92例单脐动脉胎儿的结局

目的 探讨与单脐动脉并发的其他胎儿畸形及妊娠结局,为孕期咨询和处理提供依据.方法 对2007年9月至2009年7月之间在本院诊断并分娩的92例单脐动脉胎儿的结局进行回顾分析及随访.结果 25292例分娩的孕妇中确诊单脐动脉共92例,发生率为0.36％,其中53例(57.6％)新生儿无畸形存活,14例(15.2％)带畸形生存,围产儿死亡25例(27.2％).92例单脐动脉胎儿中伴畸形者共36例(39.1％),其中单发畸形29例(占80.6％),多发畸形7例(占19.4％).心脏畸形发生率位居首位,其他畸形依次为中枢神经系统、消化系统、运动系统及泌尿系统的畸形.单脐动脉孕妇同意选择胎儿染色体检查共33例,其中3例有染色体畸形(9.1％).92例中伴发小于胎龄儿者23例(25.0％),其中78.3％(18/23)的小于胎龄儿死亡,明显高于同期非单脐动脉小于胎龄儿的病死率4.0％ (24/597)(x2=181.71,P＜0.01).结论 单脐动脉易伴发其他先天畸形,孕期B超发现单脐动脉后,需要进一步寻查其他畸形,进行胎儿超声心动、胎儿染色体核型分析等检查,伴发严重胎儿生长受限,是胎儿不良结局的重要指标.

Prognosis of 92 fetuses with single umbilical artery

Objective To explore the relation between single umbilical artery with other malformations and pregnancy outcome,and to provide evidence for pregnancy counseling and diagnosis.Methods The outcomes of 92 fetuses with single umbilical artery diagnosed and delivered in Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical University from September 2007 to July 2009 were followed up and retrospectively analyzed with Chi-square test.Results Among 25 292 pregnant women,92 cases were finally diagnosed as single umbilical artery giving the incidence of 0.36％,among which 57.6％ (53/92) of newborns survived without malformations,15.2％(14/92) survived with malformations and 27.2％ (25/92) died during perinatal period.There were 36 fetuses (39.1％,36/92) with single umbilical artery complicated with other malformations,among which 29 had single malformation (80.6 ％ ),and seven ( 19.4 ％ ) had multiple malformations.The incidence of heart defects was the highest among the complicated malformations,and then followed by central nervous system,digestive system,motor system and urinary system.Thirty-three fetuses with single umbilical artery accepted karyotype analysis.Chromosome abnormality was diagnosed in three subjects (9.1％,3/33).Twenty-three fetus (25.0％,23/92) associated with small for gestational age,and among which 18 fetuses (78.3％,18/23) died with a higher mortality than that (4.0％,24/597) of small for gestational age patients without single umbilical artery (x2=181.71,P＜0.01).Conclusions Single umbilical artery is likely to be complicated with congenital anomalies.After single umbilical artery was diagnosed by routine ultrasound,fetal ultrasonography,echocardiography and amniocentesis for karyotype analysis is suggested.Fetal growth restriction is an important indicator of fetal adverse outcomes.