1、1妇产科羊水胎儿异常妇产科羊水胎儿异常第1页/共39页第1页/共39页第2页/共39页第2页/共39页第3页/共39页Hydramnios,sometimes called polyhydramnios,is an excessive quantity of amnionic fluid.Normally,the volume of amnionic fluid increases to about 1 liter,or somewhat more,by 36 weeks but decreases thereafter.Postterm,there may be only a few hun
2、dred ml or even less.Somewhat arbitrarily,more than 2000 ml of amnionic fluid is considered excessive,or hydramnios.In most instances,the increase in amnionic fluid is gradual,or chronic hydramnios.When the volume increase very suddenly,the uterus may become markedly distended within a few days,or a
3、cute hydramnios.The fluid in hydramnios is usually similar in appearance and composition to the amnionic fluid in normal conditions.(摘自WILLIAMS OBSTETRICS 17TH edition)第3页/共39页第4页/共39页第4页/共39页第5页/共39页（2）多普勒超声技术：脐动脉、子宫动脉的S/D比值升高，舒张期返流、胎儿静脉导管返流、主动脉流量降低等。5mg/kg，每6小时给药一次。Very small amounts of amnionic f
4、luid may be found relatively often with pregnancies that have continued for weeks beyond term.羊水过多时放羊水应注意哪些问题？如由于环境因素所致如叶酸缺乏，在补充叶酸待营养状况改善后可明显下降，较易于干预。一般治疗 去除不良因素，改善胎儿供氧及营养状况。（2）外表有营养不良表现；第十四章 羊水量异常（4）选择分娩方式应考虑有无胎儿畸形、孕妇合并症的严重程度、胎儿宫内状况等。常见，不利因素主要作用在妊娠中、晚期。第5页/共39页第6页/共39页第6页/共39页第7页/共39页第7页/共39页第8页/共3
5、9页第8页/共39页第9页/共39页In some instances,the volume of amnionic fluid may fall below 300 ml and occasionally be reduced to only a few ml of visid fluid,this called oligohydramnios.The cause of this condition is not completely understood.Very small amounts of amnionic fluid may be found relatively often w
6、ith pregnancies that have continued for weeks beyond term.The risk of cord compression and,in turn,fetal distress is increased as the consequence of the scant volume of fluid.Oligohydramnios is practically always evident when there is either obstruction of the fetal urinary tract or renal agenesis.T
7、herefore,anuria almost certainly has an etiologic role in such cases of oligohydramnios.(摘自WILLIAMS OBSTETRICS 17TH edition)第9页/共39页第10页/共39页第10页/共39页第11页/共39页第11页/共39页第12页/共39页第12页/共39页第13页/共39页第13页/共39页第14页/共39页第14页/共39页第15页/共39页第15页/共39页第16页/共39页第16页/共39页第17页/共39页（1）脑重量轻，常有脑神经发育障碍；（2）胎儿体重、身长及头径均相
8、称，但与孕周不相符；（3）新生儿发育不全或身材矮小，外观无营养不良；（4）半数有先天畸形。第17页/共39页第18页/共39页（1）胎儿各器官细胞数量正常，但体积小；（2）身长和头径与孕周相符，而体重偏低；（3）新生儿的特点为大头、外观呈营养不良，发育不均称。第18页/共39页第19页/共39页（1）体重、身长、头径均减少，但相称；（2）外表有营养不良表现；（3）各器官体积均小，尤以肝脾为著；（4）胎儿无缺氧表现。第19页/共39页第20页/共39页体征：宫高低于正常宫高平均值2个标准差，则考虑FGR 妊娠晚期孕妇体重每周增加0.5kg，若体重增加缓慢或停滞则有FGR可能 胎儿发育指数=宫高(
9、cm)-3（月份+1），如指数在-3与+3之间为正常儿，低于-3则提示有FGR的可能。第20页/共39页第21页/共39页（4）选择分娩方式应考虑有无胎儿畸形、孕妇合并症的严重程度、胎儿宫内状况等。由于FGR对缺氧耐受性差，通常宜适当放宽剖宫产指征，孕晚期胎儿停止发育3周以上应剖宫产，但有胎儿结构异常者，应经阴道分娩。第21页/共39页第22页/共39页无脑儿(anencephalus)脑积水(hydrocephalus)开放性脊柱裂(bifid spine)脑脊膜膨出(meningocele)腭裂(cleft palate)先天性心脏病(congenital heart disease)21
10、-三体综合征(21-trisomy syndrome)腹裂(celoschisis)脑膨出(encephalocele)第22页/共39页第23页/共39页第23页/共39页第24页/共39页第24页/共39页第25页/共39页第25页/共39页第26页/共39页第26页/共39页第27页/共39页第27页/共39页第28页/共39页第28页/共39页第29页/共39页第29页/共39页第30页/共39页若为头先露时，阴道检查可能触及凹凸不 平的颅底部，切勿误为正常胎儿的臀部。5kg，若体重增加缓慢或停滞则有FGR可能（4）选择分娩方式应考虑有无胎儿畸形、孕妇合并症的严重程度、胎儿宫内状况等。
11、胎儿成熟后，症状严重者，可行引产术。临床表现 羊水过多的孕妇可出现呼吸困难，不能平卧；隐性脊柱裂即腰骶部脊椎管缺损，表面有皮肤覆盖，脊髓和脊神经正常，无神经症状；腹部触诊可发现胎头宽大。胎儿生长受限的诊断方法及产科处理。胎儿死亡不久者，可直接采用羊膜腔内注射药物引产或前列腺素引产。妊娠晚期孕妇体重每周增加0.Very small amounts of amnionic fluid may be found relatively often with pregnancies that have continued for weeks beyond term.孕妇血清甲胎蛋白（AFP）升高。应用前
12、列腺素合成酶抑制剂。（2）终止妊娠指征：a)治疗后无改善，胎儿停止生长3周以上；本病发生一次再发的危险性为2%-5%，发生两次再发的危险性可达10%。Postterm,there may be only a few hundred ml or even less.如遇胎肩娩出困难，可等待或行毁胎术。第30页/共39页第31页/共39页第31页/共39页第32页/共39页第32页/共39页第33页/共39页第33页/共39页第34页/共39页Hydramnios,sometimes called polyhydramnios,is an excessive quantity of amnioni
13、c fluid.Normally,the volume of amnionic fluid increases to about 1 liter,or somewhat more,by 36 weeks but decreases thereafter.Postterm,there may be only a few hundred ml or even less.Somewhat arbitrarily,more than 2000 ml of amnionic fluid is considered excessive,or hydramnios.In most instances,the
14、 increase in amnionic fluid is gradual,or chronic hydramnios.When the volume increase very suddenly,the uterus may become markedly distended within a few days,or acute hydramnios.The fluid in hydramnios is usually similar in appearance and composition to the amnionic fluid in normal conditions.(摘自WI
15、LLIAMS OBSTETRICS 17TH edition)第34页/共39页第35页/共39页第35页/共39页第36页/共39页体征：宫高低于正常宫高平均值2个标准差，则考虑FGR 妊娠晚期孕妇体重每周增加0.5kg，若体重增加缓慢或停滞则有FGR可能 胎儿发育指数=宫高(cm)-3（月份+1），如指数在-3与+3之间为正常儿，低于-3则提示有FGR的可能。第36页/共39页第37页/共39页（4）选择分娩方式应考虑有无胎儿畸形、孕妇合并症的严重程度、胎儿宫内状况等。由于FGR对缺氧耐受性差，通常宜适当放宽剖宫产指征，孕晚期胎儿停止发育3周以上应剖宫产，但有胎儿结构异常者，应经阴道分娩。第37页/共39页第38页/共39页第38页/共39页第39页/共39页
