彩色多普勒超声诊断帆状胎盘和血管前置的临床价值及漏诊误诊原因分析

目的 探讨产前彩色多普勒超声诊断帆状胎盘及血管前置的临床价值及漏诊和误诊原因分析。方法 回顾性分析2015年1月~2018年7月我院行产前彩色多普勒超声筛查946例孕妇的彩色多普勒声像图及临床特点，分析帆状胎盘和血管前置的超声诊断情况、影像学特点及妊娠结局。结果 共946例孕妇中，产科证实帆状胎盘117例，超声诊断帆状胎盘106例，漏诊11例，误诊7例，漏诊率:9.40%（11/117）,误诊率:0.84%（7/829），诊断符合率:98.10%（928/946）；产科证实血管前置19例，超声诊断血管前置16例，漏诊3例，误诊3例；漏诊率:15.79%（3/19），误诊率:0.32%（3/727），诊断符合率:99.37%（940/946）。帆状胎盘彩色多普勒超声显示脐带入口在胎盘边缘的游离胎膜内，经羊膜和绒毛膜之间进入胎盘；血管彩色多普勒超声显示胎膜血管位于胎儿先露前方跨越宫颈内口或者接近宫颈内口。有69.91%（79/113）的超声帆状胎盘孕妇选择剖宫产，另外30.09%（34/113）选择顺产；有19例产前超声诊断为血管前置孕妇均选择剖宫产，其中5例胎膜早破急诊剖宫产手术，但新生儿情况良好。结论 彩色多普勒超声能较好的显示胎盘形状、胎盘脐带插入口位置及宫颈内口血管情况，提高诊断帆状胎盘及血管前置诊断率，改善妊娠结局，降低围生期胎儿死亡率，但因各种因素影响，存在一定漏诊和误诊。

Clinical Value of Color Doppler Ultrasound in Diagnosis of Spiral Placenta and Vascular Preposition and Analysis of Misdiagnosis Causes of Missed Diagnosis

Objective To investigate the clinical value of prenatal color Doppler ultrasound in the diagnosis of sacral placenta and vascular preposition and the reasons for missed diagnosis and misdiagnosis. Methods Retrospective analysis of color Doppler sonography and clinical features of 946 pregnant women undergoing prenatal color Doppler ultrasound screening from January 2015 to July 2018, and analysis of the ultrasound of the placenta and vascular front Diagnostic conditions, imaging features and pregnancy outcomes. Results Among 946 pregnant women, 117 cases of sail-shaped placenta were confirmed by obstetrics, 106 cases of spiral placenta were diagnosed by ultrasound, 11 cases were missed, and 7 cases were misdiagnosed. The rate of missed diagnosis was 9.40% (11/117), and the rate of misdiagnosis was 0.84% (7/829), the diagnostic coincidence rate: 98.10% (928/946); obstetrics confirmed 19 cases of vascular advancement, 16 cases of anterior ultrasound diagnosis, 3 cases of missed diagnosis, 3 cases of misdiagnosis; the rate of missed diagnosis: 15.79% (3/19), The rate of misdiagnosis was 0.32% (3/727), and the diagnostic coincidence rate was 99.37% (940/946). Spiral placenta color Doppler ultrasound showed that the umbilical cord entrance was in the free fetal membrane at the edge of the placenta, entering the placenta between the amnion and the chorion; vascular color Doppler ultrasound showed that the fetal membrane blood vessels were located in front of the fetus to cross the cervix or close to the cervix. 69.91% (79/113) of the patients with ultrasonic sail-shaped placenta chose cesarean section, and another 30.09% (34/113) chose to give birth. There were 19 cases of prenatal ultrasound diagnosis for vascular anterior women who chose cesarean section, of which 5 cases of premature rupture of membranes for emergency cesarean section, but the newborn is in good condition. Conclusion Color Doppler ultrasound can better display the shape of the placenta, the position of the placenta of the placenta and the vascular part of the cervix, improve the diagnostic rate of the placenta and vascular preamplifier, improve the pregnancy outcome, and reduce the perinatal fetal mortality. However, due to various factors, there are certain missed diagnosis and misdiagnosis.