经阴道3D-US绘制“交叉征”预测CSP与胎盘植入分型的相关性

The Crossover Sign by Transvaginal 3D-US to Predict Morbidly Adherent Placenta in Cesarean Scar Pregnancy

目的:探索经阴道三维超声(3D-US)绘制"交叉征"预测疤痕妊娠(CSP)与病理性胎盘植入(MAP)分型的关系。方法:回顾性分析30例经手术记录、产后记录或组织病理确诊为MAP的孕妇,调取孕妇孕早期(6-8孕周)经阴道3D-US图像,通过绘制A线与B线分析CSP妊娠囊、子宫前壁和剖宫产瘢痕间的关系,并由此定义COS类型,分析不同类型COS与MAP发生的相关性。结果:COS-1发展为穿透性MAP的风险是COS-2的8倍(95%CI:1.1~148.4;P=0.034);COS-2进一步分为COS-2a(18例)和COS-2b(4例),COS-1发展为穿透性MAP的风险明显高于COS-2a和COS-2b,OR值分别约10.4(95%CI:5.2~162.9;P=0.038)和12(95%CI:3.8~151.4;P=0.046);与COS-2a相比,COS-2b发展为胎盘粘连的风险更高(OR=4.71,95%CI,1.3~41.7;P=0.039)。Logistic回归分析发现COS-1是穿透性MAP的独立相关因素[OR=12.05 (95%CI, 2.0~51.0)],而且COS-2b是胎盘粘连的独立相关因素[OR=3.17,(95%CI:1.1~15.0)]。结论:经阴道3D-US绘制COS可作为预测CSP是否进展为MAP严重型的一种有效手段,为CSP的管理提供重要的参考依据。

Purpose:To explore the crossover sign(COS)by transvaginal three-dimensional ultrasonography(3 D-US) to predict morbidly adherent placenta(MAP) in cesarean scar pregnancy(CSP). Methods: This was a retrospective analysis of early first-trimester(6~8 weeks’ gestation) transvaginal 3 D-US images in thirty women with MAP. The A line and B line was draw to defined as COS and then the association between different types of COS and the occurrence of MAP was analyzed. Results:The risk of placenta percreta was eight times higher in pregnancies with COS-1 than in those with COS-2((95% CI:1.1~148.4);P=0.034).COS-2 cases were further divided into COS-2 a(18 cases) and COS-2 b(4 cases),the risk of placenta percreta was significantly higher in pregnancies with COS-1 than in pregnancies with COS-2 a [OR,10.4(95% CI, 1.3–33.3);P=0.038] and higher than in those with COS-2 b[OR,12(95% CI,3.8~151.4);P=0.046].Logistic regression analysis showed that COS-1 was associated independently with severe forms of MAP(OR,12.05(95% CI, 2.0~51.0)), while COS-2 b was associated independently with placenta accreta [OR,3.17(95% CI, 1.1~15.0)]. Conclusion: The transvaginal 3 D-US assessment of COS can be used as an effective method to predict whether CSP would progresses to severe type of MAP, and thus providing an important reference for the management of CSP.