彩色多普勒超声联合超声评分在胎盘植入诊断中的综合应用

来源期刊：广州医药 | 42-47 发布时间：2022-11-30 收稿时间：2025/11/13 18:14:29 阅读量：83

作者：: 董燕,

关键词：: 彩色多普勒超声检查胎盘植入超声评分前置胎盘; color Doppler ultrasonography placenta implantation ultrasound score placenta previa

DOI：: 10.3969/j.issn.1000-8535.2022.06.009

收稿时间：: 2021-12-21
修订日期：
接收日期：
引用总数：: 3

目的通过分析胎盘植入检出率、胎盘植入典型声像图特征及胎盘植入患者妊娠结局,探讨彩色多普勒超声检查在前置胎盘合并胎盘植入患者诊断中的应用价值。方法回顾性分析2016年1月—2020年11月在广州市第一人民医院分娩的100例在产前超声检查中诊断为前置胎盘孕妇的临床资料及超声诊断资料。分析彩色多普勒检查在诊断前置胎盘合并胎盘植入中的灵敏度、特异度等指标;比较分析2组孕妇间年龄、流产和剖宫产次数及是否合并凶险性前置胎盘的情况;对比分析2组孕妇间胎盘分布情况、胎盘超声评分情况,分析胎盘植入的标志性超声声像图特征;分析2组孕妇分娩并发症及结局。结果胎盘植入检出的灵敏度72%(36/50),特异度92.6%(50/54);胎盘植入组流产和剖宫产次数高于非胎盘植入组(P<0.05),合并凶险性前置胎盘的孕妇发生胎盘植入的概率升高;胎盘植入组超声评分高于非胎盘植入组(P<0.05),胎盘内陷窝征和胎盘后间隙消失是胎盘植入的标志性声像图特征;胎盘植入组产时出血量高于非胎盘植入组(P<0.05),胎盘植入组中出现产后出血的概率也是高于非胎盘植入组(P<0.05)。结论彩色多普勒超声检查在诊断前置胎盘合并胎盘植入中的灵敏度及特异性度均较高,胎盘内陷窝征和胎盘后间隙消失在胎盘植入诊断的检出较高,可作为判断胎盘是否植入的标志性特征。运用超声评分系统可以更加客观地评价胎盘植入的诊断,对于预测其预后有重要的价值,值得推广。

Objective To explore the value of color Doppler ultrasonography in the diagnosis of placenta previa complicated with placenta implantation by analyzing the detection rate of placenta implantation,the typical sonographic characteristics of placenta implantation and the pregnancy outcome of patients.Methods The clinical data and ultrasonic diagnosis data of 100 pregnant women with placenta previa diagnosed by prenatal ultrasound in Guangzhou First People's Hospital from January 2016 to November 2020 were analyzed retrospectively.The sensitivity and specificity of color Doppler in the diagnosis of placenta previa complicated with placenta implantation were analyzed.The age,the number of abortions and cesarean sections and whether there was dangerous placenta previa between the two groups were compared and analyzed.The placental location and placental ultrasound score between the two groups were compared and analyzed,and the characteristics of landmark ultrasound images of placental implantation were analyzed.The delivery complications and outcomes of the two groups were also analyzed.Results The sensitivity and specificity of placenta implantation were 72% (36/50) and 92.6% (50/54).The number of abortion and cesarean section in placenta implantation group was significantly higher than that in non placenta implantation group (P<0.05).The probability of placenta implantation in pregnant women with dangerous placenta previa was significantly higher.The ultrasound score of placenta implantation group was significantly higher than that of non placenta implantation group(P<0.05),intraplacental lacuna sign and disappearance of retroplacental space were the landmark ultrasonographic features of placental implantation.The amount of intrapartum hemorrhage in placenta implantation group was significantly higher than that in non placenta implantation group (P<0.05).The probability of postpartum hemorrhage in placenta implantation group was also significantly higher than that in non placenta implantation group (P<0.05).Conclusions Color Doppler ultrasonography had high sensitivity and specificity in the diagnosis of placenta previa complicated with placenta implantation,intraplacental lacuna sign and disappearance of retroplacental space had high detection rates in the diagnosis of placental implantation,which can be used as a landmark feature to judge whether placenta is implanted or not.The use of ultrasound scoring system can more objectively evaluate the diagnosis of placental implantation,which has important value in predicting its prognosis and is worthy of popularization.

1、胡彦会.双侧子宫动脉栓塞治疗胎盘植入产后出血临床分析[J].广州医药,2012,43(3):30-31.

2、黄田田,刘慧,向红.产前超声征象评分对前置胎盘合并胎盘植入的诊断价值[J].中国超声医学杂志,2016,32(2):160-163.

3、 CALI G,GIAMBANCO L,PUEEIO G,et al.Morbidly adherent placenta:evaluation of ultrasound diagnostic criteria and differentiation ofplacenta accreta from percret[J].Ultrasound Obstet Gynecol,2013,41(4):406-412.

4、 COMSTOCK C,BRONSTEEN R.The antenatal diagnosis of placenta accrata[J].BJOG Int J Obstet Gy,2014,12l(2):171-182.

5、卢展辉,郑达聪,陈婷.产前超声诊断前置胎盘并胎盘植入的价值[J].中华生物医学工程杂志,2020,26(1):21-25.

6、张晓娜,童亚波.完全性前置胎盘合并胎盘植入MRI影像学表现及诊断价值[J].中国CT和MRI杂志,2018,16(11):118-120,127.

7、李琴,邓学东,王中阳,等.凶险型前置胎盘合并胎盘植入的产前超声诊断分析[J].中华医学超声杂志(电子版),2016,13(3):218-223.

8、 CHATTOPADHYAY S K,KHARIF H,SHERBEENI M M.Placenta praevia and accreta after previous caesarean section [J].Eur J Obste Gynecol Reprod Biol,1993,52(3):151-156.

9、 BAUGHMAN W C,CORTEVILLE J E,SHAHR R. Placenta accreta:spectrum of US and MR imaging findings [J].Raduo Graphics,2008,28(7):1905-1919.

10、吴小英,刘敏.凶险型前置胎盘合并胎盘植入的产前超声诊断效能及临床价值[J].福建医药杂志,2021,43(5):50-52.

11、 LAM C,KULLER J,MCMAHON M.Use of magnetic resonance imaging and ultrasound in the antenatal diagnosis of placenta accreta[J].J Soc Gynecol Investing,2002,9(1):37-40.

12、 DWYER B K,BELOGOLOVKIN V,TRAN L,et al.Prenatal diagnosis of placenta accreta,sonography or magnetic resonance imaging[J].J Ultrasound Med, 2008,27(9):1275-1281.

13、 CHOU M M,HO E S C,LEE Y H.Prenatal diagnosis of placenta previa accreta by transabdominal color Doppler ultrasound [J].Ultrasound Obstet Gynecol,2000,15(1):28-35.

14、朝葵,杨承东,赖磬丽.凶险性前置胎盘43例临床分析[J].中国妇幼保健,2013,28(24):3932-3934.

15、黄雄,邹莲英,刘俊杰,等.二维超声联合彩色多普勒超声对胎盘植入的诊断研究[J]现代医院,2014,14(10):60-61.

16、王元丽,唐明珠,杨学习.11339例孕妇无创产前检测结果对比分析[J].分子诊断与治疗杂志,2016,8(6):363-366.

17、种轶文,张爱青,王妍,等.超声评分系统预测胎盘植入凶险程度的价值[J].中华围产医学杂志,2016,19(9):705-709.

18、邓学东.产前超声诊断与鉴别诊断[M].北京:人民军医出版社,2013:293-294.

19、李胜利.胎儿畸形产前超声诊断学[M].北京:人民军医出版社,2006:540-541.

20、乐杰.妇产科学[M].7版.北京:人民卫生出版社,2007:116.

21、 FITZPATRICK K E,SELLERS S,SPARK P,et al.Authors' reply:the morbidly adherent placenta (MAP): early accurate diagnosis is essential for the meaningful interpretation of outcomes[J].BJOG,2014,121(10):1315-1316.

22、 SAKHAVAR N,HEIDARI Z,MAHMOUDZADEH-SAGHEB H.Cervical inversion as a novel technique for postpartum hemorrhage management during cesarean delivery for placenta previa accreta/increta[J].Int J Gynaecol Obstet,2015,128(2):122-125.

1、高中辉,袁文文,李奎,等.经腹超声联合多模态磁共振成像检查在前置胎盘合并胎盘植入中的诊断价值[J].妇儿健康导刊,2023,2(14):33-35.

2、屈彩霞.B超在产后出血和晚期产后出血中的运用分析[J].智慧健康,2025,11(05):1-3.DOI:10.19335/j.cnki.2096-1219.2025.05.001.

3、谢凯,李江滨.分娩前超声与MRI联合检查在凶险性前置胎盘产后出血评估中的应用价值研究[J].现代医用影像学,2025,34(07):1335-1338.