术前MRI在预测前置胎盘患者发生严重产后出血中的应用  

Preoperative prediction of massive postpartum hemorrhage in placenta previa by MRI

作　　者：郭吉敏[1] 曹满瑞[1] 张方璟[1] 刘阳[1] 陆玮[1] 范光荣 GUO Jimin;CAO Manrui;ZHANG Fangjing;LIU Yang;LU Wei;FAN Guangrong(Department of Radiology,the Affiliated Shenzhen Maternity and Child Healthcare Hospital of Southern Medical University,Shenzhen 518028,China)

机构地区：[1]南方医科大学附属深圳市妇幼保健院放射科,广东深圳518028

出　　处：《实用放射学杂志》2019年第5期772-775,共4页Journal of Practical Radiology

基　　金：2016年深圳市科技创新委员会资助项目(JCYJ20160427191826197)。

摘　　要：目的探讨前置胎盘患者术前MRI预测严重产后出血的价值。方法回顾性分析362例(其中54例发生严重产后出血)具有完整临床资料的前置胎盘患者的临床病史以及产前MRI资料。结果单因素分析显示临床资料中孕妇年龄(χ^2=3.951,P=0.047)、孕周(χ^2=6.257,P=0.012)、剖宫产次数(χ^2=36.372,P=0.001)以及是否双胎(χ^2=7.933,P=0.005)在评估严重产后出血中有统计学意义。MRI征象中以子宫局限性隆凸(OR,46.712;95%CI,13.067~166.987)、胎盘突出征(OR,22.787;95%CI,4.595~113)、胎盘内T2WI低信号带(OR,14.757;95%CI,7.149~30.461)提示孕妇发生严重产后出血的风险较大。另外,子宫肌层变薄或局限性中断,胎盘信号不均匀,胎盘下异常血管,子宫下段及宫颈血管丰富,宫颈缩短等征象在评估严重产后出血中也有统计学差异。结论结合临床病史,MRI可以在术前预测大部分的严重产后出血,对于提高多学科协作,改善患者预后具有指导意义。Objective To investigate the value of preoperative MRI for placenta previa in prediction of massive postpartum hemorrhage.Methods A retrospective analysis of the clinical history and prenatal MRI features of 362 patients with placenta previa were performed.Of these,54 cases experienced severe postpartum hemorrhage.Results Univariate analysis showed that the age of pregnant women(X^2=3.951,P=0.047),gestational age(x=6.257,P=0.012),number of cesarean sections(X^2=36.372,P=0.001)and gemellary pregnancy(X^2=7.933,P=0.005)were associated with massive postpartum hemorrhage.Among the MRI signs,Uterine bulging(OR,46.712;95%CI,13.067-166.987),placental protrusion sign(OR,22.787;95%CI,4.595-113),and introplacental T2 dark band(OR,14.757;95%C1,7.149-30.461)indicated high risk with massive postpartum hemorrhage.Myometrial thinning or localized interruption,uneven placental signal,abnormal blood vessels below the placenta,abundant blood vessels in lower uterus and cervix,cervical shortening and other signs for the evaluation of severe postpartum hemorrhage were also statistically significant.Conelusion MRI can predict most of the severe postpartum hemorrhage before surgery and is very helpful to improve the patient prognosis.

关 键 词：磁共振成像 前置胎盘 严重产后出血 

分 类 号：R445.2[医药卫生—影像医学与核医学] R714.2[医药卫生—诊断学]