产前超声评估胎儿脐血管栓塞特征及诊断  

Characteristics and Diagnosis of Fetal Umbilical Cord Embolism Assessed by Prenatal Ultrasound

作　　者：陈克然 CHEN Ke-ran(Department of Ultrasound Diagnostics,First Affiliated Hospital of Nanyang Medical College,Nanyang 473000,Henan Province,China)

机构地区：[1]河南省南阳医学高等专科学校第一附属医院超声诊断科,河南南阳473000

出　　处：《罕少疾病杂志》2022年第10期68-69,共2页Journal of Rare and Uncommon Diseases

摘　　要：目的探讨产前超声评估胎儿脐血管栓塞特征及诊断。方法以2017年5月至2020年5月经本院病理检查“金标准”证实为脐血管栓塞胎儿10例病历资料作回顾性分析,均于术前中及晚孕期接受彩色多普勒超声诊断,比较术前各孕期脐血管栓塞特征,比对“金标准”,分析术前彩色多普勒超声阳性检出率。结果经病理检查,10例脐血管栓塞胎儿均可检出,而于产前超声检查检出阳性例数7例,阳性检出率为70.00%,产前超声阳性检出率与病理检查比较,差异无统计学意义(P>0.05)。2例均误诊为单脐动脉,1例漏诊人数,7例脐血管栓塞胎儿及时行剖宫产均存活,2例误诊为单脐动脉胎儿,1例因脐血管栓塞累及脐静脉及2条脐动脉导致宫内窒息,经引产后为死胎,1例经及时剖宫产后胎儿存活,1例漏诊胎儿未经收治入院,于孕40周孕妇自觉胎动消失,前来我院急诊经超声显示死胎。结论胎儿脐血管栓塞普遍于术前孕晚期检出,结合既往病史,比对中孕期超声影像,观察管腔结构、脐带扭转等特征,测算血流参数,有助于提升术前超声诊断价值,且根据胎儿宫内状态给予针对性诊疗措施,适时性终止妊娠,对胎儿生命挽救具有关键意义。Objective To investigate the characteristics and diagnosis of fetal u mbilical cord embolism by prenatal ultrasound evaluation.Methods A retrospective analysis was performed on medical records of 60 cases of fetuses with umbilical embolization confirmed by"gold standard"of pathological examination in the hospital between May 2017 and May 2020.All of them were diagnosed by color Doppler ultrasound and during the second and third trimesters before surgery.The characteristics of preoperative um bilical cord embolism in each pregnancy were compared with the"gold sta ndard",and the positive detection rate of preoperative color Doppler ultrasound was analyzed.Results All 10 fetuses with umbilical cord embolism could be detected by pathological examination,and 7 cases were detected by prenatal ultrasound examination,with a positive detection rate of 70.00%.There was no significant difference(P>0.05).2 cases were misdiagnosed as single um bilical artery,1 case missed the number of patients,7 cases of umbilical artery embolization fetal timely cesarean section su rvived,2 cases were misdiagnosed as single umbilical artery fetus,1 case due to umbilical artery thrombectomy.The umbilical vein and2 um bilical arteries were plugged,which resulted in intra uterine asphyxia.After induced labor,the fetus was stillborn.One case survived after cesarean section in time,and one case was missed without admission when she came to our emergency department,ultrasound showed stillbirth.Conclusion Fetal umbilical cord embolism is generally detected in the third trimester before surgery.Combining with previous medical history,comparing the ultrasound images in the second trimester,observing the characteristics of lumen structu re and um bilical cord torsion,and measu ring the blood flow parameters will help to improve the value of preoperative ultrasound diagnosis.And according to the fetal intra uterine status,targeted diagnosis and treatment measures and timely termination of pregnancy are of key significance to the life-saving of the fet

关 键 词：脐血管栓塞 彩色多普勒超声 胎儿 诊断效能 

分 类 号：R714.56[医药卫生—妇产科学]