目的 探讨胎儿尿道下裂与母体不良妊娠结局的关系.方法 选取2016年6月至2022年3月在首都医科大学附属北京妇产医院分娩并诊断为胎儿或新生儿尿道下裂的103例孕妇为尿道下裂组,另选取同期于首都医科大学附属北京妇产医院分娩的无尿道下裂的胎儿或新生儿的41742例孕妇为对照组.比较尿道下裂组和对照组的妊娠合并症/并发症发生情况.根据有无小于胎龄儿(small for gestational age,SGA)将尿道下裂组进一步分为SGA组和无SGA组,比较SGA组和无SGA组的妊娠合并症/并发症发生情况、妊娠结局、超声表现特点、母体血管灌注不良发生情况,并分析尿道下裂组的剖宫产指征及早产原因.结果 尿道下裂组重度子痫前期、SGA、胎盘早剥、前置胎盘、早产及剖宫产发生率均高于对照组,差异有显著性(P＜0.05).尿道下裂组中40例(38.83%)合并SGA,63例(61.17%)无SGA,两个亚组比较,SGA组重度子痫前期、早产、胎儿宫内窘迫、剖宫产、脐动脉血流阻力增高、胎盘脐带附着异常、母体血管灌注不良的发生率显著高于无SGA组,而分娩孕周小于无SGA组,差异均有显著性(P＜0.05).胎儿宫内窘迫是尿道下裂组最主要的剖宫产指征及导致早产的原因.结论 胎儿尿道下裂孕妇发生重度子痫前期、SGA、胎盘早剥等的风险增高.产前超声检查一旦发现胎儿尿道下裂,尤其合并SGA时,需加强产前监测.尿道下裂的诊断有助于早期发现潜在的高危病例,以加强产前监测,改善妊娠结局.

目的 探讨应用胎盘植入性疾病(placenta accreta spectrum disorders,PAS)产前超声分级系统评估凶险性前置胎盘病例手术风险的价值.方法 应用PAS产前超声分级系统回顾性分析2018年9月至2020年6月在首都医科大学附属北京妇产医院收治的凶险性前置胎盘患者32例,根据此分级系统将患者分成四组:PAS 0级、PAS 1级、PAS 2级、PAS 3级.结果 所有患者分娩方式均为剖宫产手术,其中1例切除子宫,31例保留子宫.PAS 0级13例(40.6％),PAS 1级5例(15.6％),PAS 2级11例(34.4％),PAS 3级3例(9.4％);四组间患者年龄、末次超声检查孕周比较,差异均无显著性(P>0.05);四组间患者既往剖宫产次数、胎盘植入类型比较,差异有显著性(P<0.05).PAS 0级和PAS 1级患者平均出血量低于PAS 2级、PAS 3级,PAS 0级和PAS 1级患者平均自体输血量、悬浮红细胞、冰冻血浆水平低于PAS 2级,PAS 2级、PAS 3级患者的平均手术时间较PAS 0级和PAS 1级的时间长,差异均有显著性(P<0.05).除采用剖宫产手术常规止血措施外,PAS 0级和1级的患者中仅1例(5.6％,1/18)PAS 0级采用宫腔填纱止血,而PAS 2级、3级患者全部采用辅助止血措施,其中8例(57.1％,8/14)采用腹主动脉球囊,2例(14.3％,2/14)术后行双侧子宫动脉栓塞术,1例(7.1％,1/14)因胎盘植入范围太广而无法保留子宫,遂切除子宫.结论 PAS产前超声分级系统在凶险性前置胎盘患者的术前评估中具有理想的应用价值,较好地预测了患者手术出血量及子宫切除风险,为术前制订手术方案提供了可靠的影像学依据;对于PAS 2级和PAS 3级患者如拟行保留子宫的手术方案,应充分预估人工剥离胎盘后子宫胎盘剥离面出血与子宫肌层修补过程中的出血量,充分备血,做好有效的止血方案,一旦威胁到产妇的生命安全,需紧急切除子宫.

目的 探讨超声在诊断孕中期完全性子宫破裂中的价值.方法 选取2010年至2019年在首都医科大学附属北京妇产医院收治的经手术证实的8例孕中期完全性子宫破裂患者,对8例患者的术前超声声像图特点及临床资料进行回顾性分析.结果 8例病例均存在异常超声表现,且复杂多样.结合高危因素及临床表现,超声明确诊断子宫破裂2例、先兆子宫破裂1例,可疑子宫破裂4例,误诊胎盘早剥1例.结论 超声是诊断孕中期完全性子宫破裂的重要方法,可为临床诊断提供依据和参考.

Objective:To evaluate the placental villus blood flow in different pregnancy using superb microvascular imaging(SMI).Methods:Fifty single pregnant women were randomly selected from early pregnancy pregnant women with outpatient examinations from January 2019 to June 2019. The SMI technique was used to monitor the villus blood flow of the placenta during routine ultrasound examination in early, middle and late pregnancy. The blood flow of the placental villus at the insertion point of the placenta umbilical cord and the edge of the placenta was explored, and the corresponding arterial blood flow spectrum was collected, and the values of systolic/diastolic velocity ratio(S/D), pulsatility index(PI), resistance index(RI) and peak systolic velocity(PSV) were recorded. The correlation between the measurement rate of villus blood flow spectrum and the placenta position, fetal position, and pregnancy period were analyzed by Spearman correlation. Chi-square test was used compare the difference of the display rates of placental villus blood flow and the measurement rates of blood flow spectrum during different pregnancy periods. The consistency analysis of the results between the two inspectors was performed using Kappa test.Results:Finally, 30 pregnant women were enrolled. SMI showed 98.9% (89/90) of placental villus blood flow. The consistency of the examination results between the two examiners was good. The measurement rate of villus artery blood flow spectrum was not correlated with the placenta and fetal position ( P>0.05), but correlated with defferent trimesters ( r s=0.478, P<0.05). There was no difference in the display rate of villus blood flow at the insertion point of the placenta umbilical cord and at the edge of the placenta in each trimester( P>0.05). The measurement rate of blood flow spectrum was statistically different ( P<0.05). And the measurement rate of early pregnancy (33.3%/3.3%) was lower than the middle (70.0%/50.0%) and late pregnancy (56.6%/60.0%). The consistency of the examiners results between the two examiner is good (Kappa=0.55-0.92, P<0.05). Conclusions:SMI can display the blood flow of placental villus in different stages of pregnancy and can measured blood flow accordingly. The different pregnancy stages affect the measurement results. Placental villus blood flow measurement in the middle and late pregnancy is easier to measure than in the early pregnancy. The fetal position and placental position do not affect blood flow measurement.

Objective To evaluate the related factors for adverse maternal and fetal outcome among women with HELLP syndrome.Methods We retrospectively analyzed maternal and fetal medical records of pregnancy complicated HELLP syndrome from January 1,2005 to December 31,2009.Related factors included maternal age,parity,gestational age at diagnosis,adverse maternal and fetal outcomes.Statistical analysis was performed with the χ2 test analysis.Results A total of 32 pregnant women with HELLP syndrome were reviewed.The incidence of HELLP or ELLP was 2.16% among the women with severe pre-eclampsia(32/1 484).Gestational age at diagnosis was about 32 weeks and 4 days,with a peak frequency between the 27th and 37th gestational weeks.In about 84.4% of the cases,the HELLP syndrome developed before delivery.The rest developed in 48 h after delivery.The incidence of maternal complication,such as eclampsia,abruption placenta,postpartum bleeding,acute renal deficiency was higher among women with HELLP syndrome as compared with ELLP.The incidence of HELLP was significantly associated with a platelet nadir below 50×109/L(P0.05).High incidence of fetal and neonatal death was present before 30 weeks of gestational age and with intrauterine growth restriction.High incidence of HELLP syndrome was also present in women without regular care during pregnancy.Conclusion The maternaladverse outcome of HELLP was higher than that of ELLP.There was a significant association between a platelet nadir below 50×109/L and the severity of HELLP.The perinatal mortality and morbidity were high before 30 weeks.Regular care during pregnancy may play an important role in preventing maternal and fetal adverse outcomes.