Department of Ultrasonography, Hebei reproductive maternity hospital, Shijiazhuang City, Hebei Province, China.
Department of Ultrasound, Zhengding County People's Hospital, Shijiazhuang City, Hebei Province, China.
Medicine (Baltimore). 2024 Mar 15;103(11):e37531. doi: 10.1097/MD.0000000000037531.
The objective of this study is to investigate the value of early pregnancy ultrasound combined with ultrasound score (USS) for the evaluation of placenta accreta (PA) in scar uteri. Thirty cases of PA in scar uteri diagnosed by ultrasound at our hospital between June 2021 and June 2022 were selected retrospectively (observation group). In addition, 30 patients had placenta attached to the anterior wall of the uterus and covered the internal orifice of the cervix; however, no PA was selected in the same period (control group). The results of surgical pathology and ultrasound examination in the first trimester of pregnancy (11-14 weeks of pregnancy, fetal top hip length 4.5-8.4 cm) were analyzed. Ultrasonic image characteristics of the 2 groups were scored using an ultrasonic scoring scale. The ultrasonic signs and ultrasonic scores of the 2 groups were analyzed. The diagnostic value of ultrasound and USS for PA in the scarred uterus alone and in combination was analyzed based on the gold standard of surgical and pathological results. The rich blood flow signal at the junction of the uterine serosa and bladder, the rate of blood flow in the cavity of the placental parenchyma, the thinning rate of the myometrium after placenta, and the abnormal rate of the low echo area after placenta in the observation group were significantly higher than those in the control group (P < .05). The USS of the observation group was significantly higher than that of the control group (P < .05). The sensitivity (93.33%) and accuracy (95.00%) of the combined examinations were significantly higher than those of ultrasound (70.00% and 83.33%, respectively) (P < .05). The sensitivity and accuracy of combined examination were slightly higher than those of USS examination (83.33% and 90.00%), but the difference was not statistically significant (P > .05). There was no significant difference between the specificity of combined examination (93.33%) and ultrasound (96.67%) and USS (96.67%) (P > .05). Early pregnancy ultrasound and USS evaluation have high application value in the diagnosis and evaluation of early scar uterine PA. The combination of the 2 methods can further improve the sensitivity and accuracy of diagnosis.
本研究旨在探讨早孕期超声联合超声评分（USS）在评估瘢痕子宫胎盘植入（PA）中的价值。选取我院 2021 年 6 月至 2022 年 6 月超声诊断为 PA 的瘢痕子宫患者 30 例为观察组。另选取同期胎盘附着于子宫前壁并覆盖宫颈内口，但无 PA 的患者 30 例为对照组。分析两组患者早孕期（妊娠 11-14 周，胎儿顶臀长 4.5-8.4cm）超声检查结果及手术病理结果。采用超声评分标准对两组患者的超声图像特征进行评分，分析两组患者的超声征象及超声评分，并以手术病理结果为金标准，分析超声及 USS 单独及联合诊断瘢痕子宫 PA 的诊断价值。观察组子宫浆膜与膀胱交界处血流丰富信号、胎盘实质腔血流率、胎盘后肌层变薄率及胎盘后低回声区异常率均明显高于对照组（P<0.05）；观察组 USS 评分明显高于对照组（P<0.05）。联合检查的灵敏度（93.33%）及准确率（95.00%）明显高于超声（70.00%、83.33%）（P<0.05）；联合检查的灵敏度及准确率略高于 USS 检查（83.33%、90.00%），但差异无统计学意义（P>0.05）；联合检查的特异度（93.33%）与超声（96.67%）、USS（96.67%）比较差异无统计学意义（P>0.05）。早孕期超声联合 USS 评估对早期瘢痕子宫 PA 具有较高的应用价值，两者联合可进一步提高诊断的灵敏度和准确率。
