产前超声植入评分表在预测瘢痕子宫并前置胎盘植入程度中的价值
| 作者: |
1郭俏,
1谌奎芳
1 中南大学湘雅医院产科，长沙 410008 |
| 通讯: |
谌奎芳
Email: 284271118@qq.com |
| DOI: | 10.3978/j.issn.2095-6959.2020.05.019 |
摘要
目的：探讨产前超声在预测瘢痕子宫并前置胎盘患者中胎盘植入程度的临床应用价值。方法：回顾性分析2018年6月至2019年10月在中南大学湘雅医院进行产前超声检查并分娩的182例有剖宫产病史的瘢痕子宫并前置胎盘病例资料。产前使用超声植入评分表(0~16分)对胎盘植入情况进行评分，追踪其剖宫产术中情况及术后病理结果，以手术和/或病理诊断作为金标准判断有无植入及植入程度。分析产前超声诊断植入的准确性，并通过绘制受试者工作特征(receiver operating characteristic，ROC)曲线确定不同胎盘植入类型间的超声评分截断值。结果：根据手术及病理诊断，182例中，阴性41例，粘连型70例，植入型59例，穿透型12例。术中出血量：阴性组[300 (200~400) mL]<粘连组[675 (500~900) mL]<植入组[2 050 (1 500~2 500) mL]<穿透组[3 600 (2 700~5 000) mL，P<0.05]。阴性组、粘连组均无子宫切除，子宫切除率：植入组<穿透组(6.8% vs 16.7%，P<0.05)。产前超声植入评分：阴性组(3.63±0.80)<粘连组(5.23±0.92)<植入组(8.56±1.74)<穿透组(12.83±2.17，P<0.05)。阴性与粘连型、粘连型与植入型及植入型与穿透型的超声植入评分ROC曲线下面积分别为：0.90，0.96和0.94。当超声评分截断值分别为4.5，6.5和10.5时，对应的敏感度分别为：87.1%，83.1%和83.3%，特异度分别为：87.8%，91.4%和86.4%，Youden指数为最大值，分别为：0.749，0.745和0.697。因此，确定实际临床工作中各植入类型超声评分截断值分别为5，7和11分。结论：评分表式的产前超声诊断预测疤痕子宫并前置胎盘患者植入程度准确度较高，临床应用价值较大。
关键词：
前置胎盘；胎盘植入；产前超声；超声诊断
Value of prenatal ultrasound nographic accreta scoring scale in predicting the accreta degree of scarred uterus with placenta previa
CorrespondingAuthor: SHEN Kuifang Email: 284271118@qq.com
DOI: 10.3978/j.issn.2095-6959.2020.05.019
Abstract
Objective: To assess the value of prenatal ultrasound in predicting placenta accreta degree in patients with a scarred uterus and placenta previa. Methods: Retrospective analysis was performed on 182 cases of scarred uterus with a history of cesarean section and placenta previa who underwent prenatal ultrasound and delivered at Xiangya Hospital of Central South University from June 2018 to October 2019. The prenatal ultrasonographic accreta scoring scale (0–16 points) was used to evaluate the accreta degree, and the intraoperative conditions of cesarean section and postoperative pathological results were reviewed. The surgical and/or pathological diagnostic results were used as a gold standard to judge the accreta status and degree. The accuracy of prenatal ultrasound diagnosis for accreta was analyzed, and the cutoff values of ultrasound scores for different types of placenta accreta were determined by drawing the receiver operating characteristic curve. Results: According to the surgical and pathological diagnostic results, among the 182 cases, there were 41 cases of accreta negative, 70 cases of placenta adhesion, 59 cases of placenta increta and 12 cases of placenta percreta. Intraoperative blood loss was: negative group [300 (200–400) mL] < adhesion group [675 (500–900) mL] < increta group [2 050 (1 500–2 500) mL] < percreta group [3 600 (2 700–5 000) mL, P<0.05]. The negative group and the adhesion group did not have a hysterectomy, but the hysterectomy rate of the increta group was lower than percreta group (6.8% vs 16.7%, P<0.05). Prenatal ultrasonographic accreta scores were: negative group (3.63±0.80) < adhesion group (5.23±0.92) < increta group (8.56±1.74) < percreta group (12.83±2.17, P<0.05). The area under the receiver operating characteristic curve between the negative and adhesion group, adhesion and increta group, increta and percreta group were 0.90, 0.96 and 0.94, respectively. When ultrasonographic cutoff scores were 4.5, 6.5, and 10.5, the corresponding sensitivity was 87.1%, 83.1% and 83.3%, specificity was 87.8%, 91.4% and 86.4%, Youden index were the maximum, which was 0.749, 0.745, and 0.697, respectively. Therefore, the cutoff values of ultrasonographic scores for each accreta type in the actual clinical work were determined to be 5, 7, and 11, respectively. Conclusion: The accuracy of prenatal ultrasonography in predicting accreta degree in patients with a scarred uterus and placenta previa is high, and the value of clinical application is great.
Keywords：
placenta previa; placenta accreta; prenatal ultrasound; ultrasonic diagnosis