Achiron R, Goldenberg M, Lipitz S, Mashiach S
Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Obstet Gynecol. 1993 Apr;81(4):507-11.
To evaluate the diagnostic accuracy and clinical usefulness of high-resolution transvaginal duplex Doppler ultrasound in postpartum and post-abortion patients with excessive hemorrhage who are suspected of having residual trophoblast.
Forty-eight women with excessive hemorrhage referred for possible residual trophoblastic tissue were evaluated by transvaginal duplex Doppler ultrasonography. Based on two-dimensional imaging, the patients were divided prospectively into groups: women who had an empty uterus with a normal uterine cavity, those with a pure endometrial fluid collection and no echogenic foci, those who had a mixed endometrial fluid collection with foci of echogenicity, and those with intracavitary heterogeneous material with mixed echo patterns of fluid and solid components. In each group, Doppler studies were performed and the resistance index (RI) was calculated. The two-dimensional patterns and Doppler results were correlated with clinical and pathologic follow-up.
Twenty-eight subjects had a normal uterine cavity and seven had a pure endometrial fluid collection; all were treated conservatively and none showed later clinical evidence of residual trophoblastic tissue. In 13 women, residual trophoblast was strongly suggested from the images of two-dimensional ultrasonography: Five showed an endometrial fluid collection with some echogenic foci, and eight exhibited intracavitary mixed echogenic material. All underwent curettage, and residual trophoblastic tissue was found in ten of the 13. The mean (+/- standard deviation) RI to flow in the myometrial arteries was 0.54 +/- 0.15 in women without residual trophoblast and 0.35 +/- 0.1 in those with residual trophoblastic tissue (P < .01).
Our experience suggests that transvaginal duplex Doppler ultrasonography is an effective noninvasive method for evaluating patients with excessive postpartum and post-abortion hemorrhage who are suspected of having residual trophoblastic tissue. Its use enhances the positive preoperative diagnosis of residual trophoblastic tissue and may reduce unnecessary curettage procedures.
评估高分辨率经阴道双功多普勒超声对产后及流产后出血过多且怀疑有滋养细胞残留患者的诊断准确性及临床应用价值。
对48例因可能存在滋养细胞残留组织而转诊的出血过多的女性进行经阴道双功多普勒超声检查。根据二维成像，将患者前瞻性地分为几组：子宫腔空虚且子宫腔正常的女性、仅有子宫内膜积液且无回声灶的女性、有混合性子宫内膜积液且有回声灶的女性以及宫腔内有液性和实性成分混合回声模式的异质物质的女性。对每组患者进行多普勒研究并计算阻力指数（RI）。将二维图像模式和多普勒结果与临床及病理随访结果进行关联分析。
28例患者子宫腔正常，7例仅有单纯子宫内膜积液；所有患者均接受保守治疗，且均未出现后续滋养细胞残留组织的临床证据。13例女性经二维超声图像强烈提示有滋养细胞残留：5例显示子宫内膜积液伴有一些回声灶，8例表现为宫腔内混合性回声物质。所有患者均接受刮宫术，13例中有10例发现有滋养细胞残留组织。无滋养细胞残留的女性子宫肌层动脉血流的平均（±标准差）RI为0.54±0.15，有滋养细胞残留组织者为0.35±0.1（P<0.01）。
我们的经验表明，经阴道双功多普勒超声是评估产后及流产后出血过多且怀疑有滋养细胞残留组织患者的一种有效的非侵入性方法。其应用提高了术前对滋养细胞残留组织的阳性诊断率，并可能减少不必要的刮宫手术。
