Ultrasonographic Observation of Factors Related to Abnormal Insertion of Umbilical Cord Placenta and It’s Correlation with Pregnancy Outcome
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摘要:
目的 探讨孕期引起脐带胎盘插入口（以下简称插入口）异常的因素，分析插入口异常对妊娠结局的影响。 方法 2016年1月1日至2021年1月31日在云南大学附属医院（云南省第二人民医院）超声科接受检查的15771例孕妇纳入观察，分娩后病理确诊879例插入口异常，将其设为研究组，随机选取同期插入口正常的1000例设为对照组。 结果 Logistic回归分析提示多次孕产史（OR = 3.34，P < 0.001）、疤痕子宫（OR = 3.54，P = 0.003）、双胎妊娠（OR = 5.25，P < 0.001）、胎盘位置异常（OR = 3.47，P < 0.001）、胎盘形态异常（OR = 8.52，P = 0.007）、体外胚胎移植（OR = 5.06，P < 0.001）、子宫肌瘤（OR = 4.86，P < 0.001）是脐带插入口异常的高危因素。妊娠结局方面插入口正常与边缘性脐带插入临床妊娠结局无明显差异(P>0.05)，与帆状脐带插入的临床妊娠结局，差异有统计学意义（P < 0.001）。 结论 多次孕产史、疤痕子宫、双胎妊娠、胎盘位置异常、胎盘形态异常、体外胚胎移植、子宫肌瘤为脐带插入口异常的高危因素。帆状脐带入口容易造成妊娠不良结局。对于合并高危因素的妊娠，产前超声应警惕插入口位置，提高插入口异常特别是帆状脐带插入的产前诊断率，改善临床妊娠及围产儿结局。 Abstract:Objective To investigate the factors causing abnormal insertion of umbilical cord placenta during pregnancy, and to analyze the influence of abnormal insertion of umbilical cord placenta on pregnancy outcome. Methods A total of 15,771 pregnant women who were examined in the Ultrasound Department of The Second People’s Hospital of Yunnan Province from January 1, 2016 to January 31, 2021 were included in the observation. 879 cases of abnormal insertion ports were pathologically confirmed after delivery and were selected as the study group, and 1000 cases of normal insertion ports were randomly selected as the control group. Results Logistic regression analysis suggested multiple pregnancy history （OR = 3.34, P < 0.001）, scarred uterus （OR = 3.54, P < = 0.003）, twin pregnancy （OR = 5.25, P < 0.001）, abnormal placental position （OR = 3.47, P < 0.001）, abnormal placental morphology （OR = 8.52, P = 0.007）, in vitro embryo transfer （OR = 5.06, P < 0.001）, uterine fibroids （OR = 4.86, P < 0.001） were the risk factors for abnormal umbilical cord insertion. In terms of pregnancy outcomes, there was no significant difference between normal umbilical insertion and marginal umbilical insertion( P >0.05), but there was significant difference between normal umbilical insertion and velamentous umbilical insertion （P < 0.001）. Conclusion Multiple pregnancy history, scar uterus, twin pregnancy, abnormal placenta position, abnormal placenta morphology, in vitro embryo transfer, uterine fibroids are the high risk factors for abnormal umbilical cord insertion. For pregnancy with high-risk factors, doctors should be alert to the insertion location during prenatal ultrasound, so as to improve the prenatal diagnosis rate of abnormal insertion of the insertion mouth, especially the velamentous-like umbilical cord insertion, and improve clinical pregnancy and perinatal outcomes. -
Key words:
- Abnormal insertion of umbilical cord /
- Ultrasound /
- Prenatal
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表 1 研究组与对照组临床资料情况[n（%）]
Table 1. Clinical data of study group and control group [n（%）]
组别 n 双胎
妊娠胎盘位置
异常胎盘形态异常
（副胎盘/双叶胎盘）单脐
动脉子宫
肌瘤IVF 多次孕
产史疤痕
子宫脐带插入口异常 879 60（6.8） 51（5.8） 10（1.0） 17（1.9） 47（5.3） 40（4.6） 555（63.1） 150（17.1） 正常脐带插入口 1000 15（1.5） 16（1.6） 2（0.2） 8（0.8） 16（1.6） 8（0.8） 480（48.0） 70（7.0） χ2 34.627 24.022 6.482 4.583 20.269 26.436 23.715 45.842 P 0.00* 0.00* 0.02* 0.03* 0.00* 0.00* 0.00* 0.00* *P < 0.05。 
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表 2 插入口异常高危因素Logistic回归分析
Table 2. Logistic regression analysis of risk factors for abnormal insertion of umbilical cord
因素 β Wald OR 95%CI P 胎盘位置异常 1.244 15.014 3.469 1.849～6.508 0.000* 双胎妊娠 1.657 27.280 5.245 2.816～9.768 0.000* IVF 1.622 14.599 5.061 2.203～11.629 0.000* 单脐动脉 0.813 2.849 2.254 0.877～5.791 0.091 子宫肌瘤 1.582 26.703 4.864 2.669～8.863 0.000* 胎盘形态异常 2.142 7.154 8.520 1.773～40.951 0.007* 疤痕子宫 1.624 8.926 3.536 1.356～4.807 0.003* 多次孕产史 2.575 7.528 3.134 9.467～18.222 0.000* *P < 0.05。
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表 3 帆状脐带插入与正常脐带插入不良妊娠结局比较[n（%）]
Table 3. Comparison of adverse pregnancy outcomes between velamentous umbilical cord insertion and normal cord insertion [n（%）]
组别 n 早产 胎膜早破 剖宫产 产后出血 低体重儿 新生儿窒息 帆状脐带插入组 132 23（17.4） 36（27.2） 86（65.2） 31（23.5） 34（25.8） 11（8.3） 正常脐带插入组 1000 35（3.5） 112（11.2） 220（22.0） 42（4.2） 72（7.2） 26（2.6） χ2 46.5 26.5 110.1 71.9 47.3 10.4 P 0.000* 0.000* 0.000* 0.000* 0.000* 0.001* *P < 0.05。
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