背景:绒毛膜下血肿(SCH)是妊娠早期常见的并发症,其特征是子宫壁和绒毛膜之间的血液积聚。SCH可导致不良妊娠结局,如流产,早产,和其他并发症。早期发现和准确评估SCH对于适当管理和改善妊娠结局至关重要。
目的:评价虚拟器官计算机辅助分析(VOCAL)测定SCH与孕囊体积比(GS)联合血清孕酮对SCH患者早期妊娠结局的诊断效能。
方法:共纳入153名妊娠早期6-11周的SCH患者。所有患者均随访至胎龄20周。经阴道二维超声的参数,包括SCH(Cs)的周长,SCH表面积(Ss),GS(Cg)的周长,和GS的表面积(Sg),经阴道三维超声的VOCAL参数,包括SCH(3DV)和GS(3DVg)的三维体积,被记录下来。SCH的大小及其与GS大小的比率(Cs/Cg,Ss/Sg,3DVs/3DVg)进行记录和比较。
结果:与正常妊娠组相比,不良妊娠组有较高的Cs/Cg,Ss/Sg,和3DVs/3DVg比值(P<0.05)。当3DV/3DVg为0.220时,最高的预测性能预测不良妊娠结局,导致0.767的AUC,灵敏度,特异性为70.2%,分别为75%。VOCAL测量3DVs/3DVg联合血清孕酮对SCH患者早期妊娠结局的诊断AUC为0.824,具有82.1%的高灵敏度和72.1%的特异性,这表明AUC之间存在显著差异。
结论:VOCAL测量的3DV/3DVg有效地量化了SCH的严重程度,而联合血清孕酮能更好地预测不良妊娠结局。
BACKGROUND: Subchorionic hematoma (SCH) is a common complication in early pregnancy characterized by the accumulation of blood between the uterine wall and the chorionic membrane. SCH can lead to adverse pregnancy outcomes such as miscarriage, preterm birth, and other complications. Early detection and accurate assessment of SCH are crucial for appropriate management and improved pregnancy outcomes.
OBJECTIVE: To evaluate the diagnostic efficacy of virtual organ computer-assisted analysis (VOCAL) in measuring the volume ratio of SCH to gestational sac (GS) combined with serum progesterone on early pregnancy outcomes in patients with SCH.
METHODS: A total of 153 patients with SCH in their first-trimester pregnancies between 6 and 11 wk were enrolled. All patients were followed up until a gestational age of 20 wk. The parameters of transvaginal two-dimensional ultrasound, including the circumference of SCH (Cs), surface area of SCH (Ss), circumference of GS (Cg), and surface area of GS (Sg), and the parameters of VOCAL with transvaginal three-dimensional ultrasound, including the three-dimensional volume of SCH (3DVs) and GS (3DVg), were recorded. The size of the SCH and its ratio to the GS size (Cs/Cg, Ss/Sg, 3DVs/3DVg) were recorded and compared.
RESULTS: Compared with those in the normal pregnancy group, the adverse pregnancy group had higher Cs/Cg, Ss/Sg, and 3DVs/3DVg ratios (P < 0.05). When 3DVs/3DVg was 0.220, the highest predictive performance predicted adverse pregnancy outcomes, resulting in an AUC of 0.767, and the sensitivity, specificity were 70.2%, 75% respectively. VOCAL measuring 3DVs/3DVg combined with serum progesterone gave a diagnostic AUC of 0.824 for early pregnancy outcome in SCH patients, with a high sensitivity of 82.1% and a specificity of 72.1%, which showed a significant difference between AUC.
CONCLUSIONS: VOCAL-measured 3DVs/3DVg effectively quantifies the severity of SCH, while combined serum progesterone better predicts adverse pregnancy outcomes.