单胎产前超声诊断单脐动脉352例临床分析

Clinical Analysis of Singleton Pregnancy Complicated with Single Umbilical Artery Diagnosed by Ultrasonography

目的:探讨单胎产前超声诊断单脐动脉的妊娠结局,为产前咨询和临床处理提供依据。方法:对2012年5月至2018年4月住院并分娩的352例单胎产前超声诊断为单脐动脉的病例进行回顾性分析。结果:同期单胎妊娠83238例,单胎单脐动脉发生率为0.42%。352例单脐动脉中孤立性单脐动脉(iSUA)308例,占87.5%,其中27例行染色体检查,1例染色体异常(3.7%)。308例中活产296例,死胎10例,流产1例,引产1例。活产儿中合并胎儿畸形14例,畸形率为4.7%(14/296)。非孤立性单脐动脉(niSUA)44例,占12.5%,其中29例行染色体检查,7例染色体异常(24.1%)。44例中活产14例,死胎1例,流产1例,引产28例。44例中合并单一畸形25例,以中枢神经系统及骨骼系统畸形为最常见(各5例);合并多发畸形19例,以心血管畸形及肢体骨骼畸形最常见(各10例)。产后排除单脐动脉病例15例。5例妊娠晚期首次发现单脐动脉,产后病理检查提示脐血管栓塞。结论:iSUA多数结局良好,但产后应注意排查隐匿性畸形。niSUA结局不良,染色体异常风险明显增加,应积极进行产前诊断。对于妊娠晚期首发单脐动脉的病例,应高度警惕脐血管栓塞。

Objective:To investigate the prenatal outcome of singleton pregnancy complicated with single umbilical artery diagnosed by ultrasonography in order to provide evidence for prenatal counseling and clinical management.Methods:Clinical data of 352 cases of singleton pregnancy complicated with single umbilical artery diagnosed by ultrasonography and delivered between May,2012 and April,2018 were analyzed retrospectively.Results:The total number of singleton delivery was 83238.The incidence of single umbilical artery was 0.42%.308 cases were diagnosed as isolated single umbilical artery,accounting for 87.5%.27 cases went through chromosomal examination,in which one was diagnosed as chromosomal abnormality(3.7%).In the total of 308 cases,296 cases were live births,10 cases were stillbirths,1 case was abortion and 1 case was induced labor.14 cases of live birth were complicated with fetal malformation(4.7%,14/296).44 cases were diagnosed as non-isolated single umbilical artery,accounting for 12.5%.29 cases received chromosomal examination,in which 7 cases were diagnosed with chromosomal abnormalities(24.1%).In the total of 44 cases,14 were live births,1 case was stillbirth,1 case was abortion,and 28 cases were induced labor.Among the 44 cases,25 cases were complicated with single malformation.The most common malformation was in the central nervous system and skeletal system(5 cases).19 cases were complicated with multiple malformations,in which cardiovascular and limb skeletal malformations were the most common(10 cases).most of them was limb skeletal deformities and cardiovascular deformities.15 cases were excluded after delivery.5 cases of single umbilical artery were determined in late pregnancy for the first time with umbilical artery thrombosis confirmed by placental pathology after delivery.Conclusions:Good outcomes were observed in most cases with the isolated single umbilical arteries.Postnatal care should be provided for the detection of occult deformities.Non-isolated single umbilical artery could be with poor outcome.The risk of chromosomal abnormalities could increase and prenatal diagnosis should be provided.For patients with single umbilical artery observed in late pregnancy for the first time,umbilical artery thrombosis should be highly vigilant.