产前超声诊断帆状脐带附着的临床意义

Clinical significance of prenatal sonographic diagnosis of velamentous cord insertion

目的探讨产前超声诊断帆状脐带附着(VCI)的临床价值。方法回顾性分析26 733例孕妇系统性产前超声检查资料,将47例VCI孕妇的超声诊断结果与其随访结局进行比较。结果行系统性产前超声检查的26 733例孕妇中,产前超声诊断VCI 47例,其中VCI合并血管前置13例;产后随访确诊VCI 39例,其中VCI合并血管前置14例,产前超声的诊断符合率分别为82.9%、92.9%。47例产前超声诊断VCI的产妇中行急诊剖宫产术者44例(其中出现胎膜早破13例,低体质量儿5例,合并中央性前置胎盘、中央型前置胎盘伴植入、副胎盘及新生儿窒息各1例),引产2例(均因合并有胎儿发育异常),顺产1例。结论妊娠合并VCI发生率虽低,但其妊娠结局不理想,产前超声对妊娠合并VCI具有较高的诊断价值。

Objective To explore the clinical significance of prenatal sonographic diagnosis of velamentous cord insertion（VCI）. Methods Ultrasonic and clinical data of 47 cases of pregnancy with VCI were obtained and analyzed retrospectively,and pregnancy outcomes were followed. Results A total of 26 733 pregnant women received systemic prenatal ultrasonographic examination. Forty-seven cases were diagnosed of VCI by ultrasound,including 13 cases diagnosed of VCI with vasa praevia. Thirty-nine cases of VCI were confirmed by postpartum follow up, including 14 cases complicated with vasa praevia.The coincidence rate of sonographic and pathological diagnoses was 82.9% and 92.9% respectively. Pregnancy outcomes included natural labor in 1 case,emergency cesarean section in 44 cases（1 case with central placenta previa,1 case with central type of placenta previa with implants,1 case with vice placenta,13 cases with premature rupture of membranes,5 cases with low birth weight infant,1 case with neonatal asphyxia）and induced abortion in 2 cases complicated with abnormal development of fetus.Conclusion VCI has poor pregnancy outcome without properly detection and treatment. Prenatal ultrasound has high value in diagnosis of VCI.