不同孕期胎盘植入的产前超声诊断及预后影响因素分析

摘要

目的:比较不同孕期胎盘植入的产前超声特点,分析其临床价值.方法:回顾性分析2010年1月-2016年12月本院收治的胎盘植入孕产妇149例临床资料,根据孕期不同分为早孕期(妊娠＜14周)22例和中晚孕期(妊娠≥14周)127例,比较两组超声特点和胎盘植入检出率,分析胎盘植入产妇预后的相关影响因素.结果:不同孕期胎盘植入的产前超声声像差异较大,早孕期前壁肌层较薄、妊娠囊位置较低;中晚孕期胎盘与子宫肌层、宫颈组织的界限不清,周围可见丰富的彩色血流信号;早孕期胎盘植入超声检查的符合率和正确率(22.7％、72.7％)低于中晚孕期(86.6％、94.5％);胎盘位置影响产前超声检查效果,前壁胎盘、合并中央型前置胎盘均能提高产前超声检出率;产前出血、合并中央型前置胎盘产妇分别有77.5％、76.9％发生产后出血,37.5％、26.9％进行全子宫切除术,可能为影响产妇预后的危险因素.结论:不同孕期胎盘植入的产前超声声像特点差异较大,对中晚孕期检测诊断效果优于早孕期,而胎盘的位置会对超声检查产生影响,并与产前出血共同影响产妇预后.%Objective:To compare the characteristics of prenatal ultrasound for diagnozing placenta implantation in different pregnant stages,and to analyze its clinical value.Methods:The data of 149 pregnant women with placenta implantation in Weihai municipal hospital were collected from Jan 2010 to Dec 2016.All the included women were divided into early pregnant group (22 cases) and middle or late pregnant group (127 cases).The characteristics of prenatal ultrasound and rate of placenta implantation were compared between the two groups.And the related factors affecting the prognosis of placenta implantation were analyzed.Results:The characteristics of prenatal ultrasonography of placenta implantation in different pregnant stage were different.For early pregnant women,the anterior wall muscle layer was thinner and the gestationalsac position was lower,and boundaries of placental and myometrial or cervical tissue was unclear in the middle or late pregnant women.The coincidence rate and accuracy rate of antenatal ultrasonography diagnosing early pregnant placenta increta were 22.7％ and 72.7％,respectively,that significantly lower than th6se of ultrasonography diagnosing middle or late pregnaint women,which were 86.6 ％ and 94.5 ％,respectively.The location of placenta effected the results of ultrasonography diagnosis,and central placenta previa and uterine anterior wall placenta could improve the detection rate of prenatal ultrasound.The rate of postpartum hemorrhage of women with prenatal hemorrhage and central placenta previa were 77.5％ and 76.9％,respectively,and the rate of hysterectomy were 37.5 ％ and 26.9％,respectively,which all were the risk factors effected the maternal prognosis.Conclusioni The characteristics of prenatal ultrasonography of placenta implantation in different pregnant stage are very different.The accuracy of diagnosis on placenta implantation for middle and late pregnancy is better than that of early pregnancy.The location of placenta has an effect on the accuracy of ultrasound examination,and it affects maternal prognosis together with prenatal hemorrhage.