[1]胡慧,胡春花,何培芝,等.早期妊娠重度绒毛膜下血肿患者病因探讨及 个体化治疗效果研究[J].中国计划生育和妇产科,2020,(8):33-38.
　HU Hui,HU Chunhua,HE Peizhi,et al.The etiology of severe subchorionic hematoma in the first trimester of pregnancy and the effect of individual therapy[J].Chinese Journal of Family Planning & Gynecotokology,2020,(8):33-38.
点击复制

早期妊娠重度绒毛膜下血肿患者病因探讨及 个体化治疗效果研究
分享到：

《中国计划生育和妇产科》[ISSN:1674-4020/CN:51-1708/R]

卷:
期数:
2020年8期
页码:
33-38
栏目:
论著与临床
出版日期:
2020-08-25

文章信息/Info

Title:
The etiology of severe subchorionic hematoma in the first trimester of pregnancy and the effect of individual therapy
作者:
胡慧; 胡春花; 何培芝; 王萍*
上海中医药大学附属曙光医院妇科
Author(s):
HU Hui; HU Chunhua; HE Peizhi; WANG Ping*
Department of Gynecology,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine，Shanghai 200021，P.R.China
关键词:
绒毛膜下血肿; 子宫动脉血流; 低分子肝素; 中药
Keywords:
subchorionic hematoma; uterine artery blood flow; low molecular weight heparin; traditional Chinese medicine
分类号:
R 7142
摘要:
目的探讨早孕期合并重度绒毛膜下血肿（subchorionic hematoma, SCH）的先兆流产患者子宫动脉血流（uterine artery blood flow，UtA）变化、病因及具体治疗方案的有效性和安全性。方法选择2018年1月至2019年12月在上海中医药大学附属曙光医院诊断为重度SCH的早孕期先兆流产患者30例为研究组，正常早孕期妇女30例为对照组。观察比较两组患者UtA变化，并对研究组进行自身免疫指标、获得性血栓前状态、相关内分泌功能检测，探讨SCH患者的病因。针对研究组患者可能病因及有无活动性出血制订个体化治疗方案进行治疗，比较治疗前后血肿大小、UtA值，观察早期妊娠结局和安全性指标。结果① 研究组双侧阻力指数（resistance index, RI）、搏动指数（pulsatility index, PI）、收缩期峰值流速/舒张末期流速（systolic peak velocity/end diastolic velocity, S/D）之和均高于对照组［(173±009)、(410±082)、(1724±482) vs (148±012)、(303±044)、(934±174)］，差异有统计学意义（P＜005）。② 研究组患者治疗后双侧RI、PI、S/D和较治疗前下降, SCH缩小［360（429）cm3 vs 000（074）cm3］，差异有统计学意义（P＜005）。治疗后孕12周内SCH完全消退者20例（667 %）。③ 研究组治疗后早孕期保胎成功27例（900 %）；流产3例（100 %）。④ 研究组30例患者中自身免疫异常者9例（300 %）,获得性血栓前状态21例（700 %），内分泌异常13例（433 %）。⑤ 研究组治疗后未发生血小板下降、凝血机制异常等不良反应；肝功能轻度异常4例，肝功能中度异常1例，肝功能损害发生率167 %；过敏性皮疹1例，发生率33 %；上述各种异常情况经处理后均消失。结论重度SCH患者存在UtA异常，自身免疫异常、获得性血栓前状态、内分泌异常的发生率高于文献报道复发性流产相关病因的发生率。诊治SCH过程中应重视此类病因筛查。根据重度SCH患者病因及有无活动性出血实施个体化治疗方案，能够有效改善保胎效果，值得进一步探讨和应用。
Abstract:
ObjectiveTo study the changes and causes of uterine artery blood flow (UtA) of threatened abortion patients with severe subchorionic hematoma (SCH) in first trimester and efficacy and safety of individualized treatment.Methods30 patients diagnosed as threatened abortion with severe SCH in first trimester in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from January 2018 to December 2019 were selected as the study group and 30 normal pregnant women in first trimester as the control group. The changes of UtA in the two groups were observed. The autoimmunity disorder, acquired prethrombus status and related endocrine function in study group were examined to investigate the causes of SCH. According to the possible etiology of the patients in the study group and the presence or absence of active bleeding, an individualized treatment plan was developed for treatment. The hematoma size and UtA value before and after treatment were compared, and early pregnancy outcomes and safety indicators were observed.Results① Bilateral resistance index(RI),pulsatility index(PI),systolic peak velocity/end diastolic velocity (S/D) in the study group were higher than the control group ［(173±009), (410±082), (1724±482) vs (148±012), (303±044), (934± 174)］, the differences were statistically significant (P<005).② The RI, PI and S/D of the two sides of the patients in the study group after treatment were significantly lower than those before treatment,SCH reduction［360（429）cm3 vs 000（074）cm3］, the differences were statistically significant (P<005). SCH in 20 patients were completely absorbed within 12 weeks after treatment. ③ 27 cases of threatened abortion were cured in first trimester in the study group(900 %). The abortion rate was 100 %. ④ 9 cases in the study group had abnormal autoimmunity with an incidence of 300 %, 21 had acquired prethrombus status with an incidence of 700 %, and 13 had endocrine abnormalities with an incidence of 433 %. ⑤ No adverse reactions such as decreased platelet and other coagulation problems occurred in the study group after treatment. There were 4 cases with mild abnormal liver function, 1 case with moderate abnormal liver function, and the incidence rate of liver function damage was 167 %. There was 1 case of allergic rash(33 %). All the above abnormal conditions were resolved after treatment.ConclusionPatients with severe SCH in first trimester had UtA abnormalities, the incidence of immune and acquired prethrombus status, endocrine abnormalities are higher than those in the literature of recurrent spontaneous abortion. According to the cause of severe SCH and the presence or absence of active bleeding, the implementation of individualized treatment programs can effectively improve the effect of fetal preservation, and it is worth further discussion and application.

参考文献/References:

［1］Seki H, Kuromaki K, Takeda S, et al. Persistent subchorionic hematoma with clinical symptoms until delivery ［J］. Int J Gynaecol Obstet,1998,63(2):123128. ［2］Johns J, Hyett J, Jauniaux E. Obstetric outcome after threatened miscarriage with and without a hematoma on ultrasound ［J］. Obstet Gynecol,2003,102(3):483487. ［3］Xiang L, Wei Z, Cao Y. Symptoms of an intrauterine hematoma associated with pregnancy complications: a systematic review ［J］. PloS One,2014,9(11):116. ［4］Peixoto AB, Caldas TMRDC, Petrini CG, et al. The impact of firsttrimester intrauterine hematoma on adverse perinatal outcomes ［J］. Ultrasonography,2018, 37(4):330336. ［5］Tuuli MG, Norman SM, Odibo AO, et al. Perinatal outcomes in women with subchorionic hematoma:A systematic review and metaanalysis ［J］. Obstet Gynecol,2011，117(5):12051212. ［6］吴海英，申英，刘晓华,等.孕早期先兆流产合并子宫内血肿妊娠结局的临床观察 ［J］.河北医学，2016，22（3）：479481. ［7］李清，朱瑾，华克勤.绒毛膜下血肿孕妇妊娠结局的荟萃分析［J］.中华医学杂志，2016，96（17）：13831385. ［8］Ball RH, Ade CM, Schoenborn JA, et al. The clinical significance of ultransonographically detected subchorionic hemorrhages ［J］. Am J Obstet Gynecol, 1996,174(3):9961002. ［9］Nagy S, Bush M, Stone J,et al. Clinical significance of subchorionic and retroplacental hematomas detected in the first trimester of pregnancy ［J］.Obstet Gynecol,2003,102(1):94100. ［10］Aoki S, Inagaki M, Kurasawa K, et al. Retrospective study of pregnant women placed under expectant management for persistent hemorrhage ［J］. Arch Gynecol Obstet,2014,289(2):307311. ［11］查晓霞，常山.超声对先兆流产合并绒毛膜下血肿妊娠结局的预测价值 ［J］.实用医院临床杂志，2009，6（5）：5860. ［12］陆洋，李慧，李晓红.先兆流产合并绒毛膜下血肿293例妊娠结局分析 ［J］.吉林医学，2015，36（12）：24532455. ［13］Heller HT, Asch EA, Durfee SM, et al. Subchorionic hematoma: Correlation of grading techniques with firsttrimester pregnancy outcome ［J］. J Ultrasound Med, 2018,37(7):17251732. ［14］宋双，李辉.子宫动脉血流监测高危妊娠的临床研究 ［J］.中国产前诊断杂志（电子版）,2014，6（3）：615. ［15］谢幸，苟文丽.妇产科学 ［M］.第8版，北京：人民卫生出版社，2013:4750. ［16］刘芳荪，孙晓岚，林其德，等.妊娠早期子宫动脉血流的变化及其对妊娠结局的影响 ［J］.生殖与避孕，2009，29（12）：818821. ［17］李绅，王美，耿顺玲，等.早孕前、后子宫动脉血流与妊娠结局的相关性研究 ［J］.中华临床医师杂志（电子版），2015，9（2）：218222. ［18］王磊，洪向丽，鲍时华，等.复发性流产患者子宫动脉血流的超声多普勒变化 ［J］.生殖与避孕，2014，34（6）：471476. ［19］边莹，骆军英，朱桂清，等.早孕期孕妇子宫动脉血流参数与早期自然流产的相关性研究 ［J］.实用医技杂志，2018，25（2）：138139. ［20］Alijotas J, Izquierdo M, Serra B, et al. Antinuclear autoantibodies, complement level, hypergammaglobulinemia and spontaneous intrauterine hematoma in pregnant women ［J］. Am J Reprod Immunol, 2003,50(1):16. ［21］Heller DS, Rush D, Baergen RN. Subchorionic hematoma associated with thrombophilia:report of three cases［J］. Pediatr Dev Pathol, 2003,6(3):261264. ［22］Lee RH,Goodwin TM. Massive subchorionic hematoma associated with enoxaparin ［J］. Obstet Gyncol,2006,108(3):787789. ［23］Usta IM, Abdallah M, ElHajj M, et al. Massive subchorionic hematomas following thrombolytic therapy in pregnancy ［J］. Obstet Gynecol, 2004,103(5):10791082. ［24］Yamada T, Atsuki Y, Wakasaya A, et al. Characteristics of patients with subchorionic hematomas in the second trimester ［J］. J Obstet Gynaecol Res, 2012,38(1):180184. ［25］Palatnik A, Grobman WA. The relationship between firsttrimester subchorionic hematoma, cervical length, and preterm birth ［J］. Am J Obstet Gynecol,2015,213(3): 403404. ［26］Naeye RL. Abruptio placentae and placenta previa: frequency, perinatal mortality, and cigarette smoking ［J］. Obstet Gynecol,1980,55(6):701704. ［27］刘晓东.孕妇外伤后绒毛膜下血肿一例 ［C］.2012中国·北京超声医学学术大会论文集.2012:592593. ［28］刘志兰,康晓敏,张晓欣，等.复发性自然流产1101例病因分析 ［J］.上海交通大学学报(医学版),2015,35(3):396401，417. ［29］Carter EB，Goetzinger K, Tuuli MG, et al. Evaluating the optimal definition of abnormal firsttrimester uterine artery doppler parameters to predict adverse pregnancy outcomes ［J］. J Ultrasound Med, 2015, 34(7):12651269. ［30］凌丽，李绅，付锦华.复发性流产患者子宫动脉血流与妊娠结局的相关性分析 ［J］.世界最新医学信息文摘，2017，17（15）：6566. ［31］塔拉，郎旭清.复发性流产患者子宫动脉血流超声的血流参数变化对妊娠结局的影响 ［J］.中国现代药物应用，2019，13（13）：6264. ［32］丁艳婷，孟金来.绒毛膜下血肿的研究进展 ［J］.现代妇产科进展，2019，28（10）：791793. ［33］赵爱民,乔杰.低分子肝素防治自然流产中国专家共识 ［J］.中华生殖与避孕杂志，2018，38（9）：701708. ［34］吴素慧,李颖.妊娠期血栓前状态诊治探讨 ［J］.中国计划生育和妇产科,2018,10(10):310. ［35］王清任.医林改错 ［M］.沈阳:辽宁科学技术出版社,1997:17. ［36］郝晓丽，罗颂平.罗颂平教授治疗妊娠合并宫腔积血经验介绍 ［J］.亚太传统医药，2016，12（9）：100101. ［37］袁少飞,高峰丽,石素琴，等.间苯三酚与硫酸镁治疗先兆流产疗效与安全性比较的Meta分析 ［J］.药物流行病学杂志,2019,28(6):355362. ［38］Lacroix I, HuraultDelarue C, Kessler S, et al. First epidemiologic data about phloroglucinol exposure during first trimester of pregnancy ［J］. Gynecologie Obstetrique & Fertilite，2011,39(12):694697. ［39］赵骏达,郭春凤,马俊旗.黄体酮联合间苯三酚对先兆流产患者SOCS3表达及围生儿结局的影响 ［J］.中国医药导报,2019,16(35):9497，182. ［40］岳洁,刘晓华,卢钺,等.早孕期绒毛膜下血肿的位置与大小对妊娠结局的影响 ［J］.中国妇幼保健,2015,30(34):59835984.

相似文献/References:

[1]张凤悦,乔宠*.妊娠合并绒毛膜下大血肿病例报道2例 ——出血性/缺血性？[J].中国计划生育和妇产科,2020,(8):80.

备注/Memo

备注/Memo:
上海中医药大学预算内项目（项目编号：2019LK017）
更新日期/Last Update: 2020-08-25