血管前置的产前超声诊断与预后分析  

Prenatal ultrasound diagnosis and prognosis analysis of vasa previa

作　　者：翁宗杰[1] 党婷婷[1] 李雪蕾 吴秋梅[1] 凌文[1] 黄琼[1] 马宏[1] 李长征[3] 郑丽雅[1] 刘敏[1] Weng Zongjie;Dang Tingting;Li Xuelei;Wu Qiumei;Ling Wen;Huang Qiong;Ma Hong;Li Changzheng;Zheng Liya;Liu Min(Department of Ultrasound,Fujian Provincial Maternity and Children′s Hospital,Fuzhou 350001,China;Department of Ultrasound,Anhui Maternal and Children′s Hospital,Hefei 230000,China;Department of Anatomy,Fujian University of Traditional Chinese Medicine,Fuzhou 350001,China)

机构地区：[1]福建省妇幼保健院超声科,福州350001 [2]安徽省妇幼保健院超声科,合肥230000 [3]福建中医药大学解剖教研室,福州350001

出　　处：《中华超声影像学杂志》2019年第11期958-963,共6页Chinese Journal of Ultrasonography

基　　金：福建省自然科学基金(2017J01235)。

摘　　要：目的分析血管前置的产前超声诊断及预后情况,探讨产前超声对宫颈内口区域扇形扫查法的应用价值,提高血管前置的产前超声检出率。方法回顾性分析35例经手术及病理证实的血管前置孕妇产前超声表现、临床特点及妊娠结局,评价宫颈内口区域扇形扫查法的诊断效能。结果35例血管前置经宫颈内口区域扇形扫查法共检出33例,检出率为94.3%(33/35),其中中孕期首诊20例(60.6%),晚孕期首诊13例(39.4%);漏误诊2例,均为晚孕期首诊病例。35例血管前置中帆状胎盘25例,球拍状胎盘4例,低置胎盘及边缘性前置胎盘20例。35例均行剖宫产分娩,无新生儿死亡发生,足月儿11例,34周以上早产儿20例,34周以下早产儿4例。产后所有胎盘均行大体病理检查证实,胎盘血管铸型4例,其中前置血管为脐动脉分支2例,脐静脉分支2例。结论产前超声应用宫颈内口区域扇形扫查法可有效检出血管前置,中孕期是诊断血管前置的最佳时间。产后胎盘的病理形态学检查及血管铸型有利于提高对血管前置的认识。Objective To investigate the prenatal ultrasonographic features and prognosis of vasa previa,to explore the application value of sector scanning in the intracervical mouth by antenatal ultrasound,then to increase vasa previa detection rate.Methods Prenatal ultrasound images,clinical characteristics and pregnancy outcome of 35 pregnant women with vasa previa confirmed by surgery and pathology were analyzed retrospectively,the diagnostic effectiveness of sector scanning in the intracervical mouth was evaluated.Results Thirty-three of the 35 vasa previa cases were detected by sector scanning in the intracervical mouth,with a detection rate of 94.3%(33/35).Of the 35 cases,20 cases(60.6%)were first contacted in second trimester and 13 cases(39.4%)were first contacted in third trimester.Two cases were missed or misdiagnosed,which were all first contact in third trimester.Among the 35 cases,25 were velamentous placenta and 4 were battledore placenta.Twenty cases were low-lying placenta or marginal placenta previa.All 35 women underwent cesarean section.No neonatal mortality,11 term infants,20 premature infants of more than 34 weeks and 4 premature infants of less than 34 weeks.All placentas underwent pathological examination after delivery,4 cases placentas underwent vascular casting,and it was found that 2 cases were vasa previa of umbilical artery branch and 2 cases were vasa previa of allantoic veins branch.Conclusions Vasa previa can be effectively detected by prenatal ultrasonography through sector scanning in the intracervical mouth.Second trimester is the best period to detect vasa previa.Pathomorphological examination on placenta after delivery and vascular casting are helpful to the understanding of vasa previa.

关 键 词：超声检查 产前 血管前置 血管铸型 

分 类 号：R71[医药卫生—妇产科学]