超声检查在48例胎盘早剥临床诊断中的应用研究

目的分析48例胎盘早剥患者的临床资料,研究胎盘早剥的超声图像特点,以提高超声检查辅助临床诊断胎盘早剥的诊断符合率。方法选取蚌医一附院2012年1月—2014年1月期间经产科术后确诊为胎盘早剥患者共48例,对其临床资料进行回顾性分析,研究胎盘早剥的二维及彩色多普勒超声表现,记录胎盘位置、厚度,重点观察胎盘内部,边缘以及胎盘与子宫壁附着处有无异常回声,胎盘内部血流以及异常回声内的血流情况,并记录相应数值。根据声像图特点将胎盘早剥分为4型：1胎盘增厚型;2胎盘后血肿型;3胎盘边缘血肿型;4混合性包块型。同时观察娩出后的胎盘母体面有无血块压迹,占胎盘总面积的百分比。结果 48例患者中产前超声提示为胎盘早剥为40例,符合率83.33%,漏诊7例,误诊1例。40例产前超声确诊者中胎盘增厚型9例,其中产后观察胎盘剥离Ⅱ度2例,Ⅲ度7例,死胎3例;胎盘后血肿型20例（低回声8例,等回声2例,无回声1例,高回声1例,混合性回声8例）,胎盘剥离Ⅰ度4例,Ⅱ度7例,Ⅲ度9例,死胎3例;胎盘边缘血肿型3例,胎盘剥离Ⅱ度2例,Ⅲ度1例;混合性包块型8例,胎盘剥离Ⅱ度1例,Ⅲ度7例,死胎5例。结论超声检查是临床诊断胎盘早剥重要的、不可缺少的首选辅助诊断方法,对帮助提高母婴存活率有重要意义。

Role of ultrasonography in clinical diagnosis of 48 cases of placental abruption

Objective To investigate the sonographic features of placental abruption,so as to improve the coincidence rate ultrasonic inspection auxiliary diagnosis in the clinical diagnosis of placental abruption. Methods 48 cases of placental abruption confirmed by obstetric postoperative diagnosis in our hospital from Jan. 2012 to Jan. 2014 were enrolled in this study,the clinical data were retrospectively analyzed. The features of placental abruption in 2D and color Doppler ultrasound were studied. The materials about placental position,thickness,abnormal echo（ inside the placenta,at edges of placenta,and attachment between placenta and uterine wall）,and blood flow inside the placenta and sites with abnormal echo were recorded. According to the sonographic features,the placental abruption were divided into 4 types： ①placenta thickening; ②retroplacental hematoma; ③placental marginal hematoma type;④mixed mass type. At the same time,the clot impression and the ratio accounted for the total area of placenta were observed after the maternal delivery. Results 40 of 48 patients were with placental abruption by ultrasonography,the coincidence rate was 83. 33%; 7 cases were missed in the diagnosis; 1 case was misdiagnosed. In the 40 cases confirmed prenatal ultrasound,9 cases were with placenta thickening,in which included 2 cases of Ⅱ degree placenta separation,7 cases of Ⅲ degree placenta separation and 3 cases of stillbirth by postpartum observation; 20 cases were retroplacental hematoma（ low echo in 8 cases,equal echo in 2 cases,no echo in 1 cases,high echo in 1 cases,mixed echo in 8 cases）,included 4 cases of type Ⅰ placenta separation,7 cases ofⅡ degree placenta separation,9 cases of Ⅲ degree placenta separation and3 cases of stillbirth; 3 cases of placental abruption marginal hematoma,included 2 cases of Ⅱ degree placenta separation,1 case of Ⅲ degree placenta separation; 8cases of mixed mass,included 8 cases mixed mass,included 1 cases of Ⅱ degree placenta separation,7 cases of Ⅲ degree