产前三维能量多普勒超声预测前置胎盘患者剖宫产术中出血量

Antenatal 3D power Doppler ultrasound in predicting bleeding volume in patients with placenta previa undergoing cesarean surgery

目的探讨三维能量多普勒超声(3D-PDU)预测前置胎盘患者剖宫产术中出血量的价值。方法回顾性分析141例前置胎盘患者产前3D-PDU检查结果及其剖宫产术中出血量等资料,其中植入性前置胎盘组66例,非植入性前置胎盘组75例,比较2组间血管指数(VI)、血流指数(FI)和血管血流指数(VFI)和剖宫产术中出血量的差异,分析其相关性,并采用ROC曲线评价各参数预测术中出血量的效能。结果植入性前置胎盘组产前VI、FI、VFI和术中出血量均大于非植入性前置胎盘组(P均<0.05)。141例前置胎盘患者中,产前VI和VFI与剖宫产术中出血量均成正相关(r=0.702、0.737,P均<0.001)。植入性前置胎盘组中,VI、FI及VFI均与剖宫产术中出血量呈正相关(r=0.680、0.492、0.722,P均<0.001);非植入性前置胎盘组中,VI、VFI与剖宫产术中出血量呈正相关(r=0.861、0.832,P均<0.001)。141例前置胎盘患者VI、FI和VFI的ROC曲线AUC分别为0.911、0.798、0.937(P均<0.001);植入性前置胎盘组为0.966、0.722、0.938(P均<0.05);非植入性前置胎盘组为0.885、0.856、0.966(P均<0.001)。结论产前3D-PDU可用于预测前置胎盘患者剖宫产术中出血量。

Objective To explore the value of three-dimensional power Doppler ultrasound (3D-PDU) in predicting bleeding volume during cesarean surgery in patients with placenta previa.Methods Clinical data of 141 patients with placenta previa who underwent 3D-PDU examinations before cesarean surgery and the bleeding volume during cesarean surgery were retrospectively reviewed.The patients were classified into implanted placenta previa group (n=66) and non-implanted placenta previa group (n=75).The differences of vascularization index (VI),flow index (FI),vascularization flow index (VFI) and bleeding volume were compared between the 2 groups,and the correlation was analyzed.ROC curve was used to evaluate the efficacy of each index in predicting bleeding volume during cesarean surgery.Results Antenatal VI,FI,VFI and bleeding volume of the implanted placenta previa group were higher than those of non-implanted placenta previa group (all P<0.05).In all 141 patients,VI and VFI were positively correlated with the bleeding volume during cesarean surgery (r=0.702,0.737,both P<0.001).In implanted placenta previa group,VI,FI and VFI were positively correlated with the bleeding volume in cesarean section (r=0.680,0.492,0.722,all P<0.001).In non-implanted placenta previa group,VI and VFI were positively correlated with the bleeding volume during cesarean surgery (r=0.861,0.832,both P<0.001).The area under ROC curve of VI,FI and VFI in all 141 patients were 0.911,0.798 and 0.937 (all P<0.001),in implanted placenta previa group were 0.966,0.722 and 0.938 (all P<0.05),while in non-implanted placenta previa group were 0.885,0.856 and 0.966,respectively (all P<0.001).Conclusion Antenatal 3D-PDU can be applied in predicting bleeding volume in patients with placenta previa during cesarean surgery.