超声检查及彩色多普勒成像对胎盘植入的预测

Prediction of placenta accreta by ultrasonography and color Doppler imaging.

作者信息

Woodring T Casey, Klauser Chad K, Bofill James A, Martin Rick W, Morrison John C

机构信息

Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, MS 39216-4505, USA.

出版信息

J Matern Fetal Neonatal Med. 2011 Jan;24(1):118-21. doi: 10.3109/14767058.2010.483523. Epub 2010 May 7.

DOI:10.3109/14767058.2010.483523

PMID:20446895

Abstract

OBJECTIVE

To determine the accuracy of ultrasound and color flow Doppler to diagnose placenta accreta.

METHODS

Respectively, ultrasound images consistent with signs of placenta accreta (concomitant previa, numerous vascular lacunae, absent lower uterine segment between bladder-placenta, turbulent or complicated blood flow at the uteroplacental interface) were correlated with findings at the time of surgery and pathologic examination.

RESULTS

Over 64 months, 12 cases with suspected placenta accreta by ultrasound were studied. The median gestational age at first diagnosis was 25 weeks and 92% had a previa while all had at least one previous cesarean delivery. At surgery, 83% (10/12) had an adherent placenta requiring hysterectomy (eight accreta, one increta, and one percreta). There were two false positives (one complete previa, one low-lying placenta with vasa previa). Nine of 12 women (75%) required blood transfusions due to a mean hematocrit nadir of 22.7 ± 4.6%. The mean number of packed red blood cell units transfused was 4.9 ± 4.7 units (range 2-17 units).

CONCLUSION

Sonography coupled with color-flow Doppler appears helpful in allowing antenatal diagnosis of accreta.

摘要

目的

确定超声及彩色多普勒血流显像诊断胎盘植入的准确性。

方法

将符合胎盘植入征象（合并前置胎盘、大量血管腔隙、膀胱 - 胎盘间子宫下段缺失、子宫胎盘界面血流紊乱或复杂）的超声图像分别与手术及病理检查结果进行对照。

结果

在64个月期间，对12例超声怀疑胎盘植入的病例进行了研究。首次诊断时的中位孕周为25周，92%的患者为前置胎盘，且所有患者既往至少有一次剖宫产史。手术时，83%（10/12）有胎盘粘连，需行子宫切除术（8例植入性胎盘、1例侵入性胎盘、1例穿透性胎盘）。有2例假阳性（1例完全性前置胎盘、1例低置胎盘合并前置血管）。12例患者中有9例（75%）因平均血细胞比容最低点为22.7±4.6%而需要输血。输注浓缩红细胞的平均单位数为4.9±4.7单位（范围2 - 17单位）。