摘要
目的:探讨前置血管(vasa previa,VP)伴低置胎盘(low-lying placenta,LP)的临床特征。方法:本研究为回顾性病例对照研究。研究对象为2015年1月至2021年8月在广州市妇女儿童医疗中心产前检查并分娩的VP患者。按照有无合并LP,将其分为VP+LP组和VP-LP组。以同期前置胎盘(placenta previa,PP)组(128例)作为对照。比较3组的临床特征及母胎临床结局的差异。采用t检验、Mann-Whitney U检验、χ^(2)检验(或Fisher精确概率法)进行统计学分析。结果:研究期间VP病例共116例,占同期分娩孕妇的0.085%(116/136450);VP+LP组64例,VP-LP组51例(排除1例孕晚期非前置血管导致胎儿宫内死亡者)。VP+LP占PP病例总数的2.9%(64/2219),且经产妇及既往剖宫产比例高于VP-LP组[分别为62.5%(40/64)与39.2%(20/51),χ^(2)=6.17,P=0.013;31.3%(20/64)与13.7%(7/51),χ^(2)=4.85,P=0.028],9.4%(6/64)存在Ⅲ型前置血管,产前超声诊断孕周延后[28.3周(23.6~31.7周)与23.9周(23.3~25.9周),Z=2.61,P=0.007]。VP+LP组产前出血比例与VP-LP组差异无统计学意义,但产后24 h内出血量显著增加[550 ml(436~732 ml)与420 ml(300~540 ml),Z=3.37,P=0.001];VP+LP组新生儿5 min Apgar评分<7分[0.0%(0/64)与6.9%(4/58),Fisher精确概率法]及缺氧缺血性脑病的发生比例[0.0%(0/64)与8.6%(5/58),Fisher精确概率法]均低于VP-LP组(P值均<0.05),且无新生儿死亡。与PP组比较,VP+LP组产前出血比例差异无统计学意义,但分娩孕周提前[36.0周(34.3~36.9周)与37.0周(35.7~37.3周),Z=3.79,P<0.001]、胎心异常比例更高[10.9%(7/64)与3.1%(4/128),Fisher精确概率法,P=0.044];且新生儿重症监护病房收住率[36.4%(24/66)与12.1%(16/132),χ^(2)=16.04,P<0.001]及呼吸窘迫综合征发生率更高[25.8%(17/66)与12.1%(16/132),χ^(2)=5.89,P=0.015]。结论:VP伴LP存在特殊类型的Ⅲ型VP。VP伴LP患者产后24 h出血量更多,新生儿发生不良结局的风险更高,因此孕晚期诊断LP需关注伴发VP的可能。
Objective To investigate the clinical characteristics of vasa previa(VP)with low-lying placenta(LP).Methods A retrospective case-control study was conducted on pregnant women with VP who delivered at Guangzhou Women and Children's Medical Center from January 2015 to August 2021.According to the status of LP,these cases were classified into VP with LP(VP+LP)and VP without LP(VP-LP)group.The cases diagnosed with placenta previa(PP,n=128)during the same period were collected as control.Maternal-fetal clinical characteristics and outcomes were compared among the three groups using t-test,Mann-Whitney U test,and Chi-square test(or Fisher's exact test).Results During the study period,116 VP cases were diagnosed,accounting for 0.085%(116/136450)of all deliveries.Apart from one case of intrauterine death caused by non-VP reasons in the third trimester,there were 64 in the VP+LP group and 51 in the VP-LP group.VP+LP cases accounted for about 2.9%(64/2219)of all the cases with PP or LP.The proportions of multiparae and women with a history of cesarean section were significantly higher in the VP+LP group than in the VP-LP group[62.5%(40/64)vs 39.2%(20/51),χ^(2)=6.17,P=0.013;31.3%(20/64)vs 13.7%(7/51),χ^(2)=4.85,P=0.028].Besides,a rare type of VP(typeⅢ)was only found in the VP+LP group(9.4%,6/64).The median gestational age at first diagnosis by prenatal ultrasound was significantly larger in the VP+LP group than in the VP-LP group[28.3(23.6-31.7)vs 23.9(23.3-25.9)weeks,Z=2.61,P=0.007].There was no significant difference in the incidence of antepartum hemorrhage between the two groups.In contrast,the amount of postpartum hemorrhage was significantly increased in the VP+LP group[550(436-732)vs 420(300-540)ml,Z=3.37,P=0.001].Compared with the VP-LP group,the VP+LP group showed a lower incidence of lower neonatal Apgar score(<7 at 5 min)and hypoxic-ischemic encephalopathy[0.0%(0/64)vs 6.9%(4/58),0.0%(0/64)vs 8.6%(5/58),Fisher's exact test,both P<0.05].No neonatal death was reported in the VP+LP and VP-LP groups.No significan
作者
潘秀玉
颜璨
钟俊敏
郑峥
周蓓
陈运山
张国正
刘慧姝
Pan Xiuyu;Yan Can;Zhong Junmin;Zheng Zheng;Zhou Bei;Chen Yunshan;Zhang Guozheng;Liu Huishu(Department of Obstetrics,Guangzhou Women and Children's Medical Center,Guangzhou 510623,China;Department of Ultrasonography,Guangzhou Women and Children's Medical Center,Guangzhou 510623,China)
出处
《中华围产医学杂志》
CAS
CSCD
北大核心
2022年第12期925-932,共8页
Chinese Journal of Perinatal Medicine
关键词
血管前置
前置胎盘
妊娠结局
Vasa previa
Placenta previa
Pregnancy outcome
