膜状胎盘的产前超声诊断与妊娠结局随访研究

Prenatal ultrasound diagnosis and follow-up pregnancy outcome of placenta membranacea

目的观察膜状胎盘的产前超声特征,随访其妊娠结局,探讨产前超声诊断膜状胎盘的价值。方法收集2016年10月至2017年7月中国医科大学附属盛京医院经临床及病理确诊的行胎儿超声会诊诊断为膜状胎盘孕妇6例,均为单胎妊娠,年龄23~34岁,平均年龄26.83岁;孕周22^(+1)~34^(+3)周,平均孕周25.92周。观察6例膜状胎盘的产前超声特征,分析膜状胎盘孕妇临床资料并随访妊娠结局及病理诊断。结果 1例于34^+3周行剖宫产术,产一活男婴;1例因胎盘早剥而失血性休克于26^(+1)周行急诊剖宫产术,男婴存活34 d;1例于24^(+6)周自然流产;3例分别于23^(+3)周、28周、28^(+1)周行米非司酮^+利凡诺引产术。胎盘病理诊断为膜状胎盘。产前超声检查见胎盘异常增厚,占宫腔面积2/3以上,胎盘正常实质成分减少,内呈旋涡样流动液性暗区,彩色多普勒血流成像(CDFI)显示胎盘血流信号减少;胎儿生长受限6例;羊水少4例;脑-胎盘比(CPR)<P_(95)6例;双侧子宫动脉搏动指数(PI)均值增高6例。结论膜状胎盘典型超声图像特征是胎盘异常增厚,面积较相应孕周大,胎盘内正常实质成分减少,呈旋涡样流动液性暗区。膜状胎盘产前超声图像特征明确且易于辨认,产前超声可较早诊断膜状胎盘,提高妊娠管理质量,有效降低孕妇大出血风险。

Objective To observe prenatal ultrasound features and follow-up the pregnancy outcomes of placenta mem- branacea, and discuss the value of prenatal ultrasound in diagnosis of placenta membranacea. Methods From October 2016 to July 2017, 6 cases of pregnant women diagnosed with placenta membranacea by prenatal ultrasound and confirmed by clini- cal and pathology were enrolled. All of them were singleton pregnancy, aged 23 - 34 years old with mean age of 26.83 years old. The gestational age was 22＋1 - 34＋3 weeks with mean age of 25.92 weeks. The characteristics of prenatal ultrasound in 6 placenta membranacea patients were observed, the clinical data, follow-up pregnancy outcomes and pathology diagnosis were analyzed. Results One ease of premature delivery a live male baby with cesarean section at 34＋3 weeks; 1 of hemorrhagic shock due to placental abruption with emergency cesarean section at 26＋1 weeks, the male baby survived for 34 days; one case of spontaneous abortion at 24＋6 weeks; three cases performed induced abortion with Mifepristone ＋ Rivanol at 23＋3 weeks, 28 weeks and 28＋1 week, respectively. The membranous placenta was confirmed by surgery and pathological examination. The prenatal ultrasound showed that abnormal thickening in placenta, which accounted for more than 2/3 of uterine cavity. The placenta was reduced in normal parenehyma with vortex-like fluidity dark area, and signal of placental blood flow decreased diagnosed by color Doppler flow imaging（CDFI）. The fetal growth restriction in 6 cases, 4 cases of oligohydramnios, 6 cases of brain-placental ratio（CPR） 〈 P95 and increased bilateral uterine artery pulsatility index（PI）. Conclusion It is demonstrated that characteristics of prenatal ultrasonographic image is abnormal thickening and larger than normal placenta, the placenta is reduced in normal parenchyma with vortex-like fluidity dark area. As prenatal ultrasound image features of placenta mem- branacea is clear and simple, it can diagnosis placenta membranaeea earlier, which will improve quality of pregnancy manage- ment and effectively reduce the bleeding risk of pregnant women.