孕中期超声诊断帆状胎盘的应用分析

Analysis of ultrasonography for detecting velamentous umbilical cord insertion in the second trimester

关键词:  帆状胎盘  超声检查  诊断

Key words:  velamentous umbilical cord insertion  ultrasonography  diagnosis

摘要:

目的　探讨产前超声诊断帆状胎盘的应用价值。　方法　收集大连市妇幼保健院2013年10月至2014年9月孕中期系统超声检查中发现的41例帆状胎盘孕妇的临床及超声诊断资料，总结帆状胎盘的超声诊断特点，并与产后临床及病理结果比较。随访病例至分娩结束，记录妊娠结局。　结果　超声检查帆状胎盘的脐带插入点均位于胎盘附着之外的胎膜下，脐血管在未进入胎盘时已发生分支，沿胎膜走行后汇集于胎盘。孕中期系统超声检查发现的41例帆状胎盘孕妇中，39例产后经临床和病理证实。产前超声诊断符合率95.1%，误诊2例产后均证实为球拍状胎盘。确诊的39例帆状胎盘中单胎31例，双胎8例。7例合并前置血管（17.9%)。39例中经剖宫产分娩36例，阴道分娩3例，剖宫产率92.3%。均为活产儿，其中早产15例(38.5%)，足月产24例(61.5%)。　结论　孕中期系统超声检查是产前诊断帆状胎盘的有效手段。

Abstract:

Objective To investigate the value of prenatal ultrasonography in detecting velamentous umbilical cord insertion. 　Methods Forty-one cases diagnosed as velamentous umbilical cord insertion by sonography in the second trimester in Dalian Maternal and Child Health Hospital from October 2013 to September 2014 were recruited. Their prenatal ultrasonic imaging characteristics were summarized and compared with the postpartum clinical and pathological examination. The pregnancy outcomes of all cases were recorded. 　Results Velamentous umbilical cord insertion was detected when sonography showed that the umbilical cord insert into the membranes before it reach the placental margin. 39 cases were confirmed by postpartum clinical and pathology examination. The rate of prenatal diagnosis coincidence was 95.1% (39/41). Two misdiagnosed cases were confirmed as the marginal cord insertions. In the 39 cases, 31 singletons (31/39,79.5%), 8 pairs of twins (8/39,20.5%), 7 cases (7/39, 17.9%) complicated with vasa previa. Three cases were produced by vaginal delivery, 36 cases by cesarean section (92.3%). Fifteen cases (38.5%) were premature delivery, 24 cases (61.5%) term delivery, and all live birth. 　Conclusion Ultrasonography in the Second Trimester is an effective method for prenatal diagnosis of velamentous umbilical cord insertion.