产前超声征象及高危因素对不伴前置胎盘的胎盘植入性疾病的诊断价值

Diagnostic value of prenatal ultrasound signs and high-risk factors for placenta accreta spectrum without placenta previa

目的探讨产前超声征象及高危因素在不伴前置胎盘的胎盘植入性疾病(PAS)诊断中的临床应用价值。方法回顾性分析于我院规范产检并经临床或病理诊断的8例不伴前置胎盘的PAS患者资料,对其产前典型超声征象、高危因素及妊娠结局进行总结分析。结果8例不伴前置胎盘的PAS患者中,6例有剖宫产史(其中5例有宫腔操作史),2例无剖宫产史(均有宫腔操作史);6例产前超声提示胎盘植入,2例产前超声漏诊;胎盘粘连3例,胎盘植入4例,胎盘穿透1例;7例发生产后大出血(出血量≥1000 ml),1例产后出血量800 ml;1例行子宫全切术,7例保留子宫。6例产前超声发现胎盘植入的典型征象,均存在子宫-膀胱交界面异常,主要表现为子宫肌层变薄、胎盘后方低回声带消失,其中3例存在胎盘陷窝及子宫-膀胱交界面桥接血管;2例产前超声未检出胎盘植入典型征象。结论产检过程中将高危因素的筛查与PAS产前超声筛查规范相结合,应用二维灰阶超声和彩色多普勒超声全面扫查胎盘对不伴前置胎盘的PAS的诊断具有重要的临床价值。

Objective To investigate the clinical application value of prenatal ultrasound signs and high-risk factors in the diagnosis of placenta accreta spectrum(PAS)without placenta previa.Methods A retrospective analysis was performed on 8 PAS patients without placenta previa diagnosed clinically or pathologically in our hospital.The typical prenatal ultrasound signs,risk factors and pregnancy outcomes were summarized and analyzed.Results Among the 8 PAS patients without placenta previa,6 had a history of cesarean section(5 of them had a history of intrauterine operation),and 2 had no history of cesarean section(all had a history of intrauterine operation).Prenatal ultrasound suggested placenta accreta in 6 cases,and missed diagnosis in 2 cases.There were 3 cases of placenta accreta,4 cases of placenta accreta and 1 case of placenta percreta.Postpartum hemorrhage occurred in 7 cases(≥1000 ml)and in 1 case(800 ml).1 patient underwent total hysterectomy,and 7 patients retained uterus.The typical ultrasound signs of placenta accreta were found in 6 cases during prenatal screening and all of them had abnormal uterine-bladder interface,mainly manifested by thinning of the myometrium,disappearance of hypoechoic cords behind the placenta,and three of them had placental lacunae and bridging vessels at the uterine-bladder interface.No typical signs of placenta accreta were detected in 2 cases.Conclusion In the process of prenatal examination,the combination of screening of high-risk factors with the prenatal ultrasound screening standards for PAS and the application of two-dimensional gray scale ultrasound and color Doppler ultrasound is of great value in the diagnosis of PAS without placenta previa.