胎盘早剥的发病诱因及超声诊断临床价值

摘要

目的：探讨胎盘早剥的发病诱因变化及超声对胎盘早剥的临床诊断价值。方法回顾性分析在西安市第四医院临床确诊为胎盘早剥且产前均进行过超声检查的病例88例，分析胎盘早剥的诱因，并确定其类型。将孕妇分成轻型胎盘早剥组和重型胎盘早剥组，并按分娩时间分为：24小时内受检组和24小时前受检组，对组间的胎盘早剥检出情况进行分析。结果在88例胎盘早剥中，胎膜早破32例（36．36％），高血压病24例（27．27％），甲状腺功能减退22例（25．00％）。产前超声诊断胎盘早剥26例，诊断符合率为29．55％，其中重型超声检出率（85．71％）明显高于轻型超声检出率（18．92％），χ2＝20．54，P＜0．05，分娩24小时内超声检出率（40．00％）明显高于24小时前超声检出率（7．14％），χ2＝8．38，P＜0．05。结论胎盘早剥发病诱因中胎膜早破比例最高，甲状腺功能减退比例也较高；超声检查对重型胎盘早剥可进行准确诊断，对轻型胎盘早剥具有无创、可重复检查等优点。%Objective To explore the predisposing factors of placental abruption and the value of ultrasound in the diagnosis of placental abruption .Methods A retrospective analysis was carried out on 88 cases of patients who were diagnosed with placental abruption .All these patients received prenatal ultrasonic examination .Predisposing factors of placental abruption were analyzed and their types were identified . All these pregnant women were divided into mild group and severe group .According to the timing of delivery , they were also divided into group examined within 24 hours and group examined 24 hours ago .Intergroup comparison results of the detection of placental abruption were analyzed.Results Among 88 cases of placental abruption , there were 32 cases (36.36%) of premature rupture of membranes , 24 cases (27.27%) of hypertension, and 22 cases (25.00%) of hypothyroidism.A total of 26 cases were diagnosed with placental abruption by prenatal ultrasonic examination , and the diagnostic accordance rate reached 29.55%.Among them, the detection rate of ultrasonic testing of severe placental abruption was 85.71%, which was significantly higher than that of mild placental abruption (18.92%) (χ2 =20.54, P<0.05).The detection rate of ultrasonic testing of placental abruption within 24 hours after delivery was 40.00%, which was remarkably higher than the detection rate 24 hours before delivery (7.14%) with significant difference (χ2 =8.38, P <0.05). Conclusion Among all the predisposing factors of placental abruption , the proportion of premature rupture of fetal membrane is the highest while the proportion of hypothyroidism is also relatively high .Ultrasonic examination can provide an accurately diagnosis for severe placental abruption .As for patients with mild placental abruption , ultrasonic examination is noninvasive and can be performed repeatedly .