超声胎盘植入评分在凶险性前置胎盘术前的评估作用

Application of placenta accreta score by ultrasound for evaluating patients with dangerous placenta previa

目的:探讨超声胎盘植入评分在凶险性前置胎盘术前评估作用。方法:对118例凶险性前置胎盘资料回顾性分析,根据超声胎盘植入评分分组,≤5分组、6~10分组、≥10分组,对各组术中出血、输血量、子宫切除率、住院天数、母儿并发症等情况进行分析。结果:3组孕周、产次及剖宫产次数存在差异(P<0.05),而年龄、孕次、人工流产次数及距上次剖宫产年限未见差异(P>0.05);术中出血量、术中输血量、子宫切除例数、手术持续时间等在≥10分组中最高(P<0.05),急诊手术发生率无差异(P>0.05)。胎盘植入评分值与术中出血量呈正相关(r=0.77,P<0.05)。3组新生儿窒息、住院天数及术后并发症发生率在≥10分组中最高(P<0.05),新生儿体重无差异(P>0.05)。结论:术前超声胎盘植入评分能预测产后出血风险,对减少产后出血及围产期并发症,改善母婴结局起到重要提示作用。

Objective:To investigate the application of placenta accreta score by ultrasound for evaluating the patients with dangerous placenta previa before operation.Methods:The data of 118 women with dangerous placenta previa were retrospectively analyzed.According to placenta accreta score by ultrasound,the included patients were divided into group A(≤5 points),group B(6 10 points),and group C(≥10 points).The volume of intraoperative bleeding and blood transfusion,hysterectomy rate,and hospitalization days,and rate of maternal and infant complication of patients in the three groups were analyzed.Results:There were significant difference in gestational weeks,number of delivery,and number of cesarean section of patients among the three groups(P<0.05),but there were no significant difference in age,number of pregnancy,number of abortion,the rate of emergency operation,newborn weight,and the time interval from the last cesarean section of patients among the three groups(P>0.05).The volume of intraoperative blood loss and intraoperative blood transfusion,the rate of postoperative complication,and operative duration of patients,and number of patients who received hysterectomy,the number of neonatal asphyxia in group C were the highest among the three groups,and the days of hospitalization of patients in group C was also longest(P<0.05).The placenta accreta score was positively correlated with volume of intraoperative blood loss(r=0.77,P<0.05).Conclusion:The preoperative ultrasound placenta accreta score can predict the risk of postpartum hemorrhage.The measures should be conducted for patients with dangerous placenta previa based on individualize evaluation,which can reduce postpartum hemorrhage and perinatal complications,and improve the maternal and infant outcomes.