杜玲玲 贾春红 秦永利

【摘要】 目的  分析超聲评分法对凶险性前置胎盘伴胎盘植入的诊断价值。

方法  选取2017年5月～2019年12月就诊的95例凶险性前置胎盘且疑似胎盘植入患者为研究对象，术前根据超声评分法对胎盘植入程度进行评估和诊断，以术后病理结果为“金标准”，分析超声评分法对凶险性前置胎盘伴胎盘植入及不同类型的胎盘植入的诊断价值。

结果  术后病理确诊65例凶险性前置胎盘合并胎盘植入，30例凶险性前置胎盘未合并胎盘植入，超声评分法诊断准确度为87.37%（83/95），灵敏度为93.85%（61/65），特异性为73.33%（22/30）。经病理检查确诊的65例凶险性前置胎盘伴胎盘植入患者中，超声评分法正确检出17例粘连型，35例植入型，9例穿透型，总符合率为93.85%。以术后病理结果为“金标准”，绘制受试者工作特征曲线（ROC）得到超声评分法诊断凶险性前置胎盘伴胎盘植入患者的曲线下面积（AUC）为0.864（>0.7），诊断价值较高。

结论  超声评分法可准确判断凶险性前置胎盘患者是否合并胎盘植入，对不同分型的胎盘植入也有较高诊断价值，值得进一步推广。

【关键词】  凶险性前置胎盘;胎盘植入;超声评分法;诊断

中图分类号： R445.1    文献标志码： A    DOI： 10.3969/j.issn.1003-1383.2021.08.011

Diagnostic value of ultrasonic grading in the diagnosis of dangerous  placenta previa with placenta implantation

DU Lingling1， JIA Chunhong2， QIN Yongli1

（1.Department of Ultrasonic Diagnosis， Xinhua District People's Hospital of Pingdingshan， Pingdingshan 467000， Henan， China;  2. Department of Ultrasound， General Hospital of Pingmei Shenma Group， Pingdingshan 467000， Henan，China）

【Abstract】 Objective  To analyze the value of ultrasonic grading in the diagnosis of dangerous placenta previa with placenta implantation.

Methods  95 dangerous placenta previa patients with suspected placenta implantation who were treated in the hospital from May 2017 to December 2019 were selected as research subjects. The degree of placenta implantation was evaluated and diagnosed according to the ultrasonic grading method before surgery. The pathological results were taken as “gold standard”， and the diagnostic value of ultrasound grading method for dangerous placenta previa with placenta implantation and different types of placenta implantation was analyzed.

Results  65 cases of dangerous placenta previa with placenta implantation were confirmed by postoperative pathology， and there were 30 cases of dangerous placenta previa without placenta implantation， and the diagnostic accuracy of ultrasound grading method was 87.37% （83/95）， sensitivity was 93.85% （61/65）， and specificity was 73.33% （22/30）. Among the 65 patients with dangerous placenta previa and placenta implantation diagnosed by pathological examination， there were 17 cases of adhesion type， 35 cases of implantation type， and 9 cases of penetration type were correctly detected by ultrasound grading method， and the total coincidence rate was 93.85%. Taking the postoperative pathological results as the “gold standard”， the receiver operating curve （ROC） was drawn to obtain the area under the curve （AUC） of 0.864 （> 0.7） for the diagnosis of dangerous placenta previa with placenta implantation by ultrasound scoring method， and the diagnostic value was high.

Conclusion  Ultrasonic grading method can accurately determine whether patients with dangerous placenta previa are  complicated with placenta implantation. It also has high diagnostic value for different types of placenta implantation and is worthy of further promotion.

【Key words】  dangerous placenta previa; placenta implantation; ultrasonic grading; diagnosis

凶险性前置胎盘是指胎盘附着于原剖宫产手术瘢痕或子宫切口处的妊娠情况，是妊娠晚期出血的主要因素[1～2]。凶险性前置胎盘患者可能合并胎盘植入，如处理不当，会导致产后大出血，引发子宫切除、新生儿窒息等不良妊娠结局，对患者的身心造成极大伤害。因此，产前评估凶险性前置胎盘患者是否合并胎盘植入对预测妊娠风险、改善母婴结局具有重要意义。超声……