|
|
| |
|
|
| 本文已被：浏览 1972次 下载 1262次 |
|
| 妊娠早期绒毛膜下出血与胎盘脐带附着异常的相关性研究 |
| 作者简介：余转,陈宝定 |
|
|
| (江苏大学附属医院) |
|
| 摘要: |
| 【】 目的 研究通过超声检测分析妊娠早期绒毛膜下出血程度对与妊娠中期胎盘形态脐带附着部位的影响之间的相关性,提高对脐带附着异常发病机制的认识。方法 以2017年25月-2018年117月经超声诊断妊娠早期绒毛膜下出血的7979例孕妇为研究对象,按照有无血肿和出血面积与孕囊面积的比值分为三四组：正常组、少量出血组、中等量出血组,大量出血组,同时收集早孕超声检查正常、无任何并发症的妊娠孕妇102例为对照组,超声随访记录胎儿结构筛查期二维超声及彩色多普勒超声记录脐带附着部位,孕期严密随访至分娩,并于分娩或剖宫产后检查胎盘,观察是否存在胎盘、脐带异常妊娠中期胎盘厚度、胎盘附着面积大小、胎盘实质有无血池及有无脐带附着部位异常等观察指标,并进行χ2检验或Fisher’s 确切概率法检验。结果 7979例妊娠早期绒毛膜下出血,结构筛查期妊娠中期胎盘增厚、胎盘附着面积局限,胎盘实质内血池,以及脐带异常附着的发生率分别为64.56% 、46.84% 、53.16%、13.92%,其结果明显高于正常组,差异有统计学意义(P＜0.05)；脐带附着胎盘形态异常的发生率随妊娠早期绒毛膜下出血程度的加重而增加,少量出血自行吸收快,对胎盘形态的影响脐带附着位置影响较小,胎盘增厚、胎盘附着面积局限,胎盘实质内血池,脐带异常附着发生率依次为30.30%、9.09%、27.27%、为3.03%,中等量出血发生率分别为：95.45%、72.73%、68.18%、13.64%,大量出血发生率分别为：83.33%、75.00%、75.00%、29.17%,差异具有统计学意义(P＜0.05)。结论 妊娠早期发生不同程度的绒毛膜下出血与,妊娠过程中脐带异常附着具有相关性,了解绒毛膜下出血对脐带附着位置的影响,进一步明确脐带附着异常的发病机制,胎盘形态更容易发生改变,超声监测妊娠早期血肿大小能间接反映胎盘功能,从而指导妊娠,最大限度减少不良妊娠的发生。 |
| 关键词: 绒毛膜下出血 超声监测 脐带附着异常 |
| DOI： |
| 投稿时间：2019-01-24修订日期：2019-03-07 |
| 基金项目:镇江市卫生科技重点项目(SH2014084)。 |
|
| Study on correlation between subchorionic hemorrhage during the ?rst trimester and abnormal attachment of umbilical cord upon placenta |
| yuzhuan,chenbaoding |
| () |
| Abstract: |
| 【】Objective To analyze the effect of subchorionic hemorrhage of early pregnancy on placental morphologyin the middle of pregnancy by ultrasonic examination. To investigate the possible relevance between subchorionic hemorrhage during the ?rst trimesterandabnormal attachment of umbilical cord upon placenta,and toimprove the understanding of the pathogenesis ofabnormalumbilical cord insertion. Methods 79 pregnant women who were diagnosed with subchorionic hemorrhage in early pregnancy duringFebruary May, 2017 to NovemberJuly, 2018 were studied, according to hematoma and the ratio of hemorrhage area to the area of the pregnant sac, they were divided into threefour groups:normal group, small bleeding group, moderate hemorrhage Group, large hemorrhage group, and other 102 cases without any complications and normal ultrasonographic examination from those appropriate were chosen as control group,and two-dimensionalultrasound and color Doppler ultrasound ultrasound follow-up to record the observation index ,such as placental thickness in the middle of pregnancy, The size of the placenta attachment area, Placental lake and Abnormal umbilical cord insertionduring fetal structural screening and so on, and carries on the card square test or Fisher"s exact probability method test.All the cases were followed up until delivery and accepted the pathological examinations to observe the abnormalities of the placenta and umbilical cord after delivery or cesarean section.Results 79 cases of subchorionic hemorrhage in early pregnancy, placental thickening Abnormal umbilical cord insertionduring fetal structural screeningin the middle of pregnancy,was limitation of placental attachment area, Placental lake and Abnormal umbilical cord insertion were 64.56% ,46.84% ,53.16%,13.92%, and the results were significantly higher than those in normal group. The difference was statistically significant (p<0.05); the incidence of abnormalumbilical cord insertion placental morphology increases with the increase of subchorionic hemorrhage in early pregnancy, small amount of bleeding has less effect onumbilical cord insertion placental morphology, placenta thickening, placental attachment area limitation, Placental lake andand absorbs itself quickly,Abnormalumbilical cord insertion incidence was ere30.30%,9.09%,27.27%,3.03%,theincidence rate of moderate hemorrhage were95.45%,72.73%,68.18%,was 13.64%,the incidence rate of large number of hemorrhage were83.33%,75.00%,75.00%,was 29.17%, the difference was statistically significant (p<0.05). Conclusion subchorionic hemorrhage occurs in early pregnancy, placental morphology is more likely to change during pregnancy, ultrasonography monitoring the size of the early pregnancy hematoma can indirectly reflect the placenta function, guide pregnancy, minimize the occurrence of bad pregnancy.Different degrees of subchondral hemorrhage in early pregnancy are associated with abnormalumbilical cord insertion during pregnancy. To understand the influence between subchorionic hemorrhage and umbilical cord insertion, further clarify the pathogenesis of abnormal umbilical cord insertion,so as to guide pregnancy and minimize the occurrence of bad pregnancy. |
| Key words: subchorionic hemorrhage ultrasonic monitoring Abnormal umbilical cord insertion |
|
|
|
|
|
