产前超声对器质性和闭塞性单脐动脉的诊断与鉴别

Prenatal ultrasonographic diagnosis and differential diagnosis of organic and occlusive single umbilical artery

目的:比较器质性和闭塞性单脐动脉在病史、超声表现、妊娠结局等方面的异同,明确产前超声诊断是否需要及如何对二者进行鉴别,以辅助产科临床的不同处理。方法:回顾性统计分析并比较两组间孕妇自然情况、脐血管超声图像特点、血流动力学指标异常率、胎盘羊水及其他合并异常发生率、胎儿生长受限(FGR)出现比率及出现孕周、妊娠结局等。结果:两组间孕妇的自然情况中辅助生殖、吸烟占比有统计学差异。器质性单脐动脉在孕早中期得以诊断,而闭塞性多在晚孕期诊断。器质性单脐动脉组脐动静脉内径比值更高。器质性单脐动脉合并染色体异常及伴发畸形的概率比闭塞性单脐动脉更高。器质性单脐动脉组早发型FGR(28周前)发病率更高,而闭塞组迟发型FGR发病率更高。相比器质性单脐动脉,闭塞性单脐动脉组血流动力学指标异常率、胎死宫内和紧急剖宫产发生率更高。结论:器质性和闭塞性单脐动脉是发病机制不同的两种情况,孕期应对脐动脉进行规范化扫查,早中孕期超声明确脐动脉数目是重要的,利于甄别晚孕期出现的闭塞性单脐动脉。

Objective: To compare the similarities and differences between organic and occlusive single umbilical artery(SUA) in medical history, ultrasonic findings, pregnancy outcome and so on. To determine whether and how to distinguish the two goups in prenatal ultrasound diagnosis in order to assist the clinical management. Methods: The medical history, characteristics of ultrasound images, the occurrence rate of combined abnormalities, the hemodynamic parameters and the incidence of adverse pregnancy outcome were retrospectively analyzed and compared between the two groups. Results: There was significant difference in the rates of assisted reproduction and smoking between the two groups. Organic SUA can be diagnosed in the first and second trimester of pregnancy, while occlusion is often diagnosed in the third trimester. The SUA/UV diameter ratio was higher in organic SUA group. The probability of organic SUA with chromosome abnormalities, associated malforma-tions and early-onset FGR is higher. The abnormal rate of hemodynamic parameters, the incidence of intrauterine fetal demise and emergency cesarean section were higher in occlusive SUA group. Conclusion: Organic and occlusive SUA are different.Standardized scanning to determine the number of umbilical artery in early and middle pregnancy is important, which is help-ful to identify occlusive SUA in the third trimester.