[1]沈梦文,刘 羽.帆状胎盘的危险因素和合并血管前置的妊娠结局分析[J].医学信息,2023,36(09):78-81.[doi:10.3969/j.issn.1006-1959.2023.09.014]
　SHEN Meng-wen,LIU Yu.Analysis of Risk Factors of Velamentous Placenta and Pregnancy Outcome with Vasa Previa[J].Journal of Medical Information,2023,36(09):78-81.[doi:10.3969/j.issn.1006-1959.2023.09.014]
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帆状胎盘的危险因素和合并血管前置的妊娠结局分析()
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医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
36卷
期数:
2023年09期
页码:
78-81
栏目:
论著
出版日期:
2023-05-01

文章信息/Info

Title:
Analysis of Risk Factors of Velamentous Placenta and Pregnancy Outcome with Vasa Previa
文章编号:
1006-1959（2023）09-0078-04
作者:
沈梦文; 刘 羽
（安徽医科大学附属妇幼保健院妇二科，安徽 合肥 230001）
Author(s):
SHEN Meng-wen; LIU Yu
(Department of Obstetrics and Gynecology,Maternal and Child Health Hospital Affiliated to Anhui Medical University,Hefei 230001,Anhui,China)
关键词:
超声诊断; 帆状胎盘; 危险因素; 血管前置; 妊娠结局
Keywords:
Ultrasound diagnosis; Velamentous placenta; Risk factors; Vascular anterior; Pregnancy outcome
分类号:
R714.7
DOI:
10.3969/j.issn.1006-1959.2023.09.014
文献标志码:
A
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。
Abstract:
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.

参考文献/References:

[1]O’Quinn C,Cooper S,Tang S,et al.Antenatal Diagnosis of Marginal and Velamentous Placental Cord Insertion and Pregnancy Outcomes[J].Obstet Gynecol,2020,135(4):953-959.[2]Tsakiridis I,Dagklis T,Athanasiadis A,et al.Impact of Marginal and Velamentous Cord Insertion on Uterine Artery Doppler Indices,Fetal Growth,and Preeclampsia[J].J Ultrasound Med,2022,41(8):2011-2018.[3]Jauniaux E,Alfirevic Z,Bhide AG,et al.Royal College of Obstetricians and Gynaecologists.Vasa Praevia: Diagnosis and Management:Green-top Guideline No.27b[J].BJOG,2019,126(1):e49-e61.[4]卞金燕,顾欣贤,王明玥,等.经腹部阴道联合彩超对帆状胎盘及血管前置的产前诊断意义[J].现代妇产科进展,2021,30(2):129-132.[5]张丹,花秋菊,林琳,等.前置血管14例临床分析[J].大连医科大学学报,2017,39(6):580-583,588.[6]Oyelese Y,Catanzarite V,Prefumo F,et al.Vasa previa:the impact of prenatal diagonsis on outcomes[J].Obestet Gynecol,2004,103(5Pt1):937-942.[7]邱文倩,张超学,张嘉靖,等.彩色多普勒超声在胎儿胸腔占位性病变鉴别诊断中的应用[J].中国超声医学杂志,2018,34(6):543-547.[8]李天刚,王梦麟,王健,等.高分辨率血流联合时间-空间复合成像技术对帆状胎盘的诊断价值[J].临床超声医学杂志,2021,23(4):288-291.[9]龚舒,沈敏,许露,等.脐带帆状附着MRI表现及其临床意义[J].中国医学影像技术,2018,34(10):1528-1531.[10]李秀敏,刘阳,王瑞芳,等.超声诊断24例帆状胎盘的临床分析[J].中国临床医学影像杂志,2021,32(5):363-365.[11]黄鲁鑫,李娜,程如锦.产前超声诊断I型并Ⅱ型前置血管1例[J].中国超声医学杂志,2021,37(9):1080.[12]王小倩,钟嘉杰,孙志伟.孕早期脐带附着部位与围产期并发症间的相关性研究[J].临床超声医学杂志,2019,21(5):362-365.[13]de Los Reyes S,Henderson J,Eke AC.A systematic review and meta-analysis of velamentous cord insertion among singleton pregnancies and the risk of preterm delivery[J].Int J Gynaecol Obstet,2018,142(1):9-14.[14]Klahr R,Fox NS,Zafman K,et al.Frequency of spontaneous resolution of vasa previa with advancing gestational age[J].Am J Obstet Gynecol,2019,221(6):646.e1-646.e7.[15]Erfani H,Haeri S,Shainker SA,et al.Vasa previa: a multicenter retrospective cohort study[J].Am J Obstet Gynecol,2019,221(6):644.e1-644.e5.[16]龚敏.帆状胎盘终止妊娠方式及其对围产结局的影响[J].首都食品与医药,2019,26(18):17-18.[17]邹秀英.胎儿超声脐动脉S/D、大脑中动脉血流动力学联合血气分析对新生儿窒息的临床价值[J].医学影像学杂志,2018,28(11):1837-1840.[18]Kelley BP,Klochko CL,Atkinson S,et al.Sonographic Diagnosis of Velamentous and Marginal Placental Cord insertion[J].Ultrasound Q,2020,36(3):247-254.[19]Cochrane E,Pando C,Kirschen GW,et al.Assisted reproductive technologies (ART) and placental abnormalities[J].J Perinat Med,2020,48(8):825-828.[20]Yang M,Zheng Y,Li M,et al.Clinical features of velamentous umbilical cord insertion and vasa previa: A retrospective analysis based on 501 cases[J].Medicine(Baltimore),2020,99(51):e23166.[21]Albalawi A,Brancusi F,Askin F,et al.Placental Characteristics of Fetuses With Congenital Heart Disease[J].J Ultrasound Med,2017,36(5):965-972.

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更新日期/Last Update: 1900-01-01