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Transabdominal ultrasonography as a screening test for second-trimester placenta previa

机译:经腹超声检查对妊娠中期胎盘的筛查

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OBJECTIVE:: To determine the test characteristics of transabdominal ultrasonography as a screening test for second-trimester placenta previa. METHODS:: This secondary analysis of a prospective cohort study evaluated the distance from the placental edge to the internal os (placenta-cervix distance) through both transabdominal and transvaginal ultrasonography during the anatomic survey. Patients were recruited in the Maternal-Fetal Medicine Ultrasound Unit at the Hospital of the University of Pennsylvania, an urban tertiary care center. Transabdominal placenta-cervix distance cutoffs with high sensitivity for detection of previa and low-lying placenta were identified, and test characteristics were calculated. Follow-up ultrasound data, pregnancy, and delivery outcomes for those with second-trimester previa or low-lying placenta were obtained. RESULTS:: One thousand two hundred fourteen women were included in the analysis. A transabdominal placenta-cervix distance cutoff of 4.2 cm was 93.3% sensitive and 76.7% specific for detection of previa with a 99.8% negative predictive value at a screen-positive rate of 25.0%. A cutoff of 2.8 cm was 86.7% sensitive and 90.5% specific with a 99.6% negative predictive value at a screen-positive rate of 11.4%. Only 9.8% (four of 41) of previas and low-lying placentas persisted through delivery. CONCLUSION:: Transabdominal ultrasonography is an effective screening test for second-trimester placenta previa. At centers not performing universal transvaginal ultrasonography at the time of the anatomic survey, evidence-based transabdominal placenta-cervix distance cutoffs can optimize the identification of patients who require further surveillance for previa. LEVEL OF EVIDENCE:: II
机译:目的:确定经腹超声检查的特征,作为妊娠中期胎盘的筛查方法。方法:这项前瞻性队列研究的次要分析通过解剖和腹部超声检查评估了从胎盘边缘到内部os的距离(胎盘-子宫颈距离)。患者是在宾夕法尼亚大学城市三级护理中心医院的母婴超声检查室招募的。确定了具有高灵敏度的经腹胎盘-子宫颈距离截止点,用于检测前静脉和低位胎盘,并计算出测试特征。获得了妊娠中期前或胎盘低下者的超声数据,妊娠和分娩结局。结果::1,241名妇女被纳入分析。经腹的4.2cm的胎盘-宫颈距离截止对前静脉的检测敏感度为93.3%,特异性为76.7%,阴性预测值为99.8%,筛查阳性率为25.0%。 2.8 cm的临界值敏感度为86.7%,特异性为90.5%,阴性预测值为99.6%,筛查阳性率为11.4%。分娩前和低位胎盘仅占9.8%(41个中的4个)通过分娩持续存在。结论:腹部超声检查是对孕中期前置胎盘的有效筛查。在解剖调查时未进行通用经阴道超声检查的中心,以证据为基础的经腹胎盘宫颈距离切开可以优化对需要进一步监测前尿道的患者的识别。证据级别:: II

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