前置血管14例临床分析
Clinical analysis of 14 cases of vasa previa
  
DOI:10.11724/jdmu.2017.06.14
中文关键词:  前置血管  高危因素  预后
英文关键词:vasa previa  high risk factors  prognosis
基金项目:
作者单位
张 丹 沈阳市妇婴医院 妇产科辽宁 沈阳110011 
花秋菊 沈阳市妇婴医院 超声科辽宁 沈阳110011 
林 琳 沈阳市妇婴医院 妇产科辽宁 沈阳110011 
张丽君 沈阳市妇婴医院 妇产科辽宁 沈阳110011 
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中文摘要:
      目的探讨前置血管的高危因素、临床特点、治疗策略及预后。方法回顾性分析2014年1月至2017年9月沈阳市妇婴医院产科收治的14例前置血管患者的临床资料,归纳、分析其高危因素、临床特点及预后。结果14例前置血管患者中,产前经腹部超声诊断9例,产前超声诊断率64.3%,产前诊断的平均孕周为29+5周;产后明确诊断5例。14例均存在高危因素,完全性前置胎盘2例,低置胎盘2例,双胎2例,帆状胎盘3例,低置胎盘合并帆状胎盘3例,低置胎盘合并边缘性脐带入口2例。产前诊断的9例患者均剖宫产终止妊娠,围产儿结局良好。产后诊断的5例患者,1例因“拒绝阴道分娩”行剖宫产终止妊娠,围产儿结局良好,1例双胎正常分娩,新生儿之一合并尿道下裂,结局良好,1例因“相对过大胎儿”行剖宫产终止妊娠,围产儿结局良好,1例胎膜早破患者产程中因“胎儿窘迫”行急诊剖宫产,围产儿结局良好,另1例入院前发生胎膜早破、前置血管破裂,胎死宫内引产。结论超声是前置血管产前诊断最常用最可靠的方法,对于存在多胎妊娠及妊娠期超声检查提示脐带附着部位异常、帆状胎盘、低置胎盘等高危因素的孕妇,警惕前置血管,以提高前置血管检出率。此外,应当警惕临产后出现阴道流血并伴随胎心率改变的患者是否存在前置血管,以便尽早实施急诊剖宫产,改善围产儿结局。
英文摘要:
      Objective To explore the risk factors, clinical characteristics, treatment strategies and prognosis of vasa previa. Methods The clinical data of 14 cases of vasa previa in pregnant women from January 2014 to September 2017 admitted to the Shenyang women’s and Children’s Hospital were retrospectively analyzed. The risk factors, clinical features and prognosis were summarized and analyzed. Results Among the 14 cases with vasa previa, 9 cases (64.3%) were diagnosed by prenatal abdominal ultrasound, the average gestational age of prenatal diagnosis was 29+5 weeks, and 5 cases were diagnosed after delivery. All 14 cases had high risk factors, including 2 cases of complete placenta previa, 2 cases of low-lying placenta, 2 cases of spontaneous twins, 3 cases of cord velamentous insertion, 3 cases of low-lying placenta with cord velamentous insertion, and 3 cases of low-lying placenta with battledore placenta. The 9 cases with prenatal diagnosis of vasa previa had cesarean termination of pregnancy, and the perinatal outcomes were all good. As for the 5 cases that were diagnosed after delivery, 1 case of emergent cesarean delivery because of refusing vaginal delivery, 1 case of premature normal delivery of twins with one of the newborns with hypospadias, 1 case of emergent cesarean delivery because of relatively large fetus, 1 case with rupture of membrane had emergent cesarean delivery because of the fetal distress, all the above cases had good perinatal outcomes. The other one case with premature rupture of membrane resulted in a ruptured fetal vessel and fetal death. Conclusion Ultrasound is the most commonly used and reliable method for prenatal diagnosis of vasa previa. In order to improve the detection rate, we should pay attention to the vasa previa in women with high risk factors such as placental previa or low-lying placenta, multiple pregnancy, and the cord velamentous insertion at the ultrasound examination. In addition, vasa previa should be suspected when there is vaginal bleeding combined with fetal distress so emergency cesarean section can be implemented as soon as possible to improve perinatal outcome.
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