产前超声检查在前置胎盘及植入孕妇分娩大出血预测中的临床应用价值

Clinical value of prenatal ultrasonography in predicting the bleeding of placenta and implanted pregnant women

目的分析产前超声检查在前置胎盘及植入孕妇分娩大出血预测中的临床应用价值。方法选择我院2014年5月-2016年5月收治的83例前置胎盘及植入孕妇作为研究对象,根据是否合并胎盘植入分为两组,其中植入组37例,非植入组46例,所选产妇产前均采取超声检查,比较两组患者的一般资料,分析产前超声检查结果与分娩大出血的关系,评估产前超声检查结果对分娩大出血的预测能力。结果两组孕妇的年龄、孕次、产次、剖宫产史、新生儿1 min Apgar评分、分娩出血量、子宫切除与否、早产与否相比较,差异均具有统计学意义(P<0.05),流产史相比较,差异无统计学意义(P>0.05)。单因素分析结果显示,两组孕妇的前置胎盘类型、胎盘主要附着部位、胎盘距宫颈内口距离、胎盘厚度、胎盘内部回声是否均匀、子宫浆膜层-膀胱交界面血管情况及有无胎盘实质内腔隙血流情况相比较,差异均具有统计学意义(P<0.05)。上述单因素分析有统计学意义的7个变量作为自变量,使用Logistic逐步回归法建立相应的回归方程,结果显示,子宫浆膜层-膀胱交界面血管丰富紊乱或稍丰富、胎盘实质内存在腔隙血流均作为前置胎盘及植入孕妇分娩大出血的独立危险因素(P<0.05),距宫颈内口距离≥2 cm作为前置胎盘及植入孕妇分娩大出血的保护性因素(P<0.05)。结论前置胎盘及植入严重影响孕妇的分娩结局,根据孕妇的基本情况及产前超声检查结果,可以评估和预测分娩大出血发生风险,为提高分娩安全性提供依据。

Objective To analyze the clinical value of prenatal ultrasonography in predicting placenta and implantation of maternal bleeding in pregnant women. Methods 83 cases of placenta previa and implanted pregnant women from May 2014 to May 2016 were selected as the subjects. According to whether the placenta accreta was di- vided into two groups, 37 cases were implanted, 46 patients were selected. All the prenatal patients were examined by ultrasonography. The general data of the two groups were compared. The relationship between the results of prenatal ultrasonography and the bleeding was analyzed. The ability of prenatal ultrasonography to predict the bleeding was an- alyzed. Results The differences in age, pregnancy, parity, cesarean section, neonatal I min Apgar score, delivery bleed- ing, hysterectomy, or premature delivery were statistically significant （P〈0.05）. There was no significant difference in the history of abortion （P〉0.05）. Univariate analysis showed that the placenta previa type, the main place of placenta, the distance from the placenta to the cervix, the thickness of the placenta, the internal echo of the placenta, the vascular layer of the uterine serosa and bladder, and the presence or absence of placenta, the blood flow in the parenchymal space was statistically significant （P〈0.05）. The above-mentioned univariate analysis showed statistically significant 7 variables as independent variables. Logistic stepwise regression method was used to establish the corresponding regression equation. The results showed that the uterine serosa-vesicular interface was rich in vascular disorder or slightly rich, and there was a cavity in the placenta parenchyma. The blood flow was used as an independent risk factor for placenta previa and implantation of hemorrhage in pregnant women （P〈0.05）. The distance from the cervix to the cervix was 〉2 cm as a pro- tective factor for placenta previa and implantation of hemorrhage in pregnant women （P〈0.05）. Conclusion The placenta previa and implantation seriously affect the outcome of pregnant women and the results of prenatal ultrasound, the risk of bleeding delivery can be provided. women, according to the basic situation of pregnant can be evaluated and predicted, and the basis for safe delivery can be provided.