摘要目的:探讨帆状胎盘（VCI）产前超声检查的诊断价值及妊娠结局分析。方法:回顾性收集2012年1月—2022年12月于西安交通大学第一附属医院行产前检查并分娩的产前或产后诊断为VCI的孕产妇共58例，其中经产后胎盘检查确诊的45例VCI者为观察组，以同期分娩的225例脐带附着于胎盘中央或近中央处的孕产妇为对照组，分析产前超声检查的诊断结果，并比较两组孕产妇的临床特点和妊娠结局的差异。结果:（1）产前超声检查的诊断结果：58例产前或产后诊断为VCI的孕产妇中，经产前超声检查诊断者54例（93.1%，54/58），其中13例（22.4%，13/58）为误诊；漏诊4例（6.9%，4/58）。最终经产后胎盘检查确诊的VCI共45例，其中并发前置血管（VP）者11例（24.4%，11/45）；产前超声检查诊断VCI的检出率为91.1%（41/45）。（2）两组一般情况的比较：观察组与对照组孕妇的年龄、妊娠次数和人工流产次数分别比较，差异均无统计学意义（ P均>0.05）；与对照组相比，观察组采用辅助生殖技术受孕率［分别为0.4%（1/225）、13.3%（6/45）］和双胎妊娠率［分别为0.4%（1/225）、8.9%（4/45）］均显著升高（ P均<0.01）。（3）两组妊娠相关指标的比较：观察组孕妇前置胎盘、副胎盘或分叶胎盘、VP及产前出血、产后出血、产后宫内残留的发生率均显著高于对照组（ P均<0.05）；而两组孕产妇胎盘早剥、胎膜早破、胎儿窘迫及单脐动脉的发生率分别比较，差异则均无统计学意义（ P均>0.05）。观察组胎儿结构异常的发生率（4.4%，2/45）高于对照组（1.3%，3/225），但两组比较，差异无统计学意义（ P=0.195）。（4）两组围产结局的比较：两组均有1例引产孕妇未计入。观察组产妇的剖宫产率（75.0%，33/44）、早产率（29.5%，13/44）和小于胎龄儿的发生率（20.5%，9/44）均显著高于对照组［分别为45.1%（101/224）、5.4%（12/224）、5.4%（12/224）； P均<0.01］；而观察组的新生儿出生体重［（2 928±552）g］和1分钟Apgar评分［中位数为10分（范围：4~10分）］均显著低于对照组［分别为（3 353±498）g、10分（范围：5~10分）； P均<0.01］。 结论:产前超声检查是诊断VCI的重要手段。VCI易导致母儿不良妊娠结局，如产后出血、早产、小于胎龄儿等，其危险因素有双胎妊娠、辅助生殖技术受孕、前置胎盘、副胎盘等。

abstractsObjective:To explore diagnostic value of prenatal ultrasound screening in velamentous umbilical cord insertion (VCI) and its influence on perinatal outcomes, and to provide theoretical basis for clinical practice.Methods:Fifty-eight pregnant women diagnosed with VCI before or after delivery admitted to the First Affiliated Hospital of Xi′an Jiaotong University were selected from January 2012 to December 2022. The clinical features and perinatal outcomes of 45 women finally with VCI after delivery (VCI group) were retrospectively analyzed, and 225 women with normal umbilical cord attachment were selected as the control group during the same period.Results:(1) Among 58 women, 54 (93.1%, 54/58) were diagnosed with VCI by prenatal ultrasound screening, 4 patients (6.9%, 4/58) were missed; and 13 (22.4%, 13/58) were misdiagnosed. Finally, a total of 45 women were confirmed by postpartum placental examination, and 11 (24.4%,11/45) were combined with vasa previa. (2) There were no differences in age, number of pregnancies, and number of induced abortions between the two groups (all P>0.05). Compared with the control group, the rate of assisted reproductive technology [13.3% (6/45) vs 0.4% (1/225); P<0.01], and twin pregnancy rate [8.9% (4/45) vs 0.4% (1/225); P<0.01] in the VCI group were significant higher. (3) Compared with the control group, the rate of placenta previa, succenturiate placenta, vasa previa, postpartum hemorrhage, prenatal hemorrhage and postpartum intrauterine remainder in the VCI group were significant higher (all P<0.05); there was no significant difference in the incidence of placental abruption, premature rupture of membranes, fetal distress and single umbilical artery between the two groups (all P>0.05). The incidence of fetal structural abnormalities in the VCI group (4.4%, 2/45) was higher than that in the control group (1.3%, 3/225), but there was no significant difference between the two groups ( P=0.195). (4) The cesarean section rate [75.0% (33/44) vs 45.1% (101/224); P<0.01], preterm birth rate [29.5% (13/44) vs 5.4% (12/224); P<0.01], rate of small for gestational age [20.5% (9/44) vs 5.4% (12/224); P<0.01] in the VCI group were significant higher. However, neonatal birth weight [(2 928±552) vs (3 353±498) g; P<0.01], and 1-minute Apgar score (median: 10 vs 10; P<0.01) in the VCI group were lower than those in the control group. Conclusions:Prenatal ultrasound screening is an important method to diagnose VCI. VCI is more prone to adverse pregnancy outcomes, such as postpartum hemorrhage, premature delivery, small for gestational age, et al. Its risk factors include twin pregnancy, assisted reproductive technology, placenta previa, and para-placenta.