(大连市妇女儿童医疗中心超声科,,),辽宁,大连,116033
网络首发:2017-01-20,
纸质出版:2017
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刘艳, 姜瑜, 张晶, 等. 应用HD-FLOW 技术在11-13+6 周筛查帆状脐带胎盘入口的 准确性[J]. 中山大学学报(医学科学版), 2017,38(1).
LIU Yan, JIANG Yu, ZHANG Jing, et al. Veracity of Umbilical Cord Insertion at 11th-13+6 th Gestational Weeks with HD-FLOW[J]. Journal of Sun Yat-sen University (Medical Sciences), 2017, 38(1).
摘要:【目的】探讨超声早孕期筛查帆状脐带胎盘入口的可行性。【方法】收集大连市妇女儿童医疗中心行早孕筛 查、中孕系统筛查且在我院分娩的孕妇2 796 例,胎儿2998 个。早孕期(11~13+6 周)筛查脐带胎盘入口位置,将检查结果 分成三组,Ⅰ组为:明确显示脐带胎盘入口位于与胎膜上,沿着胎膜走行一段距离后,再进入胎盘,该组诊断为帆状胎盘。 Ⅱ组为:脐带胎盘入口位于胎盘边缘,无法区分插入点位于胎盘实质及胎膜上。Ⅲ组为:组明确显示脐带胎盘入口处为胎 盘实质,该组诊断为正常胎盘。将每组结果与中孕期(22~26周)筛查结果及产后临床检查结果比较。【结果】①早、中孕期 超声检查对脐带附着位置的显示率:早孕期一次检查显示率99.23%(2 975/2 998)。其中单胎显示率99.77%(2 590/2 596), 双胎显示率95.96%(380/396),三胎显示率83.33%(5/6)。中孕期一次检查显示率86.99%(2 608/2 998)。其中单胎显示:90.99% (2 362/2 596)双胎显示率61.61%(244/396)三胎显示率33.33%(2/6)。早孕与中孕检查脐带胎盘入口一次检查显示率的比 较有统计学差异P < 0.05(P = 0.00)。其中单胎、双胎、三胎早孕期一次显示率与中孕期比较均有统计学差异P < 0.05(均 P = 0.00)。②早孕期、中孕、出生后检查结果:早孕期检查结果:Ⅰ组28 例、Ⅱ组42 例、Ⅲ组2 928 例;中孕期:帆状胎盘: 37 例球拍状胎盘:30例正常胎盘:2931例;出生后检查:帆状胎盘:36例球拍状胎盘:30例正常胎盘:2 932例。③早孕期各 组检查结果与中孕及出生后结果的比较:早孕期Ⅰ组中28例中孕及出生后均诊断为帆状胎盘,早孕期Ⅱ组42例中孕期诊 断为帆状胎盘7例,球拍状胎盘22例,正常胎盘13例,出生后诊断为帆状胎盘6例,球拍状胎盘23例,正常胎盘13例;早孕 期Ⅲ组2 928例,中孕期诊断为帆状胎盘2例,球拍状胎盘8例,正常胎盘2 918例,出生后诊断为帆状胎盘2例,球拍状胎盘 7例,正常胎盘2 919例。早孕期诊断的准确率为98.29%。【结论】早孕期应用高分辨率血流成像(HD-FLOW)血流模式可以 对部分帆状胎盘做出诊断。
Abstract:【Objective】To investigate the feasibility of screening for velamentous umbilical cord insertion in early pregnancy by ultrasound.【Methods】A total of 2,796 cases of pregnant women,2 998 cases of fetuses that underwent prenatal ultrasound screening in the early and middle stage pregnancy and delivered in Dalian Women and Children Healthcare Center were included. The results of ultrasound screening of umbilical cord insertion during early pregnancy(11 ~ 13+6 w)were divided into three groups. Group Ⅰ:it is clear that the placenta of the umbilical cord is located in the fetal membranes,and then along with the fetal membranes for a long distance,and then enter the placenta. Group Ⅱ:The placenta of the umbilical cord is located at the edge of the placenta,and then insert point is not distinguished between the placenta and fetal membranes. Group Ⅲ:It is clearly shows that the umbilical cord inserted into the placenta.【Results】1. The display rate of the umbilical cord in early and mid pregnancy ultrasound examinationearly pregnancyan examination showed that the rate of 99.23%(2 975/2 998). The single child display rate of 99.77%(2 590/2 596),twindisplay rate of 95.96%(380/396),three fetal the rate of 83.33%(5/6).In the second trimester of pregnancy(22 ~ 26 w)and examination showed that the rate of 86.99%(2 608/2 998). The single child display rate of 90.99%(2 362/2 596),twin display rate of 61.61% (244/396),three fetal the rate of 33.33 %(2/6). 2. The results of early pregnancy,pregnancy,the examination of after birth Regard? ing to early pregnancy,28 cases were included in Group Ⅰ,42 cases in Group Ⅱ and 2928 cases in Group Ⅲ. Regarding to second pregnancy,37 cases were evaluated as velamentous umbilical cord insertion,30 cases were evaluated as battledore placenta and 2931 cases were evaluated as normal placenta. The results of postnatal examination were as follows:36 cases were identified as velamentous umbilical cord insertion,30 cases were evaluated as battledore placenta and 2932 cases were evaluated as normal placenta. 3. Comparison of 3 groups,early pregnancy examination results and pregnancy and after the birth. In early pregnancy,28 cases of GroupⅠ were diagnosed as velamentous umbilical cord insertion in the examination during the second trimester of pregnancy and after delivery. In the 42 cases of early pregnancy in Group Ⅱ,7 cases were diagnosed as velamentous umbilical cord insertion,22 cases were diagnosed as battledore placenta and 13 cases were normal placenta. After birth,6 cases were diagnosed as diagnosed as velamentous umbilical cord insertion,23 cases were battledore placenta and 13 cases were normal placenta. In the 2928 cases of early pregnancy of Group Ⅲ,2 cases were diagnosed as diagnosed as velamentous umbilical cord insertion,8 cases were battledore placenta and 2918 cases were normal placenta. After birth,2 cases were diagnosed as diagnosed as velamentous umbilical cord insertion,7 cases were battledore placenta and 2919 cases were normal placenta.The diagnostic accuracy of early pregnancy was 98.29%. 【Conclusion】Application of HD-Flow blood flow pattern in early pregnancy can make a diagnosis of some of the sail-shaped placenta.
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