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目的:探讨彩色多普勒超声对产前诊断胎盘植入的价值,分析其图像特征及漏诊原因,提高诊断率。方法:选取2014年5月~2014年11月经产前超声检查、临床手术或病理证实胎盘植入的10例患者临床资料进行回顾性分析。结果:10例中,产前超声诊断胎盘植入4例,符合率为40%(4/10)。超声声像图表现胎盘后间隙不清晰4例,胎盘与肌层间异常血流及子宫肌层明显变薄各3例,胎盘内漩涡形成2例。植入部位:前壁共5例,检出3例、漏诊2例;左侧壁1例、检出1例;左侧宫角1例、右侧宫底1例、后壁2例均漏诊。产前确诊胎盘植入晚孕3例、中孕1例。宫腔操作史10例,剖宫产史8例(其中1例为2次),合并前置胎盘6例(其中3例为凶险型),合并低置胎盘1例。结论:彩色多普勒超声对产前诊断胎盘植入具有重要价值。胎盘植入超声声像图具有一定的特异性表现。胎盘植入部位及孕周影响诊断率。宫腔操作史、剖宫产史、合并前置胎盘是胎盘植入的高危因素。
Objective: To explore the value of color Doppler sonography in prenatal diagnosis of placenta accreta and to analyze the characteristics of the image and the causes of missed diagnosis, and to improve the diagnostic rate. Methods: Ten patients with placenta accreta confirmed by prenatal ultrasound examination, clinical operation or pathology from May 2014 to November 2014 were retrospectively analyzed. Results: In 10 cases, 4 cases of placenta accreta were diagnosed by prenatal ultrasound, the coincidence rate was 40% (4/10). Ultrasonography showed 4 cases of unclear posterior placental space, abnormal blood flow between the placenta and myometrium and myometrium was thinning in 3 cases, placental vortex formation in 2 cases. Implantation site: anterior wall in 5 cases, 3 cases were detected, 2 cases of missed diagnosis; 1 case of the left side of the wall, 1 case was detected; 1 case of the left uterine horn, 1 case of the right uterus and 2 cases of the posterior wall were missed . Placenta previa diagnosis of placenta accreta 3 cases of pregnancy, 1 case of pregnancy. 10 cases of intrauterine operation history, 8 cases of cesarean section (including 1 case of 2 times), with placenta previa in 6 cases (3 cases of dangerous type), low placenta with 1 case. Conclusion: Color Doppler ultrasound is of great value in prenatal diagnosis of placenta accreta. Placenta accreta sonography has some specific performance. Placenta accreta and gestational age affect the diagnosis rate. Intrauterine operation history, history of cesarean section, placenta previa is placenta accreta risk factors.