Clinical utility of sonography in the diagnosis and treatment of placental abruption
Clinical utility of sonography in the diagnosis and treatment of placental abruption
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DOI：
10.7863/jum.2002.21.8.837
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发表时间：
2002-08-01
影响因子：
2.3
通讯作者：
Purnell, L
中科院分区：
文献类型：
--
作者：
Glantz, C;Purnell, L
Objective.确定超声检测胎盘脱垂的敏感性和特异性，以及超声结果是否与治疗或结局相关。方法.我们确定了149名连续的患者，他们在孕龄24周或更晚的时候接受了超声检查，以排除流产或阴道出血。产科和新生儿数据来自医院围产期数据库。超声检查结果，病理报告和医院图表进行了审查。计算超声敏感性、特异性、阳性和阴性预测值，并使用回归分析确定相关性的独立性。结果在149名患者中，17名（11%）有超声检查证据，32名（21%）在分娩时有证据。随着扫描到递送间隔的缩短，阳性预测值增加，阴性预测值降低。在55例于超声检查后14天内分娩的患者中，8例（15%）的扫描结果与分娩时的宫缩一致，29例（53%）在分娩时宫缩;超声检查的敏感性、特异性、阳性预测值和阴性预测值分别为24%、96%、88%和53%。阳性超声检查结果与2- 3倍的后续安胎、倍他乐钠使用、住院时间、随访超声图、早产、低出生体重和新生儿重症监护室入院单变量相关。在校正胎龄后，除低出生体重和新生儿重症监护室入院外，其余均具有独立显著性（P <0.05）。结论.超声检查对胎盘早剥的检测并不敏感，但阳性发现与更积极的治疗和更差的新生儿结局相关。
Objective. To determine the sensitivity and specificity of sonography for detection of placental abruption and whether sonographic results correlate with management or outcome. Methods. We identified 149 consecutive patients who underwent sonography at 24 weeks' gestational age or later for ruling out abruption or vaginal bleeding. Obstetric and neonatal data were obtained from the hospital perinatal database. Sonographic results, pathologic reports, and hospital charts were reviewed. Sonographic sensitivity, specificity, and positive and negative predictive values were calculated, and regression was used to determine independence of associations. Results. Of the 149 patients, 17 (11%) had sonographic evidence of abruption, and 32 (21%) had evidence of abruption at delivery. As the scan-to-delivery interval decreased, the positive predictive value increased and the negative predictive value decreased. Of 55 patients who gave birth within 14 days of sonography, 8 (15%) had scans consistent with abruption, and 29 (53%) had abruption at delivery; the sensitivity specificity, and positive and negative predictive values of sonography were 24%, 96%, 88%, and 53%, respectively. Positive sonographic findings were univariately associated with 2- to 3-fold greater subsequent tocolysis, betamethasone use, duration of hospitalization, follow-up sonograms, preterm delivery; low birth weight, and neonatal intensive care unit admission. All but low birth weight and neonatal intensive care unit admission remained independently significant after adjustment for gestational age (P < .05). Conclusions. Sonography is not sensitive for detection of placental abruption, but a positive finding is associated with more aggressive management and worse neonatal outcome.