双绒毛膜双胎之一胎盘植入性疾病临床及超声征象分析(附7例报道)

Clinical and ultrasonographic signs of single placenta accreta spectrum in dichorionic twins:a report of seven cases

目的探讨双绒毛膜双胎之一胎盘植入性疾病(placenta accreta spectrum,PAS)的高危因素及产前超声征象。方法回顾性选取2013年1月至2023年4月首都医科大学附属北京妇产医院双绒毛膜双胎之一PAS患者7例,总结患者临床资料及超声声像图特点。结果7例患者年龄31~52岁,中位年龄37岁,均合并3种及以上高危因素。4例产前经超声诊断PAS,存在胎盘植入的典型征象,3例产前超声漏诊,均无剖宫产手术史;4例双活胎,经剖宫产分娩,3例双胎之一胚胎停育;2例术中出血量为8000 ml及3500 ml,行全子宫切除术,余5例保留子宫。结论双绒毛膜双胎妊娠孕妇合并前置胎盘、剖宫产史、高龄及体外受精-胚胎移植等高危因素时,发生PAS的风险增高。规范产前超声检查可提高双绒毛膜双胎之一PAS早期检出率,改善妊娠结局。

Objective To explore the high risk factors of placenta accreta spectrum(PAS)in one of the dichorionic twins and to evaluate the diagnostic value of prenatal ultrasonography sighs.Methods A total of seven patients with PAS in one of the dichorionic twin pregnancies in Beijing Obstetrics and Gynecology Hospital,Capital Medical University from January 2013 to April 2023 were selected retrospectively,and their clinical data and ultrasonic features were summarized.Results The age of seven patients ranged from 31 to 52 years old,with a median age of 37 years old,all of which were complicated with more than three high-risk factors.Four cases of PAS were diagnosed by ultrasound before delivery,and there were typical signs of placenta accreta.Three cases were missed by ultrasound before delivery,and none of them had any history of cesarean section.Four cases of twins were delivered by cesarean section,and three cases of twins were aborted.Two cases suffered from intraoperative bleeding of 8000 ml and 3500 ml,and underwent total hysterectomy,while the other five cases kept their uterus.Conclusions When pregnant women with dichorionic twins are complicated with placenta previa,cesarean section history,old age and in vitro fertilization-embryo transfer,the risk of PAS increases.Standardized prenatal ultrasound examination can improve the early detection rate of PAS in one of the dichorionic twins,and improve the pregnancy outcome.