超声检查对胎儿脐带血管前置的诊断价值

目的探讨彩色多普勒超声检查对胎儿脐带血管前置的诊断价值及其临床意义。方法回顾性分析2014年1月~2017年12月期间于我院产科进行产检并住院分娩后临床确诊为脐带血管前置的24例孕妇的彩色多普勒超声图像特点以及孕妇和胎儿结局。结果同期入院孕妇共8000例，前置血管发生率为0.3%。24例前置血管孕妇，彩色多普勒超声检查正确诊断出20例，正确率为83.33%，其中超声检查漏诊1例，漏诊率为4.17%，误诊3例，2例误诊为脐带先露，1例误诊为脐带脱垂。24例前置血管孕妇中14例为脐带血管帆状附着型，5例为副胎盘型，4例为双叶胎盘型，1例为脐带胎盘边缘附着型。24例诊断为前置血管的孕妇均接受剖宫产手术，其中活婴28个，死胎6个，孕妇均健康出院。结论产前超声检查能够直观显示孕妇子宫内脐带血管走形情况，并判断脐带血管与子宫颈内口的关系，在诊断前置血管上有较高的准确率，可作为前置血管筛查和诊断的首选检查手段，最终降低胎儿围产期死亡率。

Clinical value and significance of ultrasonography in the diagnosis of fetal umbilical vasa previa

ObjectiveTo discuss the clinical value and significance of ultrasonography for fetal umbilical vasa previa.MethodsThe doppler color sonographic features of 24 pregnant women diagnosed as fetal umbilical vasa previa after delivery in the obstetrics department of our hospital from January 2014 to December 2017 and fetal outcomes were reviewed.ResultsAmong 8000 pregnant women hospitalized at that time, there were 24 vasa previa cases (0.300%), wherein 20 cases were correctly diagnosed by the color Doppler ultrasound (83.33%) and one missed diagnosis case (4.17%) and 3 misdiagnosis cases, including 2 cases of umbilical cord presentation and one case of cord prolapse. Among the 24 vasa previa cases, there were 14 cases of velamentous insertion of umbilical cord, 5 cases of accessory placenta, 4 cases of placenta bipartita and one case of marginal insertion of umbilical cord. All vasa previa cases received Cesarean section, and 28 infants survived while 6 infants dead. All 24 subjects discharged without complications.ConclusionPrenatal ultrasound examination can visualize the traveling of vasa previa and determine the orientation relationship between cord vessels and cervix internal ora. It has higher diagnosis accuracy on the vasa previa of umbilical cord, thus the first choice in screening and examination of vasa previa, so as to reduce the fetal death rate in clinical practice.