凶险型前置胎盘合并胎盘植入的产前超声诊断及临床意义

目的 探讨凶险型前置胎盘合并胎盘植入的产前超声诊断及临床意义.方法 选择2011年1月至2013年12月在四川大学华西第二医院经临床及组织病理学检查或产前超声检查确诊的42例胎盘植入合并凶险型前置胎盘、56例胎盘植入未合并凶险型前置胎盘及212例凶险型前置胎盘未合并胎盘植入共计310例患者为研究对象.回顾性分析其胎盘植入产前超声诊断检出率差异及超声检查特点（本研究遵循的程序符合四川大学华西第二医院人体试验委员会所制定的伦理学标准,得到该伦理会批准,并征得受试对象本人的知情同意,与之签订临床研究知情同意书）.各类型患者一般临床资料比较,差异无统计学意义（P＞0.05）.结果 产前超声检查对胎盘植入的检出率比较：合并前置胎盘的检出率较未合并前置胎盘的检出率高,且差异有统计学意义（χ^2=4.38,P＜0.05）;合并凶险型前置胎盘的检出率较合并普通型前置胎盘的检出率高,且差异有统计学意义（χ^2 =25.21,P＜0.01）.对凶险型前置胎盘,合并胎盘植入患者年龄≥35岁比例及宫腔操作次数≥2次的比例均较未合并胎盘植入患者高,且差异有统计学意义（χ^2=17.92,8.76;P＜0.01）.结论 产前超声诊断凶险型前置胎盘合并胎盘植入有重要临床意义.凡年龄≥35岁、有多次宫腔操作史及多次剖宫产史的凶险型前置胎盘患者需警惕合并胎盘植入的可能,应行产前超声诊断,为临床诊治提供指导,以降低母亲及胎儿死亡风险.

Antenatal Sonographic Diagnosis and Clinical Significance of Pernicious Placenta Previa Combined with Placenta Accreta

Objective To investigate antenatal sonographic diagnosis and clinical significance of pernicious placenta previa complicated with placenta accreta.Methods A total of 310 cases who were diagnosed by clinical features,histopathological examination or antenatal ultrasonography from January 2011 to December 2013 in West China Second University Hospital,Sichuan University as study subjects,which included 42 cases of pernicious placenta previa complicated with placenta accreta,56 cases of placenta accreta without pernicious placenta previa and 212 cases of pernicious placenta previa without placenta accreta.The detection rate differences of antenatal sonographic diagnosis and ultrasound characteristics of placenta accreta were retrospectively analyzed.The study protocol was approved by the Ethical Review Board of Investigation in Human Beings of West China Second University Hospital,Sichuan University.Informed consent was obtained from each participating patient.There were no statistically significant difference with general clinical datas of all patients（P〉0.05）.Results The detection rate of placenta accreta combined with placenta previa by antenatal ultrasonography was higher than that of without placenta previa,and had statistically significant difference（χ^2=4.38,P〈0.05）;the detection rate of placenta accreta combined with pernicious placenta previa was higher than that of without it,and had statistically significant difference（χ^2 =25.21,P〈0.01）.For the patients with pernicious placenta previa,the ratio of patients older than 35 years old and underwent more than twice uterine cavity operations of which combined with placenta accreta were higher than those of without placenta accreta,and had statistically significant difference （χ^2=17.92,8.76;P〈0.01）.Conclusions There was an important clinical significance for the diagnosis of pernicious placenta previa combined with placenta accreta by antenatal ultrasonography.Every pernicious placenta previa patient who was older than 35 years old and