早期妊娠合并子宫内血肿的临床意义

Clinical value of early pregnancy complicated with intrauterine hematoma

目的评估B超诊断早期妊娠合并子宫内血肿(IUH)及对妊娠结局影响的临床价值和意义。方法选取2017年1月至2018年10月间在江苏省妇幼保健院妇女保健科门诊就诊的早期妊娠并阴道超声检查诊断为IUH患者167例。根据血肿位置不同,将IUH患者分为早期妊娠合并胎盘后血肿组79例和早期妊娠合并绒毛膜下血肿组88例;根据早期妊娠合并IUH患者是否存在阴道出血分为阴道出血组55例,无阴道出血组112例。收集研究对象的一般资料,根据IUH的位置、阴道流血情况,分析其对妊娠结局的影响。结果与早期妊娠合并绒毛膜下血肿组相比,胎盘后血肿组的自然流产、胎盘粘连(植入)、产后出血、新生儿窒息发生率均明显升高,足月产发生率、新生儿体质量均明显降低(χ^2值分别为10.254、9.284、5.445、5.025、12.647,t=-2.567),差异均有统计学意义(均P<0.05);而早产、胎盘早剥、胎膜早破发生率差异均无统计学意义(均P>0.05)。与无阴道出血组比较,阴道出血组的自然流产、产后出血发生率增加,足月产发生率、新生儿体质量下降(χ^2值分别为9.424、4.335、15.300,t=-2.291),差异均有统计学意义(均P<0.05);而早产、胎盘粘连(植入)、胎盘早剥、胎膜早破、新生儿窒息发生率差异均无统计学意义(均P>0.05)。结论在早期妊娠合并IUH的患者中,胎盘后血肿及IUH合并阴道出血对妊娠结局有不利影响,阴道B超诊断早期妊娠合并IUH对预测妊娠结局有重要的参考价值。

Objective To evaluate the clinical value and significance of B-mode ultrasonography in the diagnosis of early pregnancy complicated with intrauterine hematoma(IUH) and its influence on pregnancy outcomes. Methods A total of 167 patients with IUH diagnosed by transvaginal ultrasound from the outpatient Department of Women’s Health Care in Jiangsu Maternal and Child Health Hospital during January 2017 to October 2018 were selected. According to the different location of the hematoma, IUH patients were divided into early pregnancy with retroplacental hematoma group(79 cases) and early pregnancy with subchorionic hematoma group(88 cases). According to the presence or absence of vaginal bleeding in patients with early pregnancy complicated with IUH, the patients were divided into vaginal bleeding group(55 cases) and non-vaginal bleeding group(112 cases). The general data of patients were collected, and the influence of IUH on pregnancy outcomes was analyzed according to the location of IUH and the vaginal bleeding. Results Compared with the early pregnancy with subchorionic hematoma group, the incidence of spontaneous abortion, placental adhesion(implantation), postpartum hemorrhage and neonatal asphyxia in early pregnancy with retroplacental hematoma group increased significantly, while the incidence of full-term delivery and neonatal weight decreased significantly(χ^2 value was 10.254, 9.284, 5.445, 5.025 and 12.647,respectively, t=-2.567) and the differences were statistically significant(all P<0.05). And there were no significant differences in the incidence of premature delivery, placental abruption and premature rupture of membranes between two groups(all P>0.05). Compared with non-vaginal bleeding group, the incidence of spontaneous abortion and postpartum hemorrhage in the vaginal bleeding group increased, the incidence of full-term delivery and the neonatal weight decreased(χ^2 value was 9.424, 4.335 and 15.300, respectively, t=-2.291) and the differences were statistically significant(all P<0.05) There were no significant differences in the incidence of premature delivery, placental adhesion(implantation), placental abruption, premature rupture of membranes and neonatal asphyxia(all P>0.05). Conclusion In IUH patients with early pregnancy, retroplacental hematoma and IUH with vaginal bleeding have adverse effects on pregnancy outcomes. Vaginal B-ultrasound diagnosis of early pregnancy with IUH has important reference value in predicting pregnancy outcomes.