沈诗薇,陈蔚,吴小兰
SHEN Shiwei,CHEN Wei,WU Xiaolan

• 1:南充市第四人民医院产科
• 2:南充市第四人民医院超声科
• 3:成都市第五人民医院产科

摘要(Abstract)：

目的 分析分娩前超声评分、子宫动脉搏动及阻力指数对凶险性前置胎盘产后出血(PPH)的预测价值。方法 收集72例凶险性前置胎盘患者临床资料，根据是否发生PPH分为PPH组(n=29)和非PPH组(P=43),产前超声检查预测胎盘植入评分(超声评分)、子宫动脉搏动指数(UtA-PI)及子宫动脉阻力指数(UtA-RI),采用受试者工作特征(ROC)曲线评估3项指标联合检查对凶险性前置胎盘患者PPH的预测价值，比较超声检查3项指标阳性或阴性患者的妊娠结局，产后第3天时血红蛋白(Hb)、中性粒细胞(N)、白细胞(WBC)计数及C-反应蛋白(CRP)水平。结果 PPH组超声评分高于非PPH组，黏连型胎盘植入占比及UtA-PI、UtA-RI则低于非PPH组，差异有统计学意义(P<0.05);ROC曲线分析显示，超声评分、UtA-PI、UtA-RI对凶险性前置胎盘患者PPH具有较高预测价值(AUC=0.806、0.831、0.852,P<0.05),且3项指标联合检查预测价值最高(AUC=0.960,P<0.05);3项指标联合预测PPH阳性者，44例、阴性者28例，预测阳性者PPH率及输血率、产后第3天的中性粒细胞(N)、白细胞(WBC)计数及C-反应蛋白(CRP)水平均高于阴性者，血红蛋白(Hb)水平低于阴性者，差异有统计学意义(P<0.05)。结论 超声评分结合UtA-PI、UtA-RI可作为临床预测凶险性前置胎盘患者发生PPH的指标，帮助判断妊娠结局。
Objective To analyze the predictive value of ultrasound score before delivery, uterine artery pulsatility index(UtA-PI), and resistance index(UtA-RI) on postpartum hemorrhage(PPH) of pernicious placenta previa. Methods The clinical data of 72 patients with pernicious placenta previa were collected and the patients were divided into PPH group(n=29) and non-PPH group(n=43) according to whether PPH occurred. The placenta accreta score(ultrasound score), uterine artery pulsatility index(UtA-PI) and uterine artery resistance index(UtA-RI) were examined by prenatal ultrasound. Receiver operating characteristic(ROC) curve was used to evaluate the predictive value of the combination of the three above indicators on PPH in patients with pernicious placenta previa, and the pregnancy outcomes and hemoglobin(Hb), neutrophil(N), white blood cell(WBC) count, and C-reactive protein(CRP) on the 3~(rd) day after delivery were compared between patients with positive or negative ultrasound examination indicators. Results The ultrasound score in PPH group was higher than that in non-PPH group while the proportion of adhesive placenta accreta, UtA-PI and UtA-RI were lower than those in non-PPH group(P<0.05). ROC curve analysis showed that ultrasound score, UtA-PI, and UtA-RI had high predictive value on PPH in patients with pernicious placenta previa(AUC=0.806, 0.831, 0.852;P<0.05), and the combination of the three indicators had the highest predictive value(AUC=0.960, P<0.05). The combination of the three indicators predicted positive PPH in 44 patients and negative PPH in 28 patients. The PPH rate and blood transfusion rate and levels of N, WBC, CRP on the 3~(rd) day after delivery in positive patients were significantly higher than those in negative patients while the Hb level was significantly lower than that in negative patients, which had statistically significance(P<0.05). Conclusion Ultrasound score combined with UtA-PI and UtA-RI can be used as clinical indicators to predict PPH in patients with pernicious placenta previa, and help to judge the pregnancy outcomes.

关键词(KeyWords)： 凶险性前置胎盘;产后出血;超声;胎盘植入;子宫动脉血流
pernicious placenta previa;postpartum hemorrhage;ultrasound;placenta accreta;uterine artery blood flow

Abstract:

Keywords:

基金项目(Foundation): 2017年四川省卫生和计划生育科研课题项目（17PJ247）

作者(Author): 沈诗薇,陈蔚,吴小兰
SHEN Shiwei,CHEN Wei,WU Xiaolan

DOI: 10.19367/j.cnki.2096-8388.2023.09.017

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