脐带、胎盘超声产前诊断在产科急诊风险评估中的应用效果

Application effect of prenatal ultrasound diagnosis of umbilical cord and placenta in risk assessment of obstetric emergency

目的观察脐带、胎盘超声产前诊断在产科急诊风险评估中的应用效果。方法选取2013年3月-2016年4月新余市人民医院产科急诊收治的脐带和胎盘超声异常的60例孕妇作为研究组,另选同期产前检查的60例健康孕妇作为对照组。分别对两组胎儿超声检查胎颈两侧的脐动脉血流的收缩期最大流速与舒张末期最小流速的比值(S/D值)、血管阻力指数(RI)、羊水污染情况、新生儿Apgar评分情况、孕妇分娩方式、产程时间、手术时间以及住院时间等指标进行比较和分析。结果研究组60例孕妇中,脐带绕颈22例,前置胎盘16例,胎盘植入12例,帆状脐带附着3例,胎盘早剥7例。与对照组胎儿相比,研究组胎儿产前超声RI值和S/D值均明显提高,差异均具有统计学意义(P<0.05);与对照组相比,研究组胎儿羊水污染率和剖宫产率明显提高,新生儿Apgar评分明显降低,差异均具有统计学意义(P<0.05);与对照组相比,研究组产妇产程时间、手术时间以及住院时间均明显延长,差异均具有统计学意义(P<0.05)。结论产前超声能够对脐带和胎盘异常情况进行及时准确的诊断,为临床治疗方案的选择提供指导性的意见,有临床应用价值。

Objective To observe the application effect of prenatal ultrasound diagnosis of umbilical cord and placenta in risk assessment of obstetric emergency. Methods From March 2013 to April 2016, 60 pregnant women with abnormal ultrasound of umbilical cord and placenta who were enrolled in obstetric emergency department of this hospital were selected as study group, and 60 healthy pregnant women receiving prenatal examination in this hospital during the same period were selected as control group. The ratio of the peak systolic velocity and the end diastolic minimum flow velocity （S/D） of umbilical artery blood flow on both sides of fetal neck detected by ultrasonography, vascular resistance index （RI） , amniotic fluid contamination, neonatal Apgar score, maternal delivery mode, labor time, operation time, and hospitalization time in the two groups were compared and analyzed. Results Among 60 pregnant women in study group, there were 22 cases with umbilical cord around the neck, 16 cases with placenta previa, 12 cases with placental implantation, 3 cases with placental cord adhesion, and 7 cases with placental abruption. Compared with the fetuses in control group, RI value and S/D value of prenatal ultra- sound in study group increased significantly （P〈0. 05 ） . Compared with control group, amniotic fluid contamination rate and cesarean section rate in study group significantly increased, neonatal Apgar score significantly decreased, the differences were statistically significant （P〈 0. 05 ） . Compared with control group, the duration of labor, the time of operation, and the time of hospitalization in study group were significantly prolonged, the differences were statistically significant （P〈O. 05） . Conclusion Prenatal ultrasound can diagnose the abnormalities of umbilical cord and placenta accurately and timely, and provide guidance for the selection of clinical treatment, which has clinical application value.