前置胎盘患者MRI征象和临床特征与剖宫产大出血的关系  

Relationship between MRI signs and clinical features in patients with placenta previa and massive hemorrhage during cesarean section

作　　者：曹满瑞[1] 刘炳光[1] 陆炜[1] 杜牧[1] 郭吉敏[1] 张方璟[1] 赵弘[1] 朱志军[1] 

机构地区：[1]南方医科大学附属深圳市妇幼保健院放射科,518028

出　　处：《中华放射学杂志》2016年第8期599-603,共5页Chinese Journal of Radiology

摘　　要：目的探讨前置胎盘患者的MRI征象和临床特征与发生剖宫产大出血的关系。方法回顾性分析经剖宫产分娩证实为前置胎盘，剖宫产前1周内行MRI检查且临床资料完整的363例患者，其中19例合并胎盘植入，54例发生产后大出血。分析出血患者的临床特征以及MRI征象和大出血的关系。单变量分析采用四格表χ^2检验，并计算优势比，多变量分析采用Logistic回归分析方法。结果剖宫产次数≥2次、胎盘覆盖瘢痕、子宫局限性隆突、胎盘T2WI低信号条、胎盘信号不均匀、子宫肌层变薄、胎盘突人宫颈、子宫下段及宫颈富血供和胎盘植入患者大出血概率增加，与无上述特征患者相比，大出血发生率的差异均有统计学意义（P均〈0．01）。胎盘植入患者大出血的优势比最高（43．0）。多变量分析结果显示剖宫产次数≥2次、胎盘覆盖瘢痕、子宫下段及宫颈富血供、胎盘植入患者发生剖宫产后大出血的风险大，优势比分别为6．4、2．0、2．7和17．9。结论胎盘植入是前置胎盘剖宫产大出血的重要病因，既往有多次剖宫产术史、胎盘覆盖瘢痕以及子宫下段及宫颈富血供对预测产后大出血具有较大价值。Objective To explore the relationship between MRI signs, clinical features and massive hemorrhage during cesarean section in patients with placenta previa. Methods Three hundred and sixty-three patients with placenta previa confirmed by cesarean section were retrospectively reviewed. All patients with complete clinical data underwent MRI scanning in a week before cesarean section, of which 19 cases with placenta accreta, 54 cases with postpartum hemorrhage. We analyzed the relationship between clinical features, MRI signs and massive hemorrhage during cesarean section. Chi-square test was used for univariate analysis and calculated odds ratio, while Logistic regression analysis was used for multivariate analysis. Results Comparing patients with the following characteristics to those patients without these characteristics, the probabilities of massive hemorrhage during cesarean section were statistically significant different （P〈0.01）. These characteristics including previous cesarean section （n≥2）, scar covered by placenta, local bulging of the uterine, intraplacental dark bands on T2WI, heterogeneous signal intensity in the placenta, thinning of myometrium, placenta protruding into the cervix, increased vascularity of the cervix and lower uterine segment, and placenta accrete. Univariate analysis related to massive hemorrhage showed that the odds ratio of placenta accreta was the highest （OR=43.0）. Multivariate analysis revealed that previous cesarean section （n≥2） （OR=6.4）, scar covered by placenta （OR=2.0）, increased vascularity of the cervix and lower uterine segment （OR=2.7） and placenta accrete （OR=17.9）were associated with massive hemorrhage during cesarean section. Conclusions Placental accreta is the important pathogenic factor for massive hemorrhage during cesarean section in patients with placenta previa. Repeated cesarean section, scar covered by placenta, increased vascularity of the cervix and lower uterine segment is valuable in predicting massive hemorrhage du

关 键 词：前置胎盘 胎盘 侵入性 磁共振成像 产后出血 

分 类 号：R714.2[医药卫生—妇产科学] R445.2[医药卫生—临床医学]