超声诊断剖宫产瘢痕妊娠与胎盘植入的关系研究

Relationship between ultrasound diagnosis of cesarean section scar pregnancy and placenta implantation

目的探讨超声诊断剖宫产瘢痕妊娠与胎盘植入的关系。方法回顾性分析2016~2017年经承德医学院附属医院确诊为剖宫产瘢痕妊娠的20例孕妇的临床资料,根据瘢痕妊娠超声图像将其分为低风险组(10例)和高风险组(10例),观察其不同孕期超声图像特点及胎盘植入情况,比较两组胎盘植入情况及妊娠结局。结果 20例剖宫产瘢痕妊娠患者在超声复查中,于孕9~24周经超声诊断17例为胎盘植入,经病理确诊19例为胎盘植入,超声诊断敏感性为89.47%。19例胎盘植入孕妇中,1例为胎盘粘连,14例为胎盘植入,4例为胎盘穿透,子宫切除低风险组(1例)与高风险组(2例)比较差异无统计学意义(P>0.05);胎盘穿透低风险组(0例)少于高风险组(4例),活产儿(9例)多于高风险组(4例),两组比较差异有统计学意义(P<0.05)。结论剖宫产瘢痕妊娠者在中晚孕期发展为胎盘植入的风险高,超声诊断剖宫产瘢痕妊娠分型可预估妊娠结局,对有继续妊娠意愿的剖宫产瘢痕妊娠孕妇提供参考依据。

Objective To investigate the relationship between ultrasound diagnosis of cesarean section scar pregnancy and placenta implantation.Methods Retrospective analysis of the clinical data of 20 patients diagnosed as cesarean scar pregnancy and selected to continue pregnancy from 2016 to 2017 in Affiliated Hospital of Chengde Medical University.According to the patients’scar pregnancy ultrasound image,they were divided into low-risk group(10 cases)and high-risk group(10 cases),the characteristics of ultrasound images and pregnancy implantation during different pregnancy were observed,and the placenta implantation and pregnancy outcomes of the two groups were compared.Results Of the 20 patients with cesarean scar pregnancy,17 cases were diagnosed as placenta implantation by ultrasound at 9~24 weeks of pregnancy.And 19 cases were confirmed by pathological diagnosis.The sensitivity of ultrasound diagnosis was 89.47%.Of the 19 patients with placenta implantation,1 had placental adhesions,14 had placenta implantation,and 4 had placental penetration.There were no significant differences in hysterectomy between the low-risk group and the high-risk group(P>0.05).The placental penetration in low risk group(0 cases)was less than the high risk group(4 cases),and the live births(9 cases)were more than the high risk group(4 cases).The difference between the two groups was statistically significant(P<0.05).Conclusion The risk of placental implantation in cesarean section scar pregnancy is high in the middle and late pregnancy.Ultrasound diagnosis of cesarean section scar pregnancy classification can predict pregnancy outcome,and provide reference for pregnant women with cesarean scar pregnancy who have the willingness to continue pregnancy.