复发性流产患者早孕期绒毛膜隆起的声像图特征及临床意义

Sonographic characteristics and clinical significance of chorionic bump during early pregnancy in patients with recurrent spontaneous abortion

目的 探讨复发性流产患者早孕期绒毛膜隆起的声像图特征及临床意义。方法 选取并分析我院行早孕期经阴道超声检查的复发性流产(recurrent spontaneous abortion, RSA)患者3 450例,其中早孕合并绒毛膜隆起(chorionic bumps, CB)57例作为观察组,并追踪妊娠结局;随机选取早孕且未合并CB的RSA患者154例作为对照组;分析RSA患者CB的声像图特征,如回声、数量、大小等对妊娠结局的影响及CB的转归。结果 观察组57例中胚胎停育32例(56.1%),与对照组胚胎停育25例(16.2%)相比,差异有统计学意义(P<0.001)。观察组中按CB数量分为单发和多发2个亚组,胚胎停育发生率分别为47.6%、80.0%,两组间差异有统计学意义(P=0.030)。通过绘制ROC曲线显示CB最大直径与妊娠囊最大直径比值评估胚胎停育的临界值为38.5%,ROC曲线下面积为0.722;CB体积与妊娠囊体积比值评估胚胎停育的临界值为12.0%,ROC曲线下面积为0.724。25例宫内活胎合并CB全部于13+6周前消失。结论早孕期超声诊断RAS患者合并CB与不良妊娠结局有关,其声像图特征对RSA患者具有一定临床意义。超声诊断CB对RSA患者评估妊娠结局和指导临床治疗尤为重要。

Objective To investigate the sonographic features and clinical significance of chorionic bump in early pregnancy in patients with recurrent spontaneous abortion. Methods A total of 3450 patients with recurrent spontaneous abortion(RSA) who underwent transvaginal ultrasonography in early pregnancy in our hospital were analyzed retrospectively. Among them, 57 patients with chorionic bump(CB) in early pregnancy were selected as the study group, and the pregnancy outcomes were fouowed up. 154 patients with RSA in early pregnancy without chorionic bump were randomly selected as the control group. The sonographic characteristics of CB in patients with RSA, such as echo, number and size were analyzed. Results Among the 57 cases in the study group, 32 cases(56.1%) had embryo arrest, which was significantly different from 25 cases(16.2%) in the control group( P<0.001). The study group was divided into single and multiple groups according to the number of CB. The inci-dence of embryo arrest was 47.6% and 80.0%, respectively. There was significant difference between the two groups(P=0.030). The cut-off value of CB maximum diameter to gestational sac maximum diameter ratio for assessing embryo arrest was 38.5% and the area under the ROC curve was 0.722 by plotting the ROC curve;the cut-off value of CB volume to gestational sac volume ratio for assessing embryo arrest was 12.0% and the area under the ROC curve was 0.724. All 25 cases of intrauterine live fetuses with chorionic elevation disappeared before 13+6weeks. Conclusion Ultrasonographic diagnosis of CB in RAS patients in early pregnancy is associated with adverse pregnancy outcomes, and its sonographic features have certain clinical significance for RSA patients. Ultrasound diagnosis of CB is particularly important to assess pregnancy outcomes and to guide clinical treatment in patients with RSA.