摘要
目的探讨帆状胎盘产前超声诊断的最佳时机,帆状胎盘的相关危险因素和合并血管前置的妊娠结局。方法回顾性分析2018年1月-2022年1月在安徽医科大学附属妇幼保健院收治的帆状胎盘初产妇临床资料,并按超声提示帆状胎盘孕周的不同分为中孕组(14~27+6周)106例,晚孕组(28~36+6周)59例,且晚孕组纳入的病例中孕期超声均未提示帆状胎盘。以产后胎盘、胎膜、脐带检查证实为金标准。另选取同时期收治的健康分娩、非帆状胎盘的初产妇128例作为对照组。分析帆状胎盘的危险因素,比较帆状胎盘、帆状胎盘合并血管前置、对照组之间妊娠结局的特点。结果经产后胎盘、胎膜、脐带检查证实,127例确诊为帆状胎盘,有1例孕期超声均未提示,产前中孕组超声诊断准确率70.09%,灵敏度98.68%,漏诊率1.32%。晚孕组超声诊断准确率86.67%,灵敏度98.11%,漏诊率1.89%。超声诊断帆状胎盘中孕组灵敏度高、漏诊率低,晚孕组准确率高。帆状胎盘组前置胎盘、血管前置、子宫肌瘤、辅助生殖、贫血与对照组比较,差异有统计学意义(P<0.05);经Logistic回归分析显示,辅助生殖、贫血均为帆状胎盘发生的相关危险因素。帆状胎盘组剖宫产、早产、胎儿畸形与对照组比较,差异有统计学意义(P<0.05)。结论超声在孕晚期诊断帆状胎盘准确率较高,辅助生殖、贫血是危险因素,帆状胎盘与帆状胎盘合并血管前置会增加剖宫产率、不良妊娠结局的发生。
Objective To explore the best time for prenatal ultrasound diagnosis of velamentous placenta,the related risk factors of velamentous placenta and the pregnancy outcome with vasa previa.Methods The clinical data of primiparous women with velamentous placenta admitted to Maternal and Child Health Hospital Affiliated to Anhui Medical University from January 2018 to January 2022 were retrospectively analyzed.According to the different gestational weeks of velamentous placenta indicated by ultrasound,106 cases were included into the middle pregnancy group(14-27+6 weeks),59 cases were included into the late pregnancy group(28-36+6 weeks),and none of the cases included in the late pregnancy group indicated velamentous placenta by ultrasound during the middle pregnancy.Postpartum placenta,membranes,umbilical cord examination confirmed as the gold standard.In addition,128 primiparas with healthy delivery and non-velamentous placenta were selected as the control group.The risk factors of velamentous placenta were analyzed,and the characteristics of pregnancy outcomes among velamentous placenta,velamentous placenta with vasa previa and control group were compared.Results Confirmed by postpartum placenta,fetal membrane and umbilical cord examination,127 cases were diagnosed as velamentous placenta,and 1 case was not indicated by ultrasound during pregnancy.The accuracy rate of ultrasound diagnosis in the prenatal middle pregnancy group was 70.09%,the sensitivity was 98.68%,and the missed diagnosis rate was 1.32%.In the late pregnancy group,the accuracy of ultrasound diagnosis was 86.67%,the sensitivity was 98.11%,and the missed diagnosis rate was 1.89%.Ultrasound diagnosis of velamentous placenta had high sensitivity and low missed diagnosis rate in the middle pregnancy group,and high accuracy in the late pregnancy group.There were significant differences in placenta previa,vascular previa,uterine fibroids,assisted reproduction and anemia between the velamentous placenta group and the control group(P<0.05).Logistic regression analysis showed that assisted reproduction and anemia were related risk factors for velamentous placenta.There were significant differences in cesarean section,premature delivery and fetal malformation between the two groups(P<0.05).Conclusion Ultrasound has a high accuracy in the diagnosis of velamentous placenta in the third trimester of pregnancy.Assisted reproduction and anemia are risk factors.The velamentous placenta and velamentous placenta combined with vasa previa will increase the rate of cesarean section and adverse pregnancy outcomes.
作者
沈梦文
刘羽
SHEN Meng-wen;LIU Yu(Department of Obstetrics and Gynecology,Maternal and Child Health Hospital Affiliated to Anhui Medical University,Hefei 230001,Anhui,China)
出处
《医学信息》
2023年第9期78-81,共4页
Journal of Medical Information
关键词
超声诊断
帆状胎盘
危险因素
血管前置
妊娠结局
Ultrasound diagnosis
Velamentous placenta
Risk factors
Vascular anterior
Pregnancy outcome
