妊娠中期不同类型绒毛膜下血肿对妊娠结局的影响

Effect of different types of subchorionic hematoma on pregnancy outcome in second trimester

目的探讨妊娠中期不同类型的绒毛膜下血肿对妊娠结局(流产、早产、足月产)的影响。方法回顾性分析郑州大学第一附属医院2019年10月至2022年9月收治的84例妊娠中期绒毛膜下血肿患者的临床资料,根据超声监测评估将绒毛膜下血肿分为小血肿组、中等大小血肿组及巨大血肿组;根据其有无阴道流血等临床表现,分为有阴道流血组及无阴道流血组;根据血肿持续存在时间,分为持续时间>4周组及血肿持续时间<4周组,分析各组间的流产、早产、足月产率之间有无差异。结果妊娠中期绒毛膜下血肿的大小不同,其流产、早产及足月产率不同,合并小型绒毛膜下血肿者足月产率高于合并中等大小及巨大绒毛膜下血肿者,合并中等大小及巨大血肿者妊娠流产率及早产率明显高于合并小型血肿者(P<0.05),而巨大血肿组流产率高于中等大小组(P<0.05);合并中等大小血肿组早产率高于合并小型血肿组;巨大血肿组与中等大小血肿组早产率无明显差异;超声监测到血肿持续存在时间对流产率的影响差异有统计学意义(P<0.05):血肿持续存在时间>4周者,流产率明显增高;阴道流血是孕中期绒毛膜下血肿的常见临床症状,有阴道流血组的流产率、早产率均高于无阴道流血组,差异均有统计学意义(P<0.05)。结论妊娠中期合并巨大绒毛膜下血肿及中等大小绒毛膜下血肿更易导致流产及早产的发生;血肿持续时间长也是发生流产的高危因素;妊娠中期合并绒毛膜下血肿伴有阴道流血者,流产及早产风险升高。

Objective To investigate the effect of different types of subchorionic hematomas in mid pregnancy on pregnancy outcomes(miscarriage,preterm delivery,term delivery).Methods Retrospective analysis was made on the clinical data of 84 patients with subchorionic hematoma in the second trimester of pregnancy admitted to the First Affiliated Hospital of First Affiliated Hospital of Zhengzhou University from October 2019 to September 2022.According to ultrasound monitoring and evaluation,they were divided into small hematoma group,medium sized hematoma group,and large hematoma group.According to their clinical manifestations such as vaginal bleeding,they were divided into two groups:the group with vaginal bleeding and the group without vaginal bleeding.According to the duration of the hematoma,they were divided into groups with a duration>4 weeks and a duration of<4 weeks.The differences in miscarriage,preterm birth,and term birth rates among each group were analyzed.Results The size of subchorionic hematoma in the second trimester was different,and the incidences of abortion,preterm delivery and term delivery were different.The incidence of term delivery in patients with small subchorionic hematoma was higher than that in patients with medium and large subchorionic hematoma,and the incidence of pregnancy abortion and premature delivery in patients with medium and large subchorionic hematoma was significantly higher than that in patients with small hematoma(P<0.05).The abortion rate of giant hematoma group was higher than that of medium large group(P<0.05).The preterm birth rate in the group with medium hematoma was higher than that in the group with small hematoma(P<0.05).There was no significant difference in the preterm birth rate between the large hematoma group and the medium hematoma group(P>0.05).The influence of duration of hematoma on abortion rate was significant(P<0.05):When the duration of hematoma>4 weeks,the abortion rate was significantly increased(P<0.05).Vaginal bleeding is a common clinical symptom of mid-pregnancy subchorionic hematoma.The abortion rate and premature birth rate in the group with vaginal bleeding were higher than those in the group without vaginal bleeding,and the differences were significant(P<0.05).Conclusions The second trimester of pregnancy combined with large subchorionic hematoma and medium subchorionic hematoma is more likely to lead to abortion and premature delivery.Long duration of hematoma is also a risk factor for miscarriage;Second trimester subchorionic hematoma with vaginal bleeding is correlated with an increased risk of miscarriage and premature delivery.