产前超声检查对产前出血病因诊断的临床价值

目的   探讨产前出血原因分布及产前超声检查的临床价值。方法  选取该院妇产科门诊建卡常规孕检并在该院产科接受分娩的2 490例产妇的产检及分娩资料进行回顾性分析，依据妊娠妇女孕第20周至分娩前是否发生阴道出血病史分为出血组229例和未出血组2 261例，对比两组产妇的一般资料、分娩结局，分析出血组产前出血原因分布及超声检查的价值。结果  出血组和未出血组妊娠妇女的年龄、双胎妊娠率比较，差异无统计学意义（P >0.05）；出血组的孕次、产次平均值、人工流产史、剖宫产史均高于未出血组（P <0.05）。出血组产前出血的主要原因为：前置胎盘45.41%（104/229）、胎盘早剥26.64%（61/229）、前置胎盘并胎盘植入13.10%（30/229）；产前超声诊断产前出血的确诊率分别为：前置胎盘90.38%(94/104)、胎盘早剥78.69%（48/61）、前置胎盘并胎盘植入66.67%（20/30）、胎盘植入71.43%（5/7）、子宫破裂71.43%（5/7）。出血组的剖宫产率、早产率、子宫切除率、产后出血率、新生儿死亡率、低体重儿出生率均高于未出血组（P <0.05）。结论  产前出血主要原因为前置胎盘、胎盘早剥等，超声对产前出血的诊断准确率较高，产前出血妊娠妇女发生不良分娩结局的比例更高。

Clinical value of prenatal ultrasound examination in diagnosis of prenatal bleeding

Objective To discuss the causes of prenatal bleeding and the clinical value of prenatal ultrasound examination. Methods The antenatal test and delivery data of 2,490 pregnant women, who had routine pregnancy examination in the Obstetrics and Gynecology Outpatient Department and childbirth in the Obstetrical Ward of our hospital, were retrospectively analyzed. According to the history of vaginal bleeding from the 20th week of pregnancy to the time before delivery the pregnant women were divided into hemorrhagic group of 229 cases and non-hemorrhagic group of 2,261 cases. The clinical data and birth outcome were compared between the two groups. The causes of prenatal bleeding and the value of ultrasonography in the hemorrhagic group were analyzed. Results There was no significant difference in age or twin pregnancy rate between the bleeding group and the non-bleeding group (P > 0.05). The pregnant time, the average value of delivery, the history of abortion and the history of cesarean section in the bleeding group were significantly higher than those in the non-bleeding group (P < 0.05). The main causes of prenatal hemorrhage were placenta previa  (104/229, 45.41%), placental abruption (61/229, 26.64%), placenta previa and placenta implantation (30/229, 13.10%). The diagnosis rate of prenatal ultrasound diagnosis was as follows: placenta previa 90.38% (94/104), placental abruption 78.69% (48/61), placenta previa and placenta implantation 66.67% (20/30), placenta implantation 71.43% (5/7) and uterine rupture 71.43% (5/7). The rates of cesarean section, premature delivery, uterine resection and postpartum hemorrhage, neonatal mortality, and birth rate of low-birth weight infant in the bleeding group were significantly higher than those in the non-bleeding group (P < 0.05). Conclusions The main causes of prenatal bleeding are placenta previa, placenta abruption, and so on. The diagnostic accuracy of ultrasonography is fairly high. The incidence of adverse birth outcomes is higher in pregnant women with prenatal hemorrhage.