rate of liver metabolism is maintained in IUGR, but by a smaller tissue mass, and that the rate of umbilical blood flow may be one factor determining the size of the liver. The relatively greater reduction in size of the right lobe in IUGR is probably the result of poor oxygenation of the portal venous blood.