Objective:?The study’s objective was to assess the accuracy of using prenatal 3-dimensional power Doppler analysis of vascular placental indices to accurately diagnose morbidly adherent placenta objectively. Backgrou...Objective:?The study’s objective was to assess the accuracy of using prenatal 3-dimensional power Doppler analysis of vascular placental indices to accurately diagnose morbidly adherent placenta objectively. Background:?Traditionally, 2D ultrasound was used for the diagnosis of a suspected morbidly adherent placenta (MAP) previa. More objective techniques like 3D power Doppler haven’t been well studied. Study Design:?A prospective cohort study?is?designed for women with gestational age between 28 and?32 weeks with suspected placenta previa. Patients were examined by 2D ultrasound which was used in management decisions.?3D Power Doppler’s VI, FI and VFI were measured during the same examination after manual tracing of placenta;data were blinded to obstetricians. Histopathology was performed to confirm MAP. Results: Our results showed that the 3D power Doppler VI ≥ 16 predicted the diagnosis of MAP with 100% sensitivity, 100% specificity which is better than those of 2D ultrasound. While VI > 33.1 measured by 3D Doppler predicted severe MAP with a sensitivity of 73.9% and specificity of 86.4%, which was superior to 2D ultrasound. Conclusion:?In patients with placenta previa, the 3D Doppler’s vascular index accurately predicts MAP. Furthermore, vascular and vascular flow indices of 3D Doppler were more predictive of severe cases of MAP compared to 2D ultrasound.展开更多
目的系统评价剖宫产术中不同时机行血管介入阻断对凶险性前置胎盘患者及胎儿的影响。方法采用计算机检索PubMed、Embase、Medline、Web of Science、维普、万方数据库、中国知网、中国生物医学文献数据库等中不同时机行血管介入阻断对...目的系统评价剖宫产术中不同时机行血管介入阻断对凶险性前置胎盘患者及胎儿的影响。方法采用计算机检索PubMed、Embase、Medline、Web of Science、维普、万方数据库、中国知网、中国生物医学文献数据库等中不同时机行血管介入阻断对凶险性前置胎盘的相关研究。检索时限为建库至2024年3月1日,由两名研究员独立筛选随机对照或回顾性文献、提取数据,选用Review Manager 5.4.1软件分析,参照Cochrane协作网提供的偏倚风险评估工具对文献质量进行评估。结果共纳入12篇目标文献,1030例凶险性前置胎盘患者。Meta分析结果显示,胎儿娩出前阻断可降低术后子宫切除率(OR=0.54,95%CI:0.33~0.89)和术后入住ICU病房率(OR=0.34,95%CI:0.19~0.63),但不能降低序贯子宫动脉栓塞率(OR=0.61,95%CI:0.28~1.32)。此外,对胎儿1 min Apgar评分(MD=0.11,95%CI:-0.23~0.46)、5 min Apgar评分(MD=0.10,95%CI:-0.04~0.24)、1 min Apgar评分≤7分(OR=0.81,95%CI:0.36~1.85)、5 min Apgar评分≤7分(OR=0.93,95%CI:0.33~2.63)无明显影响。结论胎儿娩出前介入阻断的临床价值更高,且不会增加胎儿不良结局。展开更多
目的:评估三维能量多普勒血管成像技术(three-dimensional power doppler angiography,3D-PDA)判断脐带附着位置及相关并发症的应用价值。方法:选取2010年1月至2012年6月中孕早期及中孕期在我院超声科检查并经二维彩色多普勒超声可疑为...目的:评估三维能量多普勒血管成像技术(three-dimensional power doppler angiography,3D-PDA)判断脐带附着位置及相关并发症的应用价值。方法:选取2010年1月至2012年6月中孕早期及中孕期在我院超声科检查并经二维彩色多普勒超声可疑为脐带异常附着160例,应用3D-PDA进一步检测其脐带附着情况,并对各病例进行随访、追踪,产后留取新鲜、完整胎盘及脐带,明确脐带附着情况。结果:160例病例中,产后大体病理确诊球拍状胎盘(脐带边缘附着)113例,帆状胎盘20例,副胎盘5例,共138例。3D-PDA诊断脐带附着异常共136例,除2例脐带边缘附着漏诊外其余分型与产后病理结果一致。结论:3D-PDA能准确、直观显示脐带附着点及其附近脐血管的走行情况,在脐带边缘附着、帆状附着、血管前置的诊断方面有重要作用。展开更多
目的探讨色素上皮衍生因子(PEDF)对胎盘位置附着异常中胎盘微血管床形成的影响。方法选择2014年6月至2015年8月我院剖宫产分娩的孕妇48例,其中胎盘植入(PA组)16例,前置胎盘(PP组)16例,对照组16例。胎盘进行病理学检查,免疫组化检测三组...目的探讨色素上皮衍生因子(PEDF)对胎盘位置附着异常中胎盘微血管床形成的影响。方法选择2014年6月至2015年8月我院剖宫产分娩的孕妇48例,其中胎盘植入(PA组)16例,前置胎盘(PP组)16例,对照组16例。胎盘进行病理学检查,免疫组化检测三组胎盘组织的MVD;RT-PCR及Western Blot检测胎盘组织中PEDF和VEGF的m RNA和蛋白质表达。结果①三组胎盘组织中PEDF及VEGF蛋白含量、PEDF及VEGF m RNA含量及MVD比较,差异均有统计学意义(P<0.05)。②胎盘中PEDF与VEGF、MVD均呈负相关关系(r=-0.778,P=0.000;r=-0.827,P=0.000)。③胎盘血管情况:PA组绒毛血管数量丰富,管径粗大,侵及肌壁间血管;PP组绒毛间血管增生程度有所减轻,未侵及肌层;对照组则无上述变化。结论①胎盘位置异常组中胎盘的PEDF表达过低是导致VEGF负性调节不足以及胎盘病理性血管形成的原因,参与了胎盘位置异常的发生。②三组胎盘中PEDF含量均有显著差异,提示PEDF含量可以反映异常胎盘血管的侵袭程度。展开更多
文摘Objective:?The study’s objective was to assess the accuracy of using prenatal 3-dimensional power Doppler analysis of vascular placental indices to accurately diagnose morbidly adherent placenta objectively. Background:?Traditionally, 2D ultrasound was used for the diagnosis of a suspected morbidly adherent placenta (MAP) previa. More objective techniques like 3D power Doppler haven’t been well studied. Study Design:?A prospective cohort study?is?designed for women with gestational age between 28 and?32 weeks with suspected placenta previa. Patients were examined by 2D ultrasound which was used in management decisions.?3D Power Doppler’s VI, FI and VFI were measured during the same examination after manual tracing of placenta;data were blinded to obstetricians. Histopathology was performed to confirm MAP. Results: Our results showed that the 3D power Doppler VI ≥ 16 predicted the diagnosis of MAP with 100% sensitivity, 100% specificity which is better than those of 2D ultrasound. While VI > 33.1 measured by 3D Doppler predicted severe MAP with a sensitivity of 73.9% and specificity of 86.4%, which was superior to 2D ultrasound. Conclusion:?In patients with placenta previa, the 3D Doppler’s vascular index accurately predicts MAP. Furthermore, vascular and vascular flow indices of 3D Doppler were more predictive of severe cases of MAP compared to 2D ultrasound.
文摘目的系统评价剖宫产术中不同时机行血管介入阻断对凶险性前置胎盘患者及胎儿的影响。方法采用计算机检索PubMed、Embase、Medline、Web of Science、维普、万方数据库、中国知网、中国生物医学文献数据库等中不同时机行血管介入阻断对凶险性前置胎盘的相关研究。检索时限为建库至2024年3月1日,由两名研究员独立筛选随机对照或回顾性文献、提取数据,选用Review Manager 5.4.1软件分析,参照Cochrane协作网提供的偏倚风险评估工具对文献质量进行评估。结果共纳入12篇目标文献,1030例凶险性前置胎盘患者。Meta分析结果显示,胎儿娩出前阻断可降低术后子宫切除率(OR=0.54,95%CI:0.33~0.89)和术后入住ICU病房率(OR=0.34,95%CI:0.19~0.63),但不能降低序贯子宫动脉栓塞率(OR=0.61,95%CI:0.28~1.32)。此外,对胎儿1 min Apgar评分(MD=0.11,95%CI:-0.23~0.46)、5 min Apgar评分(MD=0.10,95%CI:-0.04~0.24)、1 min Apgar评分≤7分(OR=0.81,95%CI:0.36~1.85)、5 min Apgar评分≤7分(OR=0.93,95%CI:0.33~2.63)无明显影响。结论胎儿娩出前介入阻断的临床价值更高,且不会增加胎儿不良结局。
文摘目的:评估三维能量多普勒血管成像技术(three-dimensional power doppler angiography,3D-PDA)判断脐带附着位置及相关并发症的应用价值。方法:选取2010年1月至2012年6月中孕早期及中孕期在我院超声科检查并经二维彩色多普勒超声可疑为脐带异常附着160例,应用3D-PDA进一步检测其脐带附着情况,并对各病例进行随访、追踪,产后留取新鲜、完整胎盘及脐带,明确脐带附着情况。结果:160例病例中,产后大体病理确诊球拍状胎盘(脐带边缘附着)113例,帆状胎盘20例,副胎盘5例,共138例。3D-PDA诊断脐带附着异常共136例,除2例脐带边缘附着漏诊外其余分型与产后病理结果一致。结论:3D-PDA能准确、直观显示脐带附着点及其附近脐血管的走行情况,在脐带边缘附着、帆状附着、血管前置的诊断方面有重要作用。
文摘目的探讨色素上皮衍生因子(PEDF)对胎盘位置附着异常中胎盘微血管床形成的影响。方法选择2014年6月至2015年8月我院剖宫产分娩的孕妇48例,其中胎盘植入(PA组)16例,前置胎盘(PP组)16例,对照组16例。胎盘进行病理学检查,免疫组化检测三组胎盘组织的MVD;RT-PCR及Western Blot检测胎盘组织中PEDF和VEGF的m RNA和蛋白质表达。结果①三组胎盘组织中PEDF及VEGF蛋白含量、PEDF及VEGF m RNA含量及MVD比较,差异均有统计学意义(P<0.05)。②胎盘中PEDF与VEGF、MVD均呈负相关关系(r=-0.778,P=0.000;r=-0.827,P=0.000)。③胎盘血管情况:PA组绒毛血管数量丰富,管径粗大,侵及肌壁间血管;PP组绒毛间血管增生程度有所减轻,未侵及肌层;对照组则无上述变化。结论①胎盘位置异常组中胎盘的PEDF表达过低是导致VEGF负性调节不足以及胎盘病理性血管形成的原因,参与了胎盘位置异常的发生。②三组胎盘中PEDF含量均有显著差异,提示PEDF含量可以反映异常胎盘血管的侵袭程度。
