Fujisaki Midori, Furukawa Seishi, Maki Yohei, Oohashi Masanao, Doi Koutarou, Sameshima Hiroshi
Department of Obstetrics & Gynecology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
Department of Obstetrics & Gynecology, School of Medicine, Kyorin University, Tokyo, Japan.
J Pregnancy. 2017;2017:8318751. doi: 10.1155/2017/8318751. Epub 2017 Apr 24.
. To determine maternal morbidity in women with placenta previa managed with prediction of morbidly adherent placenta (MAP) by ultrasonography. . A retrospective cohort study was undertaken comprising forty-one women who had placenta previa with or without risk factors for MAP. Women who had all three findings (bladder line interruption, placental lacunae, and absence of the retroplacental clear zone) were regarded as high suspicion for MAP and underwent cesarean section followed by hysterectomy. We attempted placental removal for women having two findings or less. . Among 28 women with risk, nine with high suspicion underwent hysterectomy and were diagnosed with MAP. Three of 19 women with two findings or less eventually underwent hysterectomy and were diagnosed with MAP. The sensitivity and positive predictive value for the detection of MAP were 64% and 100%. The pathological severity of MAP was significantly correlated with the cumulative number of findings. There were no cases of MAP among 13 women without risk. There was no difference of blood loss between women with high suspicion and those without risk (2186 ± 1438 ml versus 1656 ± 848 ml, resp.; = 0.34). . Management with prediction of MAP by ultrasonography is useful for obtaining permissible morbidity.
通过超声检查预测胎盘植入来确定前置胎盘孕妇的孕产妇发病率。
开展了一项回顾性队列研究,纳入41例有或无前置胎盘植入风险因素的前置胎盘孕妇。具有所有三项表现(膀胱线中断、胎盘血池和胎盘后无清晰区)的孕妇被视为高度怀疑胎盘植入,行剖宫产术,随后行子宫切除术。对于有两项及以下表现的孕妇,我们尝试进行胎盘剥离。
在28例有风险因素的孕妇中,9例高度怀疑胎盘植入的孕妇接受了子宫切除术,并被诊断为胎盘植入。19例有两项及以下表现的孕妇中有3例最终接受了子宫切除术,并被诊断为胎盘植入。检测胎盘植入的敏感性和阳性预测值分别为64%和100%。胎盘植入的病理严重程度与表现的累积数量显著相关。13例无风险因素的孕妇中无胎盘植入病例。高度怀疑胎盘植入的孕妇与无风险因素的孕妇之间的失血量无差异(分别为2186±1438ml和1656±848ml;P = 0.34)。
通过超声检查预测胎盘植入进行管理,有助于获得可接受的发病率。