凶险性前置胎盘临床特点及产前超声联合MRI的诊断价值

Clinical Characteristics of Pernicious Placenta Previa and Diagnostic Value of Prenatal Ultrasound Combined with MRI

目的探究凶险性前置胎盘(PPP)临床特点及产前超声联合磁共振成像(MRI)的诊断价值。方法选取2019年1月至2021年7月我院收治疑似PPP的130例患者作为研究对象,所有患者产前均进行彩色多普勒超声和MRI,以手术及病理诊断结果为“金标准”,比较彩色多普勒超声、MRI、彩色多普勒超声联合MRI的诊断价值,分析PPP患者的临床特点。结果手术或病理诊断结果显示130例孕妇中有80例确诊为PPP,超声诊断PPP的敏感度为87.50%,特异度为82.00%,阳性预测值为88.61%,阴性预测值为80.39%,Kappa值为0.692;MRI诊断PPP的敏感度为85.00%,特异度为86.00%,阳性预测值为90.67%,阴性预测值为78.18%,Kappa值为0.697;超声联合MRI诊断PPP的敏感度为95.00%,特异度为80.00%,阳性预测值为88.37%,阴性预测值为90.91%,Kappa值为0.767;PPP孕妇和正常孕妇年龄比较差异无统计学意义(P>0.05),PPP孕妇组流产史、剖宫产次数、剖宫产比例、产前出血、输血、产后出血量均明显高于正常孕妇组(P<0.05)。结论超声联合MRI在PPP的诊断方面有较好一致性,高于单独应用超声或MRI检查,PPP患者不良妊娠结局风险较大,临床需给予早期诊断干预,改善妊娠结局。

Objective To explore the clinical characteristics of pernicious placenta previa(PPP)and the diagnostic value of prenatal ultrasound combined with magnetic resonance imaging(MRI).Methods 130 patients with suspected PPP treated in the hospital between January 2019 and July 2021 were selected as the research subjects.All patients underwent color Doppler ultrasound and MRI before delivery.The results of surgery and pathological diagnosis were taken as the gold standard to compare the diagnostic value of color Doppler ultrasound,MRI and color Doppler ultrasound combined with MRI,and the clinical characteristics of patients with PPP were analyzed.Results The results of surgery or pathological diagnosis showed that 80 of the 130 pregnant women were diagnosed with PPP.The sensitivity,specificity,positive predictive value,negative predictive value and Kappa value were 87.50%,82.00%,88.61%,80.39%and 0.692 of ultrasound in the diagnosis of PPP,and were 85.00%,86.00%,90.67%,78.18%and 0.697 of MRI for diagnosing PPP,and were 95.00%,80.00%,88.37%,90.91%and 0.767 of ultrasound combined with MRI for diagnosing PPP.There was no statistical significance in age between pregnant women with PPP and normal pregnant women(P>0.05),and the abortion history,frequency of cesarean section,proportion of cesarean section,prenatal hemorrhage,blood transfusion and postpartum hemorrhage in pregnant group with PPP were significantly higher than those in normal pregnant women(P<0.05).Conclusion Ultrasound combined with MRI has a good consistency in the diagnosis of PPP,which is higher than the use of ultrasound or MRI alone.The risk of adverse pregnancy outcomes in patients with PPP is higher.Early clinical diagnosis and intervention are needed to improve pregnancy outcomes in clinical practice.