产前超声诊断胎盘植入

Prenatal ultrasonography in diagnosis of placenta accrete

目的探讨联合应用二维灰阶超声、CDFI及三维能量超声对胎盘植入的产前诊断价值。方法选取瘢痕子宫和(或)有其他子宫手术史的191例前置胎盘孕妇,应用二维灰阶超声、CDFI及三维能量超声扫查整个胎盘。以产时临床诊断和产后病理结果为金标准,比较产前超声诊断胎盘植入的效能。结果 191例中,粘连性胎盘13例,植入性胎盘16例,穿透性胎盘14例。单独采用二维灰阶超声、CDFI、三维能量超声诊断植入性胎盘和穿透性植入的敏感度、特异度、阳性预测值、阴性预测值分别为90.00%(27/30)、91.30%(147/161)、65.85%(27/41)、98.00%(147/150),86.67%(26/30)、93.79%(151/161)、72.22%(26/36)、97.42%(151/155)和96.67%(29/30)、96.89%(156/161)、85.29%(29/34)、99.36%(156/157)。3种方法联合应用检测植入性胎盘和穿透性胎盘的敏感度、特异度、阳性预测值、阴性预测值为100%(30/30)、98.76%(159/161)、93.75%(30/32)、100%(159/159)。结论在产前植入性胎盘和穿透性胎盘的诊断中,联合应用二维灰阶超声、CDFI及三维能量超声,一定程度上可避免漏诊,三维能量超声可作为二维灰阶超声和CDFI的补充诊断方法。

Objective To explore the value of the combination of two-dimensional gray-scale,color Doppler and three-dimensional（3D）power Doppler ultrasound in dignosis of placenta accreta.Methods A total of 191 pregnant women with placenta previa and the history of cesarean delivery or other uterine surgery were enrolled,and under gray-scale,color Doppler and 3D power Doppler ultrasound to scan entire placenta.The ultrasound findings were analyzed taking the results of clinical outcome and delivery pathology of the placenta as standard.Results In 191 pregnant women,13 patients with adherent placenta,16 placenta increta,14 placenta percreta were found.The sensitivity,specificity,positive predictive value,negative predictive value of two-dimensional ultrasound,CDFI,3D power Doppler ultrasonography for placenta increta and placenta percreta was 90.00%（27/30）,91.30%（147/161）,65.85%（27/41）,98.00%（147/150）and 86.67%（26/30）,93.79%（151/161）,72.22%（26/36）,97.42%（151/155）and 96.67%（29/30）,96.89%（156/161）,85.29%（29/34）,99.36%（156/157）,respectively,and the sensitivity,specificity,positive predictive value,negative predictive value of combination of above three methods was 100%（30/30）,98.76%（159/161）,93.75%（30/32）,100%（159/159）.Conclusion In prenatal diagnosis of placenta increta and placenta percreta,the 3Dpower Doppler ultrasound can be used as the complementary mentods of two-dimensional gray-scale ultrasound and CDFI,and the combination of three methods can be used to reduce false negative rate to some extent.