早期宫内活胎伴阴道流血的妊娠结局的探讨

Pregnancy outcomes of pregnant women with single intrauterine living fetus and vaginal bleeding in first trimester of pregnancy

目的探讨先兆流产时胎心率的特点，并结合血清β-人绒毛膜促性腺激素和孕酮评估先兆流产妊娠结局。方法选择140例孕7～10周的先兆流产者，其中继续妊娠组（A组）91例，难免流产组（B组）49例，观察其胎心率特点，就诊当日检测血清β-人绒毛膜促性腺激素和孕酮，1周后复查血清β-人绒毛膜促性腺激素和孕酮，对其检测结果进行分析。结果A组胎心率为153．54±21．18次／分钟，B组胎心率较慢，为100．21±11．30次／分钟，以120次／分为胎心率分界点，特异性为86．8％，敏感性为71．4％。就诊当日两组血清β-人绒毛膜促性腺激素水平比较差异无统计学意义（t=0．519，P〉0．05），两组孕酮水平比较差异亦无统计学意义（t=1．710，P〉0．05）；1周后两组血清β-人绒毛膜促性腺激素和孕酮比较均有统计学意义（t值分别为6．730、10．439，均P〈0．05）。结论妊娠早期血清β-人绒毛膜促性腺激素和孕酮滴度变化结合阴道B超可预测早期有胎心博动先兆流产的结局，对临床诊断及治疗有一定的价值。

Objective To predict pregancy outcomes of those pregnant women with threatened abortion in first trimester of pregnancy by changes in fetal heart rate and serum levels of β-hCG and progesterone （P） of the pregnant women. Methods The clinical data of 140 pregnant women with threatened abortion in 7 - 10 weeks of pregnancy were analyzed retrospectively. According to pregnancy outcomes of the pregnant women, all pregnant women with threatened abortion were divided into maintainable pregnancy group （group A, n = 91 ） and inevitabale abortion group （ group B, n = 49 ）. All pregnant women received vaginal ultrasonography and the fetal heart rate was monitored. Serum β-hCG and P of all pregnant women were detected by radioimmunoassay at the first visit day and 1 week later respectively. The results were analyzed statistically. Results The mean fetal heart rate in group A was 153.54 ±21.18bpm and that in group B was 100.21 ± 11.30bpm. 120bpm was regarded as cutoff point of fetal heart rate. The sensitivity and specificity of fetal heart rate were 71.4% and 86.8% respectively. There were no statistically significant differences in serum levels of β-hCG and P at the first visit day between group A and group B （t =0.519, P 〉0.05; t = 1. 710,P 〉0.05）. While one week later, in serum levels of β-hCG and P, there were both statistically significant differences between group A and group B （ t = 6. 730, 10. 439 respectively, both P 〈 0. 05 ）. Conclusion Combination of Doppler ultrasonoraphy and detection of serum levels of β-hCG and P can predict pregnancy outcome of those early pregnant women with threatened abortion and fetal heart beats, which is of important clinical significance for diagnosis and treatment of threatened abortion.