Clinical analysis of 53 cases of velamentous umbilical cord insertion
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摘要:目的 探讨帆状胎盘(VCI)对围产儿结局的影响以及处理VCI的临床策略。方法 回顾性分析53例VCI患者临床资料(VCI组), 并以同期17 877例非VCI产妇为非VCI组。分析VCI及产前明确VCI对围产儿结局的影响; 总结VCI围产儿预后不良的原因。结果 VCI组胎儿生长受限、死胎死产、早产及剖宫产发生率与非VCI组比较，差异有统计学意义(P < 0.05)。VCI组围产儿预后较非VCI组差，差异有统计学意义(P < 0.05)。53例VCI围产儿中, 3例死亡(均由产后确诊的VCI患者分娩)，其中1例死于前置血管(VP)破裂, 1例死于脐带扭转, 1例死于胎盘早剥。53例VCI患者中, 31例经产前超声确诊，其中21例于孕18~24周超声检查时发现, 8例于孕25~35周超声检查时发现, 2例于孕36周后超声检查时发现。结论 VCI在孕妇中的发生率较低，但会导致围产儿不良结局。孕早期VCI超声检查检出率较高，在产前明确诊断，可改善围产儿预后。Abstract:Objective To investigate the effect of velamentous umbilical cord insertion(VCI)on the outcome of perinatal infants and the clinical strategies for the management of VCI.Methods The clinical data of 53 VCI patients (VCI group) were retrospectively analyzed, and 17 877 non-VCI patients were included in the non-VCI group. The influence of VCI and prenatal VCI on perinatal outcomes was analyzed. The causes of poor perinatal prognosis of VCI were summarized.Results The incidence rates of fetal growth restriction, stillbirth, premature delivery and cesarean section in the VCI group showed significant differences compared with those in the non-VCI group(P < 0.05). The perinatal prognosis of the VCI group was worse than that of the non-VCI group, and the difference was statistically significant (P < 0.05). Of the 53 VCI perinatal births, three died (dilivered by patients diagnosed with VCI after birth), including 1 with rupture of anterior vessel (VP), 1 with umbilical cord torsion, and 1 with placental abruption. Of the 53 patients with VCI, thirty-one were confirmed by prenatal ultrasound, and 21 of them were detected by ultrasound at 18 to 24 weeks of gestation; eight cases were detected by ultrasonography at 25 to 35 weeks of gestation; two cases were found by ultrasound after 36 weeks of gestation.Conclusion The incidence of VCI in pregnant women is low, but it can lead to adverse perinatal outcomes. The detection rate of VCI ultrasonography in early pregnancy is higher, and definite prenatal diagnosis can improve perinatal prognosis.
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表 1 2组临床资料比较(x±s)[M(P25, P75)]
观察指标 非VCI组(n=17 877) VCI组(n=53) 年龄/岁 27(25, 29) 28(26, 31)* 分娩前流产次数/次 0(0, 1) 1(0, 2) 分娩孕天/d 279(274, 284) 268(256.5, 275)* 新生儿体质量/g 3 416.39±355.45 2 899.25±582.04* 与非VCI组比较, *P < 0.05。 
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表 2 2组分娩及围产儿情况比较
组别 n 早产 围产儿预后不良 胎儿生长受限 剖宫产 产后出血 死胎死产 VCI组 53 14* 12* 9* 35* 5 2* 非VCI组 17 877 2 328 1 693 1 426 8 175 890 71 与非VCI组比较, *P < 0.05。
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