胎盘下缘厚度和宫颈管长度测量对胎盘前置状态预后的评估作用

The prediction value of lower placental edge thickness and the cervical canal length in placenta previa

目的：通过研究中孕期存在胎盘下缘增厚和宫颈管长度缩短的胎盘前置状态患者妊娠发展情况,探讨胎盘下缘厚度和宫颈管长度在胎盘前置状态患者中的诊断价值.方法：对规律产检孕16~27周＋6发现胎盘下缘达到或覆盖宫颈内口者225例进行研究,按有无胎盘增厚和宫颈长度缩短分为观察组和对照组.观察其出现阴道流血孕妇例数,阴道流血多于月经量例数,流产例数,孕28周后确诊前置胎盘例数,胎盘因素性剖宫产例数,因产前出血治疗性急诊剖宫产早产例数.结果：胎盘下缘增厚预测前置胎盘敏感性79.66%,特异性80.00%,宫颈管缩短预测前置胎盘敏感性62.71%,特异性75.95%,胎盘下缘增厚组与对照组妊娠情况比较,出现孕期阴道流血、阴道流血量大于月经量、确诊前置胎盘、胎盘因素剖宫产、治疗性早产率均高于对照组,比较差异有统计学意义（P＜0.05）.宫颈管缩短组与对照组妊娠情况比较,出现孕期阴道流血、阴道流血量大于月经量、流产、确诊前置胎盘、胎盘因素剖宫产、治疗性早产率均高于对照组,比较有统计学意义（P＜0.05）.结论：孕中期胎盘前置状态孕妇胎盘下缘厚度和宫颈管长度测量在前置胎盘的预测中具有较好的诊断价值,两者联合预测价值更佳,胎盘下缘增厚和宫颈管缩短对不良妊娠结局都有较好的预测价值.

Objective to evaluate the effctiveness of the lower placental edge thickness and cervical canal length measurement in predicting the risk of placenta previa and adverse events in case of plcenta previa state that found in the second trimester. Methods From January of 2009 to October of 2011,225 singleton pregnancies who were found with plcenta previa state at 16~27＋6 weeks and visit us regular later were invoved in this study.these patients were subjected to transperineum sonographic measurement the lower placental edge thickness and the cervical canal length and correlated this to confirmed placenta previa and adverse clinical events later.Results In predicting the placenta previa the thick placental edge with sensitivity of 79.66%,specificity of 80.00%,while short cervical canal length with 62.71% and 75.95%.Comparing to contolls,more cases with thick placental edge suffer from vaginal bleeding,mass vaginal bleeding,confirmed placenta previa,cesearen section because of placenta previa,medical preterm delivery because of bleeding.And more cases with short cervical canal length suffer from vaginal bleeding,mass vaginal bleeding,misscarage,confirmed placenta previa,cesearen section because of placenta previa,medical preterm delivery because of bleeding.Conclusion Lower placental edge thickness and the cervical canal length measurement in placenta previa state at the second trimester is with good prediction value ,both for the confirmed placenta previa and the adverse pregnant events.