脐动脉闭塞合并脐带过度扭转的产前超声图像特征及妊娠结局分析  

Analysis of prenatal ultrasound features and pregnancy outcomes of umbilical artery occlusion combined with excessive twisting of the umbilical cord

作　　者：梁甜甜 赵华巍 王晓玲 李晓菲[1] 吴青青[1] LIANG Tiantian;ZHAO Huawei;WANG Xiaoling;LI Xiaofei;WU Qingqing(Department of Ultrasound,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100026,China)

机构地区：[1]首都医科大学附属北京妇产医院北京妇幼保健院超声科,北京市100026 [2]北京市海淀区妇幼保健院超声科

出　　处：《临床超声医学杂志》2024年第10期819-822,共4页Journal of Clinical Ultrasound in Medicine

摘　　要：目的分析胎儿脐动脉闭塞合并脐带过度扭转的产前超声图像特征及其妊娠结局。方法收集确诊为脐动脉闭塞合并脐带过度扭转病例6例,分析其产前超声图像特征、妊娠结局、脐带病理检查资料。结果产前超声图像特征:6例胎儿既往均为2条正常脐动脉,而后1条脐动脉发生闭塞且脐带过度扭转;脐动脉闭塞前胎儿超声孕周均符合临床孕周,闭塞后有3例超声孕周小于临床孕周;5例胎盘增厚;1例羊水过多;6例胎儿大脑中动脉搏动指数(MCA-PI)、脐动脉搏动指数均较正常参考值减低,脐动脉收缩期与舒张期峰值流速比值未见异常。妊娠结局:6例胎儿中,胎死宫内1例,活产儿5例,均因胎心监护出现异常行剖宫产分娩。5例活产儿中,3例早产,4例为低出生体质量儿,2例为小于胎龄儿。脐带病理检查:所有胎儿脐带均过度扭转伴脐动脉血栓形成,其中死胎脐轮部变细呈索状坏死。结论脐动脉闭塞合并脐带过度扭转时产前超声多表现为胎儿MCA-PI明显减低,结合胎心监护表现积极干预,可避免不良妊娠结局的发生。Objective To analyze prenatal ultrasound features and pregnancy outcomes of umbilical artery occlusion combined with excessive twisting of the umbilical cord.Methods A total of 6 cases diagnosed as umbilical artery occlusion combined with excessive twisting of the umbilical cord were collected.The prenatal ultrasound features,pregnancy outcomes and data of umbilical cord pathological examination were analyzed.Results Prenatal ultrasound features:all 6 fetuses originally had two normal umbilical arteries,and then one umbilical artery became occluded and the umbilical cord was excessively torsioned.Before the occlusion of the umbilical artery,the gestational age of the fetuses on ultrasound was accordance with the clinical gestational age,but after occlusion,the ultrasound gestational age of 3 cases was smaller than the clinical gestational age.5 cases had thickened placentas,and 1 case had polyhydramnios.The pulsatility index of the middle cerebral artery(MCA-PI)and pulsatility index of umbilical artery(UA-PI)of the 6 fetuses were lower than the normal reference values,while the ratio of peak systolic velocity to end-diastolic velocity of the umbilical artery(UA-S/D)showed no abnormalities.Pregnancy outcomes:among the 6 fetuses,there was 1 intrauterine fetal death and 5 live births.All 5 live births were delivered by cesarean section due to abnormal fetal heart monitoring.Among the 5 liveborn infants,3 were premature,4 had low birth weight,and 2 were small for gestational age.Umbilical cord pathological examination:all fetuses had excessively twisted umbilical cords with umbilical artery thrombosis.The umbilical cord of the stillborn fetus became narrowed and showed cord-like necrotic changes.Conclusion When umbilical artery occlusion is combined with excessive twisting of the umbilical cord,prenatal ultrasound often shows a decreased significant MCA-PI of the fetus.With active intervention based on the manifestations of fetal heart rate monitoring,the occurrence of adverse pregnancy outcomes can be avoided.

关 键 词：超声检查 产前 脐动脉闭塞 脐带过度扭转 妊娠结局 胎儿 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.2[医药卫生—诊断学]