妊娠前置血管临床高危因素分析

Analysis of clinical high-risk factors of vasa praevia during pregnancy

目的探讨妊娠前置血管临床高危因素及对策。方法应用产科多普勒B超确诊,必要时核磁共振成像(MRI)结合临床表现分析,建立统一登记和孕期随诊资料收集,逐一高危因素分析。结果 5年间(2010年1月1日-2014年12月31日),该院住院分娩发生前置血管18例,其高危因素因低置胎盘或合并有帆状、分叶状胎盘或前置胎盘者高达12例(66.67%),发现有体外受精-胚胎移植(IVF-ET)者5例(27.78%),出现瘢痕子宫1例(5.56%)。18例患者中妊娠达到37周或以上者有14例,13例剖宫产,1例产钳助产。另4例于37周前根据病情择期剖宫产,对剖宫产17例患者,除1例产时出血、胎儿窘迫死亡,其余妊娠结局良好。结论产前诊断前置血管并进行规范管理,适时择期剖宫产是保护母婴安全、产生良性分娩结局的首选,降低前置血管须从孕前做起,重视孕环境、子宫营养,尽可能减少前置血管的高危因素。

Objective To explore the high- risk factors of vasa praevia during pregnancy and countermeasures. Methods Obstetric Doppler ultrasound was used to diagnose the cases,MRI combined with clinical manifestations is necessary,the cases were registered uniformly,the follow- up data during pregnancy was collected,the high- risk factors were analyzed. Results From January 1st,2010 to December 31 st,2014,18 cases were diagnosed as vasa praevia during pregnancy in the hospital,the high- risk factors included placental factors（ low- lying placenta,velamentous placenta,lobulated placenta,or placenta praevia）（12 cases,66. 67%）,in vitro fertilization and embryo transfer（ IVF- ET）（5 cases,27. 78%）,scar uterus（1 case,5. 56%）. Among these 18 cases,the gestational weeks of 14 cases were more than or equal to 37 gestational weeks,including 13 cases undergoing cesarean section and one case undergoing forceps delivery. The other four cases underwent elective cesarean section before 37 gestational week. Among 17 cases undergoing cesarean section,the pregnany outcomes were good except one case whose fetus dieds of fetal distress caused by intrapartum hemorrhage. Conclusion Diagnosing vasa praevia during prenatal diagnosis,standardized management,and elective caesarean section are the first choice of protecting mothers and infants and obtaining good delivery outcomes. To reduce vasa praevia during pregnancy,pre- pregnancy health care is the kay point,the environment for pregnancy and uterine nutrition should be paid attention to,and the high- risk factors of vasa praevia during pregnancy should be reduced.