产前超声评估对前置胎盘患者分娩大出血的预测价值  

Clinical Significance of Ultrasound Assessment on the Prediction of the Intrapartum Hemorrhage in Patients with Placenta Previa

作　　者：闫珊玲[1] 郑红[1] 刘万清[2] 郑研[1] 韦馨[1] 孙冰[3] 

机构地区：[1]四川省德阳市人民医院超声科,四川德阳618000 [2]四川省德阳市人民医院产科,四川德阳618000 [3]同济大学附属同济医院妇产科,上海200065

出　　处：《现代生物医学进展》2016年第17期3385-3388,共4页Progress in Modern Biomedicine

基　　金：国家自然科学基金项目(81300150)

摘　　要：目的:探讨前置胎盘孕妇产前超声评估对预测产时大出血的临床价值。方法:选取2012年1月至2015年1月在我院诊断为持续性前置胎盘(妊娠晚期和/或分娩期胎盘仍为持续状态)的孕妇60名,结合孕妇临床表现和产前超声检查,分析在剖宫产术中出现大出血的预测因素。结果:60名产妇中,有22例(36.7%)出现术中大出血(>1500 m L)。对22例出现大出血的产妇进行分组比较发现,既往有子宫手术史,前置胎盘距离宫颈内口更近甚至覆盖内口,缺乏透明带和胎盘植入的产妇,都表现出产时出血量增加,相比较未发生大出血的产妇,差异有统计学意义(P<0.05)。胎盘覆盖宫颈内口,缺乏透明带,胎盘缺损,彩色多普勒异常的产妇在剖宫产时发生大出血的概率更高(P<0.05)。结论:胎盘覆盖宫颈内口,缺乏透明带,胎盘植入,彩色多普勒异常的产妇在剖宫产时发生大出血的概率更高,可作为预测产时大出血的因素。Objective： To evaluate the clinical value of ultrasound assessment in patients with placenta previa to predict the intrapartum hemorrhage. Methods： 60 pregnant women with persistent placenta previa（defined as late pregnancy and / or childbirth placenta remains persistent state）were selected in our hospital from Jan. 2012 to Jan. 2015, then combined with the clinical manifestations and prenatal ultrasound examination to analysis predictors of the intrapartum hemorrhage in cesarean section. Results： In the 60 women, 22patients（36.7%） occurred intraoperative bleeding（〉1500 m L）. By comparing 22 cases of maternal bleeding, we found patients with previous uterine surgery, placenta previa distance closer to the cervix or covering the internal ostium, lack of clear zone and presence of lacunae, showing to increase the amount of bleeding in comparison with patients who did not occuring intraoperative bleeding, and the difference was statistically significant（P〈0.05）. The distance from the internal os to the edge of the placenta, lack of clear zone, presence of lacunae, abnormal color Doppler have higher probability of severe bleeding at the time of cesarean section（P〈0.05）. Conclusion： Patients with distance from the internal os to the edge of the placenta, lack of clear zone, presence of lacunae, abnormal color Doppler have higher probability of severe bleeding, those can be used as forecast factors of intrapartum hemorrhage.

关 键 词：前置胎盘 超声 出血 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.462[医药卫生—诊断学]