MRI在不同类型前置胎盘的影像特点及对剖宫术后大出血、母儿结局的预测价值分析  

Imaging characteristics of MRI in different types of placenta previa and its predictive value for major hemorrhage after cesarean section and maternal and child outcomes

作　　者：韩文彬[1] 齐鑫[1] 喻强 王建秋[1] HAN Wen-bin;QI Xin;YU Qiang;WANG Jian-qiu(Department of Radiology, the First People′s Hospital of Yibin, Sichuan Province, Yibin 644000, China)

机构地区：[1]四川省宜宾市第一人民医院放射科

出　　处：《河北医科大学学报》2019年第8期920-923,928,共5页Journal of Hebei Medical University

基　　金：宜宾市卫生和计划生育委员会科研课题(2017yw0020)

摘　　要：目的探讨MRI在不同类型前置胎盘的影像特点及对剖宫术后大出血、母儿结局的预测价值。方法95例前置胎盘者分别为边缘性前置胎盘24例,部分性前置胎盘18例,完全性前置胎盘53例,观察不同类型前置胎盘妊娠结局;95例再分为出血组32例和非出血组63例,观察其年龄、产次、刨宫产史、流产史和前置胎盘的类型,分析引起宫产术后出血的危险因素。结果不同类型前置胎盘母婴结局比较显示,完全性前置胎盘者产后出血发生率和子宫切除率高于边缘性前置胎盘者(P<0.05)。出血组产次≥3次、既往有剖宫产史、有流产史、完全性前置胎盘、有胎盘植入者、子宫肌层变薄者、胎盘深入宫颈者、胎盘信号不均匀者比例均高于非出血组(P<0.05)。Logistic回归分析显示,既往剖宫产史、完全性前置胎盘、胎盘植入、子宫肌层变薄是影响前置胎盘者剖宫产术后出血的危险因素。结论应用MRI进行前置胎盘检查成像清晰、准确率较高。前置胎盘者中既往剖宫产史、完全性前置胎盘、胎盘植入、子宫肌层变薄是引起前置胎盘剖宫产后出血的高危因素,临床中应对此提高警惕。Objective To investigate the imaging characteristics of different types of placenta previa and to analyze the value of MRI in predicting massive hemorrhage and maternal and infant outcome after hysterectomy. Methods Ninety-five patients with placenta previa were divided into 24 cases of borderline placenta previa group, 18 cases of partial placenta previa group, and 53 cases of complete placenta previa group. The pregnancy outcomes of different types of placenta previa were observed. Ninety-five patients were further divided into the bleeding group(32 cases) and the non-bleeding group(63 cases). Their age, number of births, history of caesarean section, history of miscarriage and types of placenta previa were observed, and the risk factors of postoperative bleeding were analyzed. Results Comparison of maternal and infant outcomes of different types of placenta previa showed that the incidence of postpartum hemorrhage and hysterectomy rate of patients with complete placenta previa were higher than those with borderline placenta previa( P < 0.05). In the bleeding group, the proportion of births≥3 times, previous history of cesarean section, history of abortion, complete placenta previa, placental implantation, myometrium thinning, placenta penetration into the cervix, and uneven placental signals were all higher than those in the non-bleeding group( P < 0.05). Logistic regression analysis showed that previous history of cesarean section, complete placenta previa, placental implantation and myometrium thinning were risk factors for postpartum hemorrhage in patients with placenta previa after cesarean section. Conclusion The imaging of placenta previa by MRI is clear and accurate. Among the patients with placenta previa, previous history of cesarean section, complete placenta previa, placental implantation, and myometrium thinning are the risk factors of bleeding after cesarean section with placenta previa.

关 键 词：前置胎盘 剖宫产术 产后出血 磁共振成像 

分 类 号：R714.56[医药卫生—妇产科学]