产前经腹联合经阴道超声诊断前置胎盘并胎盘植入

Prenatal transabdominal and transvaginal ultrasound in diagnosis of placenta previa with placenta accreta spectrum

目的观察产前经腹联合经阴道超声检查对前置胎盘并胎盘植入的诊断效能。方法回顾性分76例前置胎盘并胎盘植入孕妇产前超声资料,其中39例接受单纯经腹超声检查(经腹检查组)、37例接受经腹联合经阴道超声检查(联合检查组);比较2组诊断胎盘植入准确率,分析联合检查组胎盘植入分型准确率。结果联合检查组产前诊断胎盘植入准确率91.89%(34/37),高于经腹超声检查组[30.77%(12/39),P<0.001]。依据临床分娩所见或分娩后组织病理学结果,联合检查组粘连型胎盘植入0例、植入型6例、穿透型31例;产前超声正确诊断粘连型0例、植入型4例、穿透型13例,将17例穿透型误诊为植入型(16例)或粘连型(1例),漏诊2例植入型、1例穿透型,分型诊断准确率45.95%(17/37)。结论经腹联合经阴道超声检查可显著提高产前诊断前置胎盘并胎盘植入的准确率。

Objective To evaluate the diagnostic efficacy of prenatal transabdominal and transvaginal ultrasonography for placenta previa with placenta accreta spectrum.Methods Data of 76 pregnant women with placenta previa and placenta accreta spectrum were retrospectively analyzed,among them 39 underwent transabdominal ultrasound(transabdominal examination group),while 37 underwent combination of transabdominal and transvaginal ultrasonography(combination group).The diagnostic accuracies of placenta implantation were compared between groups,and classification accuracy of placenta implantation in combination group was calculated.Results The accuracy of prenatal diagnosis of placenta accreta spectrum in combination group was 91.89%(34/37),higher than that in transabdominal ultrasound group(30.77%,P<0.001).According to clinical or histopathology results,among 37 cases in combination group,there were 0 case of placenta accreta,6 cases of placenta increta and 31 of placenta percreta.Combination of transabdominal and transvaginal ultrasonography correctly diagnosed 0 case accreta type,4 cases of increta type and 13 cases of percreta type,misdiagnosed 17 cases of percreta type(16 cases as increta type and 1 case as accreta type),meanwhile missed diagnosis 2 cases of increta type and 1 case of percreta type.The classification accuracy of placenta implantation in combination group was 45.95%(17/37).Conclusion Combination of transabdominal and transvaginal ultrasound could significantly improve the prenatal diagnostic accuracy of placenta previa with placenta accreta spectrum.