An Effective Machine-Learning Based Feature Extraction/Recognition Model for Fetal Heart Defect Detection from 2D Ultrasonic Imageries

Congenital heart defect,accounting for about 30%of congenital defects,is the most common one.Data shows that congenital heart defects have seriously affected the birth rate of healthy newborns.In Fetal andNeonatal Cardiology,medical imaging technology(2D ultrasonic,MRI)has been proved to be helpful to detect congenital defects of the fetal heart and assists sonographers in prenatal diagnosis.It is a highly complex task to recognize 2D fetal heart ultrasonic standard plane(FHUSP)manually.Compared withmanual identification,automatic identification through artificial intelligence can save a lot of time,ensure the efficiency of diagnosis,and improve the accuracy of diagnosis.In this study,a feature extraction method based on texture features(Local Binary Pattern LBP and Histogram of Oriented Gradient HOG)and combined with Bag of Words(BOW)model is carried out,and then feature fusion is performed.Finally,it adopts Support VectorMachine(SVM)to realize automatic recognition and classification of FHUSP.The data includes 788 standard plane data sets and 448 normal and abnormal plane data sets.Compared with some other methods and the single method model,the classification accuracy of our model has been obviously improved,with the highest accuracy reaching 87.35%.Similarly,we also verify the performance of the model in normal and abnormal planes,and the average accuracy in classifying abnormal and normal planes is 84.92%.The experimental results show that thismethod can effectively classify and predict different FHUSP and can provide certain assistance for sonographers to diagnose fetal congenital heart disease.

Association between Fetal Heart Rate Monitoring during Labor and Neonatal Acidosis in Full-Term Newborns: A Retrospective Multicenter Cohort Study

Introduction: Fetal heart rate monitoring during labor is used to study fetal well-being and predict neonatal acidosis of newborn. Fetal heart rate monitoring is analyzed by the obstetrical team and categorized according to the FIGO guidelines. An important limitation of this diagnostic tool is an inter- and intra-observer variability, leading to subjective cardiotocography interpretation and classification. Our objective was to study the association between the categories of fetal heart rate analysis (according to FIGO classification) and neonatal acidosis of full-term newborns. Study design: This is a multicenter retrospective cohort study conducted between 2014 and 2018 in the Grand-Est region. We searched and included retrospectively children hospitalized in a pediatric intensive care unit in one of the participating hospitals with an ICD-10 coding type “P91.6” corresponding to “Hypoxic Ischemic Encephalopathy”. Maternal, pregnancy, delivery, and newborn characteristics were collected and compared by univariate logistic regression with multiple imputation. Odds Ratio and 95% confidence intervals (CI) were calculated using the model and presented. Multiple imputation with m = 100 imputations was tested, using Rubin rules to combine the results. Results: 55 patients were included in the study. Fetal heart rate tracings classified in Category 3 as “pathological” according to FIGO guidelines were significantly associated with an increased risk of severe neonatal acidosis. Late decelerations and bradycardia during labor were associated with severe neonatal acidosis. Conclusion: Severe neonatal acidosis may be suspected by interpretation of fetal heart rate during labor. Fetal bradycardia and late decelerations are predictive of the severity of neonatal acidosis. This study emphasizes the need to screen severe neonatal acidosis and allows the identification of populations most at risk. Repeated team training and upgrading of fetal heart rate study would further reduce the incidence of neonatal acidosis.

The Impacts of Maternal Gestational Diabetes Mellitus (GDM) on Fetal Hearts

Objective To evaluate the fetal cardiac function in gestational diabetes mellitus (GDM) pregnancies under different maternal glycemic controls.Methods Forty four GDM mothers received 78 fetal echocardiographic evaluations at three gestational periods (<28,28-34 and ≥34 weeks) and were divided into poorly-(DM1) and well-(DM2) controlled groups according to their glycemic control at examination.Seventy uncomplicated mothers were selected as controls.Parameters of fetal cardiac anatomy and function were measured and analyzed.Results GDM fetuses' cardiac ventricular walls were thicker than controls',and the differences between DM1 and DM2 were not significant except for end-diastolic left ventricular walls.In both GDM groups,the aortic flow velocities increased earlier than pulmonary artery and DM1 fetuses changed earlier than DM2 ones.GDM fetuses' left atrial shortening fraction was smaller than the controls' in the period of ≥34 weeks and negatively correlated with thicknesses of left ventricular walls and interventricular septum in DM1 fetuses (r=-0.438 and -0.506).The right ventricular diastolic function in DM1 and DM2 fetuses decreased after the period of 28-34 weeks and in the period of ≥34 weeks respectively.Tei index of both left and right ventricles increased in DM1 group after the period of<28 weeks and in DM2 group only in the period of ≥34 weeks,with no significant differences between DM1 and DM2 groups in this period.Conclusion Fetuses of GDM mothers showed cardiac function impairments.Good maternal glycemic control may delay the impairments,but cannot reduce the degree.Some cardiac changes in GDM fetuses were similar to those in pregestational diabetic pregnancies except for several parameters and their changing time.

Critical evaluation of American categorization of fetal heart rate (FHR) decelerations and three tier classification—Shortcomings, contradictions, remedies and need for debate

Fetal heart rate (FHR) decelerations are the commonest aberrant feature on cardiotocograph (CTG) thus having a major influence on classification ofFHRpatterns into the three tier system. The unexplained paradox of early decelerations (head compression—an invariable phenomenon in labor) being extremely rare [1] should prompt a debate about scientific validity of current categorization. This paper demonstrates that there appear to be major fallacies in the pathophysiological hypothesis (cord compression—baroreceptor mechanism) underpinning of vast majority of (variable?) decelerations. Rapid decelerations during contractions with nadir matching peak of contractions are consistent with “pure” vagal reflex (head compression) rather than result of fetal blood pressure or oxygenation changes from cord compression. Hence, many American authors have reported that the abrupt FHR decelerations attributed to cord compression are actually due to head compression [2-6]. The paper debates if there are major fundamental fallacies in current categorization of FHR decelerations based concomitantly on rate of descent (reflecting putative aetiology?) and time relationship to contractions. Decelerations with consistently early timing (constituting majority) seem to get classed as “variable” because of rapid descent. A distorted unscientific categorization of FHR decelerations could lead to clinically unhelpful three tier classification system. Hence, the current unphysiological classification needs a fresh debate with consideration of alternative models and re-evaluation of clinical studies to test these. Open debate improves patient care and safety. The clue to benign reflex versus hypoxic nature of decelerations seems to be in the timing rather than the rate of descent. Although the likelihood of fetal hypxemia is related to depth and duration ofFHRdecelerations, the cut-offs are likely to be different for early/late/variable decelerations and it seems to be of paramount importance to get this discrimination right for useful visual or computerized system of CTG interpretation.

The Diagnostic Accuracy of Automated Fetal Heart Echocardiography by Five Dimensional Compared to Two-Dimensional Ultrasound in the Second Trimester of Pregnancy

Objective: To compare the diagnostic accuracy of Fetal Intelligent Navigation Echocardiography (FINE) method by Five-Dimensional Ultrasound in automated fetal heart examination to conventional fetal heart examination by Two-Dimensional ultrasound in second trimester pregnancy. Methods: 90 normal singleton pregnancies at the second trimester were enrolled in this prospective study. Fetal heart was examined by Two-Dimensional Ultrasound (2D US) and Five-Dimensional Ultrasound (FINE). Paired numerical data were compared using the paired samples t test. Inter-method agreement for the rating of the quality of cardiac views by 2D US or 5D US was assessed by calculation of the prevalence-adjusted and bias-adjusted kappa coefficient (PABAK). Results: There was no statistical significant difference between fetal heart echocardiography assessment using 2DUS or 5DUS(FINE) (p-value > 0.05). The overall inter-method agreement between 2D US and 5D US was 0.92. The difference in % of satisfactory views between 2D and 5D US was 1.73%, (95% CI - 0.5% to 3.33%) (P-value = 0.144). Conclusion: Our findings indicate the accuracy of 5DUS (FINE) echocardiography in evaluation of normal heart in the second trimester of pregnancy.

Interpretation of British experts’ illustrations of fetal heart rate (FHR) decelerations by Consultant Obstetricians, registrars and midwives: A prospective study—Reasons for major disagreement with experts and implications for clinical practice

Objective: To test the reproducibility of British experts’ (eFM, K2MS, Gibb and Arulkumaran) [1-3] illustrations of fetal heart rate (FHR) decelerations by trained British Obstetricians and midwives. To analyze reasons for any discrepancies by examining factors relating to the participants, British experts’ descriptions and NICE guidelines [4]. Design: Prospective observational study. Setting: National Health Service (NHS) Hospitals. Participants: 38 Obstetric Consultants, 49 registrars and 45 midwives. Methods: Printed questionnaire. Statistical Analysis: Fisher’s Exact test. Results: This largest study of its kind showed almost unbelievably high disconnect between CTG interpretation by experts and participants. 98% - 100% midwives, 80% - 100% Registrars and 74% - 100% Consultants categorized FHR decelerations differently from the five experts’ illustrations/interpretations (p < 0.0001). Remarkably, the three experts’ illustrations of early (supposedly most benign) decelerations were classed as atypical variable by 56% Consultants, 78% Registrars and 99% midwives and the CTGs as pathological by 85% of the participants. Conclusions: The high degree of disagreement with the experts’ illustrations (p < 0.0001) did not appear to be due to participant factors. The immediate reasons seemed to be the conflicting illustrations and heterogeneity of experts’ descriptions. But most importantly, these appeared to stem from non-standardized ambiguous definitions of FHR decelerations and many intrinsic systemic flaws in the current NICE guidelines [4]. The NICE concept of “true uniform” (identical) early and late decelerations seems biologically implausible (a myth) and no examples can be found. Another myth seems to be that early and late decelerations should be gradual. Only very shallow decelerations will look “gradual” on the British CTG. These systemic flaws lead to dysfunctional CTG interpretation increasing intervention as well as impairing diagnosis of fetal hypoxemia. This is because the vast majority of FHR decelerations fall in a single heterogeneous “variable” group with many further classed as “atypical” (pathological) based on disproven and discredited criteria [5-7]. There is increasing evidence in USA that a system with variable decelerations as the majority is clinically unhelpful because of loss of information [5-9]. In the interest of patient care and safety, open debate is necessary regarding a better way forward. Classification of FHR decelerations based primarily and solely on time relationship to contractions appears more scientific and clinically useful.

The Signal Extraction of Fetal Heart Rate Based on Wavelet Transform and BP Neural Network

This paper briefly introduces the collection and recognition of bio-medical sig nals, designs the method to collect FM signals. A detailed discussion on the sys tem hardware, structure and functions is also given. Under LabWindows/CVI,the ha rdware and the driver do compatible, the hardware equipment work properly active ly. The paper adopts multi threading technology for real-time analysis and make s use of latency time of CPU effectively, expedites program reflect speed, impro ve s the program to perform efficiency. One threading is collecting data; the other threading is analyzing data. Using the method, it is broaden to analyze the sig nal in real-time. Wavelet transform to remove the main interference in the FM a nd by adding time-window to recognize with BP network; Finally the results of c ollecting signals and BP networks are discussed.8 pregnant women’s signals of F M were collected successfully by using the sensor. The correct of BP network rec ognition is about 83.3% by using the above measure.

Unexplained fetal tachycardia:A case report

BACKGROUND This study aimed to explore the possible etiology and treatment of severe fetal tachycardia in the absence of organic disease and provide a reference for clinical management of severe fetal tachycardia.CASE SUMMARY A 29-year-old pregnant woman,with a gravidity 1 parity 0,presented with a fetal heart rate(FHR)of 243 beats per minute during a routine antenatal examination at 31+2 wk of gestation.Before termination of pregnancy at 38 wk of gestation,the FHR repeatedly showed serious abnormalities,lasting more than 30 min.However,the pregnant woman and the fetus had no clinical symptoms,and repeated examination revealed no organic lesions.The mother and the baby were regularly followed up.CONCLUSION This was a case of severe fetal tachycardia with no organic lesions and management based on clinical experience.

CTGNet: Automatic Analysis of Fetal Heart Rate from Cardiotocograph Using Artificial Intelligence

Objective:This study investigates the efficacy of analyzing fetal heart rate(FHR)signals based on Artificial Intelligence to obtain a baseline calculation and identify accelerations/decelerations in the FHR through electronic fetal monitoring during labor.Methods:A total of 43,888 cardiotocograph(CTG)records of female patients in labor from January 2012 to December 2020 were collected from the NanFang Hospital of Southern Medical University.After filtering the data,2341 FHR records were used for the study.The ObVue fetal monitoring system,manufactured by Lian-Med Technology Co.Ltd.,was used to monitor the FHR signals for these pregnant women from the beginning of the first stage of labor to the end of delivery.Two obstetric experts together annotated the FHR signals in the system to determine the baseline as well as accelerations/decelerations of the FHR.Our cardiotocograph network(CTGNet)as well as traditional methods were then used to automatically analyze the baseline and acceleration/deceleration of the FHR signals.The results of calculations were compared with the annotations provided by the obstetric experts,and ten-fold cross-validation was applied to evaluate them.The root-mean-square difference(RMSD)between the baselines,acceleration F-measure(Acc.F-measure),deceleration F-measure(Dec.F-measure),coefficient of synthetic inconsistency(SI)and the morphological analysis discordance index(MADI)were used as evaluation metrics.The data were analyzed by using a pairedt-test.Results:The proposed CTGNet was superior to the best traditional method,proposed by Mantel,in terms of the RMSD.BL(1.7935±0.8099vs.2.0293±0.9267,t=-3.55,P=0.004),Acc.F-measure(86.8562±10.9422vs.72.2367±14.2096,t=12.43,P<0.001),Dec.F-measure(72.1038±33.2592vs.58.5040±38.0276,t=4.10,P<0.001),SI(34.8277±20.9595vs.54.8049±25.0265,t=-9.39,P<0.001),and MADI(3.1741±1.9901vs.3.7289±2.7253,t=-2.74,P=0.012).The proposed CTGNet thus had significant advantages over the best traditional method on all evaluation metrics.Conclusion:The proposed Artificial Intelligence-based method CTGNet delivers good performance in terms of the automatic analysis of FHR based on cardiotocograph data.It promises to be a key component of smart obstetrics systems of the future.

The Efficacy of In-Phase and Quadrature Demodulation in Electronic Fetal Heart Rate Monitoring During Labor

Objective:To investigate the efficacy of in-phase and quadrature(IQ)demodulation in electronic fetal heart rate monitoring(EFM)to reduce false reports of fetal heart rate(FHR)doubling or halving.Methods:This is a prospective cohort study.A total of 263 full-term pregnant women who delivered at Peking University Shenzhen Hospital between August 2019 and July 2020 were prospectively enrolled in the study.FHR monitoring began when the cervix was dilated to 2-3 cm and continued until delivery.Raw fetal Doppler audio signals and internal and external cardiotocography curves from internal electrode monitoring,EFM with conventional demodulation(external),and EFM with IQ demodulation(external)were acquired to compare FHR doubling and halving time.In cohort 1,FHR was compared between IQ demodulation and conventional demodulation.In cohort 2,FHR was compared between IQ demodulation,conventional demodulation,and internal FHR monitoring.Count data were statistically analyzed using the Chi-squared test,and measurement data were statistically analyzed usingt-test for correlation coefficients,and Bland-Altman analysis for concordance ranges.Results:To compare IQ demodulation and conventional demodulation,225 pregnant women were monitored for a total of 835,870 seconds.The beat-to-beat interval of FHRs in raw fetal Doppler audio signals was used as the reference.The results showed a doubling time of 3401 seconds(0.407%,3401/835,870)and a halving time of 2918 seconds(0.349%,2918/835,870)with conventional demodulation,compared to 241 seconds(0.029%,241/835,870)and 589 seconds(0.070%,589/835,870),respectively,with IQ demodulation.IQ demodulation reduced FHR doubling by approximately 93%(3160/3401)and FHR halving by approximately 80%(2329/2918)compared to conventional demodulation(P<0.01).Conclusion:EFM with IQ demodulation significantly reduces false FHR doubling and halving,with an efficacy similar to that of internal FHR monitoring.

Valvuloplasty of fetal pulmonary atresia with intact ventricular septum and hypoplastic right heart: Mid-term follow-up results

Objective:This study aimed to analyze and evaluate the results of mid-term follow-up after fetal pulmonary valvuloplasty(FPV)in fetuses with pulmonary atresia with intact ventricular septum(PA/IVS).Methods:From August 31,2018,to May 31,2019,seven fetuses with PA/IVS and hypoplastic right heart were included in this study.All underwent echocardiography by the same specialist and were operated on by the same team.Intervention and echocardiography data were collected,and changes in the associated indices noted during follow-up were analyzed.Results:All seven fetuses successfully underwent FPV.The median gestational age at FPV was 27.54 weeks.The average FPV procedural time was 6 min.Persistent bradycardia requiring treatment occurred in 4/7 procedures.Finally,five pregnancies were successfully delivered,and the other two were aborted.Compared to data before fetal cardiac interventions(FCI),tricuspid valve annulus diameter/mitral valve annulus diameter(TV/MV)and right ventricle diameter/left ventricle diameter(RV/LV)of all fetuses had progressively improved.The maximum tricuspid regurgitation velocity decreased from 4.60 m/s to 3.64 m/s.The average follow-up time was 30.40±2.05 months.During the follow-up period,the diameter of the tricuspid valve ring in five children continued to improve,and the development rate of the tricuspid valve was relatively obvious from 6 months to 1 year after birth.However,the development of the right ventricle after birth was relatively slow.It was discovered that there were individual variations in the development of the right ventricle during follow-up.Conclusion:The findings support the potential for the development of the right ventricle and tricuspid valve in fetuses with PA/IVS who underwent FCI.Development of the right ventricle and tricuspid valve does not occur synchronously during pregnancy.The right ventricle develops rapidly in utero,but the development of tricuspid valve is more apparent after birth than in utero.

胎儿心脏定量分析技术评估辅助生殖胎儿心脏形态和功能

目的:探讨胎儿心脏定量分析(fetal HQ)技术在辅助生殖技术(ART)胎儿心脏功能及形态评价中的应用价值。方法:本研究共纳入60例ART受孕胎儿(ART组),冻胚移植与鲜胚移植各30例,67例自然受孕胎儿(对照组)。应用fetal HQ软件计算得出整体球形指数(GSI)、左右心室整体应变值(GS)、面积变化分数(FAC)、24节段球形指数(SI)。应用Pearson相关性分析孕妇年龄、孕周、胎儿预估体质量、体质量指数、胎儿心率与心脏各参数的相关性。结果:(1)与对照组相比,ART组孕妇年龄更大、产次更少(P<0.05),其它临床特征差异无统计学意义(P>0.05)。(2)ART组胎儿与对照组比较GSI、GS、FAC、右室2~24节段SI值差异有统计学意义(P<0.05);按移植方式进行亚组分析,冻胚组与对照组GSI及右室GS、右室FAC存在差异;鲜胚组与对照组GSI、GS、FAC存在差异;冻胚组与鲜胚组右室GS、右室FAC存在差异(P<0.05)。(3)相关性分析显示孕妇年龄、孕次、产次、胎儿预估体质量、体质量指数、胎儿心率、孕周与心脏各参数之间均无相关关系。结论:fetal HQ可以反映ART胎儿心脏心功能变化、整体及各节段形态变化,为中孕期ART胎儿心脏改变的早期识别提供了一种新的评估方法。

微小RNA-15a表达与妊娠期糖尿病患者胎儿心脏畸形的关系分析

目的探讨微小RNA-15a(miR-15a)表达与妊娠期糖尿病(GDM)患者胎儿心脏畸形的关系。方法选取891例GDM患者作为疾病组,同时选取健康孕妇891例作为健康组,检测并比较2组母体血清miR-15a表达。根据疾病组是否发生胎儿心脏畸形将其分为畸形组和非畸形组,比较2组血清miR-15a表达及一般资料。另根据确诊孕周将疾病组患者分为A组和B组,根据空腹血糖升高程度将血糖控制不良患者分为C组和D组。采用多因素Logistic回归分析法分析GDM患者胎儿心脏畸形影响因素。绘制受试者工作特征(ROC)曲线分析血清miR-15a表达对GDM患者胎儿心脏畸形的预测价值。结果疾病组血清miR-15a表达高于健康组,差异有统计学意义(P<0.001)。GDM患者中胎儿心脏畸形发生率为2.87%(24/835)。畸形组血清miR-15a表达、年龄、孕前体质量指数和不良孕产史、血糖控制不良占比高于非畸形组,妊娠早期规律服用叶酸占比低于非畸形组,差异有统计学意义(P<0.05)。A组、B组的血清miR-15a表达、胎儿心脏畸形发生率比较,差异无统计学意义(P>0.05)。D组血清miR-15a表达、胎儿心脏畸形发生率高于C组,差异有统计学意义(P<0.05)。血清miR-15a表达(OR=16.651,95%CI:6.252~44.344)、年龄(OR=1.078,95%CI:1.006~1.156)、血糖控制不佳(OR=3.404,95%CI:1.852~5.137)是GDM患者胎儿心脏畸形的影响因素(P<0.05)。血清miR-15a表达预测GDM患者胎儿心脏畸形的最佳临界值、灵敏度、特异度、曲线下面积分别为2.34、87.50%、73.24%、0.827(95%CI:0.799~0.852)。结论在GDM患者中,血清miR-15a表达异常升高,其是预测GDM患者胎儿心脏畸形的有效指标。

基于多模态超声建构胎儿先天性心脏病决策树模型及其应用价值

目的:分析基于多模态超声建构胎儿先天性心脏病决策树模型及其应用价值。方法:随机选取2021年4月-2023年7月在本院产前超声检查孕中期孕妇300例,常规产科超声检查确定胎儿生长程度,核实孕周,采用超声多断面模式方法对胎儿心脏进行多断面检测,包括四腔心断面、三血管断面、主动脉弓断面、左室流出道断面、右室流出道断面。对正常分娩的新生儿进行心脏多断面超声检测。对300例胎儿进行多断面模式超声检测,分析胎儿是否伴有先天性心脏畸形,对比超声检查与随访结果符合情况。结果:超声检出21例先天性心脏畸形胎儿,8例选择引产,余13例正常分娩。超声诊断与随访结果对比,卵圆孔直径增大、法洛四联症、完全型心内膜垫缺损、二尖瓣闭锁、右室发育不良综合征、左室发育不良综合征、大动脉转位、永存动脉干、单心室、三尖瓣下移符合率均为100%,超声诊断室间隔缺损7例,随访发现室间隔诊断5例,诊断符合率71.4%。279例超声诊断无先天性心脏畸形胎儿出生后经超声诊断发现有1例卵圆孔未闭、3例室间隔缺损,共4例漏诊患儿,漏诊率0.54%。四腔心断面、三血管断面、主动脉弓断面、左室流出道断面、右室流出道断面诊断胎儿畸形率分别为3.95%、0.63%、2.76%、3.27%、3.25%。由决策树模型可得,产前超声检查发现胎儿心脏可疑异常、高龄孕妇、孕妇接受药物治疗或射线暴露、孕妇有先天性心脏病家族史是胎儿存在先天性心脏病的独立危险因素,其中产前超声检查发现胎儿心脏可疑异常的影响最为显著。结论:孕中期胎儿产前超声多断面模式筛查胎儿先天性心脏病,能够对多数胎儿先天性心脏病进行诊断。

单胎脐带过度扭转产时胎心监护特征及围产结局

目的 探讨脐带过度扭转的产妇在产时胎心监护图形特点、分娩方式及对围产儿预后的影响。方法 本研究采用回顾性病例对照研究的方法,选取2012年1月—2021年12月于北京某三甲医院产科住院分娩时发现脐带过度扭转的单胎孕妇122例(扭转组),同期住院的无脐带过度扭转136例产妇(对照组),比较两组产妇的一般情况、分娩方式、围产儿结局,及不同程度脐带过度扭转的胎心监护特征对新生儿的影响。结果 扭转组与对照组间产妇的平均孕周差异有统计学意义(P<0.05),在分娩方式(剖宫产或阴道顺产)、新生儿出生体重、身长、脐带长度、胎儿窘迫发生率差异有统计学意义(P<0.05),扭转组的Ⅱ类、Ⅲ类胎心监护图形显著高于对照组(P<0.05),脐带重度扭转与轻度扭转相比,更易发生胎儿窘迫、出现Ⅱ类、Ⅲ类监护,差异均有统计学意义(P<0.05)。结论 脐带过度扭转存在一定的孕期高危因素,增加了剖宫产和阴道助产的机会,胎儿宫内窘迫发生率增加,其大部分监护图形正常,但Ⅱ类,Ⅲ类图形明显增加。

胎儿心脏定量分析技术评价妊娠期肝内胆汁淤积症孕妇胎儿心室收缩功能

目的:探讨妊娠期肝内胆汁淤积症(intrahepatic cholestasis of pregnancy,ICP)对胎儿心室收缩功能的影响,为临床早期发现ICP胎儿心功能异常提供依据。方法:选取2022年7月至2023年4月于川北医学院附属医院就诊孕妇67例,孕周27~40周,其中ICP孕妇29例(ICP组),正常孕妇38例(对照组)。应用胎儿心脏定量分析(fetal heart quantification,Fetal HQ)软件测量胎儿心室收缩功能,包括纵向收缩功能:左、右心室整体纵向应变(global strain,GLS)、间隔壁应变(sept wall strain,SWS)、侧壁应变(free wall strain,FWS);横向收缩功能:左、右心室24节段短轴缩短率(fractional shortening,FS);整体收缩功能:左、右心室面积变化分数(fetal area change,FAC)、左心室射血分数(ejection fraction,EF)。结果:ICP组纵向收缩功能指标左、右心室GLS、SWS、FWS均低于对照组,差异有统计学意义(P<0.05);两组间横向收缩功能指标左、右心室24节段FS比较,差异均无统计学意义(P>0.05);ICP组整体收缩功能指标左、右心室FAC均低于对照组,差异有统计学意义(P<0.05),而两组间左心室EF比较,差异无统计学意义(P>0.05)。结论:在宫内高胆汁酸环境下,ICP胎儿心脏左、右心室整体及纵向收缩功能明显受损,横向收缩功能未见明显改变;并且与传统心脏功能评价指标左心室EF相比,FAC可以更加敏感地反映胎儿心脏整体功能的改变。

基于5G技术的远程母胎监护体系建设实践

目的/意义探索在妇产科医院建立基于5G技术的远程母胎监护体系,为医疗系统基于5G技术完善远程医疗、智慧医疗提供参考。方法/过程利用5G技术速度快、频谱宽、低时延等优点,结合母胎监护、在线教育、远程问诊、人工智能、健康数据管理、就医绿色通道等服务,构建孕产妇母胎监护数据库与母胎监护人工智能模型,建设远程母胎监护体系,优化胎心监护流程。结果/结论实现母胎监护院内、院外、医联体、互联网医院、救护车转运等的应用结合。

两种方法检测先天性心脏发育异常胎儿的染色体结果分析

目的:探讨拷贝数变异测序(CNV-seq)技术和染色体核型分析技术检测先天性心脏发育异常(CHD)胎儿染色体的应用价值。方法:以2019年2月至2022年8月天津市中心妇产科医院经超声科诊断胎儿CHD的60例孕妇为研究对象,并根据是否伴发心外异常分为独立性CHD组和伴心外结构/软指标异常CHD组,所有孕妇行羊水穿刺进行核型分析及CNV-seq检测,统计分析两种方法对异常染色体的检出率。结果:两种方法检测共发现染色体异常患者20例,异常染色体检出率为33.3%,其中核型分析检出染色体异常例数为13例,CNV-seq检测异常CNVs例数为18例,两种方法结果均异常者11例,核型独立检出平衡易位2例,CNV-seq独立检出微缺失/微重复7例。伴心外结构/软指标异常CHD组染色体异常检出率略高于独立性CHD组,两组间比较差异无统计学意义[37.8%(14/37)vs.26.1%(6/23),χ^(2)=1.76,P>0.05]。结论:联合应用核型分析和CNV-seq检测技术,可以进一步明确诊断由染色体异常引发的胎儿CHD。

基于二维斑点追踪技术制定妊娠28~39周低风险胎儿心脏大小和形态的参考值范围

目的采用二维斑点追踪技术制定妊娠28~39周的低风险胎儿心脏大小和形态的参考值范围。方法前瞻性收集复旦大学附属妇产科医院行超声心动图检查的低风险单胎妊娠453例,应用二维斑点追踪技术评估胎儿四腔心和心室的大小(长径、宽径和面积)及形态(球形指数,即长径与宽径的比值)。使用同类相关系数评估组间和组内测量的重复一致性。对心脏测量参数进行统计分析,建立低风险胎儿心脏大小和形态的参考值范围。结果胎儿心脏参数测量的重复一致性检验的组间和组内相关系数为0.691~0.980。胎儿四腔心和心室大小随孕周的增加而增加(均P<0.001),左室舒张末期长径大于右室,舒张末期宽径小于右室,差异均有统计学意义(均P<0.001),而两心室的舒张末期面积对比差异无统计学意义(P=0.050)。四腔心的球形指数与孕周不存在相关性(P=0.811)。左室的基底段和中间段的球形指数大于右室,心尖段的球形指数小于右室,差异均有统计学意义(均P<0.01)。结论采用二维斑点追踪技术评估胎儿心脏参数具有较好的可重复性。本研究制定的低风险胎儿心脏大小和形态参考值范围,将为产前评价心脏重塑提供帮助。