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目的运用彩色多普勒与胎儿电子监护仪对妊娠中晚期的胎儿进行监测,来观察胎儿的血液动力学改变及在宫内的储备能力和发育情况,以指导临床决定的分娩方式。方法在门诊通过彩色多普勒和胎儿电子监护议对200例孕期在32~42w的孕妇,均为正常孕妇,无妊娠合并症者,进行脐动脉血流监测和胎心监护,以观察胎儿的脐动脉收缩期最大值与舒张末期值之比(S/D)比值;胎儿在宫内的情况即无刺激试验(NST)。结果 200例孕妇中,先进行NST初筛,在NST监护中,对有脐带因素、NST可疑及NST异常波形的再进行脐动脉血流测定,测定结果,S/D比值<3有175例,S/D比值≥3有25例,其中脐绕颈有55例,经过二者测定后综合分析,对其中异常者的85%采取了剖宫产分娩,证实S/D比值≥3的胎儿长后评分低于6分,约占93.3%,脐绕颈约占91.1%,胎盘循环功能差造成胎儿宫内发育迟缓者约占66.6%。结论脐带为连接母体和胎儿的唯一通道,脐血流携带宫内胎儿生长发育状况的信息,而胎儿中枢神经系统对低氧的耐受力最差,所以,脐动脉血流监测联合应用胎心监护,二者互补,不仅提高了单一心电监护的可靠性,同时也为临床提供了较为可靠的剖宫产手术依据,从而大大改善了围生儿的预后。
Objective To monitor fetal changes in hemodynamics and reserve capacity and development in the uterus by color Doppler and fetal electronic monitor on the fetus in the second trimester of pregnancy to guide the clinically decided mode of delivery. Methods At the outpatient department, 200 pregnant women with gestational age of 32 ~ 42w were examined by color Doppler and fetal electronic monitoring. All of the pregnant women were normal pregnant women without pregnancy complications. Umbilical artery blood flow monitoring and fetal heart rate monitoring were performed to observe the fetal Umbilical artery systolic maximum and end-diastolic ratio (S / D) ratio; fetal intrauterine conditions that no stimulation test (NST). Results 200 pregnant women, the first NST screening, NST monitoring, with umbilical cord factors, NST suspicious and NST abnormal waveform of the umbilical artery blood flow determination, the results, S / D ratio <3 175 cases, S / D ratio of ≥ 3 in 25 cases, of which 55 cases of umbilical around the neck, after both the determination of a comprehensive analysis of 85% of them were abnormal cesarean delivery, confirmed that the S / D ratio ≥ 3 fetal length After the score was less than 6 points, accounting for 93.3%, umbilical around the neck about 91.1%, poor placental circulation caused by intrauterine growth retardation accounted for 66.6%. Conclusion The umbilical cord is the only way to connect the mother and the fetus. The umbilical blood flow carries the information about the growth and development of intrauterine fetus. However, the fetal central nervous system is the worst tolerant to hypoxia. Therefore, umbilical artery blood flow monitoring combined with fetal heart rate Guardianship, the two complement each other, not only improve the reliability of a single ECG, but also provide a more reliable clinical basis for cesarean section, which greatly improved the prognosis of perinatal children.