Department of Obstetrics and Gynecology and Research Institute, William Beaumont Hospital, Royal Oak, Michigan; and the Departments of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, Baylor College of Medicine, Houston, Texas, and the University of Rochester, Rochester, New York.
Obstet Gynecol. 2013 Aug;122(2 Pt 1):352-357. doi: 10.1097/AOG.0b013e31829cac58.
To review experience with diagnosis, clinical associations, and outcomes of vasa previa in a single institution.
This was a retrospective review of all identified vasa previa cases from January 1 1990, to June 30, 2010.
Sixty cases of vasa previa were identified (53 singletons, seven twins); 56 cases were diagnosed before delivery. An abnormal cord insertion or abnormal placental location was present in 55 cases. Missed diagnoses were attributed to technical and observer factors. Preterm bleeding was encountered in 25 (42%) case group participants. Seven case group participants required an emergent delivery, with significant neonatal morbidity and mortality. Twin pregnancies had a significantly earlier median age at delivery of 32 weeks of gestation compared with 35 weeks of gestations in singletons (P=.01). The seven twin pregnancies had a 28.6% emergent preterm delivery rate, whereas singletons had a 4.1% rate (P=.07). In 14 case group participants, the membranous fetal vessel was located in the lower uterus and not directly over the cervix. The vessel location was not related to the risk of emergent delivery.
Transvaginal ultrasound scans of at-risk patients can identify most cases of vasa previa. Preterm bleeding does not usually require immediate delivery. The rate of emergent preterm delivery was low in singleton pregnancies. Twins were delivered, on average, 3 weeks earlier than singletons.
III.
回顾单一机构中前置血管的诊断、临床关联和结局经验。
这是一项对 1990 年 1 月 1 日至 2010 年 6 月 30 日期间所有确诊的前置血管病例进行的回顾性研究。
共发现 60 例前置血管（53 例单胎，7 例双胎）；56 例在分娩前确诊。55 例存在脐带插入异常或胎盘位置异常。漏诊归因于技术和观察者因素。25 例（42%）病例组参与者出现早产出血。7 例病例组参与者需要紧急分娩，新生儿发病率和死亡率显著。与单胎妊娠相比，双胎妊娠的中位分娩年龄明显更早，为 32 周（P=0.01）。7 例双胎妊娠紧急早产分娩率为 28.6%，而单胎妊娠为 4.1%（P=0.07）。在 14 例病例组参与者中，膜状胎儿血管位于子宫下部，而不是直接位于宫颈上方。血管位置与紧急分娩的风险无关。
高危患者的经阴道超声扫描可以识别大多数前置血管病例。早产出血通常不需要立即分娩。单胎妊娠的紧急早产分娩率较低。双胞胎的分娩时间平均比单胎早 3 周。
III 级。
