背景:胎盘早剥(PA)是一种主要的产科并发症,与母儿结局较差有关。虽然超声检查结果可能支持PA的诊断,这些发现与PA的严重程度以及产妇和新生儿结局之间的关联尚不清楚.我们旨在评估PA病例的母婴结局与没有相关的超声检查结果。
方法:在这项回顾性队列研究中,包括2009年至2022年期间因PA而复杂的所有交付。胎盘组织病理学,产科,和新生儿结局比较PA病例与不支持超声检查结果。两组之间比较了严重新生儿发病率的复合,包括以下≥1种情况:癫痫发作,脑室内出血,缺氧缺血性脑病,脑室周围白质软化,呼吸窘迫综合征,脓毒症,贫血,输血或死亡。
结果:在符合研究条件的420例PA患者中,有超声特征的PA组50例(12%),无超声特征的PA组370例(88%)。具有超声特征的PA组的特征是早产率明显更高(p<0.001),严重复合不良新生儿结局(p<0.01),胎盘组织病理学中的复合母体血管灌注不良病变(p=0.001)在多变量回归分析中,早产与超声特征的存在独立相关(aOR=8.79,95%CI2.41-31.93,p<0.001)。
结论:PA具有支持的超声特征与较高的产科和新生儿不良结局以及胎盘病变的发生率相关。这些发现强调了在决定管理之前对每例PA进行超声检查评估的重要性。
BACKGROUND: Placental abruption (PA) is a major obstetric complication associated with worse maternal and neonatal outcomes. Though ultrasound findings may support the diagnosis of PA, the association of such findings to the severity of PA and maternal and neonatal outcomes is not yet clear. We aimed to assess the maternal and neonatal outcomes of PA cases with vs. without related sonographic findings.
METHODS: In this retrospective cohort study, all deliveries complicated by PA between 2009 and 2022 were included. Placental histopathology, obstetric, and neonatal outcomes were compared between cases of PA with vs. without supporting sonographic findings. A composite of severe neonatal morbidity was compared between the groups, including ≥1 of the following: seizures, intraventricular hemorrhage, hypoxic-ischemic encephalopathy, periventricular leukomalacia, respiratory-distress syndrome, sepsis, anemia, blood transfusion or death.
RESULTS: Of the 420 cases with PA eligible for the study, 50 patients (12 %) were in the PA with sonographic features group and 370 (88 %) were in the PA without sonographic features group. The PA with sonographic features group was characterized by significantly higher rates of prematurity (p < 0.001), severe composite adverse neonatal outcome (p < 0.01), and a composite maternal vascular malperfusion lesions in placental histopathology (p = 0.001) In multivariable regression analyses, preterm birth was independently associated with the presence of sonographic features (aOR = 8.79, 95 % CI 2.41-31.93, p < 0.001).
CONCLUSIONS: PA with supporting sonographic features is associated with higher rates of adverse obstetric and neonatal outcomes and placental lesions. These findings emphasize the importance of sonographic evaluation for every case of PA before deciding upon management.