Application of abdominal aortic balloon occlusion followed by uterine artery embolization for the treatment of pernicious placenta previa complicated with placenta accreta during cesarean section

Objective:This study aimed to investigate the clinical effects of abdominal aortic balloon occlusion followed by uterine artery embolization for the treatment of pernicious placenta previa complicated with placenta accreta during cesarean section.Methods:We performed a retrospective analysis of the clinical data for 623 patients who experienced pernicious placenta previa complicated with placenta accreta and received treatment in our hospital from January 2013 to January 2019.All patients underwent abdominal aortic balloon occlusion before their cesarean section.Seventyeight patients received bilateral uterine artery embolization,and among them,placenta accreta was found at the opening of the cervix in 13 patients.Due to suturing difficulty after the removal of the placenta,gauze packing was used to temporarily compress the hemorrhage.As soon as the uterus was sutured,emergent bilateral uterine artery embolization was performed.Active bleeding was noted in the remaining 65 patients when the lower part of the uterus was pressed after the placenta was removed and the uterus was sutured,therefor,bilateral uterine artery embolization was performed urgently.Results:Of the 623 patients,545 patients underwent only abdominal aortic balloon occlusion and 78 patients underwent additional emergent bilateral uterine artery embolization due to hemorrhaging during or after their cesarean section.No hysterectomies were performed.In the 78 patients,the amount of bleeding was 800-3,200 ml with an average of 1,650 ml during the operation;the volume of blood transfused was 360-1,750 ml(average:960 ml).The fetal fluoroscopy time was 3–8 s(average:5 s).The dose of radiation exposure was(4.2±2.9) m Gy.Fetal appearance,pulse,grimace,activity,and respiration(Apgar) score were normal.No serious complications were observed during or after the operation in the follow-up visits.Conclusion:For patients with pernicious placenta previa complicated with placenta accreta who experience active bleeding after cesarean section and abdominal aortic balloon occlusion,bilateral uterine artery embolization can effectively reduce blood loss and requirement of blood transfusion during the operation,and lowers the risk of hysterectomy.

Correlation of An Ultrasonic Scoring System and Intraoperative Blood Loss in Placenta Accreta Spectrum Disorders: A Retrospective Cohort Study

Objective This study aims to investigate the correlation of an ultrasonic scoring system with intraoperative blood loss(IBL) in placenta accreta spectrum(PAS) disorders.Methods A retrospective cohort study was conducted between January 2015 and November 2019.Clinical data for patients with PAS have been obtained from medical records. Generalized additive models were used to explore the nonlinear relationships between ultrasonic scores and IBL. Logistic regressions were used to determine the differences in the risk of IBL ≥ 1,500 m L among groups with different ultrasonic scores.Results A total of 332 patients participated in the analysis. Generalized additive models showed a significant positive correlation between score and blood loss. The amount of IBL was increased due to the rise in the ultrasonic score. All cases were divided into three groups according to the scores(low score group: ≤ 6 points, n = 147;median score group: 7-9 points, n = 126;and high score group: ≥ 10 points, n = 59). Compared with the low score group, the high score group showed a higher risk of IBL≥ 1,500 m L [odds ratio, 15.09;95% confidence interval(3.85, 59.19);P ≤ 0.001] after a multivariable adjustment.Conclusions The risk of blood loss equal to or greater than 1,500 m L increases further when ultrasonic score greater than or equal to 10 points, the preparation for transfusion and referral mechanism should be considered.

Subsequent placenta accreta after previous mifepristone-induced abortion: A case report

BACKGROUND Mifepristone-induced abortion(MIA)has been used worldwide to terminate pregnancies.However,the association between placenta accrete(PA)and MIA has seldom been reported.CASE SUMMARY A 26-year-old pregnant woman presented with painless vaginal bleeding at 35 wk of gestation.She had a medical abortion(mifepristone followed by misoprostol)1 year ago at the sixth week of gestation.Her personal history for previous surgery was negative.Abdominal ultrasonography showed a normal foetus with complete placenta previa.The foetal membrane ruptured with massive vaginal bleeding and severe abdominal pain.An emergency Caesarean section was performed,and the newborn was delivered.The placenta failed to expel and manual extraction was carried out.A large defect was noted in the uterine fundus and repair of the uterine rupture was conducted immediately.The postoperative pathology report showed placenta accreta.CONCLUSION The evidence suggests a possible etiologic role of MIA in PA,as the incidence of PA after MIA is much higher than general population.Millions of pregnancies are complicated by PA each year,some of which result in fatality.To prevent subsequent placental complications after MIA,hormonal supplementation might be a promising therapeutic options.However,further studies are needed to identify the high-risk factors and to confirm the effectiveness of estrogen supplement therapy.

Surgical Excision of Placenta with Lower Uterine Segment as a Conservative Management in a Case of Placenta Accreta: A Case Report

Introduction: Placenta accreta is due to invasive placental implantation. It is diagnosed when there is failure of delivery of a retained placenta. This is usually complicated by massive intrapartum hemorrhage that ends by hysterectomy. Case: We report a case of conservative management in a case of placenta accreta involving an elliptical shape incision of the lower segment with removal of placenta with underlying lower uterine segment in a stable patient desiring future fertility. Conclusion: Conservative management may be valid in carefully selected cases of placenta accreta diagnosed pre-operatively in tertiary hospitals with availability of blood-bank and multi-disciplinary approach.

Application of Abdominal Aortic Balloon Occlusion Combined with Tourniquet in Pregnant Women with Severe Placenta Accreta Spectrum

Objective Abdominal aortic balloon occlusion(AABO)is a vascular intervention method that has been widely used in the treatment of severe placenta accreta spectrum(PAS).The aim of this study was to investigate the benefits,potential risks,and characteristics of AABO combined with tourniquet binding of the lower uterine segment(LUS)in treatment of pregnant women with PAS.Methods In this study,64 pregnant women with PAS scores greater than 5 were enrolled as research subjects and divided into two groups.Group A(n=34)underwent normal operative procedures including tourniquet binding of the LUS.Group B(n=30)underwent AABO combined with tourniquet binding of the LUS.General clinical characteristics,ultrasonography PAS score,intraoperative blood loss(IBL),blood loss within 24 h after surgery(24-h BL),postoperative complications,and neonatal data of the two groups were retrospectively reviewed.The influencing factors of IBL for the two groups were analyzed.Results The amounts of IBL,24-h BL,total input red blood cell,and the incidence of disseminated intravascular coagulation were significantly lower in group B than in group A(P<0.05),and this difference was even more significant in the subgroup of placenta percreta(PAS scores≥10).Further multivariate linear analysis showed that the combined therapy of AABO and tourniquet could independently predict lower IBL than normal operative procedures did(P=0.001).Conclusion AABO combined with tourniquet binding of the LUS could improve the outcomes of pregnant women with severe PAS and reduce serious peripartum complications of AABO.

Outcome of Patients with Placenta Accreta at El Shatby Maternity University Hospital

Objective: The aim of this study was to determine the incidence, risk factors, and outcomes of management of patients with placenta accreta. Background Placenta accreta occurs when the placental implantation is abnormal. The marked increase in incidence has been attributed to the increasing prevalence of cesarean delivery in recent years. The most common theory is defective decidualization. The most important risk factor for placenta accreta is placenta previa after a prior cesarean delivery. The first clinical manifestation of placenta accreta is usually profuse, life-threatening hemorrhage. The recommended management of suspected placenta accreta is planned preterm cesarean hysterectomy with the placenta left in situ. Patients and methods: It’s a study of all cases of placenta accreta at El-Shatby Maternity University Hospital starting from 1/4/2016 till 1/10/2016. Selection of the cases will only be dependent upon their pregnancy gestational age above 28 weeks of gestation. Results: The incidence of placenta accreta was 1/75 cesarean deliveries. The ultrasonography and doppler had a false negative rate of 54.6% and a sensitivity of 45.2% in diagnosis of placenta accreta. The rate of blood transfusion was 79.6%. Uterine preserving procedures performed in 66%. Cesarean hysterectomy performed in 34%. Intensive care unit admission occurred in 27.3%. The mean gestational age at delivery was 33.8 ± 4.6 weeks’ gestation. 31.8% admitted to the neonatal intensive care unit. Conclusion: The incidence of placenta accreta increased due to the increasing rate of cesarean deliveries, prenatal diagnosis of placenta accreta is paramount, as most women are asymptomatic. Prenatal diagnosis allows time for a multidisciplinary team to make delivery plans, which will help decrease surgical complications.

Conservative Management of Placenta Accreta of Seven Cases

Introduction: Placenta accreta is a potentially life threatening obstetrical condition. The incidence has increased. Diagnosis before delivery allows multidisciplinary planning in an attempt to minimize potential maternal or neonatal morbidity and mortality. Prenatal ultrasonography is used to support the diagnosis and guide clinical management leading probably to favorable outcomes. Actually a conservative option which includes leaving all or part of the placenta in situ when fertility preservation is desired is recommended. Methods: We retrospectively reviewed the medical records of all patients diagnosed with placenta accreta in gynecology-obstetrics department of the university hospital Mohammed the VI of Marrakesh;Morocco;from January the first 2014 to January the second 2016. Results: We found seven cases. We described: The epidemiological characteristics, risk factors, management of placenta accreta, outcomes and prognosis. The incidence of placenta accreta was 1/3847 deliveries. The mean term of delivery was 35 weeks. We have adopted a successful conservative treatment in six cases (71.4%). The radical treatment was adopted in one patient initially admitted for severe post-partum hemorrhage;the prognosis was good in 85.7% cases. Conclusion: Conservative management of placenta accreta is a safe and efficient and is an interesting alternative for hysterectomy.

Modified Triple P Approach by Gynecologic Oncologist-Led Team for Placenta Accreta Spectrum Improves the Outcome: Non-Randomized Controlled Trial

Introduction: Placenta Accreta Spectrum (PAS) is associated with significant maternal and fetal morbidity and mortality. The ideal conservative management still does not exist. We aimed to compare the outcome of cesarean section for PAS by a gynecologic oncologist-led team using the modified triple P approach and by a non-gynecologic oncologist-led team. Material and Methods: This is non-randomized controlled trial. Group A had Cesarean Section by gynecologic oncologist. Gynecologic oncologist-led team did all Cesarean Section following a modified triple P approach. The first P is for “Plan” the uterine incision. The second P for “Pelvic” devascularization by internal iliac artery ligation. The third P is for Placenta non-separation with resection of the myometrium. Group B had Cesarean Section by non-gynecologic oncologist-led team. The main outcome measures were the need for hysterectomy, amount of blood loss, and the management-related complications. Results: Group A had significantly less estimated blood loss, and received less number of backed RBCs units, and less operative time than group B. The uterus is preserved in all cases of group A and in 50% of cases of group B. The overall maternal morbidity rate was 17.5% in group A and 72.2% in group B. Conclusion: This study provides evidence that the modified triple P approach for PAS by gynecologic oncologist-led team presents lower maternal morbidity in comparison to surgery by non-gynecologic oncologist-led team.

Fazari’s Sign in Ultrasound Scan of Morbid Adherent Placenta/Placenta Accreta Spectrum (MAP/PAS) and Fazari’s Triad during (MAP/PAS) Surgery

Morbid Adherent Placenta (MAP)/Placenta Accreta Spectrum (PAS) is a serious diagnosis which has a risk of complications. Ultrasound scan helps in early diagnosis and has great value in further confirmation and follow up. Observed new clinical sign and associated clinical triad are discussed here.

A Seven-Step Approach to Control Severe Hemorrhage in Cesarean Delivery with the Placenta Accreta Spectrum Disorders Avoiding Hysterectomy

Objectives: To describe a novel procedure to treat hemorrhage of placenta accreta spectrum disorders (PAS) or cesarean-scar pregnancy (CSP). Methods: This was a retrospective study of women under cesarean delivery with PAS or placenta previa. Patients’ information was acquired from hospital records. A novel procedure of surgery is developed with seven major steps, including avoiding placenta incised, elevating upward the uterine, clamping the uterine arteries with sponge forceps, removing the placenta, opening the vesicouterine space and suture techniques. Results: A total of 38 patients were reviewed. Twenty-one patients diagnosed with placenta accrete syndrome and 3 patients with CSP were underwent surgery with the novel procedure of surgery and all severe hemorrhage was controlled without hysterectomy. There were 2 women with bladder injuries needing primary repair. Fourteen patients with placenta previa underwent cesarean delivery and there was no intraoperative complication of the total 14 patients. Conclusion: The seven-step approach is more secure and effective to control severe hemorrhage without other invasive procedures in cesarean delivery with PAS. It is technically easier to maintain and improve surgical skills.

Efficacy of Tourniquet Application in Minimizing Intraoperative Blood Loss in Cesarean Hysterectomies for Placenta Accreta—A Comparative Study

Objective: To assess the effect of tourniquet application of intraoperative blood loss in placenta accreta cases undergoing cesarean hysterectomy. Materials and methods: Nine cases and twenty controls with USG and colour Doppler diagnosed placenta accreta with previous cesarean section were chosen to utilize this novel approach. These cases were planned for elective cesarean section followed by hysterectomy. The twenty controls underwent a classical cesarean section followed by total abdominal hysterectomy with the placenta?in situ. Among the nine cases, after delivery of the fetus through upper segment cesarean section, a cotton gauze tourniquet was applied all around the lower pole of uterus. Hysterectomy was performed with placenta?in situ. Abdomen closed after achieving complete haemostasis. Results: The average operative time taken was 85 ± 11.72 minutes among cases and 98.25 ± 9.9 minutes among controls (p = 0.0039). Average blood loss was 1011.11 ± 99.3 ml among the cases and 1855 ± 222.95 ml among the controls (p ≤ 0.0001). Average requirement of blood transfusion required was two units for the cases and five units for the controls (p = 0.0002). No intra-operative or post-operative surgical complications were observed in any of the cases whereas the controls reportedly had a few. All the mothers and babies were healthy at the time of discharge. Conclusion: The presence of placenta accreta is associated with major fetal and maternal complications. The technique of tourniquet application is efficacious in minimizing the intra-operative blood loss and surgical complications due to obstruction of operative field by bleeding and also by preventing massive blood transfusion related complications.

残角子宫妊娠至34+周合并胎盘植入1例分析

目的探讨残角子宫妊娠的妊娠机制、临床诊断及处理,分析误诊原因。方法总结甘肃省妇幼保健院产科2021年7月收治的1例残角子宫妊娠至34+周并发胎盘植入病人的病史资料及诊疗方案,做文献复习。结果孕妇主诉停经34^(+)周,产检发现前置胎盘5 d。入院主要诊断“残角子宫妊娠,胎盘植入,孕34^(+)周,孕2产1”。入院后完善相关检查,行手术治疗,术中明确残角子宫妊娠合并胎盘植入,娩出胎儿后,切除残角子宫。分析误诊原因:未定期检查,中孕期未能分辨宫腔与宫颈的关系,病人有经阴道分娩史,故误诊为正常宫腔妊娠。中孕期检查如发现妊娠子宫位置较高,应充分扫查盆腔有无单角子宫存在,妊娠子宫与宫颈有无相连,有助于残角子宫妊娠漏诊的发现,MRI辅助检查在中晚孕期能提高残角子宫妊娠诊断的准确率。结论孕期需要加强监测及管理,仔细询问病史,详细专科查体,提高早期诊断率,降低母婴不良事件的发生。

腹主动脉球囊阻断术与改良后子宫血管阻断术在胎盘植入性疾病患者再次剖宫产中的应用比较

目的研究预置腹主动脉球囊阻断术与改良后子宫血管阻断术在前置胎盘伴胎盘植入性疾病再次剖宫产中的应用效果。方法选取2016年4月至2022年12月在合肥市妇幼保健院行再次剖宫产手术治疗的前置胎盘伴胎盘植入性疾病的瘢痕子宫患者97例。术前行腹主动脉球囊阻断术48例为对照组,术中行改良后子宫血管阻断术49例为观察组。观察比较两组患者术中、术后情况。结果观察组的术后行双侧子宫动脉栓塞术数、人均住院费用均小于对照组,差异均有统计学意义(P<0.05);两组的术中平均出血量、输注红细胞悬液量、子宫切除率、膀胱破裂率差异无统计学意义(P>0.05)。结论两种手术方式在完全性前置胎盘伴胎盘植入患者的再次剖宫产手术治疗中均能有效减少术中出血,而使用改良后子宫血管阻断术,未出现血管介入手术并发症,无需X线暴露,母儿安全性高,同时降低了住院费用,具有临床推广潜力。

止血囊与纱条填塞分别联合腹主动脉临时阻断术应用于伴胎盘植入孕妇剖宫产术中止血的价值

目的:探讨止血囊与纱条填塞分别联合腹主动脉临时阻断术用于伴胎盘植入孕妇剖宫产术中止血的价值。方法:回顾性分析伴胎盘植入且有意愿保留子宫的185例孕妇的临床资料,按照手术止血方法不同分为止血囊组(n=92)和纱条组(n=93)。对比两组手术相关指标(腹主动脉临时阻断时间、止血成功率、填塞物脱落率、填塞时间)、围术期出血量、纤维蛋白原(FIB)、凝血酶原时间(PT)、活化部分凝血酶原时间(APTT),统计并发症总发生率。结果:止血囊组腹主动脉临时阻断时间和填塞时间短于纱条组(P<0.05),术中及术后2、24 h出血量均少于纱条组(P<0.05),止血成功率高于纱条组(P<0.05),填塞物脱落率和术后并发症总发生率均低于纱条组(P<0.05),术后24 h FIB高于纱条组(P<0.05),PT和APTT低于纱条组(P<0.05)。结论:腹主动脉临时阻断术联合止血囊以及纱条均可有效改善伴胎盘植入剖宫产术中出血,止血囊成功率和安全性更高。

子宫动脉结扎联合腹主动脉球囊阻断术在胎盘植入性疾病剖宫产术中的应用

目的 :探讨子宫动脉结扎联合腹主动脉球囊阻断术在胎盘植入性疾病(placenta accreta spectrum disorders,PAS)剖宫产术中的有效性和有安全性。方法 :将83例PAS剖宫产产妇随机分为观察组(n=42)和对照组(n=41)。对照组给予腹主动脉球囊阻断剖宫产术,观察组给予子宫动脉结扎联合腹主动脉球囊阻断剖宫产术。比较2组手术相关指标和并发症。结果 :观察组手术时间长于对照组,术中出血量、术后24 h总出血量少于对照组,术后血红蛋白差值小于对照组(均P <0.05),并发症发生率低于对照组(4.76%vs 19.51%,χ^(2)=4.260,P=0.028)。结论 :子宫动脉结扎联合腹主动脉球囊阻断术有助于降低PAS剖宫产产妇术中及术后出血量,减少产后出血等并发症的发生。

子宫下段前后壁提拉缝合术联合子宫双侧壁加固缝合法在凶险性前置胎盘剖宫产中止血的应用

目的探讨子宫下段前后壁提拉缝合术联合子宫双侧壁加固缝合法在凶险性前置胎盘剖宫产中的止血效果和应用。方法回顾性选择运用子宫下段前后壁提拉缝合联合子宫双侧壁加固缝合术治疗的凶险性前置胎盘患者11例,观察患者一般情况、围手术期指标、术后情况及新生儿结局等,评价手术效果。结果11例患者术中证实均有胎盘植入,有5例胎盘植入深度达到子宫浆膜层。11例患者均实行子宫下段宫颈提拉缝合联合子宫双侧壁加固缝合术,无一例失败。患者术中出血量中位数为400(300~700)mL。平均手术时间为(65±14)min。11例患者中10例患者术后恶露及体温正常,无明显感染征象,术后住院时间均≤7 d。1例术后出现发热,原因不明,恶露正常,血常规及感染指标正常,复查妇科彩超提示宫腔内少量积液,无明显胎盘组织,术后8天自动出院。出院后随访,无产褥期感染。11例新生儿无窒息。5例早产儿转新生儿科后均未行气管插管辅助呼吸,均治愈出院。结论子宫下段前后壁提拉缝合联合子宫双侧壁加固缝合术在凶险性前置胎盘手术中止血效果好,可行性强,术中及术后均无明显产后出血及其他术后并发症。

1例凶险性前置胎盘行双侧骼内动脉球囊封堵联合剖宫产术后并发DIC的护理

总结1例凶险性前置胎盘行双侧骼内动脉球囊封堵联合剖宫产术后并发弥散性血管内凝血(DIC)的护理。通过多学科团队的联合诊治及护理,病人病情平稳出院。随访半年,病人状况良好。

产前胎盘超声评分法联合MRI对前置胎盘合并胎盘植入的诊断价值研究

目的分析产前胎盘超声评分法联合核磁共振成像(MRI)对前置胎盘合并胎盘植入的诊断价值。方法选取2021年6月~2023年12月在中山市博爱医院产科门诊就诊的102例既往有剖宫产史或宫腔操作史、中晚孕期前置胎盘且疑似胎盘植入患者为研究对象,在晚孕期(≥28周)分别对所有研究对象进行产前胎盘超声、MRI检查。以病理诊断结果为金标准,分析胎盘超声评分法、MRI、胎盘超声评分+MRI(联合诊断)三种检查方式对前置胎盘合并胎盘植入的诊断价值。结果术后病理诊断结果显示,102例疑似胎盘前置合并胎盘植入患者中,66例确诊,36例为非胎盘前置合并胎盘植入患者;胎盘超声评分法诊断确诊63例胎盘前置合并胎盘植入患者;MRI诊断确诊62例,联合诊断确诊79例。三种检查方式对比,特异度、准确度、阳性预测值无明显差异(P>0.05),灵敏度、阴性预测值存在显著差异(P<0.05)。联合诊断的灵敏度、阴性预测值显著高于胎盘超声评分法、MRI诊断(P<0.05);联合诊断的准确度高于MRI诊断(P<0.05)。胎盘超声评分法、MRI诊断对比,灵敏度、特异度、准确度、阴性预测值均无显著差异(P>0.05)。ROC曲线分析结果表明,三种检查方式的AUC均>65%,联合诊断的AUC最大(81.23%)。结论产前胎盘超声评分法联合MRI对前置胎盘合并胎盘植入具有较高的诊断价值。

LncRNA SNHG8在胎盘植入的表达及其对滋养细胞侵袭及迁移的影响

目的 探讨lncRNA SNHG8在胎盘植入(placenta accreta,PA)中的表达及对滋养细胞侵袭迁移的影响。方法 采用q RT-PCR检测PA组及对照组各30例胎盘组织中lncRNA SNHG8的表达,同时与30例PA患者产前超声评分做相关性分析。采用Transwell和划痕实验检测干扰lncRNA SNHG8后对人绒毛膜滋养层细胞(HTR8/SVneo cells)侵袭和迁移的影响,同时,Western blot检测MMP-2和MMP-9的表达情况;StarBase软件预测lncRNA SNHG8下游靶点,并在两组胎盘组织中检测其表达;双荧光素酶报告实验检测lncRNA SNHG8与miR-542-3p的靶向关系。结果 与对照组比较,lncRNA SNHG8在胎盘植入组胎盘组织中表达上调(P <0.05),并与产前超声评分呈正相关。干扰lncRNA SNHG8后抑制了滋养细胞的侵袭迁移(P <0.05),MMP-2及MMP-9蛋白表达也明显下降(P <0.05)。生物学预测miR-542-3p存在与lncRNA SNHG8的结合位点,miR-542-3p在PA胎盘组织中表达下调(P <0.05),双荧光素酶报告实验证实lncRNA SNHG8能靶向调控miR-542-3p。共转染si-SNHG8与miR-542-3p inhibitor后,与si-SNHG8+inhibitor-NC相比,滋养细胞侵袭迁移能力增强(P <0.05)。结论 lncRNA SNHG8在PA胎盘组织中高表达并与其严重程度相关,lncRNA SNHG8通过调节miR-542-3p水平促进滋养细胞侵袭迁移行为学功能,提示lncRNA SNHG8在PA滋养细胞的侵袭迁移中发挥重要作用,有望成为临床诊断生物标记物和治疗靶点。

子宫动脉血流联合多参数对胎盘植入性疾病的诊断价值研究

目的探讨子宫动脉血流联合多参数在胎盘植入性疾病诊断中的应用价值。方法本研究为回顾性队列研究,选取2017年1月—2021年12月就诊于首都医科大学附属北京妇产医院且诊断为前置胎盘的孕妇为研究对象。通过医院电子病历系统获取孕妇的一般资料、既往史、产检信息[子宫动脉搏动指数(pulsatility index,PI)和胎盘超声征象等]、手术信息。根据手术结果将其分为胎盘植入组与非植入组。分析子宫动脉PI值联合剖宫产史及超声征象诊断胎盘植入性疾病的价值。结果共纳入符合标准的前置胎盘孕妇80例,其中植入组34例,非植入组46例。与非植入组相比,植入组孕妇的年龄(P=0.017)、剖宫产史(P<0.001)均显著升高,子宫动脉平均PI值显著降低(P=0.006),胎盘后低回声带局部中断或消失(P<0.001)、胎盘后丰富血流(P<0.001)、子宫-膀胱交界线中断/消失/不规则(P=0.003)等超声征象均具有显著性差异;子宫动脉PI值、剖宫产史、超声征象三者联合诊断胎盘植入性疾病的ROC曲线下面积为0.96(95%CI:0.93~0.99),灵敏度为97.06%(95%CI:91%~100%),特异度为65.22%(95%CI:51%~79%)。结论子宫动脉血流PI值联合多参数预测胎盘植入性疾病的灵敏度较高,有助于早期发现胎盘植入性疾病并及早进行干预。