改良胎盘超声评分量表对胎盘植入诊断价值的研究

Comparative study on the diagnostic value of modified prenatal ultrasound placenta scale for placenta accreta

目的探讨改良产前胎盘超声评分量表对胎盘植入的诊断价值。方法产前进行超声胎盘评分产妇共144例,按照产后病理和临床诊断分为植入组(植入组又分为粘连型、植入型、穿透型)和非植入组,按改良产前胎盘超声评分量表评分,绘制ROC曲线计算界值,应用特异性、敏感性、阳性预测值、阴性预测值、产后诊断符合率等指标对比分析改良评分法和种氏评分法两种方法对胎盘植入不同类型的诊断效能。结果按改良后产前胎盘超声评分量表,>2分为粘连型胎盘植入;>4分为重型胎盘植入,其中>4分为植入型胎盘植入,>9分为穿透型胎盘植入,即3~4分粘连型可能(敏感度95.0%、特异度73.2%),5~9分植入型可能(敏感度93.2%、特异度75.0%),10分及以上穿透型可能(敏感度100%、特异度97.7%)。改良产前胎盘超声评分量表对胎盘植入各类型产前诊断的敏感度、特异度、阳性预测值、阴性预测值及产后符合率均明显优于原产前胎盘超声评分量表(P<0.05)。结论改良产前胎盘超声评分量表更加合理,能够更好地为临床服务。

Objective To explore the diagnostic value of modified antenatal placental ultrasound scale in placental accreta.Methods A total of 144 parturients with placental ultrasound score were divided into two groups according to postpartum pathology and clinical diagnosis,including implantation group(implantation group was divided into adhesive group,implantable group and penetrating group)and non-implantable group.The ROC curve was drawn to calculate the boundary value,and the diagnostic efficacy of the two methods in different types of placental implantation was compared and analyzed from the aspects of specificity,sensitivity,positive predictive value,negative predictive value and the coincidence rate of postpartum diagnosis.Results According to the modified antenatal placental ultrasound rating scale,>2 was divided into adhesive placenta accreta,>4 was divided into severe placental implantation,>4 was accretive placenta accreta,>9 was penetrating placental implantation,that is to say,3 to 4 points were more likely to placenta adhesion(sensitivity 95.0%,specificity 73.2%),5 to 9 points were more likely to placental implantation(sensitivity 93.2%,specificity 75.0%),and 10 points or more were more likely to penetrate(sensitivity 100%,specificity 99.7%).The sensitivity,specificity,positive predictive value,negative predictive value and postpartum coincidence rate of the modified antenatal placental ultrasound scale for the diagnosis of placental implantation were significantly better than those of the preterm placental ultrasound scale(P<0.05).Conclusion The modified antenatal placental ultrasound score scale is more scientific and reasonable,and can serve the clinic better.