妊娠早期绒毛膜下出血与胎盘脐带附着异常的关系研究

Correlation between subchorionic hemorrhage during the first trimester and abnormal attachment of umbilical cord upon placenta

目的探讨妊娠早期绒毛膜下出血与脐带附着部位之间的关系,提高超声对脐带附着部位异常的检出率。方法选取我院经超声诊断为妊娠早期绒毛膜下出血的79例单胎妊娠孕妇(病例组),按照出血面积与孕囊面积的比值分为少量出血亚组33例、中等量出血亚组22例及大量出血亚组24例;另选同期妊娠早期超声检查正常且无任何并发症的102例单胎妊娠孕妇(对照组)。各组均于结构筛查期采用二维超声及彩色多普勒超声观察脐带附着部位,记录两组脐带附着部位情况及病例组不同亚组间脐带附着部位情况;分析不同亚组与脐带附着部位异常的关系。结果病例组脐带异常附着的发生率为13.92%,明显高于对照组(2.94%),差异有统计学意义(P<0.05);病例组中,少量出血亚组、中等量出血亚组、大量出血亚组脐带附着部位异常发生率分别为3.03%、13.64%、29.17%,组间比较差异有统计学意义(P<0.05);相关性分析显示,妊娠早期绒毛膜下出血程度与结构筛查期脐带附着部位异常呈正相关性(r=0.32,P<0.05)。结论妊娠早期发生绒毛膜下出血会对脐带附着部位产生影响,两者呈正相关,即出血程度越高,脐带附着部位异常的发生率越高。

Objective To investigate the relationship between subchorionic hemorrhage during the first trimester and abnormal attachment of umbilical cord upon placenta,and to improve the detection rate of abnormal umbilical cord insertion.Methods A total of 79 pregnancies diagnosed as subchorionic hemorrhage in early pregnancy were selected as case group,according to the ratio of hemorrhage area and the area of the pregnant sac,they were divided into 3 subgroups:mild hemorrhage subgroup(n=33),moderate hemorrhage subgroup(n=22),massive hemorrhage subgroup(n=24),and other 102 cases with normal ultrasonographic features were chosen as control group.Two-dimensional ultrasound and color Doppler ultrasound were used to observe the umbilical cord insertion during fetal structural screening.The umbilical cord attachment sites of the two groups and the umbilical cord attachment sites between different subgroups of the case group were recorded.Pearson correlation analysis software was used to analyze the correlation between different subgroups and umbilical cord attachment sites.Results The incidence of abnormal attachment of umbilical cord in the case group was 13.92%,which was significantly higher than that of in normal group(2.94%),there was significant difference(P<0.05).The abnormal incidence rate of umbilical cord attachment sites were 3.03%,13.64%,29.17%in mild hemorrhage subgroup,moderate hemorrhage subgroup and massive hemorrhage subgroup,respectively(P<0.05).Correlation analysis showed that the degree of subchorionic hemorrhage was positively correlated with abnormal umbilical cord insertion(r=0.32,P<0.05).Conclusion The occurrence of subchorionic hemorrhage in early pregnancy has an effect on the attachment site of the umbilical cord.They are positively correlated,it means that the higher the degree of bleeding is,the higher the incidence of abnormalities in the attachment site of the umbilical cord should be.