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Albumin transfusion in non-immune fetal hydrops: Doppler ultrasound evaluation of the acute effects on blood circulation in the fetal aorta and the umbilical arteries. 白蛋白输注在非免疫性胎儿水肿:多普勒超声评价对胎儿主动脉和脐动脉血液循环的急性影响。
Pub Date : 1989-01-01 DOI: 10.1159/000263433
G Lingman, M Stangenberg, J Legarth, F Rahman

A case of non-immune fetal hydrops, diagnosed as mucopolysaccharidosis VII with hypoalbuminemia, was treated in utero with albumin transfusions via cordocentesis on five occasions. Blood samples were taken for analysis of full blood count and blood gases before and after the transfusions. Pulsed Doppler ultrasound examinations of the arterial waveform were performed in the umbilical arteries and the descending fetal aorta and analyzed for the pulsatility index (PI). The hemoglobin concentration and the hematocrit decreased from 111 +/- 5 g/l and 0.335 +/- 0.008 to 95 +/- 5 g/l and 0.282 +/- 0.023 (mean +/- SD), respectively, after the transfusions. The calculated blood volume increased more than the given volume, indicating an autotransfusion causing additional plasma volume expansion. The blood gases were not significantly changed by transfusion. The PI decreased both in the umbilical arteries (p less than 0.05) and the descending fetal aorta, indicating peripheral vasodilatation. A positive correlation was found between the umbilical artery PI and the hematocrit before and after the albumin transfusion (r = 0.59; p less than 0.05). This relation could be due to covariation with other factors, e.g. peripheral vasodilatation secondary to the increased blood volume and the puncture of the umbilical vein itself. No improvement of the hydrops was seen after the albumin transfusions. The fetus died in utero during spontaneous labor after 30 gestational weeks.

一例非免疫性胎儿水肿,诊断为粘多糖病伴低白蛋白血症,在子宫内通过脐带穿刺白蛋白输注5次治疗。在输血前后采集血液样本进行全血细胞计数和血气分析。采用脉冲多普勒超声检查脐动脉和胎儿降主动脉动脉波形,分析脉搏指数(PI)。输血后血红蛋白浓度和红细胞压积分别由111 +/- 5 g/l和0.335 +/- 0.008降至95 +/- 5 g/l和0.282 +/- 0.023(平均+/- SD)。计算出的血容量比给定的血容量增加更多,表明自体输血导致额外的血浆容量扩大。输血对血气没有显著影响。脐动脉及胎儿降主动脉PI均下降(p < 0.05),提示外周血管舒张。输血前后脐动脉PI与红细胞压积呈正相关(r = 0.59;P < 0.05)。这种关系可能是由于与其他因素的共同变异,例如,外周血管扩张继发于血容量增加和脐静脉本身的穿刺。白蛋白输注后水肿未见改善。妊娠30周后,胎儿在子宫内自然分娩中死亡。
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引用次数: 4
When to perform the next intra-uterine transfusion in patients with Rh allo-immunization: combined intravascular and intraperitoneal transfusion allows longer intervals. 同种异体Rh免疫患者何时进行下一次子宫内输血:血管内和腹腔内联合输血可延长间隔时间。
Pub Date : 1989-01-01 DOI: 10.1159/000263385
U Nicolini, N K Kochenour, P Greco, E Letsky, C H Rodeck

Data from 99 intra-uterine transfusions performed in 30 patients (31 fetuses) with Rh allo-immunization have been reviewed. Mean gestational age at the first transfusion was 23.6 weeks and mean fetal haematocrit 19.8%. The number of procedures was on average 3.2 per fetus. Survival rate was 84%. Fifty-nine intravascular transfusions were combined with intraperitoneal transfusions. Combined intravascular and intraperitoneal transfusions, when compared to intravascular transfusions alone, achieved a significantly longer interval between transfusions and also maintained a higher fetal haematocrit at the subsequent transfusion. Mean fall in fetal haematocrit was 0.98% per day with a wide range. There was a general tendency towards a less marked fall during the second interval between transfusions than in the first with the exception of those cases in which the percentage of fetal red cells at the start of the second transfusion was increased compared to that which was found at the end of the first, i.e., when fetal erythropoiesis was not suppressed.

本文回顾了30例(31例胎儿)Rh异体免疫患者99例子宫内输血的数据。第一次输血时的平均胎龄为23.6周,平均胎儿红细胞压积为19.8%。平均每个胎儿做3.2次手术。生存率为84%。59例血管内与腹腔联合输血。与单独的血管内输血相比,血管内和腹腔内联合输血的间隔时间明显更长,并且在随后的输血中保持更高的胎儿红细胞压积。胎儿红细胞压积平均每天下降0.98%,下降幅度较大。总的趋势是,在第二次输血间隔期间,胎儿红细胞的百分比比第一次输血间隔期间下降的幅度较小,但在第二次输血开始时,胎儿红细胞的百分比比在第一次输血结束时发现的百分比增加的情况除外,即当胎儿红细胞生成未被抑制时。
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引用次数: 37
Reevaluation of nonstress test by umbilical venous blood profile using cordocentesis. 脐带穿刺法脐静脉血非应激试验的再评价。
Pub Date : 1989-01-01 DOI: 10.1159/000263437
K Okamura, H Endoh, T Watanabe, S Tanigawara, M Iwamoto, J Murotsuki, A Yajima

Fetal blood sampling by cordocentesis was performed in 85 cases of fetuses with either nonimmune hydrops fetalis, anomalies, intrauterine growth retardation, maternal immunological disorders, Rh incompatibility, hydronephrosis, polyhydramnios, maternal preeclampsia or fetal tumor. Fetal heart rate monitoring was also recorded before cordocentesis. We evaluated the usefulness of the nonstress test (NST) with regard to fetal hematologic gas profiles including pH, pO2 and pCO2. When the acceleration was classified into reactive and nonreactive group, pH and pO2 were significantly higher in the reactive group than in the nonreactive group. pCO2 was significantly lower in the former than the latter. However, the sensitivity and specificity of the reactive NST predicting fetal umbilical venous pO2 over 20 mm Hg was 79.7 and 68.7%, respectively. The false-positive rate of nonreactive NST predicting hypoxemia below 20 mm Hg pO2 was 44%. As a consequence, we cannot always rely on the NST, and should perform fetal blood sampling to assess fetal condition for further management.

对非免疫性积水、畸形、宫内发育迟缓、母体免疫障碍、Rh不相容、肾积水、羊水过多、母体子痫前期或胎儿肿瘤的85例胎儿进行脐带穿刺采血。脐带穿刺前记录胎儿心率监测。我们评估了非应激测试(NST)对胎儿血液学气体谱的有用性,包括pH, pO2和pCO2。将加速分为反应性组和非反应性组时,反应性组的pH和pO2明显高于非反应性组。前者的二氧化碳分压显著低于后者。然而,反应性NST预测胎儿脐静脉pO2≥20 mm Hg的敏感性和特异性分别为79.7和68.7%。非反应性NST预测20mmhg pO2以下低氧血症的假阳性率为44%。因此,我们不能总是依赖于NST,而应该进行胎儿血液取样来评估胎儿状况,以便进一步处理。
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引用次数: 7
First trimester maternal serum lysosomal enzymes: implications for carrier testing and prenatal diagnosis. 孕早期母体血清溶酶体酶:携带者检测和产前诊断的意义。
Pub Date : 1989-01-01 DOI: 10.1159/000263445
R A Kaufmann, A Drugan, M I Evans, D Mitchell, Y Ben-Yoseph, K S Moghissi

Carrier detection for lysosomal storage diseases is sometimes possible by evaluating maternal serum levels of specific enzymes. However, lysosomal enzymes (LE) can be modified by maternal hormonal changes in pregnancy or embryonic contributions. Maternal serum was obtained prospectively in the follicular phase and at 2-5 and 7-11 weeks after conception from 13 infertility patients with precisely known ovulation dates. Eleven enzyme activities were determined fluorimetrically using 4-methylumbelliferyl substrates. Using repeated measures ANOVA, alpha-N-acetyl-glucosaminidase (p less than 0.05), hexosaminidase A (p less than 0.005) and hexosaminidase A and B (p less than 0.005) increased during the first trimester, and 8 enzymes did not change significantly. Our data show differing patterns of LE in the first trimester. These may be explained by: (1) variability of maternal reaction to hormonal changes of pregnancy, or (2) variable embryonic contributions suggesting differential ontogeny and placental transfer of these enzymes. The increase in levels of the 3 specific LE in maternal serum may interfere with the accuracy of carrier testing in early pregnancy, but pregnancy should not interfere with the other 8.

有时可以通过评估母体血清中特定酶的水平来检测溶酶体贮积病的携带者。然而,溶酶体酶(LE)可以通过妊娠期或胚胎期母体激素的变化而改变。在卵泡期和受孕后2-5周和7-11周,从13例精确确定排卵日期的不孕症患者中前瞻性地获得了母体血清。用4-甲基伞形花基底物荧光法测定了11种酶的活性。经重复测量方差分析,α - n -乙酰氨基葡萄糖酶(p < 0.05)、己糖氨基酶A (p < 0.005)、己糖氨基酶A和己糖氨基酶B (p < 0.005)在妊娠早期升高,8种酶无显著变化。我们的数据显示不同的LE模式在前三个月。这可以解释为:(1)母体对妊娠激素变化的反应的可变性,或(2)这些酶在个体发育和胎盘转移方面的不同胚胎贡献。孕妇血清中3种特异性LE水平的升高可能会影响妊娠早期携带者检测的准确性,但妊娠不应影响其他8种。
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引用次数: 0
Amniotic fluid alpha-fetoprotein levels in the differential diagnosis of cystic hygroma. 羊水甲胎蛋白水平在囊性水肿鉴别诊断中的应用。
Pub Date : 1989-01-01 DOI: 10.1159/000263448
Y Sorokin, M P Johnson, A Drugan, F C Koppitch, M I Evans

In 7 second trimester pregnancies ultrasound (US) demonstrated cystic hygroma colli (CHC); amniocentesis was performed in 6 patients. In the 7th patient, because of oligohydramnios, the fluid for karyotype was aspirated from the CHC. Five pregnancies had been referred secondary to abnormalities on US and 2 others because of low maternal serum alpha-fetoprotein (MSAFP). Four karyotypes were abnormal (45,X;47,XX+21; 47,XY+21; 46,XX/45,X), and 3 had normal karyotypes. Amniotic fluid alpha-fetoprotein (AFAFP) was normal in 4 pregnancies and low in 2 (0.09 MOM, 0.41 MOM). Of 2 pregnancies with trisomy 21 one had been referred for low MSAFP. In 2 pregnancies with normal karyotypes, US findings at early gestational age (14-17 weeks) of small, nonseptated, bilateral CHC disappeared during pregnancy; these women delivered normal, term babies. Most prenatally diagnosed CHC are not in fetuses with Turner syndrome. With a normal karyotype and CHC as the only finding on early US in utero, normal neonatal survival is possible. AFAFP is not elevated in pregnancies with CHC. If AFAFP is elevated with a positive acetylcholinesterase, such results may suggest that the CHC was inadvertently aspirated.

7例中期妊娠超声(US)显示结肠囊性水肿(CHC);6例患者行羊膜穿刺术。第7例患者因羊水过少,从CHC中抽取核型液。5例妊娠是继发于US异常,另外2例是由于母体血清甲胎蛋白(MSAFP)低。4个核型异常(45,X;47,XX+21;47岁的XY + 21;46例,XX/45,X), 3例核型正常。羊水甲胎蛋白(AFAFP) 4例正常,2例低(0.09、0.41)。在2例21三体妊娠中,1例因MSAFP低而被转诊。在2例核型正常的妊娠中,早期胎龄(14-17周)小的、未分离的、双侧CHC的超声检查结果在妊娠期间消失;这些妇女生下了正常的足月婴儿。大多数产前诊断为CHC的胎儿并不患有特纳综合征。正常核型和CHC是子宫早期US的唯一发现,正常的新生儿存活是可能的。妊娠CHC时AFAFP不升高。如果AFAFP升高与乙酰胆碱酯酶阳性,这样的结果可能表明CHC是无意中吸入的。
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引用次数: 6
Placenta previa and congenital cardiac anomalies. 前置胎盘和先天性心脏异常。
Pub Date : 1989-01-01 DOI: 10.1159/000263435
A Neri, Y Manor, A Matityahu, L Blieden

This study was designed to evaluate the association of placenta previa (PP) with cardiac anomalies in the fetus/neonate. The study group (n = 82 babies) was compared to a control group (n = 82) matched for maternal and gestational age. Five babies of the study group expired within 24 h of delivery, and postmortem examination was carried out in 4 of them. The living children of the control and study group (51 of the 77 babies) underwent complete cardiac workup including physical examination, ECG, chest X-ray and echocardiography. The incidence of congenital cardiac anomalies in the study group was significantly higher (Fisher exact test, p = 0.025). The obstetrician should refer the pregnant woman with PP for echocardiographic studies.

本研究旨在评估前置胎盘(PP)与胎儿/新生儿心脏异常的关系。研究组(n = 82名婴儿)与对照组(n = 82名)进行比较,对照组的母亲和胎龄相匹配。研究组5例婴儿出生后24 h内死亡,其中4例进行尸检。对照组和研究组的活着的孩子(77个婴儿中的51个)接受了完整的心脏检查,包括身体检查、心电图、胸部x光和超声心动图。研究组先天性心脏异常发生率明显高于对照组(Fisher精确检验,p = 0.025)。产科医生应推荐患有PP的孕妇进行超声心动图检查。
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引用次数: 4
Fetal goitrous hypothyroidism. A new diagnostic and therapeutic approach. 胎儿甲状腺功能减退。一种新的诊断和治疗方法。
Pub Date : 1989-01-01
R L Johnson, H J Finberg, A H Perelman, W H Clewell

We present a first case in whom fetal hypothyroidism with goiter was both successfully diagnosed and treated in utero. An obstetrical sonogram at 33 weeks revealed a bilobed fetal neck mass, compatible with enlarged thyroid gland, associated with neck hyperextension, reduced gastric fluid, and polyhydramnios. Umbilical blood sampling after volume reduction amniocentesis confirmed fetal hypothyroidism with a euthyroid mother. Fetal T4 measured 1.3 micrograms/dl, free T4 0.3 ng/dl, and thyroid-stimulating hormone 186 microU. Intraamniotic levothyroxine, 500 micrograms, was given twice with a 14-day interval. The head flexed, gastric fluid increased, and amniotic fluid levels returned to normal. Prenatal (36 weeks) and neonatal blood sampling demonstrated return to euthyroid indices. Ultrasonic estimates of thyroid volume decreased by over 50%. Vaginal delivery at 39 weeks was uncomplicated. The newborn appeared normal and is being maintained on thyroid replacement therapy.

我们提出了第一例在子宫内成功诊断和治疗甲状腺肿大的胎儿甲状腺功能减退症。孕33周的产科超声检查显示胎儿颈部肿块呈双叶状,伴甲状腺肿大,伴有颈部过伸、胃液减少和羊水过多。羊膜穿刺术后脐血取样证实胎儿甲状腺功能减退,母亲甲状腺功能正常。胎儿T4测定1.3微克/分升,游离T4 0.3纳克/分升,促甲状腺激素186微克/分升。羊膜内左旋甲状腺素500微克,两次,间隔14天。头部弯曲,胃液增多,羊水水平恢复正常。产前(36周)和新生儿血样显示甲状腺功能恢复正常。超声估计甲状腺体积下降超过50%。39周阴道分娩并不复杂。新生儿表现正常,目前正在接受甲状腺替代治疗。
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引用次数: 0
Early third trimester selective feticide of a compromising twin. 妊娠晚期早期选择性堕胎的妥协双胞胎。
Pub Date : 1989-01-01 DOI: 10.1159/000263428
K Still, T Kolatat, T Corbett, P Byrne
We report successful selective feticide of an anomalous, comprising twin by using intracardiac potassium chloride injection at 26 weeks gestation. This was associated with later delivery and survival of a very low birth weight infant with normal neurodevelopmental follow-up at 2 years. We suggest that selective feticide in such cases may have an important role to play in management.
我们报告成功的选择性堕胎异常,包括双胞胎在妊娠26周使用心内氯化钾注射。这与出生体重极低的婴儿在2年正常神经发育随访后的分娩和存活有关。我们建议,在这种情况下,选择性堕胎可能在管理中发挥重要作用。
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引用次数: 3
Aneuploidy with neural tube defects: another reason for complete evaluation in patients with suspected ultrasound anomalies or elevated maternal serum alpha-fetoprotein. 非整倍体伴神经管缺陷:怀疑超声异常或母体血清甲胎蛋白升高的患者需要完全评估的另一个原因。
Pub Date : 1989-01-01 DOI: 10.1159/000263429
A Drugan, M P Johnson, E Dvorin, J Moody, E L Krivchenia, D Schwartz, M I Evans

Some recent reports have suggested that invasive testing is unnecessary when ultrasound either confirms or refutes a neural tube defect (NTD). However, counseling for recurrence risks and the possibilities for in utero therapy would be significantly altered by an aneuploid karyotype. We report our experience with 53 pregnancies affected by NTD in which we found 13.2% of these fetuses with abnormal chromosomes. In view of the higher than previously published incidence of aneuploidy, we believe that fetal karyotypes are essential in the evaluation of all fetuses with NTDs.

最近的一些报告表明,当超声证实或驳斥神经管缺陷(NTD)时,侵入性检查是不必要的。然而,对复发风险的咨询和子宫内治疗的可能性将被非整倍体核型显著改变。我们报告了53例NTD妊娠的经验,其中13.2%的胎儿染色体异常。鉴于非整倍体的发生率高于先前发表的,我们认为胎儿核型在评估所有患有ntd的胎儿时是必不可少的。
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引用次数: 27
Compensatory adrenal hypertrophy following unilateral adrenalectomy of fetuses of rats given alcohol throughout gestation. 妊娠期间给予酒精的大鼠胎儿单侧肾上腺切除术后代偿性肾上腺肥大。
Pub Date : 1989-01-01 DOI: 10.1159/000263447
K Arishima, M Lee, M Yamamoto, Y Eguchi

The effect of maternal alcohol consumption on fetal compensatory adrenal hypertrophy following unilateral adrenalectomy was studied in rats. Females were given 20% alcohol in tap water for 4 weeks prior to mating and 30% alcohol in tap water throughout gestation (alcohol), or were pair-fed to the alcohol group (pair-fed) or were fed ad libitum (control). On day 20, fetuses were unilaterally left-adrenalectomized or sham operated. Mothers were sacrificed on day 22 of gestation and right adrenals of adrenalectomized, sham-operated, and unoperated fetuses were removed and weighed. Some adrenals were fixed, sectioned, and stained for histological examination. Adrenalectomized fetuses of all three dietary treatment groups demonstrated compensatory hypertrophy. Adrenals of alcohol-exposed fetuses weighed less than those of pair-fed or control fetuses, and the ratio of adrenal weight/body weight was greater, regardless of surgical procedure. Histological sections of right adrenals of left-adrenalectomized fetuses showed larger cells and widened sinusoids, compared to unoperated fetuses in the corresponding dietary treatment groups. These results are consistent with a retardation in adrenal growth and development as a result of alcohol exposure, but show that alcohol consumption throughout gestation does not affect the ability of the adrenals to undergo compensatory hypertrophy following unilateral adrenalectomy.

在大鼠中研究了母亲饮酒对单侧肾上腺切除术后胎儿代偿性肾上腺肥大的影响。雌性在交配前4周给予含20%酒精的自来水,在整个妊娠期间给予含30%酒精的自来水(酒精),或成对喂食给酒精组(成对喂食)或随意喂食(对照组)。第20天,单侧左肾上腺切除或假手术。母鼠于妊娠第22天处死,切除右肾上腺,假手术,未手术的胎儿取下并称重。部分肾上腺固定、切片、染色进行组织学检查。所有三个饮食治疗组肾上腺切除的胎儿均表现出代偿性肥厚。与手术方式无关,酒精暴露胎儿的肾上腺重量低于配对喂养或对照组胎儿,肾上腺重量/体重之比更大。左肾上腺切除胎儿的右肾上腺的组织学切片显示,与相应饮食治疗组未手术的胎儿相比,右肾上腺细胞更大,窦变宽。这些结果与酒精暴露导致的肾上腺生长发育迟缓一致,但表明整个妊娠期饮酒并不影响单侧肾上腺切除术后肾上腺代偿性肥大的能力。
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引用次数: 1
期刊
Fetal therapy
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