经腹联合经阴道超声在孕晚期孕妇前置胎盘诊断中的应用效果

Application effect of abdominal and transvaginal ultrasound in the diagnosis of placenta previa in late pregnant women

目的探析经腹超声、经阴道超声在孕晚期孕妇前置胎盘诊断中的应用效果。方法共选择我院妇产科就诊的疑似80例孕晚期前置胎盘孕妇,就诊时间为2020年1月至2023年12月,孕妇均接受经腹超声、经阴道超声两种检查方式,以手术结果作为金标准,统计不同诊断方式(单一诊断、联合诊断)下诊断不同分型前置胎盘的诊断结果、诊断效能以及受试者工作特征(ROC)曲线分析结果。结果80例疑似患者中,前置胎盘患者71例,非前置胎盘患者9例。手术诊断不同分型的前置胎盘结果为:完全型25例、部分型18例、边缘型14例、低置胎盘14例;经腹部超声诊断不同分型的前置胎盘符合率分别为:完全型80.0%、部分型88.9%、边缘型71.4%、低置胎盘57.1%;经阴道超声诊断不同分型的前置胎盘符合率分别为:完全型96.0%、部分型88.9%、边缘型78.6%、低置胎盘42.9%;联合诊断不同分型的前置胎盘符合率分别为:完全型100%、部分型100%、边缘型92.9%、低置胎盘85.7%。联合诊断低置胎盘的符合率明显高于单一诊断方式(P<0.05),联合诊断在部分型、边缘型前置胎盘的符合率高于经腹部超声(P<0.05)。经腹超声单一诊断的灵敏度、特异度、准确度分别为69.0%(49/71)、44.4%(4/9)、66.3%(53/80),经阴道超声单一诊断的灵敏度、特异度、准确度分别为71.8%(51/71)、33.3%(3/9)、71.3%(54/80),联合诊断的灵敏度、特异度、准确度分别为94.4%(67/71)、67.5%(8/9)、93.8%(75/80),联合诊断孕晚期孕妇前置胎盘的灵敏度、特异度以及准确度明显高于经腹超声、经阴道超声(P<0.05)。ROC曲线分析显示,经腹超声、经腹超声联合诊断的曲线下面积高于单一诊断的曲线下面积(P<0.05)。结论经腹超声、经阴道超声联合诊断方式在孕晚期孕妇低置胎盘诊断中的诊断符合率较高,其灵敏度、特异度以及准确度较单一诊断方式更高,更有助于临床医师进行病情诊断。

Objective To explore the application effect of transabdominal ultrasound and transvaginal ultrasound in the diagnosis of placenta previa in late pregnant women.Methods A total of 80 suspected late pregnancy placenta previa pregnant women who visited our obstetrics and gynecology department from January 2020 to December 2023 were selected.All pregnant women underwent two examination methods,transabdominal ultrasound and transvaginal ultrasound.The delivery results were used as the gold standard to statistically analyze the diagnostic results,diagnostic efficacy,and ROC curve analysis results of different types of placenta previa under different diagnostic methods(single diagnosis,combined diagnosis).Results Among the 80 suspected patients,there were 71 patients with placenta previa and 9 patients without placenta previa.The surgical diagnosis of different subtypes of placenta previa resulted in 25 cases of complete placenta previa,18 cases of partial placenta previa,14 cases of marginal placenta previa,and 14 cases of placenta previa with low placenta previa;The diagnostic accuracy of different subtypes of placenta previa by abdominal ultrasound was 80.0%for complete placenta previa,88.9%for partial placenta previa,71.4%for marginal placenta previa,and 57.1%for low placenta previa;The diagnostic accuracy of different subtypes of placenta previa using transvaginal ultrasound was 96.0%for complete placenta previa,88.9%for partial placenta previa,78.6%for marginal placenta previa,and 42.9%for low placenta previa.The coincidence rates of different subtypes of placenta previa for joint diagnosis are:complete type 100%,partial type 100%,marginal type 92.9%,and low placenta 85.7%.The conformity rate of combined diagnosis of placenta previa is significantly higher than that of single diagnostic method(P<0.05),and the conformity rate of combined diagnosis of partial and marginal placenta previa is higher than that of transabdominal ultrasound(P<0.05).The sensitivity,specificity,and accuracy of single diagnosis using transabdominal ultrasound were 69.0%(49/71),44.4%(4/9),and 66.3%(53/80),respectively.The sensitivity,specificity,and accuracy of single diagnosis using transvaginal ultrasound were 71.8%(51/71),33.3%(3/9),and 71.3%(54/80),respectively.The sensitivity,specificity,and accuracy of combined diagnosis were 94.4%(67/71),67.5%(8/9),and 93.8%(75/80),respectively.The sensitivity,specificity,and accuracy of combined diagnosis of placenta previa in late pregnant women were significantly higher than those of transabdominal ultrasound and transvaginal ultrasound(P<0.05).ROC curve analysis showed that the area under the curve of transabdominal ultrasound and transabdominal ultrasound combined diagnosis was higher than that of single diagnosis(P<0.05).Conclusion The combined diagnostic methods of transabdominal ultrasound and transvaginal ultrasound have a higher diagnostic accuracy in the diagnosis of low placenta in late pregnancy.Their sensitivity,specificity,and accuracy are higher than those of a single diagnostic method,which is more helpful for clinical physicians to diagnose the condition.