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目的通过学习5例脐血管破裂病例及文献复习,分析探讨减少脐血管破裂病例不良结局的诊治要点。方法回顾性分析5例脐血管破裂病例的诊治、结局及相关文献复习。结果 5年间脐血管破裂的发生率约1/7379,其发病机制目前尚不明确,可能的原因有局部脐静脉壁薄弱、局部华通胶缺失、脐带过度扭曲、脐带脱垂、脐带被牵拉、感染、凝血因子Ⅻ、Ⅶ缺乏、脐带囊肿等。1例产前死胎,1例住院待产突发胎心异常,其余3例均发生于足月临产时突发胎心异常;胎心监护显示持续变异减速及延长减速。1例死胎引产,1例胎心异常行胎头吸引术助娩,3例急诊剖宫产;仅1例新生儿经抢救后存活。病理检查示局部脐血管不全破裂,血肿及中性粒细胞浸润。结论自发性脐血管破裂出血是产科罕见的一种并发症,一旦发生,胎儿在短时间内可出现急性失血,导致胎儿宫内急性缺血缺氧,可致死亡,预后不良,需快速诊断和处理以改善妊娠结局。
Objective To study the main points of diagnosis and treatment to reduce the adverse outcome of umbilical vascular rupture by studying 5 cases of umbilical vascular rupture and literature review. Methods Retrospective analysis of 5 cases of umbilical rupture of the diagnosis and treatment, outcome and related literature review. Results The incidence of umbilical vascular rupture was about 1/7379 in 5 years. The pathogenesis of umbilical cord rupture was not clear at present. The possible reasons are: local weakness of umbilical vein wall, lack of local huartu gum, excessive distortion of umbilical cord, umbilical cord prolapse, , Infection, clotting factor Ⅻ, Ⅶ lack of umbilical cord cyst. One case of prenatal fetal death, one case of hospitalized childbirth unexpected fetal heart rate anomalies, and the remaining three cases occurred in full-term abortion fetal heart rate abnormalities; fetal heart rate monitoring showed sustained degeneration and prolonged deceleration. 1 case of stillbirth induced abortion, 1 case of fetal heart rate abnormal fetal head suction to help deliver, 3 cases of emergency cesarean section; only 1 case of newborn survived after the rescue. Pathological examination showed partial umbilical vascular insufficiency rupture, hematoma and neutrophil infiltration. Conclusions Spontaneous umbilical vascular rupture is a rare complication of obstetrics. Once the fetus is born, the fetus may have acute blood loss in a short period of time, resulting in acute ischemia and hypoxia in the fetus, leading to death and poor prognosis. Treatment to improve pregnancy outcome.