前置胎盘孕妇产前超声评估预测产时大出血的临床价值分析
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摘要
目的:观察前置胎盘孕妇产前采用超声评估预测其产时大出血的临床价值分析。方法:选择某院2016年3月～2017年3月收治的经产前超声诊断为前置胎盘患者共计71例进行分组,其中26例(36.62%)出现产前大出血称为出血组,另45例(63.38%)安全生产称为对照组。分析两组超声检查异常之处,并分析超声检查前置胎盘产时大出血的危险因素。结果:出血组患者年龄、流产次数、分娩次数、子宫手术史均高于对照组,差异具有统计学意义(P<0.001);出血组超声检查胎盘为中央型、附着于前壁、距宫颈内口<2cm、胎盘植入、缺损率明显高于对照组,差异具有统计学意义(P<0.001)。结论:高龄产妇、多次流产、子宫手术史均为发生前置胎盘高危基本因素,行超声检查时应详细查看是否存在胎盘为主要附着前壁、缺损、植入、中央前置型、距宫颈口距离<2cm超声学特征的高危出血倾向。
Objective: To observe the clinical value of prenatal ultrasonography in predicting postpartum hemorrhage in pregnant women with placenta previa. Methods: A total of 71 patients with placenta previa diagnosed by prenatal ultrasound admitted and treated recently in a hospital(from March 2016 to March 2017) were divided. Among them, 26 cases(36.62%) with massive prenatal bleeding were referred as the bleeding group, and 45 cases(63.38%) with safe production were referred as the control group. The abnormality of ultrasonographic examination in the two groups was analyzed, and the risk factors of massive hemorrhage were analyzed. Results: The age, abortion frequency, delivery frequency and uterine operation history of patients in the bleeding group were higher than those in the control group, and the difference was statistically significant(P<0.001). In the bleeding group, the ultrasonic examination showed that the placenta was of central type, attached to the anterior wall, <2 cm away from the internal cervical mouth, placenta implantation and defect rate were significantly higher than those in the control group, and the difference was statistically significant(P<0. 001). Conclusion: Advanced maternal age, multiple miscarriages and uterine surgery history are all basic factors for the occurrence of high risk placenta previa. During ultrasonic examination, it is necessary to check in detail whether the placenta is the main attached anterior wall, defect, implantation, central preposition type, and distance from the cervical orifice <2 cm with ultrasonic characteristics of high risk bleeding tendency.
Objective: To observe the clinical value of prenatal ultrasonography in predicting postpartum hemorrhage in pregnant women with placenta previa. Methods: A total of 71 patients with placenta previa diagnosed by prenatal ultrasound admitted and treated recently in a hospital(from March 2016 to March 2017) were divided. Among them, 26 cases(36.62%) with massive prenatal bleeding were referred as the bleeding group, and 45 cases(63.38%) with safe production were referred as the control group. The abnormality of ultrasonographic examination in the two groups was analyzed, and the risk factors of massive hemorrhage were analyzed. Results: The age, abortion frequency, delivery frequency and uterine operation history of patients in the bleeding group were higher than those in the control group, and the difference was statistically significant(P<0.001). In the bleeding group, the ultrasonic examination showed that the placenta was of central type, attached to the anterior wall, <2 cm away from the internal cervical mouth, placenta implantation and defect rate were significantly higher than those in the control group, and the difference was statistically significant(P<0. 001). Conclusion: Advanced maternal age, multiple miscarriages and uterine surgery history are all basic factors for the occurrence of high risk placenta previa. During ultrasonic examination, it is necessary to check in detail whether the placenta is the main attached anterior wall, defect, implantation, central preposition type, and distance from the cervical orifice <2 cm with ultrasonic characteristics of high risk bleeding tendency.
引文
1 黄田田,刘慧,向红.产前超声征象评分对前置胎盘合并胎盘植入的诊断价值.中国超声医学杂志,2016,32(2):160～163.
2 黄安茜,谭艳娟,包凌云,等.超声联合磁共振检查对植入型凶险性前置胎盘的诊断价值.中华急诊医学杂志,2014,23(5):567～569.
3 王淳.经腹壁超声联合经会阴超声对晚孕期产妇前置胎盘的临床诊断价值分析.中国实验诊断学,2015,19(12):2097～2099.
4 吴青青.超声影像学技术在凶险型前置胎盘诊断中的价值.中国实用妇科与产科杂志,2014,30(12):923～926.
5 Bowman Z S,Eller A G,Bardsley T R,et al.Risk Factors for Placenta Accrera:A Large Prospective Cohort.Am J Perinat,2014,31(9):799～804.
6 王军,熊苗,陈宇.前置胎盘合并剖宫产史患者产后大出血危险因素分析.实用医学杂志,2015,31(20):3394～3397.
7 施华芳,皮丕湘,丁依玲.二维超声及彩色多普勒对瘢痕子宫合并前置胎盘植入的诊断及临床分析.中南大学学报(医学版),2012,37(9):939～943.
8 李婧宇,蔡爱露,王冰,等.前置胎盘是否合并胎盘植入的产前超声诊断.中国现代医学杂志,2014,24(5):68～71.
2 黄安茜,谭艳娟,包凌云,等.超声联合磁共振检查对植入型凶险性前置胎盘的诊断价值.中华急诊医学杂志,2014,23(5):567～569.
3 王淳.经腹壁超声联合经会阴超声对晚孕期产妇前置胎盘的临床诊断价值分析.中国实验诊断学,2015,19(12):2097～2099.
4 吴青青.超声影像学技术在凶险型前置胎盘诊断中的价值.中国实用妇科与产科杂志,2014,30(12):923～926.
5 Bowman Z S,Eller A G,Bardsley T R,et al.Risk Factors for Placenta Accrera:A Large Prospective Cohort.Am J Perinat,2014,31(9):799～804.
6 王军,熊苗,陈宇.前置胎盘合并剖宫产史患者产后大出血危险因素分析.实用医学杂志,2015,31(20):3394～3397.
7 施华芳,皮丕湘,丁依玲.二维超声及彩色多普勒对瘢痕子宫合并前置胎盘植入的诊断及临床分析.中南大学学报(医学版),2012,37(9):939～943.
8 李婧宇,蔡爱露,王冰,等.前置胎盘是否合并胎盘植入的产前超声诊断.中国现代医学杂志,2014,24(5):68～71.