Yang J I, Lim Y K, Kim H S, Chang K H, Lee J P, Ryu H S
Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea.
Ultrasound Obstet Gynecol. 2006 Aug;28(2):178-82. doi: 10.1002/uog.2797.
To investigate the value of transvaginal sonographic findings of intraplacental lacunae for predicting adherent placenta and clinical outcome in patients with placenta previa totalis and a history of Cesarean section.
Fifty-one patients with placenta previa totalis diagnosed by transvaginal sonography and with a history of Cesarean section who delivered at our hospital were included in the study. The sonographic findings of intraplacental lacunae were classified into one of four grades. Pathological analysis of the placenta was performed for all patients who delivered, and in cases of hysterectomy, examination of the uterus was also performed. The placental findings and obstetric complications, including massive transfusion, intensive care unit admission and Cesarean hysterectomy, were compared with the grade of lacuna.
Lacunae were classified as Grade 1+ in 10 cases, Grade 2+ in 11 cases, Grade 3+ in five cases and as Grade 0 (i.e. lacunae were absent) in the remaining 25 cases. When lacunae of > or = Grade 1+ were considered, the sensitivity, specificity, positive predictive value and negative predictive value of diagnosing adherent placenta were 86.9%, 78.6%, 76.9% and 88.0%, respectively. When lacunae of > or = Grade 2+ were considered, the sensitivity, specificity, positive predictive value and negative predictive value of diagnosing placenta increta or percreta were 100%, 97.2%, 93.8% and 100%, respectively. Hysterectomy was performed in 18 cases, among whom two cases showed Grade 1+ lacunae, 11 cases showed Grade 2+ lacunae, and five cases showed Grade 3+ lacunae. No hysterectomy was performed in any case in which lacunae were absent. Compared to those without lacunae, the number of massive transfusions and intensive care unit admissions and cases of disseminated intravascular coagulopathy and Cesarean hysterectomy were significantly greater in those with lacunae (P < 0.0001).
Transvaginal sonographic findings of intraplacental lacunae in patients with placenta previa totalis and a history of Cesarean section are useful in the prediction of adherent placenta and may have a role in the prediction of clinical outcome.
探讨经阴道超声检查发现的胎盘内血池对前置胎盘合并剖宫产史患者胎盘植入及临床结局的预测价值。
本研究纳入了51例在我院经阴道超声诊断为前置胎盘且有剖宫产史并分娩的患者。胎盘内血池的超声表现分为四个等级之一。对所有分娩患者的胎盘进行病理分析，对于行子宫切除术的患者，还对子宫进行检查。将胎盘表现及产科并发症，包括大量输血、入住重症监护病房及剖宫产子宫切除术，与血池等级进行比较。
10例血池为1+级，11例为2+级，5例为3+级，其余25例血池为0级（即无血池）。当考虑血池≥1+级时，诊断胎盘植入的敏感性、特异性、阳性预测值和阴性预测值分别为86.9%、78.6%、76.9%和88.0%。当考虑血池≥2+级时，诊断胎盘植入或穿透性胎盘植入的敏感性、特异性、阳性预测值和阴性预测值分别为100%、97.2%、93.8%和100%。18例行子宫切除术，其中2例血池为1+级，11例为2+级，5例为3+级。无血池的病例均未行子宫切除术。与无血池者相比，有血池者的大量输血次数、入住重症监护病房次数、弥散性血管内凝血病例数及剖宫产子宫切除术病例数明显更多（P<0.0001）。
前置胎盘合并剖宫产史患者经阴道超声检查发现的胎盘内血池对胎盘植入具有预测价值，且可能对临床结局的预测有一定作用。
