目的:探讨前置血管的临床特点及围生儿结局。方法:回顾性分析2018年1月至2020年12月青岛大学附属医院收治前置血管17例临床资料,分析其临床特征、终止时机和围产儿结局。结果:① 临床特征:17例前置血管患者平均年龄33岁,平均体质量指数(BMI) 26.82 Kg/m2;单胎16例(94.1%),双胎1例(5.9%);孕期超声诊断前置血管并经分娩时确诊15例(88.2%),孕期超声未提示,但分娩时诊断2例(11.7%)。② 分娩方式及围生儿结局:6例(35.2%)于孕晚期入院管理,孕37周经剖宫产娩出;8例(47.1%)孕期超声诊断前置血管,因先兆早产行紧急剖宫产,其妊娠结局良好,新生儿出生后1分钟Apgar评分均为9~10分;1例(5.9%)于孕22周超声检查出来,因染色体异常行中孕引产术;1例(5.9%)孕期超声未诊断前置血管,孕34周因胎膜早破行催产素引产,引产过程阴道流血中转剖宫产,术中诊断前置血管,新生儿Apgar评分(1~5 min) 5~7分;1例(5.9%)于孕40周因社会因素行剖宫产,术中发现前置血管,新生儿评分10分。17例患者中,帆状胎盘8例(47.1%),副胎盘2例(11.7%),前置胎盘并胎盘植入5例(29.5%),2例(11.7%)胎盘未见明显异常。结论:产前超声是前置血管诊断的可靠方法,孕晚期适时剖宫产终止妊娠有助于良好的围生儿结局。 Objective: To study the clinical features of vasa previa and outcome of perinatal infant. Methods: 17cases of vasa previa who admitted in The Affiliated Hospital of Qingdao University from January 2018 to December 2020 were recruited. The clinical data, the management and perinatal outcome were analyzed retrospectively. Results: 1) Clinical features: The mean age of 17 patients with vasa previa was 33 years, and the mean body mass index (BMI) was 26.82 Kg/m2. There were 16 single fetuses (94.1%) and 1 twin fetuses (5.9%). 15 cases (88.2%) were diagnosed by ultrasound during pregnancy and confirmed by delivery, but 2 cases (11.7%) were diagnosed by ultrasound during delivery. 2) Delivery mode and perinatal outcome: 6 cases (35.2%) were hospitalized in late preg-nancy and delivered by cesarean section at 37 weeks of gestation; Eight cases (47.1%) were diag-nosed as vasa previa by ultrasound during pregnancy and underwent emergency cesarean section due to preterm labor with aura. The pregnancy outcome was good and Apgar score was 9~10 in 1 minute after birth. One patient (5.9%) was diagnosed by ultrasound at 22 weeks of gestation and underwent midpregnancy induced labor due to chromosomal abnormalities. One case (5.9%) was not diagnosed with prefrontal vessels by ultrasound during pregnancy. At 34 weeks of gestation, labor was induced by oxytocin due to premature rupture of membranes, vaginal bleeding during labor induction was transferred to cesarean section. Prefrontal vessels were diagnosed during op-eration, and Apgar score (1~5 min) was 5~7. One case (5.9%) underwent cesarean section at 40 weeks of gestation due to social factors. Prefrontal vessels were found during the operation. Neona-tal score was 10. Among the 17 patients, there were 8 cases (47.1%) of Vela placenta, 2 cases (11.7%) of accessory placenta, 5 cases (29.5%) of placenta previa with placenta implantation, and 2 cases (11.7%) of placenta without obvious abnormality. Conclusion: Prenatal ultrasound is a relia-ble method for vasa previa diagnosis, and the termination of pregnancy by caesarean section in the third trimester is beneficial to the good perinatal outcome.
目的:探讨前置血管的临床特点及围生儿结局。方法:回顾性分析2018年1月至2020年12月青岛大学附属医院收治前置血管17例临床资料,分析其临床特征、终止时机和围产儿结局。结果:① 临床特征:17例前置血管患者平均年龄33岁,平均体质量指数(BMI) 26.82 Kg/m2;单胎16例(94.1%),双胎1例(5.9%);孕期超声诊断前置血管并经分娩时确诊15例(88.2%),孕期超声未提示,但分娩时诊断2例(11.7%)。② 分娩方式及围生儿结局:6例(35.2%)于孕晚期入院管理,孕37周经剖宫产娩出;8例(47.1%)孕期超声诊断前置血管,因先兆早产行紧急剖宫产,其妊娠结局良好,新生儿出生后1分钟Apgar评分均为9~10分;1例(5.9%)于孕22周超声检查出来,因染色体异常行中孕引产术;1例(5.9%)孕期超声未诊断前置血管,孕34周因胎膜早破行催产素引产,引产过程阴道流血中转剖宫产,术中诊断前置血管,新生儿Apgar评分(1~5 min) 5~7分;1例(5.9%)于孕40周因社会因素行剖宫产,术中发现前置血管,新生儿评分10分。17例患者中,帆状胎盘8例(47.1%),副胎盘2例(11.7%),前置胎盘并胎盘植入5例(29.5%),2例(11.7%)胎盘未见明显异常。结论:产前超声是前置血管诊断的可靠方法,孕晚期适时剖宫产终止妊娠有助于良好的围生儿结局。
前置血管,临床特点,围产儿结局
Jingjing Lyu, Yan Kong, Ning Wang*
The Affiliated Hospital of Qingdao University, Qingdao Shandong
Received: Sep. 15th, 2022; accepted: Oct. 2nd, 2022; published: Oct. 10th, 2022
Objective: To study the clinical features of vasa previa and outcome of perinatal infant. Methods: 17cases of vasa previa who admitted in The Affiliated Hospital of Qingdao University from January 2018 to December 2020 were recruited. The clinical data, the management and perinatal outcome were analyzed retrospectively. Results: 1) Clinical features: The mean age of 17 patients with vasa previa was 33 years, and the mean body mass index (BMI) was 26.82 Kg/m2. There were 16 single fetuses (94.1%) and 1 twin fetuses (5.9%). 15 cases (88.2%) were diagnosed by ultrasound during pregnancy and confirmed by delivery, but 2 cases (11.7%) were diagnosed by ultrasound during delivery. 2) Delivery mode and perinatal outcome: 6 cases (35.2%) were hospitalized in late pregnancy and delivered by cesarean section at 37 weeks of gestation; Eight cases (47.1%) were diagnosed as vasa previa by ultrasound during pregnancy and underwent emergency cesarean section due to preterm labor with aura. The pregnancy outcome was good and Apgar score was 9~10 in 1 minute after birth. One patient (5.9%) was diagnosed by ultrasound at 22 weeks of gestation and underwent midpregnancy induced labor due to chromosomal abnormalities. One case (5.9%) was not diagnosed with prefrontal vessels by ultrasound during pregnancy. At 34 weeks of gestation, labor was induced by oxytocin due to premature rupture of membranes, vaginal bleeding during labor induction was transferred to cesarean section. Prefrontal vessels were diagnosed during operation, and Apgar score (1~5 min) was 5~7. One case (5.9%) underwent cesarean section at 40 weeks of gestation due to social factors. Prefrontal vessels were found during the operation. Neonatal score was 10. Among the 17 patients, there were 8 cases (47.1%) of Vela placenta, 2 cases (11.7%) of accessory placenta, 5 cases (29.5%) of placenta previa with placenta implantation, and 2 cases (11.7%) of placenta without obvious abnormality. Conclusion: Prenatal ultrasound is a reliable method for vasa previa diagnosis, and the termination of pregnancy by caesarean section in the third trimester is beneficial to the good perinatal outcome.
Keywords:Vasa Previa, Clinical Features, Outcome of Perinatal
Copyright © 2022 by author(s) and Hans Publishers Inc.
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前置血管(Vasa previa)是指无脐带或胎盘保护的胎儿血管,自由走行于胎膜上,位于胎先露下方,达子宫下段或跨越宫颈内口。胎膜早破或临产时,该类无保护的胎儿血管易发生自发性或医源性破裂,胎儿在短时间内可能急性失血,仅100 mL出血量即可导致胎儿短时间内发生休克及死亡 [
2018年1月至2020年12月青岛大学附属医院收治前置血管17例,患者年龄27~44岁,平均年龄33岁,体质量指数(BMI) 21.63~33.79 Kg/m2,平均为26.82 Kg/m2。通过孕期超声和分娩时胎盘检查明确前置血管的诊断。(本研究已通过本院伦理委员会同意,注册伦理号:QYFY WZLL 27273)
收集17例前置血管病例的临床资料,并回顾性分析其临床特点、孕期处理及围产儿结局。观察指标包括:年龄、孕次、产次、助孕史、妊娠期合并症史、分娩方式、分娩孕周、围产儿结局等(见表1)。
多由超声诊断,超声声像特点:子宫颈矢状切面上子宫颈内口上方可见平直的管状血管回声,缺乏脐带螺旋,沿子宫颈内口或接近子宫颈内口的胎膜下走行,位置固定,脉冲多普勒显示血管搏动与胎心率一致 [
由专业医务人员进行胎盘胎膜的检查;产时见胎儿血管走行于胎膜间、无华通胶及胎盘组织保护,该血管位于子宫下段或跨越子宫颈内口位于胎先露下方;产后检查胎盘见脐血管附着于胎膜上,或胎膜上见血管断端 [
前置血管胎盘类型分型,分为三型,I型前置血管为单叶胎盘,即帆状胎盘;II型前置血管胎盘为多叶胎盘,如分叶胎盘或副胎盘;III型为血管游离于胎盘边缘走行,以“回头客”轨道再次进入胎盘 [
应用SPSS 26.0软件进行统计学处理,计量资料以均值±标准差或中位数±标准误表示,计数资料以率表示。
病例 | 年龄 | 诊断孕周 | 孕产史 | 产前症状 | 分娩孕周 | 分娩方式 | 胎盘情况 | 新生儿评分 (1~5 min)分 |
---|---|---|---|---|---|---|---|---|
1 | 30 | 24+ | G2P1 | 阴道流血 | 36+5 | 剖宫产 | 前置胎盘并植入;帆状胎盘 | 10~10 |
2 | 36 | 33+ | G5P1 | 无 | 34+3 | 剖宫产 | 前置胎盘并植入;分叶状胎盘 | 9~10 |
3 | 29 | 30+ | G2P0 | 无 | 37 | 剖宫产 | 帆状胎盘 | 10~10 |
4 | 36 | 术中 | G8P3 | 阴道流血 | 34+5 | 顺转剖 | 正常胎盘 | 5~7 |
5 | 27 | 24+ | G1P0 | 无 | 37+4 | 剖宫产 | 帆状胎盘 | 10~10 |
6 | 31 | 24+ | G2P1 | 无 | 37+4 | 剖宫产 | 前置胎盘 | 9~10 |
7 | 31 | 35+ | G1P0 | 阴道褐色分泌物 | 36 | 剖宫产 | 帆状胎盘 | 10~10 |
8 | 33 | 35+ | G3P1 | 无 | 37 | 剖宫产 | 前置胎盘;球拍状胎盘 | 9~10 |
9 | 30 | 术中 | G3P0 | 无 | 40 | 剖宫产 | 副胎盘 | 10~10 |
10* | 31 | 22+ | G3P1 | 无 | 23+3 | 中孕引产术 | 正常胎盘 | 10~10 |
11 | 44 | 37+ | G4P1 | 不规律下腹紧 | 37+4 | 剖宫产 | 副胎盘 | 10~10 |
12 | 39 | 30+ | G5P1 | 规律下腹紧 | 36+1 | 剖宫产 | 帆状胎盘 | 10~10 |
13 | 33 | 24+ | G2P1 | 无 | 35+4 | 剖宫产 | 帆状胎盘 | 10~10/10~10 |
14 | 35 | 24+ | G2P1 | 不规律下腹紧 | 34 | 剖宫产 | 帆状胎盘 | 9~9 |
15 | 32 | 24+ | G2P1 | 胎膜早破 | 37+5 | 剖宫产 | 帆状胎盘 | 10~10 |
16 | 38 | 34+ | G4P1 | 胎膜早破 | 34+6 | 剖宫产 | 胎盘植入 | 9~9 |
17 | 40 | 32+ | G3P1 | 无 | 37+3 | 剖宫产 | 帆状胎盘 | 10~10 |
表1. 前置血管17例产妇临床资料及围产儿结局
17例患者,初产妇4例(23.5%),经产妇13例(76.5%),其中经产妇中前次妊娠方式,顺产7例(53.8%),剖宫产6例(46.2%),11例(84.6%)于20~30岁初次分娩,2例(15.4%)于30-40岁初次分娩。所有患者均为自然受孕,单胎16例(94.1%),双胎1例(5.9%)。其中,10例(58.8%)曾行流产,人工流产7例(70%),药物流产2例(20%),自然流产1例(10%)。孕期合并症中,妊娠期糖尿病5例(29.4%),慢高1例(5.9%),1例(5.9%)唐筛高风险,1例(5.9%)于孕35周诊断胎儿生长受限。
孕期超声诊断并经分娩时确诊15例(88.2%),其中7例(46.6%)于孕24~28周诊断,3例(20%)于孕28~32周诊断,5例(33.4)于孕32~38周。孕期超声未提示,但分娩时诊断2例(11.7%)。
6例(35.2%)孕期超声诊断前置血管,于孕晚期入院管理,孕37周行剖宫产娩出;5例(29.4%)孕期超声诊断前置血管,因先兆早产行紧急剖宫产;3例(17.6%)因胎膜早破行紧急剖宫产;以上产妇妊娠结局良好,新生儿出生后1分钟Apgar评分均为9~10分。另有1例(5.9%)于孕22周超声诊断前置血管,因染色体异常行中孕引产术;1例(5.9%)孕期超声未诊断前置血管,因胎膜早破于孕34周5天行催产素引产,引产过程中阴道流血从而中转剖宫产,新生儿评分(1~5 min) 5~7分;1例(5.9%)孕期未诊断前置血管,于孕40周因社会因素行剖宫产,术中确诊,新生儿评分10分。17例患者中,经专业医护人员检查胎盘,帆状胎盘8例(47.1%),副胎盘2例(11.7%),前置胎盘并胎盘植入5例(29.5%),2例(11.7%)胎盘未见明显异常。
孕期前置血管筛查至关重要,有研究提出在对前置血管进行常规筛查时,超声具有较高的诊断准确性和低的假阳性率,尤其是经阴道彩色多普勒超声检查,通过数据分析,有效的产前血管诊断可能有助于预防约10%的死产 [
虽然前置血管发生率低,一旦破裂出血对胎儿的影响是致命性的。产前超声检查是诊断前置血管最简单可靠的方法,加强孕期管理,适时终止妊娠能改善围生儿结局。前置血管孕妇提前入院管理是为了能保证糖皮质激素治疗,更好地监测分娩迹象,降低紧急剖宫产发生率,避免胎儿血管破裂后的灾难性后果 [
本研究样本量少,临床观测因素不够全面,后续研究中应增大样本量,以便更客观了解前置血管的临床特点及妊娠结局。
综上所述,前置血管发生率低,但一旦发生,围产儿结局不可预想,孕期应增加筛查前置血管意识,产前超声是前置血管诊断的可靠方法,孕晚期适时剖宫产终止妊娠有助于良好的围生儿结局。
吕菁菁,孔 琰,王 宁. 前置血管17例临床分析Clinical Analysis of 17 Cases of Vasa Previa[J]. 临床医学进展, 2022, 12(10): 8914-8918. https://doi.org/10.12677/ACM.2022.12101287