先兆流产患者绒毛膜下血肿的危险因素及妊娠结局分析

Risk factors and pregnancy outcomes of subchorionic hematoma in patients with threatened abortion

摘要:

目的 研究孕早期先兆流产孕妇出现绒毛膜下血肿（SCH）的危险因素及其对妊娠结局产生的不良影响。方法 回顾性收集2021年1月至2022年6月就诊于郑州大学第三附属医院就诊的先兆流产合并SCH的孕妇89例作为SCH组，选取同期就诊的先兆流产孕妇106例作为正常组，统计并分析两组孕妇的免疫指标、妊娠期并发症和妊娠结局如流产、早产和足月产及新生儿情况。结果 两组孕妇血清学检测结果相比较，SCH组的血同型半胱氨酸、狼疮抗凝物阳性率、抗心磷脂抗体阳性率及抗核抗体谱阳性率均高于正常组，差异有统计学意义（P<0.05）。蛋白S活性、蛋白C活性及抗凝血酶Ⅲ（AT-Ⅲ）低于正常组，差异有统计学意义（P<0.05）。SCH组的胎膜早破率、胎儿宫内窘迫率、流产率均高于正常组，而胎儿分娩孕周及胎儿出生体重均低于正常组，差异有统计学意义（P<0.05）。结论 妊娠期的自身抗体阳性是SCH发生的危险因素，同时SCH可能会导致不良妊娠结局的发生如流产、胎儿较低出生孕周及较低出生体重。

Abstract:

Objective To investigate the risk factors of subchorionic hematoma (SCH) in pregnant women with threatened abortion in early pregnancy and its adverse effect on pregnancy outcome.Methods Eighty-nine pregnant women with threatened abortion complicated with SCH who visited the Third Affiliated Hospital of Zhengzhou University from January 2021 to June 2022 were retrospectively collected as SCH group, and 106 pregnant women with threatened abortion who visited the Third Affiliated Hospital during the same period were selected as normal group. Immunological indicators, pregnancy complications and pregnancy outcomes such as miscarriage, premature and full-term births, and newborns in both groups were analyzed.Results Serological test results between the two groups showed that the serum homocysteine level, the positive rates of lupus anticoagulant, anti-phospholipid antibody and anti-nuclear antibody spectrum in SCH group were higher than those in normal group, with statistical significance (P<0.05). The activity of protein S and protein C, antithrombin Ⅲ (AT-Ⅲ) were lower than those in normal group, with statistical significance (P<0.05). The rate of premature rupture of membranes, fetal distress rate and abortion rate in SCH group were higher than those in normal group, while the gestational week of fetal delivery and fetal birth weight were lower than those in normal group, and the difference was statistically significant (P<0.05).Conclusion Positive autoantibody during pregnancy is a risk factor for SCH, and SCH may lead to adverse pregnancy outcomes such as abortion, lower gestational age and lower birth weight.