| 尚小轶,杨 静,申 方,罗晓婷,孙 敏,冯 彪.超声影像学对胎盘植入程度的危险度评价及与胎盘植入程度的相关性[J].,2021,(22):4353-4357 |
| 超声影像学对胎盘植入程度的危险度评价及与胎盘植入程度的相关性 |
| The Risk of Placenta Accreta by Ultrasound Imaging and Its Correlation with Placenta Accreta |
| 投稿时间：2021-03-17 修订日期：2021-04-12 |
| DOI：10.13241/j.cnki.pmb.2021.22.032 |
| 中文关键词: 超声影像学 胎盘植入 程度 |
| 英文关键词: Ultrasonography Placental Implantation Degree |
| 基金项目:陕西省教育厅专项科研计划项目（19JK0224） |
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| 中文摘要: |
| 摘要 目的：探讨超声影像学对胎盘植入程度的危险度进行评价及与胎盘植入程度的相关性。方法：回顾性分析2017年7月-2020年7月期间于我院住院治疗的胎盘植入患者60例。分析分娩前超声影像学特点，按照胎盘位置及厚度、胎盘后低回声带是否消失、膀胱线是否连续、胎盘陷窝性状、胎盘基底部血流信号、宫颈形态是否完整、宫颈是否存在血窦，以及剖宫产史等项目，每项评0-2分，计算总分值。计算不同类型胎盘植入患者超声评分量表的临界值，并比较各类型患者术中出血量及子宫切除率。结果：60例患者中粘连型38例、植入型13例、穿透型9例。 粘连型出血量低于重型（P＜0.01），在重型患者中，植入型与穿透型术中出血量无差异（P=0.360）。粘连型患者均未切除子宫。粘连型与重型子宫切除率相比有差异（P＜0.01），重型高于粘连型。其中植入型子宫切除率低于穿透型（P＜0.01）。粘连型超声评分低于重型（P＜0.01）。重型患者中，植入型超声评分又低于穿透型（P＜0.01）。受试者工作特性曲线显示：当AUC为90.5 %、评分≥2.5 时，敏感度为 92.3 %，特异度为73.7 %，粘连型和植入型的最佳临界值为3分；当AUC为73.5 %、评分≥9.5分时，敏感度为55.6 %，特异度为76.9 %，因此确定植入和穿透型的界值为10分；当AUC为78.0 %、评分≥2.5 时，敏感度为72.7 %，特异度为88.2 %，是否出现产后出血的最佳临界值为3分。结论：超声影像学可评估胎盘植入的程度，并预测术中出血及子宫切除的风险。以评分 3分为界，用以预测粘连和重型胎盘植入、产后出血的发生。以评分≥10分为界，用以预测植入型和穿透型胎盘植入。其中，评分≥10分时，穿透型植入可能性大。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate risk of placenta accreta by ultrasound imaging and its correlation with placenta accreta. Methods: Retrospective analysis of the clinical data of 80 patients with placenta accreta hospitalized in our hospital from January 2017 to December 2019. Analysis of the characteristics of ultrasound imaging before delivery, according to the location and thickness of placenta, whether the low gyrus after placenta disappeared, whether the bladder line is continuous, placental socket character, placental basal blood flow signal, cervical morphology is complete, presence of blood sinus, and the history of cesarean section and other items, each evaluation 0-2 points, calculate the total score. The critical value of ultrasound scale for different types of placenta accreta patients was calculated and the intraoperative bleeding volume and hysterectomy rate were compared. Results: Of the 60 cases, 38 were adhesive type, 13 were implant type and 9 were penetrating type. Implantation type, penetrating type collectively referred to as heavy placenta accreta. The bleeding volume of adhesion type was lower than that of severe type(P<0.01). In severe patients, there was no statistically significant difference of intraoperative bleeding volume between implant type and penetrating type(P=0.360). The uterus was not excised in the patients with adhesion. Compared with the rate of severe hysterectomy, the difference was statistically significant(P<0.01), and the heavy type was higher than the adhesive type. Among them, the rate of implantation hysterectomy(15.3 %) was lower than that of penetration type (44.4 %, P<0.01). The adhesion ultrasound score was lower than that of heavy (P<0.01). The implantable ultrasound score was also lower than the penetrant type(P<0.01). When the AUC was 90.5 %, the score ≥2.5, the sensitivity was 92.3 %, the specificity was 73.7 %, the optimal critical value of adhesion type and implant type was 3 points; when the AUC was 73.5 %, the score was 9.5, the sensitivity was 55.6 %, and the specificity was 76 %. Thus, the threshold for implant and penetration was determined to be 10; when the AUC was 78.0 %, the score ≥2.5, the sensitivity was 72.7 %, the specificity was 88.2%, and the optimal threshold for postpartum hemorrhage was 3. Conclusion: Ultrasound imaging can assess the extent of placenta accreta and predict the risk of intraoperative bleeding and hysterectomy. Score 3 was used to predict the occurrence of adhesion and severe (including implantation and penetration) placenta accreta and postpartum hemorrhage. A score ≥10 was used to predict implantable and penetrating placental implantation. Among them, when the score ≥10, the possibility of penetrating implant is great. |
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