孕中晚期子宫颈长度缩短差值及胎盘下缘增厚差值对严重产后出血风险的评估研究  

Evaluation of the risk of severe postpartum hemorrhage by the difference of cervical length shortening and the placental inferior margin thickening in the second and third trimesters

作　　者：罗丽萍[1] 汪芳艳 廖宗高[1] LUO Liping;WANG Fangyan;LIAO Zonggao(Jiangxi Maternal and Child Health Hospital,Nanchang,Jiangxi,330006,China)

机构地区：[1]江西省妇幼保健院,江西南昌330006

出　　处：《当代医学》2023年第21期115-118,共4页Contemporary Medicine

基　　金：江西省卫健委科技计划(202130804)。

摘　　要：目的探讨孕中、晚期子宫颈长度(CL)缩短差值及胎盘下缘增厚差值对严重产后出血(PPH)风险的评估价值。方法选取2020年1月至2021年7月于本院妇产科接受手术分娩的21例完全性前置胎盘孕妇作为研究对象,按照末次腹部B超显示CL分为CL正常组(n=8,CL≥30 mm)与CL缩短组(n=13,CL<30 mm),比较两组预后情况(产前出血、急诊剖宫产、PPH),分析PPH严重程度,比较严重PPH与非严重PPH患者孕中、晚期胎盘下缘厚度及CL变化,绘制ROC曲线分析孕中、晚期CL缩短差值、胎盘下缘厚度差值对严重PPH的预测价值。结果CL正常组产前出血、急诊剖宫产、PPH发生率均明显低于CL缩短组,差异有统计学意义(P<0.05)。15例PPH患者中,严重PPH 6例,非严重PPH 9例。严重PPH患者孕中期及孕晚期胎盘下缘厚度均厚于非严重PPH患者,孕中期及孕晚期CL均短于非严重PPH患者,孕中、晚期胎盘下缘厚度差值与CL缩短差值均大于非严重PPH患者,差异有统计学意义(P<0.05)。ROC曲线分析结果显示,孕中、晚期CL缩短差值预测严重PPH的AUC为0.90,最佳界限值为5.8 mm;孕中、晚期胎盘下缘厚度差值预测严重PPH的AUC为0.87,最佳界限值为4.5 mm;均具有一定预测价值。结论孕中、晚期CL缩短差值≥5.8 mm或胎盘下缘厚度差值≥4.5 mm,均可能导致严重PPH,及时判断PPH能为临床准备与管理、决定是否提前准备血源及选择适宜的剖宫产手术时机,降低母儿并发症风险提供有效的参考依据。Objective To investigate the evaluate value of the risk of severe postpartum hemorrhage(PPH)by the difference of cervical length(CL)shortening and the placental inferior margin thickening in the second and third trimesters.Methods 21 pregnant women with complete placenta previa who underwent surgery delivery in the department of Obstetrics and Gynecology of our hospital from January 2020 to July 2021 were selected as the study subjects,they were divided into the CL normal group(n=8,CL≥30 mm)and the CL shortening group(n=13,CL<30 mm)according to the last abdominal B ultrasound cervical length,the prognosis(prenatal hemorrhage,emergency cesarean section,PPH)was compared between the two groups,the severity of PPH was analyzed,and the changes of placental inferior margin thickening and CL in patients with severe PPH and non-severe PPH were compared in the second and third trimester of pregnancy,ROC curve was drawn to analyze the predictive value of the difference of cervical length shortening and the placental inferior margin thickening in the second and third trimesters in severe PPH.Results The incidence of prenatal hemorrhage,emergency cesarean section and PPH in the normal CL group were significantly lower than those in the CL shortening group,the differences were statistically significant(P<0.05).Among the 15 patients with PPH,6 had severe PPH and 9 had non-severe PPH.The placental inferior margin thickening in the second and third trimester in patients with severe PPH were thicker than those in patients with non-severe PPH,the CL in the second and third trimester were shorter than those in patients with non-severe PPH,and the difference of the placental inferior margin thickening and the difference of CL shortening in the second and third trimester were greater than those in patients with non-severe PPH,the differences were statistically significant(P<0.05).The ROC curve analysis showed that the AUC of the difference of CL shortening in the second and third trimester of pregnancy to predict severe PPH was 0.9

关 键 词：严重产后出血 风险评估 子宫颈长度缩短差值 胎盘下缘厚度 孕中期 孕晚期 分娩预后 

分 类 号：R714.461[医药卫生—妇产科学]