脐动脉舒张末期血流缺失35例的分娩时机及处理方案

Termination of pregnancy with absent end-diastolic velocity in umbilical artery

目的分析胎儿脐动脉舒张末期血流缺失（absentend—diastolicvelocity，AEDV）出现时间，探讨其临床处理与围产儿结局的关系以及终止妊娠时机对围产儿预后的影响。方法对首都医科大学附属北京妇产医院2008年1月至2009年12月间35例发生AEDV的母儿临床资料进行分析，以妊娠28周为界，并按治疗与否分为4组。第1组5例（14．3％）为发现AEDV孕周％28周未治疗组；第2组13例（37．1％）为发现AEDV孕周％28周治疗组；第3组11例（31．4％）为发现AEDV孕周≥28周未治疗组；第4组6例（17．1％）为发现AEDV孕周≥28周治疗组。35例孕妇中，除第2组有3例孕妇外，其余均伴有不同程度的各种妊娠合并症。收集的资料用频数、率或均数±标准差表示。结果35例孕妇中，19例分娩，占54．3％，共获23例新生儿，结局良好。第1组出现AEDV孕周〈28周，平均（22．8±2．2）周。其中双胎输血综合征1例及溶血、肝酶升高和血小板减少综合征并胎盘早剥1例，发现AEDV后即引产或剖宫取胎，余3例均未治疗，2周后AEDV自然恢复，新生儿存活。第2组出现AEDV孕周〈28周，平均（24．2±2．0）周，平均终止妊娠孕周（31．4±5．57周，平均治疗时间（10．7±5．5）d。6例治疗后AEDv未恢复，其中5例引产，1例早产；余7例中，6例剖宫产，1例足月自然分娩。除早产1例家属放弃胎儿、1例新生儿失访外，余新生儿结局良好。第3组出现AEDV孕周〉28周，平均（30．9±2．8）周，平均终止妊娠孕周（31．24-2．9）周，均未治疗。5例因严重母儿合并症引产，余6例剖宫产分娩，其中1例因胎盘早剥新生儿死亡，另6例新生儿（1例双胎）结局良好。第4组出现AEDV孕周〉28周，平均（29．5±0．8）周，平均终止妊娠孕周（32．8±2．9）周，平均治疗时间（10．8±6．7）d。2例治疗后予引产；4例治疗后AEDV恢复正常，剖宫产分娩，新生儿结局良好。结论对于AEDV伴有严重并发症的孕妇，积极治疗后，围产儿预后与终止妊娠的孕周有关。AEDV如不伴严重并发症者，部分可自行恢复，且围产儿结局良好。

Objective To investigate the relationship between absent end-diastolic velocity （AEDV） in umbilical artery and perinatal outcome, and to explore the effect of termination time of pregnancy on perinatal outcome. Methods Data of thirty-five pregnant women with AEDV admitted into Beijing Obstetrics and Gynecology Hospital from January 2008 to December 2009 were retrospectively analyzed. According to gestational age and treatment, they were divided into four groups. Group 1： AEDV was identified before 28 weeks without treatment （n= 5）; Group 2： AE.DV was found before 28 weeks, and then was treated （n= 13）; Group 3： AEDV was found after 28 weeks, and was not treated （n=11）; Group 4： AEDV was found after 28 weeks, and then was treated （n = 6）. Except for three patients in Group 2, all patients had complications. Data were presented by frequency, rate or meant SD. Results Among the 35 patients, 19 （54.3%） delivered and 23 living children were born. When AEDV was found, the gestational age was less than 28 weeks and the mean gestational age was （22.8~2.2） weeks in Group 1, （24.2±2.0） weeks in Group 2,however, the gestational age was over 28 weeks and the mean value was （30.9 ±2.8） weeks in Group 3 and （29.54±0.8） weeks in Group 4. Treatment was given to women in Groups 2 and 4, but not in Group 1 and 3. In Group 1, one patient complicated with twin-twin transfusion syndrome; one with hemolysis, elevated liver enzymes and low platelet syndrome and placental abruption; three recovered after two weeks and babies survived. In Group 2, the termination time was （31.4±5.5） gestational weeks and the duration of treatment was （10.7 ±5.5） days. AEDV of six patients were not improved after treatment, among which five accepted induced abortion, one had preterm delivery. The rest six women underwent cesarean section and one term delivered. Babies survived except for one preterm neonate and one lost in follow-up. In Group 3, the termination time was （31.2 d± 2.9） gestational weeks. Five patients accepted artificial abortion for severe complications of mother or babies; the other six patients accepted cesarean section, among which one complicated with placental abruption and baby died. The rest five babies survived. In Group 4, the pregnancies were terminated at an average of （32.84±2.9） gestational weeks and the duration of treatment was （10.8±6.7） days. Two accepted induction after treatment and four recovered to normal after treatment and accepted cesarean section with four wellbeing babies. Conclusions Perinatal outcomes of patients with AEDV complicated with severe complications after active treatment might relate to the termination time. Some patients with AEDV without severe complications might recover spontaneously with good prognosis.