背景:Vasaprevia,无保护的胎儿血管位于子宫颈内部开口附近的情况,是一种潜在的致命产科并发症.这些血管的不稳定状况增加了自发性或人工胎膜破裂的胎儿出血的风险,经常导致胎儿/新生儿死亡或严重发病。因此,在许多中心,当产前诊断为vasaprevia时,住院管理是主要的。这项研究旨在确定在产前诊断为血管前置的妊娠亚群是否可以作为门诊患者安全管理。
方法:我们回顾了单胎妊娠中所有血管前置的病例,没有胎儿异常,在西奈山医院确诊,多伦多,从2008年1月到2017年12月。病例分为三组进行分析:门诊患者(OP),无症状住院(ASH)和有症状住院(SH)。SH组包括任何产前出血或可疑胎儿非压力测试的患者。那些出现有症状的子宫活动/先兆早产并在诊断后7天内分娩的患者被排除在研究之外。分析了住院的细节,产前皮质类固醇给药,宫颈长度测量,以及胎儿/新生儿死亡率和发病率。
结果:在84例经诊断的前置血管病例中,47符合资格标准。共有15例作为OP处理,22为ASH,10为SH。计划外剖腹产在SH组中最高(40%与0%ASHvs.13.3%OP)。SH组患者最早分娩(中位数为33.8周,四分位数间距(IQR)33.2-34.3周)。在无症状的患者中,ASH臂中的那些比OP臂中的那些更早交付(35.3[34.6-36.2]周与36.7[35.6-37.2]周,p=0.037)。没有胎儿/新生儿死亡病例,贫血或严重的新生儿发病率,根据宫颈长度或产前皮质类固醇给药,组间没有显着差异。
结论:我们的研究表明,产前诊断为血管前置的无症状妇女,单胎怀孕,在低风险的早产可以作为门诊病人安全管理,只要他们能够在产前出血或早期分娩的情况下迅速进入医院。
Vasa previa, a condition where unprotected fetal blood vessels lie in proximity to the internal cervical opening, is a potentially lethal obstetric complication. The precarious situation of these vessels increases the risk of fetal hemorrhage with spontaneous or artificial rupture of membranes, frequently causing fetal/neonatal demise or severe morbidity. As a result, in many centers, inpatient management forms the mainstay when vasa previa is diagnosed antenatally. This study aimed to determine whether a subpopulation of pregnancies diagnosed antenatally with vasa previa could be safely managed as outpatients.
We reviewed all cases of vasa previa in singleton pregnancies, with no fetal anomalies, diagnosed at Mount Sinai Hospital, Toronto, from January 2008 to December 2017. Cases were categorized into three arms for analysis: outpatients (OP), asymptomatic hospitalized (ASH) and symptomatic hospitalized (SH). The SH arm included patients admitted with any antepartum bleeding or suspicious fetal non-stress test. Those that presented with symptomatic uterine activity/threatened preterm labor and delivered within 7 days of diagnosis were excluded from the study. Records were analyzed for details on hospitalization, antenatal corticosteroid administration, cervical length measurements, and fetal/neonatal mortality and morbidity.
Of the 84 antenatally-diagnosed cases of vasa previa, 47 fulfilled eligibility criteria. A total of 15 cases were managed as OP, 22 as ASH and 10 as SH. Unplanned cesareans were highest in the SH arm (40% vs. 0% ASH vs. 13.3% OP). Those in the SH arm delivered earliest (median 33.8 weeks, interquartile range (IQR) 33.2-34.3 weeks). Of the asymptomatic patients, those in the ASH arm delivered earlier than those in the OP arm (35.3 [34.6-36.2] weeks vs. 36.7 [35.6-37.2] weeks, p = 0.037). There were no cases of fetal/neonatal death, anemia or severe neonatal morbidity and no significant differences between groups based on cervical length or antenatal corticosteroid administration.
Our study suggests that asymptomatic women with an antenatal diagnosis of vasa previa, singleton pregnancies, and at low risk for preterm birth may safely managed as outpatients, as long as they are able to access hospital promptly in the event of antepartum bleeding or early labor.