11例单条脐动脉栓塞产前超声特征及临床分析

Prenatal ultrasonographic features and clinical analysis of umbilical artery thrombosis in 11 cases

目的:探讨单条脐动脉栓塞(Umbilical artery thrombosis,UAT)的产前超声特征和临床特点。方法:研究对象为2015年1月—2021年6月在我院住院分娩的11例单条UAT患者,回顾性分析其临床特点、产前超声特征、妊娠结局及胎盘脐带病理资料。结果:(1)4例(36.4%)患有妊娠期糖尿病,2例(18.2%)合并抗磷脂综合征,1例同时患有重度子痫前期和甲状腺功能减退。2例(18.2%)孕期曾行脐静脉穿刺术。11例超声首次提示膀胱水平横切面仅有1条脐动脉的平均孕周为(36.7±2.8)周,回顾既往超声检查均有2条脐动脉。8例(72.7%)提示单条UAT;3例误诊为单脐动脉。(2)单条UAT的超声表现:11例均为1条脐动脉内见血栓回声且血流信号消失。9例(81.8%)提示脐带绕颈。4例(36.4%)脐动脉的收缩期峰值流速/舒张末期流速比值(S/D)介于相应孕周参考值的10 th~<25 th,2例(18.2%)5 th~<10 th,5例(45.5%)<5 th;11例脐动脉搏动指数(PI)均<5 th;3例测量了大脑中动脉PI,其中2例<5 th,3例脑-胎盘比均无异常。(3)11例均为活产,其中9例转新生儿重症监护室。产后脐带检查4例(36.4%)脐带高度螺旋,1例(9.1%)帆状胎盘。病理提示11例脐带均有2条脐动脉,其中1条脐动脉内见血栓。结论:单条UAT有特征性产前超声表现,未栓塞脐动脉S/D、PI下降可能有助于诊断单条UAT。大脑中动脉PI下降对评估胎儿宫内状态有重要意义。分娩时机应权衡早产和不良围产结局风险后决定。

Objective:To investigate the prenatal ultrasonographic features and clinical characteristics of single umbilical artery thrombosis(UAT).Methods:Eleven pregnant women with single UAT who delivered in our hospital from January 2015 to June 2021 were recruited,and their clinical characteristics,ultrasonographic features,perinatal outcomes and histopathological data were analyzed retrospectively.Results:(1)Four cases(36.4%)had gestational diabetes mellitus,two cases(18.2%)had antiphospholipid syndrome,and one case had severe preeclampsia and hypothyroidism at the same time.Umbilical vein puncture was performed in two cases(18.2%).The mean gestational age of 11 cases with only one umbilical artery(UA)firstly found on the horizontal transverse section of the bladder was(36.7±2.8)weeks.There were two umbilical arteries in the previous ultrasonic examination.Eight cases were diagnosed as single UAT.Three cases were misdiagnosed as single UA.(2)Sonographic findings of single UAT were as follows:thrombus in one UA and obstructed blood flow were observed in 11cases.Nuchal cord was found in nine cases(81.8%).The ratio of UA peak systolic velocity to end diastolic velocity(S/D)was between 10 th~<25 th percentile in four cases(36.4%),between 5 th~<10 th percentile in two cases(18.2%),<5 th percentile in five cases(45.5%).UA pulsatility index(PI)<5 th percentile in all cases.PI of middle cerebral artery(MCA)were measured in three cases.MCA-PI<5th percentile in two cases and cerebroplacental ratios were normal in these three cases.(3)All newborns were born alive and nine cases were transferred to neonatal intensive care unit.Hyper-coiling cords were found in four cases(36.4%)and velamentous placenta was found in one case.The pathological findings showed two UAs in all cords with thrombi in one UA.Conclusion:Single UAT has characteristic prenatal sonographic findings.The decrease of S/D and PI measured in the remaining unobstructed UA may be helpful for the diagnosis of single UAT.The decrease of MCA-PI has important significance for the assessment of fetal intrauterine condition.The timing of delivery should be determined after weighing the risk of premature birth and adverse perinatal outcomes.