前置血管25例临床分析

Clinical Analysis of 25 Cases of Vasa Previa

目的:探讨前置血管的孕期处理及围产儿结局。方法:收集2011年1月至2017年8月在北京大学第三医院分娩的25例前置血管患者的临床资料,回顾性分析其临床特点、孕期处理和围产儿结局。结果:(1)临床特征:25例前置血管患者占同期分娩产妇总数的0.8‰。患者年龄24~44岁,平均32.9±4.9岁。自然受孕20例(80.0%),体外受精-胚胎移植后受孕5例(20.0%);单胎22例(88.0%),双胎3例(12.0%)。孕期超声诊断15例(60.0%)并经分娩后胎盘检查证实,孕期超声检查未提示但分娩时诊断10例(40.0%)。帆状胎盘21例(84.0%),副胎盘4例(16.0%)。(2)孕期监测及处理:孕期超声诊断前置血管的15例患者中,14例于孕28~34周入院给予地塞米松促胎肺成熟,15例中13例因前置血管计划剖宫产分娩,2例因子痫前期、胎膜早破分别于孕34.8周和孕30.4周急诊剖宫产分娩。产时诊断前置血管的10例患者,5例择期剖宫产分娩,分娩孕周38.3~40.0周;4例因瘢痕子宫、先兆临产或胎膜早破、胎盘早剥急诊剖宫产分娩,分娩孕周36.0~39.3周;1例孕36.9周自然分娩。(3)围产儿结局:25例患者分娩活产儿28个,平均出生体质量2737.9±632.2 g。24例剖宫产分娩者均无新生儿窒息。仅1例患者孕36.9周阴道分娩,新生儿重度窒息。结论:孕期进行超声筛查大部分能产前明确前置血管诊断,孕28~32周收住院给予糖皮质激素促胎肺成熟,孕34~37周剖宫产终止妊娠,可获得良好的围产儿结局。

Objective：To study the treatment of vasa previa and outcome of perinatal infant. Methods：25 cases of vasa previa who admitted in Peking University third hospital from January 2011 to August 2017 were recruited. The clinical data,the management and perinatal outcome were analyzed retrospectively. Results：（1）Clinical features：25 patients with vasa previa accounted for 0.8%0 of the total number of births. The average age of patients was 32.9 ±4.9 years old. 15 patients（60. 0% ） were primiparas, 10 patients（40. 0% ） were pluriparas. 20 patients（80.0%） were conceived naturally,5 patients（20.0% ） were vitro fertilization. 22 patients（88.0% ） were single births,3 patients（12.0%） were twins. 15 patients（60%） were diagnosed by ultrasound antenatal, and confirmed by checking the placenta after delivery, 10 patients （40.0% ） were diagnosed intrapartum. 21 patients （84.0%） were velamentous cord insertion, 4 patients （ 16.0% ） were succenturiate placental lobe. （2）Monitoring and treatment during pregnancy： Among the 15 patients with antenatal diagnosed by ultrasound, 14 patients were admitted to the hospital with dexamethasone for the maturation of the fetal lung during 28 -34 weeks of pregnan- cy. Among them,13 cases were delivered by planning caesarean section, and 2 cases with pre-eclampsia and premature rupture of the membranes were delivered by the emergency caesarean section at 34.8 weeks and 30.4 weeks, respectively. 10 patients diagnosed intrapartum,5 patients had a planning caesarean section,and the delivery pregnancy week was 38. 3 -40. 0 weeks. 4 cases were delivered by the emergency caesarean section due to scar uterine, precursors, premature rupture of membranes, placental abruption, and delivery pregnancy week were 36. 0 -39.3 weeks. Another one patient was delivered by vagina at 36. 9 weeks. （3）Outcome of perinatal：There were 28 live births,the average quality of birth weight was 2737. 9 ±632. 2 g. No neonatal asphyxiation was found in 24 caesarean sections. Only one patient with a vaginal delivery at 36. 9 weeks,the newborn was severely asphyxia- ted. Conclusions： Patients with risk factors for vasa previa should receive ultrasound screening to clarify the diagnosis,28 -32 weeks gestation should admit to the hospital to recieve corticosteroids treatment to promote fetal lung maturity. Terminated by cesarean section during 34 -37 weeks,can obtain good perinatal outcome.