超声及MRI在胎盘植入诊断中的应用现状及评价

胎盘植入是胎盘绒毛因内膜缺陷而直接侵入子宫内膜,或胎盘直接种植到子宫肌层及浆膜层内。根据胎盘绒毛植入子宫肌层的深度,可将胎盘植入分为胎盘粘连、胎盘植入和胎盘穿通。超声和MRI是目前临床最常用于诊断胎盘植入的方法。超声已成为胎盘植入的首选检查方法;但当胎盘位于子宫后壁或需要判断胎盘植入深度时,超声检查结果不可靠。作为超声检查的辅助手段,MRI对于胎盘位于子宫后壁的患者具有较大优势,同时对于胎盘植入的分型(尤其对于胎盘穿通的患者)明显优于超声。对临床怀疑有胎盘植入高危因素的孕妇可先行超声检查;当超声诊断不明确、胎盘位于子宫后壁或不能判断其植入深度时,可进一步行MRI,以优化诊断率。     

彩色多普勒在胎盘植入诊断中的应用价值

目的应用彩色多普勒超声观察产前胎盘植入的声像图特征,提高产前诊断和J临床治疗中的应用价值。方法回顾性分析在本院进行诊治、并最终经手术后病理证实为胎盘植入的患者56例,分析其产前胎盘植入的声像图特征,得出对产前胎盘植入的检出率。结果产前胎盘植入的二维声像图以胎盘增厚、胎盘内漩涡形成、胎盘后间隙消失、局部肌层菲薄为主要特征;而加用彩色多普勒后,则可显示出胎盘漩涡内的丰富血流及增多的胎盘基底血管丛。56例胎盘植入患者中,产前超声正确诊断出20例,检出率约为35．7％。结论彩色多普勒超声在胎盘植入的产前诊断中有重要的临床应用价值。     

剖宫产瘢痕妊娠：MRI与经阴道超声对照

目的评价MRI及经阴道超声诊断剖宫产瘢痕妊娠（CSP）的价值。方法回顾性分析经手术证实的28例CSP患者的MRI、经阴道超声表现,对比两种方法显示孕囊位置、大小、性质、对子宫肌层的浸润、是否合并囊内及宫腔出血、对卵黄囊显示及存活状况等情况。结果MRI及经阴道超声均可显示23例囊性孕囊和5例包块型孕囊。23例囊性孕囊中,MRI诊断孕囊内合并出血6例,经阴道超声发现囊内出血2例;MRI无法显示卵黄囊及判断胚胎是否存活;经阴道超声发现卵黄囊12例,其中胚胎存活10例。MRI显示孕囊位于瘢痕周围肌层内9例,位于瘢痕处向官腔方向延伸14例,经阴道超声诊断位于肌层8例,瘢痕及官腔内15例。5例包块型孕囊中,MRI均见包块内出血,经阴道超声诊断包块内出血3例;MRI诊断包块对子宫肌层浸润5例,经阴道超声无法判断孕囊对子宫肌层的浸润。MRI诊断官腔内积血18例,经阴道超声诊断8例。结论联合应用阴道超声与MRI有利于诊断CSP。     

高频彩超对腹壁子宫内膜异位症的诊断价值

目的探讨彩色多普勒超声在诊断腹壁子宫内膜异位症中的应用价值。方法对8例经手术及病理证实的腹壁切口子宫内膜异位症患者的超声图像资料进行总结分析。结果腹壁子宫内膜异位症声像图均表现为腹壁切口处皮下不均质的低回声结节,边界不清,周边回声增强,内部血流信号不丰富。术前诊断与超声检查比较有统计学意义（t=6.44,P〈0.01）。结论高频彩超能发现早期病变以及明确病变范围,有助于临床诊断腹壁子宫内膜异位症,为临床提供依据,指导临床手术。     

凶险性前置胎盘并胎盘置入产前MRI检查的临床应用价值

目的探讨凶险性前置胎盘并胎盘置入产前MRI检查的临床应用价值。方法回顾性分析2018-01—2020-08间于西平县人民医院行产前MRI检查拟诊为凶险性前置胎盘并胎盘植入行剖宫产术的78例产妇的临床资料。以术前阴道超声联合术中所见或病理学(联合检查)结果为"金标准",统计术前MRI检查的灵敏度、特异性、准确率,以及阳性预测值和阴性预测值。结果 MRI诊断凶险性前置胎盘合并胎盘植入的灵敏度为93.44%,特异性为82.35%,准确率为93.59%。阳性预测值为95.16%,阴性预测值为87.50%。结论对拟诊为凶险性前置胎盘合并胎盘植入行剖宫产的产妇,术前行MRI检查有较高的灵敏度、特异性和准确率,尤其可协助评估胎盘置入子宫肌层的深度、宫旁侵犯,以及与周围器官的关系等,更有助于凶险性前置胎盘并胎盘植入的确诊。     

产前不同超声特征对瘢痕子宫胎盘植入的评价分析

目的 探讨产前不同超声特征对瘢痕子宫胎盘植入的诊断意义及评估效果。方法 选择2020年1月至2021年9月于我院妇产科建档、产检时疑似瘢痕子宫胎盘植入的55例孕妇作为研究对象。应用超声检查对产前患者进行诊断和评估，以病理诊断结果为依据评价其诊断价值。结果 超声诊断结果显示，55例孕妇产前共检出51例为瘢痕子宫胎盘植入患者；术后病理诊断结果显示，55例孕妇均为瘢痕子宫胎盘植入，超声诊断符合率为92.73%(51/55)。55例患者产前超声表现主要分为Ⅰ型、Ⅱ型、Ⅲ型3种类型，Ⅰ型占比为21.82%(12/55),Ⅱ型占比为61.82%(34/55),Ⅲ型占比为16.36%(9/55)。术后病理结果显示，超声表现为Ⅲ型的患者术中出血量最多，不同超声表现类型间术中出血量比较有显著差异(P<0.05)。超声表现为Ⅰ型的患者病理诊断多为粘连性胎盘，占75.00%(9/12);Ⅱ型患者多为植入性胎盘，占91.18%(31/34);Ⅲ型患者多为穿透性胎盘，占66.67%(6/9)。结论 产前超声检查对于瘢痕子宫胎盘植入具有较高的诊断价值，且可以评估胎盘植入的类型，有利于临床诊疗的决策，提高母婴...     

彩色多普勒超声诊断宫外孕101例分析

目的探讨彩色多普勒超声诊断宫外孕的价值。方法通过分析经手术病理证实宫外孕患者101例的彩色多普勒超声的声像图特征,总结宫外孕的影像学表现。结果 80例在子宫底或附件区探及包块,其中21例宫腔内同时出现假妊娠囊,70例于囊实性包块内或周边显示有彩色血流信号。10例在子宫底或附件包块的束状结构内见到原始心管搏动,69%的患者记录到类滋养层周围血流频谱。结论彩色多普勒超声是诊断宫外孕简便、有效、首选的方法。     

超声诊断复发静脉内平滑肌瘤病

目的观察超声对子宫切除术后复发静脉内平滑肌瘤病(IVL)的诊断价值。方法回顾性分析14例经手术及病理证实的子宫切除术后复发IVL的声像图表现。结果 14例中,超声明确诊断6例(6/14,42.86%),性质或来源待定5例(5/14,35.71%),误诊3例(3/14,21.43%)。子宫切除术后复发IVL的声像图特点为右心房、下腔静脉及髂静脉内病变呈条索状连续中等回声或低回声,其与管壁间可见静脉血流信号,3例于病变内部可探及动脉血流信号;盆腔和腹腔病变表现为低回声或中等回声,边界清,形态规则或不规则,单发或多发,多发者大小不等,散在分布或互相融合,CDFI示病变内丰富血流信号或少许血流信号;3例盆腔病变表现为形态极不规则低回声或中等回声,其内回声不均匀,呈镶嵌样,CDFI见丰富血流信号。结论子宫切除术后复发IVL声像图表现有一定特点,但目前超声诊断率较低。     

阴道超声及彩色多普勒血流显像（CDFI）在宫颈癌临床诊断中的价值

目的探讨阴道超声及彩色多普勒血流显像（CDFI）在宫颈癌临床渗断中的价值。方法同顺性分析98例经手术病理证实的宫颈癌患者经阴道超声检查的二维声像图及彩色多普勒血流显像（CDFI）表现。结果宫颈鳞状细胞癌79例,腺癌19例。早期宫颈癌宫颈正常或稍大．宫颈管回声略增强,部分可见回声断续,宫颈肌层无占位性病变．CDFI无明娃异常血流信号;中晚期宫颈癌宫颈形态改变．明显增大,可见低回声或不均匀回声肿块．CDFI可及丰富血流信号,呈高速低阻型动脉皿流。结论阴道超声及CDFI是一种无创伤性、分辨率高、敏感度强的检查方法,为宫颈癌的早期诊断、术前分期、鉴别诊断提供重要依据。     

MRI及超声在凶险性前置胎盘诊断中的价值比较

目的 探讨磁共振成像(MRI)在凶险性前置胎盘诊断中的价值。方法 回顾性分析2018年1月至2020年1月在我院就诊的120例凶险性前置胎盘患者的临床资料,其中合并胎盘植入患者79例,未合并胎盘植入患者41例,比较超声和MRI诊断结果。结果 本组MRI诊断凶险性前置胎盘的准确率为93.33%,明显高于超声诊断的74.17%(P<0.05);其中孕周<37周和孕周≥37周患者的MRI诊断准确率分别为88.89%和96%,明显高于超声诊断的71.11%和76%(P均<0.05)。胎盘植入与无胎盘植入患者的年龄、孕周比较,差异均无统计学意义(P>0.05);在合并胎盘植入的79例患者中,MRI诊断准确率为94.94%,明显高于超声诊断的69.92%(P<0.05);在无胎盘植入的41例患者中,MRI和超声诊断准确率比较,差异无统计学意义(P>0.05)。结论 MRI在凶险性前置胎盘诊断中有较好的价值,可有效鉴别胎盘植入型凶险性前置胎盘;临床需积极对有剖宫产史的再妊娠患者进行筛查,以尽早干预。     

产前超声早期诊断胎儿前腹壁异常的临床意义

目的探讨早孕及中孕早期超声诊断胎儿前腹壁异常的临床意义。方法回顾性分析我院早孕及中孕早期超声诊断的21胎前腹壁异常胎儿超声表现及随访结果,分析比较前腹壁异常的超声声像图特征。结果早孕及中孕早期超声筛查出21胎胎儿前腹壁异常,均在首次超声检查时发现,均经引产直接观察或病理检查进一步证实;其中脐膨出12胎,泄殖腔外翻1胎,体蒂异常8胎。7胎接受羊水穿刺检查,1胎脐膨出为13-三体,余染色体未见异常。结论早孕及中孕早期超声检查可有效诊断及鉴别诊断前腹壁异常,具有重要临床意义。     

孕早期胎儿心脏结构的超声筛查

目的探讨孕11~13~(+6)周经腹部超声筛查胎儿心脏畸形的可行性及临床价值。方法于孕11~13~(+6)周对3360胎行心脏四切面扫查,包括胎儿四腔心切面、三血管切面、左心室流出道切面及右心室流出道切面。根据孕周分为A(11~11~(+6)周)、B(12~12~(+6)周)、C(13~13~(+6)周)3组,比较3组胎儿心脏切面满意显示率。并于该时期筛查胎儿严重心脏畸形并随访至中孕期。结果 C组心脏各切面显示率明显高于A、B组,差异有统计学意义(P0.05)。3360胎中于早孕期筛查出心脏异常12胎,并于中孕期得以证实。结论孕早期经腹部超声筛查胎儿严重心脏畸形是可行的。     

Outcomes of prospectively-collected consecutive cases of antenatal-suspected placenta accreta

BackgroundAccurate diagnosis of placenta accreta is tentative before surgery. This study developed a predictive score for antenatal diagnosis of placenta accreta through mathematical modeling using clinical signs.MethodsAntenatal cases of suspected placenta accreta were collected prospectively in a single-site tertiary delivery center. Women with clinical signs of placenta accreta (placenta previa, number of previous cesarean deliveries and/or ultrasound suspicion of placenta accreta) were included. The diagnosis of accreta was confirmed surgically. The primary endpoint was the proportion of surgically-diagnosed placenta accreta among all suspected cases. Logistic regression modeling was performed to assess preoperative risk factors for placenta accreta. The risk score was tested on a receiver operator characteristic curve to identify subjects with placenta accreta and the optimum cut-point was chosen.ResultsOver nine years, 92 suspected accreta cases were identified from 46 623 deliveries (0.2%). The diagnosis was confirmed at surgery in 52/92 cases (56%) and there were no maternal deaths. Blood transfusion requirements were greater in patients with placenta accreta versus patients without placenta accreta (median 7 [range 0–25, interquartile range 3–10] versus 0 [0–6, 0–2] units of blood, P <0.0001). Area under the curve of the receiver operator characteristic curve was 0.846, with contribution from three variables (placenta previa, number of previous cesarean deliveries and ultrasound suspicion), each with a P value <0.05. From the ROC curve a cut-point with 100% sensitivity and specificity 25% (95% CI 12.69%–41.20%) was achieved, compared with 86.6% sensitivity (95% CI 74.21%–94.41%) and 60.0% specificity (95% CI 43.33%–75.14%) using ultrasound alone.ConclusionsCombining diagnostic features associated with placenta accreta through mathematical modeling has better positive predictive value than ultrasound alone.     

Clinical analysis of 47 cases with placenta accreta

Objective: To explore the incidence, risk factors and treatment for placenta accreta.Methods: A retrospective analysis was carried out from May 1997 to May 2007 in Peking Union Medical College Hospital which involved 47 placenta accreta cases and 141 controls.Results: According to our study, the incidence of placenta accreta was 0.262%(47/17,918). The percentages of placenta previa in case group were significantly higher than those of control group (P<0.01). Ninety-five point seven four percent (95.74%) of the cases were cured with conservative methods. In the second trimester, the efficiency of dilatation and curettage was 42. 86%, uterine artery embolism (UAE) was 100%. In the third trimester, the efficiency of dilatation and curettage was 20.69%, tamping was 86.67%, and UAE was 100%.Conclusion: The incidence of placenta accreta in the second trimester seems increasing, which was higher than the incidence in the third trimester. The incidence of placenta accreta was only related to placenta previa. Uterine artery embolism was the best conservative management. While in the third trimester tamping was still the most effective conservative method. The majority of the cases could reserve their reproductive functions.     

凶险性前置胎盘合并胎盘植入剖宫产术中腹主动脉远端球囊阻断的临床疗效

目的分析剖宫产术中腹主动脉远端球囊阻断对于治疗凶险性前置胎盘合并胎盘植入的临床疗效。方法回顾性分析72例凶险性前置胎盘合并胎盘植入产妇的资料。其中53例(阻断组)于剖宫产术前预留腹主动脉球囊导管,术中暂时阻断腹主动脉血流;19例(未阻断组)未留置腹主动脉球囊导管,直接行剖宫产手术。比较2组术中、术后情况及新生儿情况。结果球囊阻断组术中出血量、术中输血量、子宫切除率均低于未阻断组(P均0.05),2组间术后转入重症监护室(ICU)的比例及ICU住院时间差异均有统计学意义(P均0.05),手术时间、术后感染发生率及术后住院总时间差异均无统计学意义(P均0.05)。2组间新生儿体质量及出生后5min、10min的Apgar评分差异均无统计学意义(P均0.05)。结论凶险性前置胎盘合并胎盘植入剖宫产术中行腹主动脉远端球囊阻断安全可行,可有效减少术中出血及输血量,降低子宫切除率。     

双侧子宫动脉预留导管栓塞在凶险性前置胎盘伴胎盘植入中的应用

目的探讨双侧子宫动脉预留导管产后行子宫动脉栓塞术在凶险性前置胎盘伴胎盘植入剖宫产术中的应用价值。方法回顾性分析16例接受剖宫产联合双侧子宫动脉预置导管栓塞治疗的凶险性前置胎盘伴胎盘植入产妇的资料。记录术中出血量、输血量、子宫切除情况、透视时间、辐射剂量、并发症及新生儿情况。结果剖宫产联合双侧子宫动脉栓塞术的技术成功率为93.75%(15/16)。术中平均出血量(1 575.00±1 040.83)ml,平均输血量为(3.44±2.34)U悬浮少白细胞红细胞。胎儿娩出前平均透视时间(0.89±0.24)min,平均辐射剂量(7.17±2.12)mGy。1例新生儿出生后重度窒息,其余15名新生儿出生后5min Apgar评分为(9.38±0.89)分。1例产妇因术后因再次活动性出血并发弥漫性血管内凝血而行全子宫切除术。2例产妇术后感臀部疼痛。结论双侧子宫动脉预留导管产后行子宫动脉栓塞术可用于凶险性前置胎盘伴胎盘植入的治疗,有利于减少剖宫产术中出血及输血量,降低子宫切除的风险,且辐射剂量较低、术后并发症较少。     

Anesthetic management of placenta accreta in a low-resource setting: a case series

BackgroundCurrent recommendations for the anesthetic management of placenta accreta support a conservative approach with neuraxial anesthesia and uterine artery embolization. These are based on case series from experienced centers in developed countries. The aim of this study was to describe the anesthetic management of placenta accreta in a low-resource setting.MethodsA retrospective case note review was performed. From 1 August 2006 to 31 July 2011 placentas from cases of suspected placenta accreta were reassessed histologically to confirm the diagnosis. Patient charts were reviewed and information on anesthetic technique, monitoring, blood transfusion, maternal and fetal outcomes was extracted.ResultsThirty-nine cases were identified. Mean (±SD) maternal age was 33 ± 5.4 years. Hysterectomy was performed at the time of cesarean section in all cases. Thirty-four patients received neuraxial anesthesia, of whom 15 required conversion to general anesthesia. Invasive blood pressure monitoring was used in all patients and a central venous catheter was inserted in 33 cases. Complications associated with monitoring occurred in five patients. Median [IQR] blood loss was 2000 [1100–2700] mL and the median [IQR] number of units of red blood cell transfused was 2 [0–6]. Vasoactive medication was used in 14 patients and 15 patients were transferred to the intensive care unit postoperatively. No maternal or newborn deaths occurred.ConclusionA multidisciplinary approach can prove valuable when placenta accreta is suspected before delivery. In low-resource settings, lack of interventional radiology services and prenatal diagnostic capability may have an impact on anesthetic management in patients with placenta accreta. However, other than greater blood loss, our study demonstrated that good maternal and neonatal outcomes are possible in spite of limited resources.     

腹主动脉球囊阻断应用于植入型凶险型前置胎盘剖宫产中的效果

目的 探讨腹主动脉球囊阻断在植入型凶险型前置胎盘产妇剖宫产术中的临床应用效果。方法 回顾性分析18例接受腹主动脉球囊阻断联合剖宫产手术的植入型凶险型前置胎盘产妇的临床资料。记录术中出血量、输血量、球囊阻断有效率、总阻断时间、子宫切除情况及并发症等。结果 18例产妇均成功行腹主动脉球囊阻断辅助剖宫产术,技术成功率为100%（18/18）。剖宫产术中平均出血量为（1 276.11±761.59）ml,平均输入悬浮少白红细胞（2.86±1.51）U,无一例因出血而死亡。球囊阻断有效率100%（18/18）,球囊有效阻断时间（24.06±26.19）min。4例（4/18,22.22%）产妇在胎儿娩出后行子宫切除术,均由于胎盘植入严重,甚至广泛侵犯宫颈、膀胱、肠道。剖宫产前后产妇均未出现与球囊阻断、介入栓塞相关的严重并发症。结论 对于凶险型前置胎盘产妇,腹主动脉球囊可以有效阻断血流,减少剖宫产术中出血量、输血量,降低子宫切除率及手术风险。