凶险性前置胎盘合并胎盘植入的超声诊断价值

Ultrasound diagnostic value of pernicious placenta previa with placenta accreta

目的探讨超声诊断凶险性前置胎盘(PPP)合并胎盘植入的临床价值。方法选取南京市妇幼保健院2020年1月至2022年6月收治的86例PPP患者作为研究对象,根据产后病理学结果将其分为植入组(42例)、对照组(44例)。比较两组超声声像特征、超声评分及妊娠结局;绘制受试者操作特征曲线评估超声评分诊断PPP孕妇发生胎盘植入的诊断价值。结果植入组产前子宫肌层变薄≤2.0 cm、胎盘增厚>5.0 cm、胎盘后间隙消失、子宫肌层弓状动脉排列紊乱、子宫浆膜层与膀胱交界处血管排列紊乱、子宫下段膨隆、宫颈膨大、宫颈管胎盘覆盖处血流丰富占比高于对照组(P<0.05)。植入组子宫超声评分高于对照组(P<0.05)。超声评分诊断PPP孕妇发生胎盘植入的截断值为7.6分,曲线下面积为0.877(95%CI:0.832~0.927,P<0.001),灵敏度为85.78%,特异度为78.40%,约登指数为0.64。植入组分娩出血量高于对照组,子宫切除、新生儿黄疸、新生儿窒息、新生儿死亡发生率高于对照组(P<0.05)。结论超声声像特征、超声评分对于产前诊断PPP孕妇发生胎盘植入具有较高的临床价值,PPP孕妇发生胎盘植入会显著增大不良妊娠结局的发生率。

Objective To investigate the clinical value of ultrasonography in the diagnosis of pernicious placenta previa(PPP)with placenta accreta.Methods A total of 86 cases with PPP patients admitted to Nanjing Women and Children’s Healthcare Hospital from January 2020 to June 2022 were selected.According to the postpartum pathology results,they were divided into implantation group(42 cases)and control group(44 cases).The ultrasonographic characteristics,ultrasound score,and pregnancy outcome were compared between two groups;receiver operating characteristic curve was drawn to evaluate the diagnostic value of ultrasound score in PPP pregnant women with placenta accreta.Results The proportion of the thinning of myometrium≤2.0 cm,thickening of placenta>5.0 cm,absence of postplacental space,disordered arrangement of arcuate artery of myometrium,disordered arrangement of vessels at the junction of serous layer and bladder,distension of lower uterine segment,cervical enlargement,and rich blood flow in the placenta covering of cervical canal in the implantation group were higher than those in control group(P<0.05).Prenatal ultrasound scores in implantation group were higher than those in control group(P<0.05).The cut-off value of ultrasound score for the diagnosing placenta of placenta accreta in pregnant women was 7.6 points,and the area under the curve was 0.877(95%CI:0.832-0.927,P<0.001),the sensitivity was 85.78%,the specificity was 78.40%,and the Joaden index was 0.64.Delivery bleeding in implantation group was higher than that in control group,the incidence of hysterectomy,neonatal jaundice,neonatal asphyxia,and neonatal death were higher than those in control group(P<0.05).Conclusion Ultrasonographic characteristics and ultrasound scores have high clinical value in prenatal diagnosis of placenta accreta in PPP pregnant women.Placenta accreta in PPP pregnant women will significantly increase the incidence of adverse pregnancy outcomes.