影响胎盘植入程度的危险因素及其超声影像学表现分析  

Risk factors and sonographic findings associated with the type of placenta accreta spectrum disorders

作　　者：张慧婧[1] 窦若冲 林莉[1] 王芊芸 黄贝尔 赵先兰[2] 陈敦金[3] 丁依玲[4] 丁虹娟[5] 崔世红[6] 张卫社[7] 辛虹[8] 顾蔚蓉 胡娅莉[10] 丁桂凤 漆洪波[12] 范玲[13] 马玉燕[14] 路军丽[15] 杨悦[16] 蔺莉[17] 骆秀翠[18] 张晓红[19] 樊尚荣[20] 杨慧霞[1] Zhang Huijing;Dou Ruochong;Lin Li;Wang Qianyun;Huang Beier;Zhao Xianlan;Chert Dunjin;Ding Yiling;Ding Hongjuan;Cui Shihong;Zhang Weishe;Xin Hong;Gu Weirong;Hu Yali;Ding Guifeng;Qi Hongbo;Fan Ling;Ma Yuyan;Lu Junli;Yang Yue;Lin Li;Luo Xiucui;Zhang Xiaohong;Fan Shangrong;Yang Huixia(Department of Obstetrics and Gynecology,Peking University First Hospital,Beijing 100034,China;Department of Obstetrics and Gynecology,Nanfing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210093,China;Department of Obstetrics,Urumqi Maternity and Child Health Hospital,Urumqi 830001,China;Department of Obstetrics and Gynecology,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400042, China;Department of Obstetrics,Beijing Obstetrics and Gynecology Hospital of Capital Medical University, Beijing 100026,China;Department of Obstetrics and Gynecology,Qilu Hospital of Shangdong University, Ji'nan 266035,China;Department of Obstetrics and Gynecology,Beijing Chaoyang Hospital of Capital Medical University,Beijing 100043,China;Department of Obstetrics and Gynecology,Civil Aviation General Hospital of Peking University,Beijing 100025,China;Department of Obstetrics and Gynecology,Beijing Friendship Hospital of Capital Medical University,Beijing 100050,China;Department of Obstetrics, Lianyungang Maternity and Child Health Hospital,Lianyungang 100142,China;Department of Obstetrics and Gynecology,Peking University People's Hospital,Beijing 100044,China;Department of Obstetrics,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Obstetrics and Gynecology,Peking University Shenzhen Hospital,Shenzhen 518035,China;Department of Obstetrics and Gynecology,The Third Affiliated Hospital of Guangzhou Medical University,Guangzhou 510150,China;Department of Obstetrics and Gynecology,The Second Xiangya Hospital of Central South University,Changsha 410008,China;Department of Obstetrics and Gynecology,Nanfing Maternity and Child Health Hospital,the Affiliated O

机构地区：[1]北京大学第一医院妇产科,100034 [10]南京大学医学院附属鼓楼医院妇产科,210008 [11]乌鲁木齐市妇幼保健院产科,830001 [12]重庆医科大学附属第一医院妇产科,400042 [13]首都医科大学附属北京妇产医院产科,100026 [14]山东大学齐鲁医院妇产科,济南250012 [15]首都医科大学附属北京朝阳医院妇产科,100043 [16]北京大学民航临床医学院妇产科,100025 [17]首都医科大学附属北京友谊医院妇产科,100050 [18]江苏省连云港市妇幼保健院产科,222000 [19]北京大学人民医院妇产科,100044 [2]郑州大学第一附属医院产科,450052 [20]北京大学深圳医院妇产科,518035 [3]广州医科大学附属第三医院妇产科,510150 [4]中南大学湘雅二医院妇产科,长沙410008 [5]南京市妇幼保健院产科,210004 [6]郑州大学第三附属医院产科,450052 [7]中南大学湘雅医院妇产科,长沙410008 [8]河北医科大学第二医院产科,石家庄050000 [9]复旦大学附属妇产科医院产科,上海200011

出　　处：《中华妇产科杂志》2019年第1期27-32,共6页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的研究影响胎盘植入程度的危险因素,并分析超声影像学表现与胎盘植入程度的相关性。方法本研究为观察性病例对照研究,收集2011年1月至2015年12月全国20家三级甲等医院共2 219例胎盘植入孕妇的临床资料,根据胎盘植入肌层的深度分为植入性胎盘组(PI组)1 755例(79.1%,1 755/2 219)和穿透性胎盘组(PP组)464例(20.9%,464/2 219)。采用单因素分析及多因素logistic回归,分析胎盘植入的危险因素,及超声影像学表现与胎盘植入程度的相关性。结果影响胎盘植入程度的危险因素包括孕妇年龄、孕次、流产史、既往剖宫产术史、前置胎盘等(P均<0.05),其中,既往剖宫产术史(χ^2=157.961)和前置胎盘(χ^2=91.759)与胎盘植入程度的相关性最为明显(P均<0.05)。超声诊断胎盘植入的影像学指标可用于预测胎盘植入的程度,其中子宫浆膜与膀胱的界限、胎盘与子宫肌层界限、子宫肌层回声连续性以及胎盘后异常血流信号与胎盘植入程度的相关性显著(P均<0.01)。 结论既往剖宫产术史和前置胎盘是影响胎盘植入程度最主要的危险因素;超声检查是目前诊断胎盘植入的主要手段。ObjectiveTo evaluate the risk factors and sonographic findings of pregnancies complicated by placenta increta or placenta percreta. MethodsTotally, 2 219 cases were retrospectively analyzed from 20 tertiary hospitals in China from January 2011 to December 2015. The data were collected based on the original case records. All cases were divided into two groups, the placenta increta (PI) group (79.1%, 1 755/2 219) and the placenta percreta (PP) group (20.9%, 464/2 219) , according to the degree of placental implantation. The risk factors and sonographic findings of placenta increta or percreta were analyzed by uni-factor and logistic regression statistic methods. ResultsThe risk factors associated with the degree of placental implantation were age, gravida, previous abortion or miscarriage, previous cesarean sections, and placenta previa (all P<0.05), especially, previous cesarean sections (χ^2=157.961) and placenta previa (χ^2=91.759). Sonographic findings could be used to predict the degree of placental invasion especially the boundaries between placenta and uterine serosa, the boundary between placenta and myometrium, the disruption of the placental-uterine wall interface and loss of the normal retroplacental hypoechoic zone(all P<0.01).ConclusionsPrevious cesarean sections and placenta previa are the main independent risk factors associated with the degree of placenta implantation. Ultrasound could be used to make a prenatal suggestive diagnosis of placenta accreta spectrum disorders.

关 键 词：侵入性胎盘 超声检查 危险因素 

分 类 号：R714.462[医药卫生—妇产科学] R445.1[医药卫生—临床医学]