Lerner J P, Deane S, Timor-Tritsch I E
Department of Obstetrics and Gynecology, Sloane Hospital for Women, Columbia-Presbyterian Medical Center, New York, New York 10032, USA.
Ultrasound Obstet Gynecol. 1995 Mar;5(3):198-201. doi: 10.1046/j.1469-0705.1995.05030198.x.
The safe use of transvaginal sonography in patients with placenta previa has been confirmed, and has revolutionized precise placental localization. The aim of our study was to evaluate the efficacy of transvaginal sonography and color-coded blood flow in the prediction of placenta accreta. Twenty-one patients with persistent placenta previa were scanned using transvaginal sonography and color-coded flow. Suspicion for placenta accreta consisted of total placenta previa at term with several placental lacunae exhibiting marked or turbulent blood flow, as seen with color Doppler transvaginal sonography from within the placenta, extending into the surrounding tissues. Five of the patients exhibited sonographic placental patterns suspicious for placenta accreta and one patient exhibited placental and cervical blood flow described as lacunar. Five Cesarean hysterectomies were performed for placenta accreta. Every placenta accreta was correctly diagnosed sonographically by the use of color flow studies. One patient with suspicion of placenta accreta delivered at another institution, a Cesarean hysterectomy was performed, and the pathology was confirmed. The one placenta previa exhibiting turbulent lacunar flow in the cervical area only was not confirmed to be an accreta at Cesarean section, although hemostasis was difficult at the placental bed. The remaining 15 patients with placenta previa and who on sonography were not suspicious for placenta accreta underwent uncomplicated Cesarean section. Transvaginal sonography and color Doppler imaging improve the diagnostic accuracy in the prediction of placenta accreta in patients with persistent placenta previa. A pattern of turbulent blood flow extending from the placenta into the surrounding tissues should alert the physician to the possibility of placenta accreta.
经阴道超声检查在前置胎盘患者中的安全应用已得到证实，并且彻底改变了胎盘的精确定位。我们研究的目的是评估经阴道超声检查及彩色编码血流在预测胎盘植入方面的效果。对21例持续性前置胎盘患者进行经阴道超声检查及彩色编码血流扫描。胎盘植入的可疑表现包括足月完全性前置胎盘，胎盘内有多个血池，彩色多普勒经阴道超声显示血池内血流信号明显或紊乱，并延伸至周围组织。5例患者超声检查显示胎盘形态可疑为胎盘植入，1例患者胎盘及宫颈血流呈血池样表现。5例行剖宫产子宫切除术治疗胎盘植入。通过彩色血流研究，所有胎盘植入均经超声正确诊断。1例可疑胎盘植入患者在另一机构分娩，行剖宫产子宫切除术，病理检查确诊。1例仅宫颈区域血池血流紊乱的前置胎盘患者，剖宫产时虽胎盘床止血困难，但未证实为胎盘植入。其余15例前置胎盘且超声检查不怀疑胎盘植入的患者行剖宫产术，过程顺利。经阴道超声检查及彩色多普勒成像提高了持续性前置胎盘患者胎盘植入预测的诊断准确性。胎盘血流紊乱并延伸至周围组织的表现应提醒医生警惕胎盘植入的可能性。
