脐动脉栓塞18例临床分析

Clinical analysis of umbilical artery embolism in 18 cases

目的探讨脐动脉栓塞的临床特点及妊娠结局。方法本研究为回顾性病例系列研究。研究对象为2018年1月至2020年2月在厦门市妇幼保健院住院分娩的18例脐动脉栓塞患者。分析患者的一般情况(年龄、妊娠并发症、产前超声提示脐动脉情况等)、妊娠结局(分娩方式、胎儿或新生儿结局等)及胎盘病理检查资料。对数据资料采用描述性统计方法进行分析。结果(1)本单位脐动脉栓塞的产前检出率为0.062%(18/29130)。18例孕妇年龄(30.1±6.1)岁,其中4例高龄产妇(年龄≥35岁),1例<18岁;17例为单胎妊娠,1例为双绒毛膜双羊膜囊双胎妊娠之一。超声首次提示单脐动脉或可疑脐动脉栓塞的孕周为(35.1±2.6)周,其中16例孕晚期超声提示单脐动脉,2例可疑脐动脉栓塞。18例患者的妊娠并发症主要包括妊娠期糖尿病(8例)、胎儿生长受限(4例)和脐带插入点异常(3例)。(2)18例中的16例活产孕妇均为剖宫产分娩,产妇结局均良好;2例胎儿宫内死亡。16例活产新生儿中,早产9例,足月产7例;平均出生体重(2434±816)g;4例为小于胎龄儿;3例发生新生儿窒息。11例新生儿收住重症监护病房,其中5例存在脑损伤。(3)18例中,17例胎盘病理检查提示2条脐动脉中的1条血栓形成,1例合并脐静脉血栓。11例脐带过度扭转,3例脐带插入点异常。1例拒绝胎盘病理检查。结论妊娠晚期超声首次提示单脐动脉时,应警惕脐血管栓塞。分娩时机应综合考虑早产及突发不良事件的风险。分娩方式建议考虑剖宫产。

Objective To investigate the clinical characteristics and pregnancy outcomes of fetal umbilical artery embolism.Methods This retrospective case series recruited 18 cases of fetal umbilical artery embolism delivered at Xiamen Maternal and Child Healthcare Hospital from January 2018 to February 2020.Maternal age,complications,umbilical artery condition revealed by prenatal ultrasound,delivery mode,perinatal outcomes,and placental pathological examinations were analyzed using descriptive statistical methods.Results(1)The total prenatal detection rate of umbilical artery embolism was 0.062%(18/29130).The average maternal age was(30.1±6.1)years old.Four of the 18 cases aged other 35 and one was younger than 18 years old;17 cases were singleton pregnancy,and the other one was a dichorionic diamniotic twin pregnancy.The mean gestational age was(35.1±2.6)weeks when an abnormal umbilical artery was first indicated by ultrasound,including 16 with a single umbilical artery shown in the third trimester and two with suspected umbilical artery embolism.The main complications were followed as gestational diabetes mellitus(8/18),fetal growth restriction(4/18),and abnormal umbilical cord insertion(3/18).(2)Cesarean section was performed for 16 cases,resulting in live births,while the other two cases had intrauterine death.Among the 16 neonates,nine were premature infants,and seven were full-term infants,with an average birth weight of(2434±816)g;four were small for gestational age,and neonatal asphyxia occurred in three cases.Eleven were admitted to the neonatal intensive care unit,including five with brain injury.(3)Placental pathological examinations showed embolism in one of the two umbilical arteries in 17 cases and the umbilical vein in one case.Excessive torsion of the umbilical cord was observed in 11 cases and the umbilical cord's abnormal insertion in three cases.One case refused placental pathological examination.Conclusions Umbilical artery embolism should be considered when a single umbilical artery is indicated by ultrasound in the third trimester.The time of delivery should be based on the risk of premature birth and unexpected adverse events.A cesarean section is suggested.