阴道超声测量宫颈长度对前置胎盘孕妇在急性剖宫产及出血的预测价值  

Value of cervical length measured by ltrasonographic for predicting emergency cesarean section and hemorrhage of pregnent women with placenta previa

作　　者：张祖艳 夏小文 柯晓琼 钱超 ZHANG Zuyan;XIA Xiaowen;KE Xiaoqiong;QIAN Chao(Yangxin Maternal and Child Health Care Hospital, Hubei Province, 435200)

机构地区：[1]湖北省阳新县妇幼保健院,435200

出　　处：《中国计划生育学杂志》2020年第3期439-442,共4页Chinese Journal of Family Planning

摘　　要：目的:探究阴道超声测量宫颈长度(CL)对前置胎盘孕妇行急性剖宫产(CS)及出血的预测价值。方法:回顾分析2016年1月-2018年10月本院收治的前置胎盘并分娩孕产妇102例临床资料,分为急性CS组(n=32)及择期CS组(n=70)。阴道多普勒超声测量患者各个妊娠期CL。观察记录临床资料、CL变化、妊娠及临床结局,分析急性CS及出血与CL相关性。结果:急性CS组孕周、初产妇比例低于择期CS组,新生儿体重<2000g、阴道出血发生比例高于择期CS组,孕32~34周时急性CS组CL低于择期CS组(均P<0.05);采用ROC曲线分析CL预测CS价值,CL变化>6.3mm时,预测CS的敏感度65.6%、特异度78.6%、阳性预测值58.3%、阴性预测值87.7%,AUC为0.786(%95CI:0.688~0.885),CL对CS有一定检测意义;多因素logistic回归分析,阴道出血、CL变化、孕晚期CL<25mm与急性CS有显著相关性。结论:当阴道超声测量宫颈长度无症状缩短时需警惕大出血可能,妊娠中期至晚期宫颈长度变化过大预示急性剖宫产可能。Objective:To investigate the value of cervical length(CL)measured by ltrasonographic for predicting emergency cesarean section(CS)and hemorrhage of pregnent women with placenta previa.Methods:The data of 102 pregnant women with placenta previa from January 2016 to October 2018 were retrospectively analyzed,and they were divided into group A(32 women with emergency CS)and group B(70 women with selective CS).The relationship between emergency CS and CL of women was analyzed.Results:The average gestational weeks when delivery of women and the percentage of primipara in group A were significant lower than those of women in group B,but the percentage of women with their neonatal weight<2000g and the rate of abnormal vaginal bleeding before onset labour of women in group A were significant higher(P<0.05).The CL of women during 32-34 gestational weeks in group A was shorter than that of women in group B(P<0.05).When the CL changed was more than 6.3mm,ROC curve analysis showed that the sensitivity,the specificity,the positive predictive value,the negative predictive value,and AUC were 65.6%,78.6%,58.3%,87.7%and 0.786(95%CI:0.688-0.885),respectively,which indicated that CL value had certain predicting value for CS.Multivariate logistic regression analysis showed that abnormal vaginal bleeding,and CL changes,and CL<25mm during the third trimester of pregnancy were significantly correlated with emergency CS.Conclusion:The shortening of CL measured by transvaginal ultrasound of asymptomatic pregnant women implies the possibility of massive hemorrhage.The excessive change of CL from the second to the third trimesters of pregnancy indicates the possibility of emergency CS.

关 键 词：前置胎盘 超声检测 宫颈长度 急性剖宫产 出血 

分 类 号：R445.1[医药卫生—影像医学与核医学] R719.8[医药卫生—诊断学]