The clinical significance of ultrasonographically detected subchorionic hemorrhages
The clinical significance of ultrasonographically detected subchorionic hemorrhages
复制标题
DOI：
10.1016/s0002-9378(96)70339-3
复制
发表时间：
1996-03-01
影响因子：
9.8
通讯作者：
Crane, JP
中科院分区：
文献类型：
--
作者：
Ball, RH;Ade, CM;Crane, JP
目的：零假设是当有超声记录的绒毛膜下出血的孕妇与没有这些出血的孕妇进行比较时，结局没有差异。STUDY设计：我们利用我们的计算机超声数据库进行了一项病例对照研究。在两个单独的对照组中，病例与两个或三个对照组相匹配。匹配标准是孕妇年龄、扫描时的孕周和侵入性操作(绒毛取样或羊膜穿刺术)。一般排除标准为无胎心运动和胎儿畸形。绒毛膜下出血是两个对照组的排除标准；然而，此外，阴道出血是两组之一的另一个标准。统计分析采用X~2分析和Yates‘s校正。计算优势比和95%可信区间。结果：病例组和对照组母体特征无差异。绒毛膜下出血发生率为1.3%。与无绒毛下出血或出血的对照组相比，流产(优势比2.8，95%可信区间1.7~7.4)、死产(4.5，1.5~13.2)、胎盘早剥(11.2，2.7~46.4)和早产(2.6，1.5~4.6)的风险增加。与有出血的对照组相比，这些风险也增加了，但流产除外。在这种情况下，两个病例和对照组的风险相似，但与没有出血的对照组相比，风险增加了。两组新生儿平均出生体重均低于对照组。结论：超声检查发现绒毛膜下出血增加流产、死产、胎盘早剥和早产的风险。仅出血的存在似乎就增加了流产的风险。目前尚不清楚绒毛膜下出血是病因，还是仅仅是产生这些负面影响的潜在过程的迹象。
OBJECTIVES: The null hypothesis is that there is no difference in outcome when pregnancies with ultrasonographically documented subchorionic hemorrhages are compared with those without these hemorrhages.STUDY DESIGN: We performed a case-control study, utilizing our computerized ultrasonographic database. Cases were matched with two or three controls in two separate control groups. Matching criteria were maternal age, gestational age at scan, and invasive procedures (chorionic villus sampling or amniocentesis). General exclusion criteria were absence of fetal heart motion and fetal anomalies. Presence of subchorionic hemorrhage was an exclusion criterion for both control groups; however, in addition presence of vaginal bleeding was a further criterion for one of the two. Statistical analysis was performed with the chi(2) analysis and Yates' correction. Odds ratios and 95% confidence intervals were calculated.RESULTS: There was no difference in maternal characteristics between the cases and controls. The incidence of subchorionic hemorrhage was 1.3%. There was an increased risk of miscarriage (odds ratio 2.8, 95% confidence interval 1.7 to 7.4), stillbirth (4.5, 1.5 to 13.2), abruptio placentae (11.2, 2.7 to 46.4), and preterm labor (2.6, 1.5 to 4.6) when cases were compared with controls without subchorionic hemorrhage or bleeding. These risks were also increased in comparison with the control group with bleeding, except with respect to miscarriage. In this case the risks were similar in both cases and controls but increased with respect to the controls without bleeding. The mean birth weight was lower in the cases than in both control groups.CONCLUSION: The presence of an ultrasonographically detected subchorionic hemorrhage increases the risk of miscarriage, stillbirth, abruptio placentae, and preterm labor. The presence of bleeding alone appears to increase the risk of miscarriage. It is unclear whether the subchorionic hemorrhage is causative or whether it is simply a sign of an underlying process that produces these negative effects.