Liang Y, Han Z, Wang W, Yuan T, Dong X, Li X L
Department of Obstetrics and Gynecology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.
Zhonghua Fu Chan Ke Za Zhi. 2024 Oct 25;59(10):771-776. doi: 10.3760/cma.j.cn112141-20240329-00189.
To explore diagnostic value of prenatal ultrasound screening in velamentous umbilical cord insertion (VCI) and its influence on perinatal outcomes, and to provide theoretical basis for clinical practice. Fifty-eight pregnant women diagnosed with VCI before or after delivery admitted to the First Affiliated Hospital of Xi'an Jiaotong University were selected from January 2012 to December 2022. The clinical features and perinatal outcomes of 45 women finally with VCI after delivery (VCI group) were retrospectively analyzed, and 225 women with normal umbilical cord attachment were selected as the control group during the same period. (1) Among 58 women, 54 (93.1%, 54/58) were diagnosed with VCI by prenatal ultrasound screening, 4 patients (6.9%, 4/58) were missed; and 13 (22.4%, 13/58) were misdiagnosed. Finally, a total of 45 women were confirmed by postpartum placental examination, and 11 (24.4%,11/45) were combined with vasa previa. (2) There were no differences in age, number of pregnancies, and number of induced abortions between the two groups (all >0.05). Compared with the control group, the rate of assisted reproductive technology [13.3% (6/45) vs 0.4% (1/225); <0.01], and twin pregnancy rate [8.9% (4/45) vs 0.4% (1/225); <0.01] in the VCI group were significant higher. (3) Compared with the control group, the rate of placenta previa, succenturiate placenta, vasa previa, postpartum hemorrhage, prenatal hemorrhage and postpartum intrauterine remainder in the VCI group were significant higher (all <0.05); there was no significant difference in the incidence of placental abruption, premature rupture of membranes, fetal distress and single umbilical artery between the two groups (all >0.05). The incidence of fetal structural abnormalities in the VCI group (4.4%, 2/45) was higher than that in the control group (1.3%, 3/225), but there was no significant difference between the two groups (=0.195). (4) The cesarean section rate [75.0% (33/44) vs 45.1% (101/224); <0.01], preterm birth rate [29.5% (13/44) vs 5.4% (12/224); <0.01], rate of small for gestational age [20.5% (9/44) vs 5.4% (12/224); <0.01] in the VCI group were significant higher. However, neonatal birth weight [(2 928±552) vs (3 353±498) g; <0.01], and 1-minute Apgar score (median: 10 vs 10; <0.01) in the VCI group were lower than those in the control group. Prenatal ultrasound screening is an important method to diagnose VCI. VCI is more prone to adverse pregnancy outcomes, such as postpartum hemorrhage, premature delivery, small for gestational age, et al. Its risk factors include twin pregnancy, assisted reproductive technology, placenta previa, and para-placenta.
探讨产前超声筛查对帆状脐带附着（VCI）的诊断价值及其对围产儿结局的影响，为临床实践提供理论依据。选取2012年1月至2022年12月在西安交通大学第一附属医院分娩前或分娩后诊断为VCI的58例孕妇。回顾性分析最终45例产后确诊为VCI的孕妇（VCI组）的临床特征及围产儿结局，并选取同期225例脐带附着正常的孕妇作为对照组。（1）58例孕妇中，产前超声筛查诊断为VCI 54例（93.1%，54/58），漏诊4例（6.9%，4/58）；误诊13例（22.4%，13/58）。最终经产后胎盘检查确诊45例，其中合并前置血管11例（24.4%，11/45）。（2）两组孕妇年龄、妊娠次数、人工流产次数比较，差异均无统计学意义（均>0.05）。与对照组比较，VCI组辅助生殖技术使用率[13.3%（6/45）比0.4%（1/225）；<0.01]、双胎妊娠率[8.9%（4/45）比0.4%（1/225）；<0.01]显著升高。（3）与对照组比较，VCI组前置胎盘、副胎盘、前置血管、产后出血、产前出血、产后宫内残留发生率显著升高（均<0.05）；两组胎盘早剥、胎膜早破、胎儿窘迫及单脐动脉发生率比较，差异均无统计学意义（均>0.05）。VCI组胎儿结构异常发生率（4.4%，2/45）高于对照组（1.3%，3/225），但两组比较差异无统计学意义（=0.195）。（4）VCI组剖宫产率[75.0%（33/44）比45.1%（101/224）；<0.01]、早产率[29.5%（13/44）比5.4%（12/224）；<开0.01]、小于胎龄儿发生率[20.5%（9/44）比5.4%（12/224）；<0.01]显著升高。然而，VCI组新生儿出生体重[（2 928±552）比（3 353±498）g；<0.01]、1分钟Apgar评分（中位数：10比10；<0.01）低于对照组。产前超声筛查是诊断VCI的重要方法。VCI更容易发生不良妊娠结局，如产后出血、早产、小于胎龄儿等。其危险因素包括双胎妊娠、辅助生殖技术、前置胎盘及副胎盘。
