单胎妊娠的单脐动脉缺失侧别发生率及其与胎儿各系统畸形发生的相关性

Incidence of single umbilical artery deletion in singleton pregnancy and its correlation with fetal malformations

目的观察单胎妊娠的单脐动脉(SUA)胎儿各系统畸形与缺失侧别的相关性。方法选择2016年5月—2020年5月在本院接受诊治的单胎妊娠的单脐动脉120例,均经产后病理证实,同期选择健康单胎胎儿120例作为对照组,彩色多普勒超声监测SUA组与对照组的血流频谱图,评估SUA各系统发生畸形情况、缺失侧别发生情况;比较SUA组、对照组脐动脉血流速度峰谷比(S/D)、动脉阻力指数(RI)、动脉搏动指数(PI)。结果单脐动脉120例,左侧缺失86例(71.7%),右侧缺失34例(28.3%);单脐动脉左侧缺失组与右侧缺失组相比,两组首次发现单脐动脉孕周、年龄指标差异无统计学意义(P>0.05);单脐动脉120例,合并各系统畸形30例(25.0%),包括多发性畸形7例(5.8%),颈部及颜面部畸形6例(5.0%),复杂心血管畸形9例(7.5%),中枢神经系统畸形2例(1.7%),骨骼畸形1例(0.8%),泌尿系统畸形2例(1.7%),消化系统及腹壁畸形2例(1.7%),胸腔畸形1例(0.8%);单脐动脉左侧缺失与右侧相比,合并多发性畸形、颈部及颜面部畸形、复发性心血管畸形发生率显著增高,差异有统计学意义(P<0.05);两组合并中枢系统畸形、骨骼畸形、泌尿系统畸形、消化系统及腹壁畸形、胸腔畸形比较差异无统计学意义(P>0.05);SUA组脐动脉血流速度峰谷比(S/D)、动脉阻力指数(RI)、动脉搏动指数(PI)指标显著高于对照组,差异有统计学意义(P<0.05)。结论单胎妊娠的单脐动脉胎儿临床常见为左侧缺失,极易合并复杂性心血管畸形、多发畸形、颈部及颜面畸形。

Objective To observe the relationship between the malformation of single umbilical artery(SUA) and the missing side. Methods 120 cases of single umbilical artery of single pregnancy in our hospital from May 2016 to May 2020 were selected and confirmed by postpartum pathology.At the same time, 120 healthy singleton fetuses were selected as the control group. The blood flow spectrum of SUA group and control group was monitored by color Doppler ultrasound, and the occurrence of malformation and missing side of SUA system was evaluated;The peak to valley ratio(S/D), arterial resistance index(RI), and arterial pulsatility index(PI) were compared between SUA group and control group. Results There were 120 cases of single umbilical artery, 86 cases(71.7%) of left-sided deletion and 34 cases(28.3%) of right-sided deletion;There were 120 cases of single umbilical artery, 30 cases(25.0%) with multiple malformations, including 7 cases(5.8%) of multiple malformations, 6 cases(5.0%) of neck and face malformations, 9 cases(7.5%) of complex cardiovascular malformations, 2 cases(1.7%) of central nervous system malformations, 1 cases(0.8%) of skeletal malformations, 2 cases(1.7%) of urinary system malformations, 2 cases(1.7%) of digestive system and abdominal wall malformations 1 cases(0.8%) were in shape;The incidence of multiple malformations, neck and facial malformations, and recurrent cardiovascular malformations was significantly higher than that in the right(P<0.05). There was no significant difference in central system malformation, skeletal malformation, urinary system malformation, digestive system, abdominal wall malformation and thoracic deformity between the two groups(P>0.05). The peak to valley ratio(S/D), arterial resistance index(RI) and arterial pulsatility index(PI) in SUA group were significantly higher than those in control group(P<0.05). Conclusion Single umbilical artery fetus in single pregnancy is often left absence, which is easily complicated with complex cardiovascular malformations, multiple malformations, neck and face malformations.