前置胎盘孕妇产前超声在胎盘植入诊断中的价值

Value of prenatal ultrasonography in diagnosis of placenta accreta in patients with placenta pracvia

目的探讨产前超声检查诊断前置胎盘植入的应用价值。方法选取2009年3月—2016年6月湖州市妇幼保健院产科行剖宫产分娩的87例前置胎盘孕妇作为研究对象,所有对象产前均接受常规二维超声及彩色多普勒超声检查,根据术后病理结果分为胎盘植入组、胎盘非植入组,对比2组患者的超声声像特征,并计算产前超声诊断胎盘植入的灵敏度、特异度、漏诊率、误诊率、Kappa值。结果 87例前置胎盘患者,前置胎盘植入组的胎盘增厚、胎盘后部间隙全部或部分消失、胎盘附着处子宫肌层厚度、胎盘内部回声不均匀、胎盘附着处子宫浆膜层-膀胱交界面血管丰富、局灶性或广泛性胎盘实质内腔隙血流的发生率均显著高于非胎盘植入组,差异具有统计学意义(P<0.05);胎盘植入和非胎盘植入组的前置胎盘类型差异不具有统计学意义(P>0.05);以病理学结果作为金标准,产前超声诊断前置胎盘植入的灵敏度为80.00%、特异度为91.23%、漏诊率为20.00%、误诊率为8.77%,Kappa值为0.718。结论产前超声检查诊断前置胎盘植入具有较高的灵敏度与特异度,可为安全分娩提供指导。

Objective To evaluate the value of prenatal uhrasonography in diagnosis of placenta accreta in patients with placenta pracvia. Methods A total of 87 pregnant women with placenta previa undergoing cesarean section I our Department from March ,2009 to June ,2016 were enrolled into this study. The two-dimensional ultrasound and color Doppler ultrasonography were performed in all patients. The patients were divided into placenta accrete group and non-accrete group according to the postoperative pathological results. The uhrasonographic features of the two groups were compared. The sensitivity, specificity, missed diagnosis rate, misdiagnosis rate and Kappa value of prenatal uhrasound for the placenta accrete were evaluated. Results Among 87 cases of placenta previa, the incidence of thickened placenta, disappearance of part or all of the posterior placental space, myometrial thickness that placenta attached to, placenta internal uneven echo, well vascularized uterine serous layer-bladder interface that placenta attached to ,focal or generalized placental parenchyma lacunae blood flow in the placenta accrete group was significantly higher than that of non-accrete group（ P 〈 0.05 ）. There was no significant difference in the type of placenta previa between placenta accreta group and non-accrete group （ P 〉 0.05 ）. Taking pathological results as the gold standard, the sensitivity of preimplantation ultrasound was 80.00%, specificity was 91.23% ,missed rate was 20.00% ,misdiagnosis rate was 8.77%, and Kappa was 0. 718. Conclusion Prenatal ultrasound examination for placenta accreta in patients with placenta previa has a high sensitivity and specificity ,which can provide guidance for safe delivery.