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目的探讨产前超声检查对妊娠中晚期出血导致不良妊娠结局的影响。方法选取2014年4月-2016年4月内在北京圣宝妇产医院进行妊娠分娩的2 000例产妇为研究对象,孕期21~39周,平均年龄为(26.5±3.7)岁。将有过中晚期阴道出血的354例孕妇设为出血组,另外1 646例无中晚期阴道出血历史的孕妇为未出血组。妊娠前两组产妇均进行常规超声检查,直到出院随访,搜集孕妇和胎儿的所有临床资料。根据资料和检查结果,分析导致妊娠中晚期出血的因素;记录所有产妇的妊娠结局,并进行分析比较;将妊娠中晚期出血产妇产前的超声检查结果与产后所证实的诊断结果进行比较分析,确定超声检查的准确率。结果出血组(30.2%)不良妊娠结局高于未出血组(5.8%),两组比较,差异有统计学意义(P<0.05)。而出血组(69.8%)正常妊娠结局低于未出血组(94.2%),两组比较,差异具有统计学意义(P<0.05)。通过记录误诊和漏诊的例数以及产后实际诊断结果,最终得出产前超声检查的总体准确率高达85.3%,且大部分的准确率都高达75%以上。结论产前超声检查可有效降低不良妊娠结局的发生率,并降低漏诊误诊的风险,对妊娠中晚期出血的产妇具有极其重要的意义。
Objective To investigate the effect of prenatal ultrasound on adverse pregnancy outcomes in the second trimester of pregnancy. Methods A total of 2 000 pregnant women undergoing gestation and childbirth at Beijing Sheng Bao Maternity Hospital from April 2014 to April 2016 were selected as study subjects. The average age was (26.5 ± 3.7) years between 21 and 39 weeks of gestation. 354 pregnant women who had had late vaginal bleeding were classified as bleeding group, and another 1 646 pregnant women with no history of vaginal bleeding were non-bleeding group. The first two groups of pregnant women before pregnancy were routine ultrasound, until discharged from the hospital to collect all the clinical data of pregnant women and fetuses. According to the data and the test results, the factors that led to the bleeding in the middle and late pregnancy were analyzed. The pregnancy outcomes of all the pregnant women were recorded and analyzed. The results of prenatal ultrasound examination and postpartum diagnosis were compared between the two groups. Determine the accuracy of ultrasound examination. Results The outcome of adverse pregnancy in the bleeding group (30.2%) was higher than that in the non-bleeding group (5.8%). There was significant difference between the two groups (P <0.05). The normal pregnancy outcome in bleeding group (69.8%) was lower than that in non-bleeding group (94.2%). There was significant difference between the two groups (P <0.05). By recording the number of misdiagnosis and misdiagnosis as well as the actual post-natal diagnosis, the overall accuracy of prenatal ultrasonography was as high as 85.3%, and most of them were as high as 75% or more. Conclusion Prenatal ultrasound can effectively reduce the incidence of adverse pregnancy outcomes and reduce the risk of misdiagnosis. It is of great significance to the pregnant women with bleeding during the second trimester of pregnancy.