前置血管围产结局130例分析

Clinical Analysis of 130 Cases about the Vasa Previa

目的:探讨前置血管临床特点、孕期管理及围产儿结局。方法:回顾性分析2013年1月至2019年5月在四川大学华西第二医院分娩的130例前置血管患者临床资料,分析其临床高危因素、孕期管理及围产儿结局。结果:130例前置血管患者占我院同期分娩产妇的1.86‰。108例(83.1%)单胎,22例(16.9%)多胎,自然受孕109例(83.8%),辅助受孕21例(16.2%),其中妊娠合并帆状胎盘(68.5%)和前置胎盘(33.8%)占多数,96.2%产前诊断前置血管的患者合并至少一个高危因素。产前诊断111例,70.3%中孕期诊断,29.7%晚孕期诊断,诊断后行严密监测,入院孕周(33.7±2.2周),分娩孕周为35.0±1.6周,34~37周分娩77例。130例分娩活产儿150个,活产儿中存活145个,其出生体质量为2422.8±462.5 g,74例(51.0%)转NICU,在NICU住院时间为8(1~49)天。产前诊断组中,多胎妊娠病例的入院孕周、分娩孕周较单胎早,早产率和新生儿死亡率明显高于单胎妊娠病例(P<0.05)。产前诊断组与产时产后诊断组新生儿早产率为87.8%与55.6%(P<0.05),新生儿死亡率分别为2.4%和7.4%(P=0.220)。结论:规范产前检查、早期诊断、严密监护胎儿情况并适时终止妊娠有助于改善前置血管孕妇围产儿结局。

Objective:To study the clinical characteristics and management strategies of vasa previa,and to describe Perinatal infants′outcomes.Methods:This was a retrospective descriptive study that included all cases of vasa previa from January 2013 to May 2019 in the West China Second University Hospital,Sichuan University.The clinical data,risk factors,management and perinatal outcomes were analyzed.Results:One hundred thirty cases of vasa previa were identified,accounting for 1.86‰ of the total number of births over the same period.There were 109(83.8%) natural conception cases,21(16.2%) assisted production cases,108(83.1%).108(83.1%) cases were singleton pregnancies while 22(16.9%) were multiple pregnancies.Among them,89 cases(68.5%) were velamentous cord insertion,and 44(33.8%) were placenta previa.Almost 96.2% cases of vasa previa had one or more risk indicators.One hundred eleven cases(85.4%) were diagnosed antenatally,with 78(70.3%) diagnosed in the second trimester and 33(29.7%) diagnosed in late pregnancy.Close monitoring was carried out after confirmed diagnosis.Patients with vasa previa were hospitalized at 33.7±2.2 weeks,and delivered at 35.1±1.6 weeks.There were 150 live births weighed 2422.8 ± 462.5 g,among which 145 survived with an average birth body mass of 2422.8±462.5 g.74(51.0%) cases were transferred to NICU and stayed for an average of 8 days.In prenatal diagnosis group,multiple pregnancies had an earlier hospitalization time,earlier delivery and higher neonatal mortality(P<0.05).The preterm birth rate of prenatal diagnosis group and postnatal diagnosis group were 87.8% and 55.6%(P<0.05),and the mortality rates were 2.4% and 7.4%(P=0.220).All surviving newborns have a good outcome.Conclusions:Early diagnosis,standardized prenatal examinations,close monitoring and timely termination of pregnancy for patients with vasa previa are critical for maternal and neonatal outcomes.