经腹超声在孕中期胎盘前置诊断中的应用

Application of Transabdominal Ultrasonography in the Diagnosis of Placenta Previa in Mid-term Pregnancy

目的探讨经腹超声在孕中期胎盘前置状态诊断中的应用价值。方法选择2017年1月至2017年9月在我院进行孕期检查的854例孕妇作为研究对象,所有孕妇均接受经腹超声和经阴超声检查,观察经腹超声和经阴道超声对前置胎盘的检出率,观察经腹超声和经阴超声的诊断价值。结果经腹超声共检出前置胎盘67例,检出率7.85%,经阴超声检出71例,占8.31%,最终临床确诊前置胎盘76例,占8.90%。经腹超声和经阴道超声完全性前置胎盘、部分性前置胎盘、边缘性前置胎盘、低置胎盘及总前置胎盘检出率相比较差异均无统计学意义(P>0.05)。ROC曲线显示,经腹超声诊断前置胎盘的灵敏度为82.89%,特异性为99.49%,阳性预测值为94.03%,阴性预测值为98.35%,符合度为98.01%,AUC为0.912,95%CI为0.891～0.930;经阴道超声检查诊断前置胎盘的灵敏度为92.11%,特异性为99.87%,阳性预测值98.59%,阴性预测值为99.23%,符合度为99.18%,AUC为0.960,95%CI为0.944～0.972,经阴道超声AUC高于经腹超声,差异有统计学意义(Z=2.868,P=0.0041)。经腹超声及经阴超声双阳性诊断前置胎盘的灵敏度为80.26%,特异性为100%,阳性预测值100%,阴性预测值98.11%,符合度98.24%。经腹超声及经阴超声之一阳性诊断前置胎盘的灵敏度为98.68%,特异性为99.49%,阳性预测值94.94%,阴性预测值99.87%,符合度为99.41%。结论经腹超声和经阴超声均是孕中期胎盘前置的常用检查手段,二者不同方式联合应用有助于胎盘前置的诊断及排除,值得临床推广应用。

Objective To investigate the value of transabdominal ultrasonography in the diagnosis of placenta previa in mid-term pregnancy.Methods 854 pregnant women who were examined in our hospital from January 2017 to September 2017 were selected as subjects.All pregnant women were given transabdominal ultrasound and transvaginal ultrasound examination.The detection rates of placenta previa in transabdominal ultrasound and transvaginal ultrasound were observed.Results 67 cases of placenta previa were de-tected by transabdominal ultrasound,and the detection rate was 7.85%.71 cases were detected by transvaginal ultrasound accounting for 8.31%.In the end,76 cases of placenta previa were clinically diagnosed which accounted for 8.90%.There was no significant difference in the incidence of total placenta previa,partial placenta previa,marginal placenta previa,low placenta and total placenta previa(P>0.05).The ROC curve showed that the sensitivity,specificity,positive predictive value,negative predictive value and coincidence of transabdominal ultrasound in the diagnosis of placenta previa were 82.89%,99.49%,94.03%,98.35%and 98.01%respectively with AUC=0.912,95%CI=0.891C^0.930.The sensitivity,specificity,positive predictive value and nega-tive predictive value of transvaginal ultrasound were 92.11%,99.87%,98.59%,99.23%and 99.18%separately with AUC=0.960,95%CI=0.944~0.972.The AUC of transvaginal ultrasound was higher than that of transabdominal ultrasound and the differ-ence was statistically significant(Z=2.868,P=0.0041).The sensitivity,specificity,positive predictive value and negative predic-tive value of transabdominal ultrasound were 80.26%,100%,100%,98.11%,98.24%respectively.The sensitivity,specifici-ty,positive predictive value and negative predictive value of transvaginal ultrasound were 98.68%,99.49%,94.94%,99.87%and 99.41%respectively.Conclusion Both transabdominal ultrasound and transvaginal ultrasound are the common means of exami-nation of placenta previa in mid-term pregnancy.The combination of the two different ways is helpful in the diagnosis and elimination of placenta previa,which is worthy of clinical application.