The Clinical Application Of Ultrasound In Antepartum Haemorrhage In The Middle-late Pregnancy And The Associated Pregnancy Outcome

Background Antepartum hemorrhage (Antepartum hemorrhage, APH) is bleeding from the vagina during pregnancy from the24th week (somethings defined as from the20th week or28th week) gestational age to term. It is the most common obstetric critical illness.The amount ranges from spotting to massive. The maternal and fetal are easily endangered in massive bleeding or died, even a small amount of bleeding may also be bleeding precursor, leading to adverse pregnancy outcomes. Especially the second and third trimester (he20th week gestational age to term) bleeding, is the main causes of maternal and fetal morbidity and mortality. It is the key to the clinically effective to control the bleeding and save the lives of maternal and fetal to reduce obstetric complications by correct and timely diagnosis of the cause of bleeding, standarding management the pregnant women who was bleeding or had bleeding risk factors during pregnancy. At present, at home and abroad have more studies bout the relevant of prenatal bleeding and its pregnancy outcome, such as"Antepartum bleeding of unknown origin in the second half of pregnancy and pregnancy outcomes"," Pregnancy outcome after a primary antenatal hemorrhage between16and24weeks’ gestation",et al. The most studied of single factor is placenta previa and its pregnancy outcomes, for example,"Risk factors and pregnancy outcome in different types of placenta previa".Prenatal ultrasonography is the most commonly used means of diagnosis in the cause of the second and third trimester bleeding,and it is the basis for further clinical intervention.It is very important to reduce prenatal bleeding due to adverse pregnancy outcomes.Objective (1)To analyze the cause of bleeding in the second and the third trimester and the associated pregnancy outcome.(2) To explore the clinical value of prenatal ultrasound in diagnosis of cause at the second and the third trimester.Materials and Methods:(1) Retrospective analysis3855pregnant women who were cured in the center treatment of high-risk maternal or were waiting for childbirth in conventional obstetric in the1th hospital of Huai hua from Apr.2009to Mar.2012. We had been tracking or following-up all mothers and babies to seven days by the end of pregnancy. The254pregnant women who had at least once vaginal bleeding after20weeks of pregnancy to birth were named as follows: hemorrhage group. All pregnant women had been at least one prenatal ultrasound examination in our department. Another3601pregnant women who labored at the same period, without vaginal bleeding from20weeks of pregnancy to delivery time, were named as follows: non-bleeding group.(2) We analyzed the etiology of bleeding, the situation of prenatal ultrasound diagnosis and compared the differences of pregnancy outcome between the two groups.(3) The statistical method of measurement data (mean±standard deviation) SPSS17.0statistical software for analysis, t test, the rate between the two groups were compared using χ2test, P<0.05for difference was statistically significant.Results There were three major factors of antenatal hemorrhage in the bleeding group, named as:local factors (including placenta previa, placental abruption, placenta accreta, uterine rupture, vasa previa, cervical incompetence), systemic factors, and unexplained. Among of which placenta previa, placental abruption and placenta accreta were the main causes, The adverse pregnancy outcome inclouded:stillbirth, premature birth, low birth weight, neonatal morbidity, neonatal death, hysterectomy, and postpartum hemorrhage. The incidence of all adverse pregnancy outcomes of the bleeding group was higher than that of non-bleeding group,but the incidence of normal pregnancy outcomes was lower than that of non-bleeding group. The difference was statistically significant (P<0.05).Conclusion (1) There are many causes of bleeding in the middle-late pregnancy.The local factors are the main,of which placenta previa, placental abruption and placenta accreta are the three major causes.Ultrasound monitoring can confirm the diagnosis and provide scientific, objective basis for clinical intervention, mode of delivery.(2) The bleeding in the middle-late pregnancy often associates with adverse pregnancy outcome and ultrasound dynamic monitoring can avoid a part of which.