Zhang H J, Dou R C, Lin L, Wang Q Y, Huang B E, Zhao X L, Chen D J, Ding Y L, Ding H J, Cui S H, Zhang W S, Xin H, Gu W R, Hu Y L, Ding G F, Qi H B, Fan L, Ma Y Y, Lu J L, Yang Y, Lin L, Luo X C, Zhang X H, Fan S R, Yang H X
Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China.
Department of Obstetrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
Zhonghua Fu Chan Ke Za Zhi. 2019 Jan 25;54(1):27-32. doi: 10.3760/cma.j.issn.0529-5675.2019.01.007.
To evaluate the risk factors and sonographic findings of pregnancies complicated by placenta increta or placenta percreta. Totally, 2 219 cases were retrospectively analyzed from 20 tertiary hospitals in China from January 2011 to December 2015. The data were collected based on the original case records. All cases were divided into two groups, the placenta increta (PI) group (79.1%, 1 755/2 219) and the placenta percreta (PP) group (20.9%, 464/2 219) , according to the degree of placental implantation. The risk factors and sonographic findings of placenta increta or percreta were analyzed by uni-factor and logistic regression statistic methods. The risk factors associated with the degree of placental implantation were age, gravida, previous abortion or miscarriage, previous cesarean sections, and placenta previa (all <0.05), especially, previous cesarean sections (χ(2)=157.961) and placenta previa (χ(2)=91.759). Sonographic findings could be used to predict the degree of placental invasion especially the boundaries between placenta and uterine serosa, the boundary between placenta and myometrium, the disruption of the placental-uterine wall interface and loss of the normal retroplacental hypoechoic zone(all <0.01). Previous cesarean sections and placenta previa are the main independent risk factors associated with the degree of placenta implantation. Ultrasound could be used to make a prenatal suggestive diagnosis of placenta accreta spectrum disorders.
评估妊娠合并胎盘植入或穿透性胎盘植入的危险因素及超声表现。回顾性分析2011年1月至2015年12月中国20家三级医院的2219例病例。数据基于原始病历收集。根据胎盘植入程度，将所有病例分为两组，即胎盘植入（PI）组（79.1%，1755/2219）和穿透性胎盘植入（PP）组（20.9%，464/2219）。采用单因素和逻辑回归统计方法分析胎盘植入或穿透性胎盘植入的危险因素及超声表现。与胎盘植入程度相关的危险因素有年龄、孕周、既往流产史、既往剖宫产史和前置胎盘（均P<0.05），尤其是既往剖宫产史（χ²=157.961）和前置胎盘（χ²=91.759）。超声表现可用于预测胎盘侵入程度，尤其是胎盘与子宫浆膜层之间的界限、胎盘与肌层之间的界限、胎盘 - 子宫壁界面的中断以及正常胎盘后低回声区的消失（均P<0.01）。既往剖宫产史和前置胎盘是与胎盘植入程度相关的主要独立危险因素。超声可用于产前提示胎盘植入谱系疾病的诊断。
