Prenatal diagnosis of placenta previa accreta by transabdominal color Doppler ultrasound
Prenatal diagnosis of placenta previa accreta by transabdominal color Doppler ultrasound
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DOI：
10.1046/j.1469-0705.2000.00018.x
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发表时间：
2000-01-01
影响因子：
7.1
通讯作者：
Lee, YH
中科院分区：
文献类型：
--
作者：
Chou, MM;Ho, ESC;Lee, YH
目的探讨经腹彩色多普勒超声对胎盘植入的诊断价值。方法对80例妊娠中期和晚期胎盘植入高危的持续性前置胎盘患者进行经腹B超和彩色多普勒超声检查。所用彩色多普勒成像标准包括弥漫性实质内胎盘腔隙性血流;局灶性实质内胎盘腔隙性血流;膀胱-子宫浆膜间期血供过多;明显的胎盘下静脉复合体;和胎盘下多普勒血管信号丢失。结果80例患者中有16例表现出与植入性胎盘高度相关的彩色多普勒图像特征，其中14例有植入性胎盘的组织病理学证据。2例患者的假阳性彩色多普勒成像证据被误认为是由叶片静脉曲张引起的间期血供过多。13例可疑子宫内膜异位症患者行子宫切除术。在64例彩色多普勒成像结果阴性的患者中，3例有胎盘植入，2例需要剖宫产子宫切除术;另1例因子宫下段出血接受子宫动脉结扎术。彩色多普勒超声诊断前置胎盘植入的敏感性为82.4%（14/17），特异性为96.8%（61/63）。结论产前经腹彩色多普勒超声可对植入性前置胎盘的血管形态进行分类，其阳性预测值为87.5%（14/16），阴性预测值为95.3%（61/64）。这些特定血管模式的识别对受影响患者的围产期临床管理产生了积极的影响。
Objective The aim of this study was to evaluate the efficacy of transabdominal color Doppler ultrasound in diagnosing placenta accreta.Design Eighty patients with persisent placenta previa underwent transabdominal B-mode ann color Doppler ultrasound evaluation in the second and third trimesters because they han a high risk of placenta accreta. Color Doppler imaging criteria used included diffuse intrapar enchymal placental lacunar flow,; focal intraparenchymal placental lacunar flow; bladder-uterine serosa interphase hypervascularity; prominent subplacental venous complex; and loss of subplacental Doppler vascular signals. The color Doppler images were interpreted prospectively for signs of placenta previa accreta according to the exhibited color Doppler sonographic features.Results Sixteen of the 80 patients exhibited characteristic color Doppler imaging patterns highly specific for placenta accreta according to the preceding criteria, and 14 of these had histopathological proof of placenta accreta. Two patients had false-positive color Doppler imaging evidence mistaken for interphase hypervascularity caused by blad- varices. Thirteen patients underwent hysterectomy in the group suspicious for accreta. Of the 64 patients with negative color Doppler imaging results, three had placenta accreta, while two required cesarean hysterectomy; the remaining patient underwent uterine artery ligation for bleeding from the lower uterine segment. The sensitivity of color Doppler imaging in the diagnosis of placenta previa accreta was 82.4% (14/17) and the specificity was 96.8% (61/63). The positive and negative predictive values were 87.5% (14/16) and 95.3% (61/64), respectively.Conclusions Variable vascular morphological patterns of placenta previa accreta were exhibited and categorized by transabdominal color Doppler sonography in the antenatal period. The identification of these specific vascular patterns had a positive impact on the peripartum clinical management of the affected patients.