摘要
【目的】探讨宫内妊娠早孕期阴道流血的结局预测。【方法】选择2009年10月至2013年2月因阴道流血在我院就医、初诊为先兆流产的孕妇153例,分为流产组66例和继续妊娠组87例,同时选取正常早孕妇女94例作为对照组。就诊当日放射免疫法检测血β-HCG、孕酮和雌二醇,并行腹部B超检查;48 h后复查β-HCG,必要时复查B超确定胚胎停育或出现胎心搏动,妊娠11~13周产科B超检查确定继续妊娠,随访至妊娠28~30周。【结果】流产组2次血β-HCG水平（27.68±25.02、52.61±48.69）U/m L,均明显低于继续妊娠组（38.95±28.95、78.20±57.69）U/m L和正常对照组（40.72±30.11、81.61±60.91）U/m L,P〈0.05。但3组间β-HCG数值及其48 h后变化幅度均有较大范围重叠;流产组血清孕酮水平（11.02±4.57）ng/m L,显著低于继续妊娠组（24.65±7.71）ng/m L,和正常对照组（25.43±8.12）ng/m L,P〈0.01;流产组血清雌二醇水平（146.71±55.50）pg/m L,也明显低于继续妊娠组（402.53±170.79）pg/m L,和正常对照组（425.17±130.05）pg/m L,P〈0.01;腹部B超检查示流产组仅21.21%（14/66）出现胚芽。【结论】宫内妊娠早孕期阴道流血需动态监测,结局预测需要多方面综合评估：血β-HCG监测不能准确评定胚胎,单次血清孕酮或雌二醇水平检测对妊娠结局有预测价值;B超检查确定早期妊娠结局,对于孕7~8周B超检到胎心搏动的高危孕妇,仍需继续随诊。
【Objective】 To investigate outcome prediction of early intrauterine pregnancy with vaginal bleeding.【Methods】 153 pregnant women with vaginal bleeding in early pregnancy who were primarily diagnosed with threatened abortion were recruited in our study from October 2009 to February 2013.They were divided into two groups according to their pregnancy outcomes.The group of spontaneous abortion included 66 women and the other group of 87 was viable pregnancy.94 normal pregnant women of early pregnancy were recruited as control group.Serum β-human chorionic gonadotropin（β-HCG）,progesterone and estradiol were determined by radioimmunoassay at the first visit and β-HCG was retested 48 hours later.Meanwhile,abdominal ultrasound examination was performed to confirm embryonic viability by detection of cardiac activity.【Results】 Compared with group of viable pregnancy（38.95 ± 28.95,78.20 ± 57.69） U/m L and control group（40.72 ± 30.11,81.61 ± 60.91） U/m L,serum β-HCG levels at the first visit and 48 h later were significantly lower in spontaneous abortion group（27.68 ± 25.02,52.61 ± 48.69） U/m L,P 0.05.But there existed considerable overlap in β-HCG values and its rise range after 48 h among three groups.Serum progesterone andestradiol were also dramatically declined in spontaneous abortion group [（11.02 ± 4.57） ng/m L,（146.71 ± 55.50） pg/m L,P 0.01],while progesterone level in group of viable pregnancy and normal control were（24.65 ± 7.71） ng/m L and（25.43 ± 8.12）ng/m L,and estradiol level were（402.53 ± 170.79）pg/m L and（425.17 ± 130.05）pg/m L.For ultrasound measurements,embryos were detected in only 21.21%（14/66） of noviable pregnancies.【Conclusion】 Early intrauterine pregnancy with vaginal bleeding needs serial mornitoring and their outcomes should be evaluated by multivariate analyses.Single test of serum progesterone or estradiol level shows predictive value and detection of cardiac activity by ultrasound examination is confirmed evidence of viable pregnancy.But for those with high risk of spontaneous abortion,follow-up should be continued.
出处
《中山大学学报（医学科学版）》
CAS
CSCD
北大核心
2015年第1期108-113,共6页
Journal of Sun Yat-Sen University:Medical Sciences
基金
广东省科技计划项目(2012B031800406)
广东省卫生厅科研项目(A2011028)
关键词
宫内妊娠
早孕期
阴道流血
妊娠结局
intrauterine pregnancy
early pregnancy
vaginal bleeding
pregnancy outcome
