妊娠晚期前置胎盘患者宫颈长度及形态与不良分娩结局的关系  

Relationship of cervical length,morphology and maternal adverse outcomes in placenta praevia patients on the third trimester of pregnancy

作　　者：赵新美[1] 吴春燕[1] 李绍雷 吴鹏西[1] ZHAO Xinmei;WU Chunyan;LI Shaolei;WU Pengxi(Department of Medical Ultrasound,the Affiliated Wuxi People's Hospital of Nanjing Medical University,Wuxi 214023,China)

机构地区：[1]南京医科大学附属无锡市人民医院超声医学科,江苏无锡214023

出　　处：《中国医学影像技术》2020年第6期887-892,共6页Chinese Journal of Medical Imaging Technology

摘　　要：目的探讨妊娠晚期前置胎盘患者宫颈长度(CL)及形态与不良分娩结局的关系。方法回顾性分析84例经剖宫产证实为前置胎盘的单胎妊娠孕妇,其中20例合并胎盘植入,27例发生大出血;以CL=30 mm为临界值将其分为研究组(CL≤30 mm,n=21)和对照组(CL>30 mm,n=63),观察CL与胎盘植入和剖宫产大出血的关系。结果研究组CL为(26.9±2.9)mm,低于对照组的(38.5±3.4)mm(P<0.001)。CL≤30 mm、宫颈形态不完整、宫颈血窦患者中胎盘植入及剖宫产大出血概率增加(P<0.1);CL≤30 mm是胎盘植入的危险因素。以CL=35.05 mm为临界值预测胎盘植入及大出血效果均最好,对前者敏感度、特异度、AUC分别为81.3%、90.0%及0.890[95%CI(0.813,0.967)],对后者分别为82.5%、74.1%和0.814[95%CI(0.717,0.912)]。结论妊娠晚期前置胎盘患者宫颈缩短(CL≤35.05 mm)、宫颈形态不完整、宫颈血窦与胎盘植入和剖宫产大出血有关,可用于评估前置胎盘并指导调整治疗方案。Objective To explore the relationship of cervical length(CL),morphology and maternal adverse outcomes in placenta praevia patients on the third trimester of pregnancy.Methods Ultrasonic and clinical data of 84 singleton pregnancies confirmed as placenta praevia with cesarean section were retrospectively analyzed,including 20 cases with placenta accreta and 27 with massive hemorrhage.Taken 30 mm as the cut-off value of CL,the patients were divided into study group(CL≤30 mm,n=21)and control group(CL>30 mm,n=63).Then the relationship of CL,placenta praevia and massive hemorrhage during cesarean section were investigated.Results CL was(26.9±2.9)mm in study group,lower than that in control group([38.5±3.4]mm,P<0.001).The probability of placenta accreta and massive hemorrhage increased in patients with CL≤30 mm,cervical morphological incompleteness and cervical sinus(P<0.1),and CL≤30 mm was a risk factor for placental accreta.Taken CL=35.05 mm as the cut-off value,the best prediction of placental accrete and massive hemorrhage were obtained,with the sensitivity,specificity and AUC of the former was 81.3%,90.0%and 0.890(95%CI[0.813,0.967]),of the latter was 82.5%,74.1%and 0.814(95%CI[0.717,0.912]),respectively.Conclusion Cervical shortening(CL≤35.05 mm),cervical morphological incompleteness and cervical sinus on the third trimester are related to placenta accreta and massive hemorrhage during cesarean section,which might be used to evaluate placenta praevia and guiding adjustment of treatment plan.

关 键 词：胎盘 侵入性 超声检查 出血 剖宫产术 宫颈长度 

分 类 号：R714.2[医药卫生—妇产科学] R445.1[医药卫生—临床医学]