332例胎盘植入病例临床分析

Clinical analysis of 332 cases of placenta implantation

目的探讨影响胎盘植入风险及其预后的高危因素,根据这些临床高危因素评估其风险,同时对比彩超检査及MRI检查对胎盘植入诊断的敏感度和特异度。方法回顾性分析332例胎盘植入孕产妇经过病理学检查验证的病例资料,包括瘢痕子宫与否、孕产次数、宫腔手术次数、前置胎盘与否、剖宫产次数、早孕期阴道出血史,将胎盘植入孕产妇分为轻度组(n=270)与重度组(n=62)。采用Logistic回归方法对影响胎盘植入风险的高危因素进行单因素和多因素分析,同时对比彩超检査和MRI检査结合彩超诊断胎盘植入的敏感度和特异度。结果轻度组与重度组相比,剖宫产次数、前置胎盘与否、宫腔手术次数、孕产次数、瘢痕子宫与否间差异有统计学意义(P<0.01),而在早孕期有无阴道出血史间差异无统计学意义(P>0.05)。瘢痕子宫、剖宫产次数及前置胎盘是影响胎盘植入风险的高危因素。重度组的产后出血、术中术后输血、膀胱损伤、子宫切除、早产及新生儿窒息的比率均明显高于轻度组(P<0.01)。MRI结合彩超组诊断胎盘植入的敏感度、特异度均高于彩超组(P<0.05)。结论瘢痕子宫、剖宫产次数及前置胎盘是影响胎盘植入风险的高危因素,针对这类孕妇需加强孕期产检。彩超对产前胎盘植入检出率较高,必要时可结合MRI检查。

Objective To investigate the risk factors affecting the risk and prognosis of placenta implantation,so as to evaluate the risk of placenta implantation according to these clinical high-risk factors,and to compare the sensitivity and specificity of color Doppler ultrasonography and MRI in the diagnosis of placenta implantation.Methods The clinical data of 332 cases of placenta implantation confirmed by pathological examination,including scar uterus or not,number of pregnancy and delivery,number of uterine cavity surgery,placenta previa or not,number of cesarean section and history of vaginal bleeding in early pregnancy were retrospectively analyzed,and these patients were divided into mild group(n=270)and severe group(n=62).Logistic regression method was used to analyze the high risk factors of placenta implantation.Meanwhile,the sensitivity and specificity of color Doppler ultrasonography and MRI combined with color Doppler ultrasonography for the diagnosis of placenta implantation were compared.Results There were significant differences in the frequency of cesarean section,placenta previa,uterine cavity surgery,pregnancy and delivery and scarred uterus between the mild group and severe group(P<0.01),but there was no significant difference in the history of vaginal bleeding in early pregnancy between the two groups(P>0.05).Scar uterus,the number of cesarean section and placenta previa were high risk factors for placenta implantation.The rates of postpartum hemorrhage,intraoperative and postoperative blood transfusion,bladder injury,hysterectomy,premature delivery and neonatal asphyxia in the severe group were significantly higher than those in the mild group(P<0.01).The sensitivity and specificity of MRI combined with color Doppler ultrasound in the diagnosis of placental implantation were higher than those of color Doppler ultrasound group(P<0.05).Conclusions Scar uterus,frequency of cesarean section and placenta previa are high risk factors affecting the risk of placenta implantation.The detection rate of placenta implantation by color Doppler ultrasonography is high,and it can be combined with MRI if necessary.