摘要
目的分析胎盘植入阴道超声联合经腹超声征象与产后出血的关系。方法2019年9月—2022年3月于郑州市中心医院行胎盘植入评估检查的产妇668例,分别采用经阴道或(和)经腹部超声对病人进行检查,收集胎盘植入超声征象和产后出血资料。根据分娩所见或分娩后组织病理学检查确诊胎盘植入病人44例,根据产后是否出血分为出血组、非出血组。比较阴道超声或(和)腹部超声诊断胎盘植入分型的价值;Logistics回归模型分析与产后出血有关的危险因素;采用受试者工作特征(ROC)曲线分析超声征象对产后出血预测价值。结果44例胎盘植入病人中经阴道超声检出39例,经腹部超声检出35例。采用并联试验诊断方法,经阴道超声和经腹超声检查联合检出42例。联合检查的灵敏度、特异度高于单独检查。44例胎盘植入病人产后出血18例,非出血26例。两组胎盘位置、宫颈形态、胎盘基底部血流等比较,差异均具有统计学意义(χ^(2)=6.218~8.307,P<0.05)。Logistics回归分析显示,胎盘位置为病人产后出血的影响因素(OR=1.923,95%CI=1.356~3.046,P<0.05)。以胎盘位置做预测产后出血的ROC曲线,截断值为3.81,曲线下面积(AUC)为0.801,预测产后出血的灵敏度与特异度分别为83.3%和76.9%。结论产前经阴道超声联合经腹超声检查能有效诊断胎盘植入发生风险,超声征象中胎盘位置是产后出血的危险因素,对出血危险度有良好的预测价值。
Objective To explore the association of placenta accreta signs detected by transvaginal plus transabdominal ultrasonography with postpartum hemorrhage.Methods We included 668 parturients who underwent assessment for placenta accreta through transvaginal or/and transabdominal ultrasonography at Zhengzhou Central Hospital from September 2019 to March 2022.The information on ultrasound signs of placenta accreta and postpartum hemorrhage was collected.Placenta accreta was confirmed in 44 cases according to intrapartum observations or postpartum histopathological findings.They were divided into hemorrhage group and non-hemorrhage group based on the presence or absence of postpartum hemorrhage.The value of transvaginal ultrasonography or/and transabdominal ultrasonography in diagnosing the types of placenta accreta spectrum was analyzed.A Logistic regression model was used to analyze the risk factors related to postpartum hemorrhage.A receiver operating characteristic(ROC)curve was plotted to evaluate the predictive value of the ultrasound signs for postpartum hemorrhage.Results Of the 44 cases of placenta accreta,39 were detected by transvaginal ultrasonography,35 were detected by transabdominal ultrasonography,and 42 were detected by the combination of transvaginal and transabdominal ultrasonography.The sensitivity and specificity of the combined examination were higher than those of any examination.Among the 44 patients with placenta accreta,18 had postpartum hemorrhage,and 26 had no postpartum hemorrhage.The two groups were significantly different in placenta position,cervical morphology,and blood flow in the basal placenta(χ^(2)=6.218-8.307,P<0.05).The Logistic regression analysis showed that placenta position was the factor influencing postpartum hemorrhage(OR=1.923,95%CI=1.356-3.046,P<0.05).The ROC curve for placenta position predicting postpartum hemorrhage showed:cut-off value,3.81;the area under the curve,0.801;sensitivity,83.3%;and specificity,76.9%.Conclusion Prepartum transvaginal plus transabdominal ultr
作者
张敬丽
闫媛媛
谷小乐
ZHANG Jingli;YAN Yuanyuan;GU Xiaole(Department of Ultrasound Medicine,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450007,China)
出处
《青岛大学学报（医学版）》
CAS
2023年第4期576-580,共5页
Journal of Qingdao University(Medical Sciences)
基金
河南省高等学校重点科研项目计划(19A320077)
