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目的探讨自由手技术行脐血管穿刺抽取胎儿血进行产前诊断的价值及安全性。方法对1473例有产前诊断指征的中晚孕期孕妇在普通超声探头引导下应用自由手技术行游离脐带穿刺术,抽取胎儿血进行产前诊断。确定穿刺成功标准,分析影响成功穿刺的因素,观察穿刺并发症。结果穿刺成功率99.05%(1459/1473),经脐血诊断染色体异常207例,非整倍体38例。重度地中海贫血47例,宫内病毒感染10例,发现母胎输血综合征致胎儿贫血2例。发生脐带渗血(>15s)153例(10.38%);穿刺经胎盘396例,胎盘出血(>30s)148例(37.37%),出血均自行停止。胎儿心动过缓41例(278%);死胎3例(0.20%);早产11例(0.74%);晚期流产2例(0.13%);绒毛膜羊膜炎1例(0.07%);无脐带血肿、胎儿损伤等并发症发生。手术者穿刺技巧及熟练程度、选择适当的穿刺孕周是提高成功率降低并发症的主要因素。结论自由手技术行脐血管穿刺抽取胎儿血行产前诊断是一项安全、简便、可靠的方法。
Objective To explore the value and safety of prenatal diagnosis of uterine bleeding by umbilical cord blood puncture with free hand technique. Methods 1473 pregnant women with indications for prenatal diagnosis of prenatal pregnancy under the guidance of a common ultrasound probe using free hand technique free umbilical cord puncture, fetus fetus blood for prenatal diagnosis. Determine the success criteria of puncture, analysis of the factors that affect the success of puncture and observe puncture complications. Results The success rate of puncture was 99.05% (1459/1473). There were 207 cases of chromosomal abnormalities diagnosed by cord blood and 38 cases of aneuploidy. Severe thalassemia in 47 cases, intrauterine virus infection in 10 cases, found in maternal fetal transfusion syndrome caused by fetal anemia in 2 cases. There were 153 cases (10.38%) of umbilical cord bleeding (> 15 s). There were 396 cases of placenta puncture and 148 cases (> 37%) of placental hemorrhage (> 30 seconds). 41 cases of fetal bradycardia (2 78%), 3 cases of stillbirth (0.20%), 11 cases of premature delivery (0.74%), 2 cases of late abortion (0.13%), 1 case of chorioamnionitis (0.07%), Umbilical cord hematoma, fetal injury and other complications. Surgery puncture skills and proficiency, select the appropriate gestational wear is to improve the success rate and reduce complications of the main factors. Conclusion Free hand technique is a safe, simple and reliable method for prenatal diagnosis of umbilical cord blood aspiration.