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題 名 | Assessment of Trophoblastic Flow in Abnormal First Trimester Intrauterine Pregnancy=早期異常妊娠之滋養層細胞血流研究 |
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作 者 | 林聖凱; 何師竹; 羅鳳菊; 彭小鈴; 李玉華; | 書刊名 | 中華醫學雜誌 |
卷 期 | 59:1 1997.01[民86.01] |
頁 次 | 頁1-6 |
分類號 | 417.28153 |
關鍵詞 | 早期妊娠; 經陰道彩色都卜勒超音波; 滋養層細胞血流; Early gestations; Transvaginal color doppler; Trophoblastic flow; |
語 文 | 英文(English) |
中文摘要 | 背景:都卜勒超音波使用於正常及高危險妊娠,以評估子宮-胎盤- 胎兒血流之成效已日漸受到肯定。但對於早期妊娠之研究則不多見,此因早期子宮-胎盤-胎兒血流過於微小,不易偵測所致。本研究利用經陰道超音波及彩色都卜勒超音波偵測子宮-胎盤-胎兒血流,配合血中��-hCG濃度及胎兒組織染色體檢查結果,以探討早期妊娠之生理病理變化。 方法:實驗組個案之收集,來自早期妊娠合併異常出血,經系列超音波檢查證實為萎縮性胚囊或過期流產。而對照組則取自避孕失敗要求終止懷孕者,以消弭彩色超音波可能對正常懷孕有不良影響之疑慮。共收集萎縮性胚囊、過期流產及正常懷孕分別有34、50及21例;所有案例在進行子宮擴括術前一週內,均再接受經陰道彩色都卜勒超音波檢查(測滋養層細胞及子宮動脈血流)及血中��-hCG濃度測定。至於子宮擴括術取得之絨毛組織以無菌方式處理,送實驗室作染色體檢查。 結果:滋養層細胞血流最早可於妊娠5週時被偵測出。而且在正常懷孕組(對照組)可發現其滋養層細胞及子宮動脈血流阻力係數(RI)及血中��-hCG濃度,分別隨著妊娠進行而有下降及上昇之趨勢;然而此現象卻不見於實驗組(萎縮性胚囊及過期流產)。至於實驗組中個案染色體正常與否,其滋養層細胞及子宮動脈血流阻力係數及血中��-hCG濃度並無明顯差異。 結論:早期子宮-胎盤-胎兒血流的研究,雖可讓我們瞭解早期正常懷孕之胎兒-胎盤血流的生理變化,但對於懷孕失敗的機制並無法提供有力的佐證。個案數不足及胚體死亡至超音波確定診斷之時差變異頗大,均可能是導致上述結果的主因。 |
英文摘要 | Background: The use of color Doppler sonography in assessing feto-maternal circulation during pregnancy has recently been advocated. However, studies of evaluation of trophoblastic flow in the first trimester of pregnancy, with color Doppler sonography,are rare. The objects of this study were to assess the trophoblastic flow in first trimester pregnancy failure by using transvaginal color Doppler sonography, and attempted to elucidate the pathophysiology of early feto-maternal circulation. Methods: One hundred and five cases of first trimester intrauterine pregnancy were enrolled in this study, including 34 cases of blighted ova, 50 missed abortions and 21 normal pregnancies. All patients received transvaginal sonography (Acuson 128, 5MHz). First, color Doppler was mapped and then trophoblastic flow (TBF) was detected and the resistance index (RI) was calculated. Main uterine artery (UA) flow was measured in the later part of this study. Serial sonographic examinations with serum-human chorionic gonadotropin (��-hCG) levels were obtained to confirm a diagnosis of pregnancy failure. Discrepancy in gestational age calculated by the last menstrual period and by sonar measurement was recorded for analysis. The aborted tissues were submitted for karyotyping from six cases of normal pregnancy, 11 cases of blighted ovum and 22 cases of missed abortion. Results: Preliminary result showed TBF can be detected at as early as the fifth week of gestation. The RIs of TBF and UA seemed to decrease; however, serum �� -hCG levels increased as gestational age advanced in normal pregnancies. This change was not shown in the abnormal groups. No significant difference in the RI of TBF or UA flow was noted between normal and abnormal pregnancies. Also the result of karyotyping did not correlate well with the RIs of TBF and UA, and serum��-hCG levels. Conclusion: The assessment of feto-maternal circulation in early pregnancy does provide information on the physiology of early normal placentation, but not of the early pregnancy failure. Limited case numbers and different time intervals between fetal demise and sonographic diagnosis may play roles in the above findings. |
本系統中英文摘要資訊取自各篇刊載內容。