妊娠合并单脐动脉225例妊娠结局分析

Analysis of pregnancy outcome of 225 cases of pregnancy with single umbilical artery

目的探讨妊娠合并单脐动脉的临床特点及妊娠结局。方法回顾性分析2016年1月至2020年12月石家庄市第四医院产科收治的225例单胎妊娠合并单脐动脉孕产妇的临床病理资料作为单脐动脉组;随机抽取同期300例正常脐带单胎妊娠孕产妇作为对照组。分析两组孕产妇的一般资料、孕期并发症、妊娠结局情况。结果(1)两组孕妇年龄、产前体重指数(BMI)比较,差异无统计学意义(P均>0.05);两组分娩孕周及分娩方式比较,差异有统计学意义(P均<0.05)。(2)单脐动脉组孕妇妊娠期高血压疾病、妊娠期糖尿病、羊水过多/过少、胎儿窘迫、胎儿生长受限、前置胎盘发生率均高于对照组,差异有统计学意义(P均<0.05);两组妊娠合并甲状腺疾病发生率比较,差异无统计学意义(P>0.05)。(3)单脐动脉组孕妇胎盘早剥、羊水污染、胎死宫内、胎儿畸形发生率高于对照组,差异有统计学意义(P均<0.05);两组胎膜早破、脐带缠绕/真结、胎盘植入/粘连、产后出血发生率,差异无统计学意义(P均>0.05)。(4)单脐动脉组新生儿平均体重低于对照组,差异有统计学意义(t=-9.014,P<0.05);单脐动脉组低出生体重儿、新生儿畸形发生率高于对照组,差异有统计学意义(P均<0.05);两组新生儿1min Apgar评分、新生儿窒息、新生儿黄疸发生率,差异无统计学意义(P均>0.05)。(5)单脐动脉组胎盘平均重量、平均脐带直径低于对照组胎盘平均重量及平均脐带直径,差异有统计学意义(t值分别为-3.430和4.212,P均<0.05);单脐动脉组胎盘梗死、脐带插入部位异常、副叶胎盘发生率高于对照组,差异有统计学意义(P均<0.05)。结论妊娠合并单脐动脉常伴发多种妊娠并发症或合并症,其胎儿不良结局发生率较高,早期诊断和定期随访,因人而异的个体化治疗方案选择对改善妊娠结局、降低围产儿病率和死亡率具有重要意义。

Objective To investigate the clinical characteristics and pregnancy outcome of pregnancy with single umbilical artery.MethodsFrom January 2016 to December 2020,totally 225 cases of single pregnancy with single umbilical artery were retrospectively analyzed as single umbilical artery group.The clinical pathological data of 300 cases of normal umbilical cord singleton pregnant women and their newborns were randomly selected as the control group.The general data,pregnancy complications and pregnancy outcome of the two groups were analyzed.Results(1)There were no significant differences in age and prenatal BMI between the two groups(P>0.05),but there were significant differences in gestational age or delivery mode between the two groups(P<0.05).(2)The incidences of hypertensive disorder complicating pregnancy,gestational diabetes,oligohydramnios,fetal intrauterine distress,fetal Intrauterine growth restriction and placenta previa in the single umbilical artery group were higher than those in the control group,and there was significant difference(P<0.05).There was no significant difference between the two groups in the incidence of thyroid disease in pregnancy(P>0.05).(3)The incidences of placental abruption,amniotic fluid contamination,intrauterine fetal death and fetal malformation in the single umbilical artery group were significantly higher than those in the control group(P<0.05),while the incidences of premature rupture of membranes,umbilical cord entanglement/true knot,placenta implantation/adhesion and postpartum hemorrhage had no significant difference between the two groups(P>0.05).(4)The average birth weight of the single umbilical artery group was lower than that of the control group(t=-9.014,P<0.05).The incidence of low birth weight and neonatal malformation in the single umbilical artery group was higher than that in the control group,there being significant difference(P<0.05).There was no significant difference in 1 min Apgar score or the incidence of neonatal asphyxia and neonatal jaundice between the two groups(P>0.05).(5)The meanplacental weight and diameter of umbilical cord in single umbilical artery group were significantly lower than those incontrol group(t=-3.430/4.212,P<0.05).The incidence of placental infarction,abnormal insertion site of umbilical cordand accessory lobe placenta in single umbilical artery group were significantly higher than that in control group(P<0.05).Conclusion Multiple pregnancy complications often occur in pregnancy with single umbilical artery,the incidence of adverse fetal outcomes is high.Early diagnosis and regular follow-up and individualized treatment are important for improving pregnancy outcome and reducing perinatal morbidity and mortality.