超声检测子宫弓状动脉及脐动脉血流对前置胎盘合并胎盘植入的诊断价值

Ultrasound detection of uterine arcuate artery and umbilical artery blood flow in the diagnosis of placenta previa with accreta

目的评价孕中期超声检测子宫弓状动脉及脐动脉血流参数用于诊断前置胎盘合并胎盘植入的临床价值。方法以自2017年5月至2019年5月于诸暨市人民医院定期接受产检并终止妊娠的前置胎盘合并胎盘植入患者80例及同期健康妊娠期女性80例为研究对象,通过彩色多普勒超声分别检测子宫弓状动脉血流搏动指数(PI)、阻力指数(RI)、收缩期峰值流速(PSV)和脐动脉血流PI、RI、收缩期与舒张期流速比值(S/D)等参数,观察研究对象胎盘后血流状况,分析子宫弓状动脉和脐动脉血流相关参数与前置胎盘合并胎盘植入的相关性。结果前置胎盘合并胎盘植入组子宫弓状动脉血流PI和RI分别为(0.45±0.12)和(0.38±0.08),均显著低于正常妊娠组的(0.59±0.17)和(0.46±0.11),而子宫弓状动脉血流PVS和脐动脉血流PI、RI、S/D分别为(45.13±4.62)、(1.16±0.27)、(0.73±0.22)和(3.32±0.31),均显著高于正常妊娠组的(34.27±3.82)、(0.79±0.21)、(0.52±0.13)和(2.71±0.24)(t=3.057~9.241,均P<0.05)。前置胎盘合并胎盘植入组胎盘后可见丰富且混乱血流信号的比例[91.25%(73/80)]显著高于正常妊娠组[86.25%(69/80)](χ^(2)=96.341,P<0.01)。妊娠期子宫弓状动脉血流PI和RI检测数值均与前置胎盘合并胎盘植入的发生呈负相关(r=-0.742、-0.716,均P<0.05),而子宫弓状动脉血流PVS和脐动脉血流PI、RI、S/D检测数值均与前置胎盘合并胎盘植入的发生呈正相关性(r=0.759~0.885,均P<0.01)。结论超声检测妊娠期女性子宫弓状动脉和脐动脉血流参数,并观察胎盘后血流状况,对前置胎盘合并胎盘植入具有一定的诊断价值,妇科临床应予以关注。

Objective To investigate the clinical value of ultrasound detection of uterine arcuate artery and umbilical artery blood flow parameters measured by ultrasound imaging during the second trimester of pregnancy in the diagnosis of placenta previa with accreta.Methods Eighty patients with placenta previa with accreta who received regular prenatal examination and terminated pregnancy from May 2017 to May 2019 in Zhuji People's Hospital and 80 healthy pregnant women were included in this study.Uterine arcuate artery and umbilical artery blood flow parameters pulsatility index(PI),resistance index(RI),peak systolic velocity(PSV),umbilical artery blood flow PI and RI,ratio of peak systolic to diastolic flow velocity(S/D)were measured by color Doppler ultrasound.Uterine arcuate artery and umbilical artery blood flow parameters were correlated with the occurrence of placenta previa with accreta.Results Uterine arcuate artery PI and RI in patients with placenta previa with accreta were(0.45±0.12)and(0.38±0.08),which were significantly lower than(0.59±0.17)and(0.46±0.11)in healthy pregnant women.In patients with placenta previa with accreta,uterine arcuate artery PVS and umbilical artery blood flow parameters PI,RI,and S/D were(45.13±4.62),(1.16±0.27),(0.73±0.22)and(3.32±0.31),respectively,which were significantly higher than those in healthy pregnant women[(34.27±3.82),(0.79±0.21),(0.52±0.13)and(2.71±0.24),t=3.057-9.241,all P<0.01].The proportion of placenta previa with previa patients exhibiting abundant and chaotic blood flow signals was significantly higher than that in healthy pregnant women[91.25%(73/80)vs.86.25%(69/80),χ^(2)=96.341,P<0.01].Uterine arcuate artery blood flow parameters PI and RI were negatively correlated with the occurrence of placenta previa with previa(r=-0.742,-0.716,both P<0.05).Uterine arcuate artery blood parameter PVS and umbilical artery blood flow parameters PI,RI and S/D were positively correlated with the occurrence of placenta previa with previa(r=0.759-0.885,all P<0.01).Conclusion Ultrasound detection of uterine arcuate artery and umbilical artery blood flow parameters and monitoring blood flow changes in pregnant women have a great value in the diagnosis of placenta previa with accreta,which needs more attention in the gynecological clinic.