| 摘要: |
| 【摘要】目的 探讨产前超声征象及高危因素在不伴前置胎盘的胎盘植入性疾病诊断中的价值。方法 回顾性分析2020年9月至2021年12月在首都医科大学附属北京妇产医院规范产检，经临床或病理诊断的8例不伴前置胎盘的胎盘植入患者，对其高危因素、产前典型超声征象及妊娠结局进行总结分析。结果 经临床诊断或胎盘病理诊断胎盘植入患者66例，临床资料不全或超声图像显示不规范的13例，45例伴前置胎盘，8例不伴前置胎盘。8例不伴前置胎盘的植入病例中，3例胎盘粘连型，4例胎盘植入型，1例胎盘穿透型；6例产前超声提示胎盘植入，2例产前超声漏诊；6例有剖宫产史中，其中5例有宫腔操作史，2例无剖宫产史，均有宫腔操作手术史；7例发生产后大出血（≥1000ml），1例产后出血800ml；1例行子宫全切术，7例保留子宫。其中6例在产前筛查过程中发现胎盘植入典型超声征像，均存在子宫-膀胱交界面异常，主要表现为子宫肌层变薄、胎盘后方低回声带消失，3例均存在胎盘陷窝及子宫-膀胱交界面的桥接血管；2例术前超声检查未按照胎盘植入性疾病产前超声筛查规范留存图像，未检出胎盘植入典型征象。结论 因此，产前检查过程中，高危因素的筛查结合胎盘植入性疾病产前超声筛查规范应用二维灰阶超声和二维彩色多普勒超声全面扫查胎盘在不伴前置胎盘的胎盘植入性疾病诊断中具有重要价值。 |
| 关键词: 超声检查；胎盘植入性疾病；前置胎盘；剖宫产史 高危因素；子宫全切术；产后大出血 |
| DOI： |
| 投稿时间：2022-04-19修订日期：2022-09-02 |
| 基金项目:无 |
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| Value analysis of prenatal ultrasound signs and high-risk factors in the diagnosis of placenta accreta spectrum without placenta previa |
| xuejingjing,wangli |
| (Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital) |
| Abstract: |
| 【Abstract】 objective To investigate the value of prenatal ultrasound signs and high-risk factors in the diagnosis of placenta accreta spectrum without placenta previa. Methods A retrospective analysis was performed on placenta accreta spectrum patients without placenta previa diagnosed during delivery or by cesarean section in Beijing Obstetrics and Gynecology Hospital affiliated to Capital Medical University from September 2020 to December 2021 ,The risk factors, typical prenatal ultrasound signs and pregnancy outcomes were summarized and analyzed.Results There were 66 cases of placenta accreta spectrum diagnosed by clinical diagnosis or placenta pathology, 13 cases had incomplete clinical data or non-standard ultrasound images, 45 cases with placenta previa and 8 cases without placenta previa.Among the 8 cases of placenta accreta spectrum without placenta previa, 3 cases were placental accreta, 4 cases were placental increta, and 1 case was placental percreta.Prenatal ultrasound suggested placenta accreta spectrum in 6 cases, and missed diagnosis in 2 cases.Among the 6 cases with a history of cesarean section, 5 had a history of intrauterine operation, and 2 had no history of cesarean operation, but all had a history of intrauterine operation.Postpartum hemorrhage occurred in 7 cases (≥1000ml) and 800ml in 1 case; One patient underwent total hysterectomy, and 7 patients retained uterus.The typical ultrasound signs of placenta implantation were found in 6 cases during prenatal screening,the abnormality of the uterine - bladder interface was found in all patients, mainly manifested by thinning of the myometrium and Loss of clear zone,All 3 cases had placental lacunae and bridging vessels at the uterine - bladder interface.2 cases did not retain images according to prenatal ultrasound screening standards for placental accreta spectrum, and no typical signs of placental implantation were detected.Conclusions Therefore, in the process of prenatal examination, the screening of high-risk factors combined with the prenatal ultrasound screening standards for placenta accreta spectrum disease, the application of two-dimensional gray scale ultrasound and two-dimensional color Doppler ultrasound in the comprehensive examination of placenta is of great value in the diagnosis of placental implantation diseases without placenta previa. |
| Key words: Ultrasonography Placenta accreta spectrum Placenta previa The history of cesarean section High risk factor Total hysterectomy Massive hemorrhage after postpartum |
