摘要
目的探讨超声评分联合病史预测凶险型前置胎盘(PPP)凶险程度的价值。方法回顾性分析2017年5~12月我院产科收治并终止妊娠的58例PPP患者的临床资料。根据超声评分联合病史进行PPP及胎盘植入的产前诊断,术后评估其诊断符合率、敏感度及特异度,并绘制受试者工作特征性曲线(ROC),计算曲线下面积(AUC),计算各类型胎盘植入的综合评分界值。结果所有患者术前均考虑PPP;术后证实超声评分联合病史对PPP合并胎盘植入的诊断符合率为93.1%(54/58),敏感度为94.5%(52/55),特异度为66.7%(2/3)。根据ROC曲线,计算粘连型与植入型AUC为92.5%,约登指数最大者对应的分值为7.5分,敏感度、特异度分别为76.9%、84.6%,因此考虑粘连型与植入型的界值为8分。植入型与穿透型AUC为92.7%,约登指数最大者对应的分值为11.5分,敏感度、特异度分别为89.5%、81.8%,因此考虑植入型与穿透型的界值为12分。结论对于孕晚期怀疑PPP的孕妇,可行超声评分联合病史进行凶险程度的预测,提前制定相应处理方案,尽可能提高围生期母婴生存质量。
Objective To explore the value of ultrasound score combined with medical history for predicting the risk degree of pernicious placenta previa.Methods Clinical data of 58 patients with pernicious placenta previa treated in obstetrics department of our hospital and given terminal pregnancy from May to December 2017 were retrospectively analyzed.Prenatal diagnosis of pernicious placenta previa and placenta accrete was performed according to the ultrasound score scale combined with medical history score.The coincidence rate of the diagnosis,the sensitivity,and the specificity were evaluated after operation.At the same time,the receiver operating characteristic curve（ROC curve） was plotted and the area under the curve（AUC） was calculated.The cut-off score for each type of placenta accrete was calculated.Results All patients were considered as pernicious placenta previa before surgery.Postoperatively,according to the ultrasound scoring combined with medical history,the coincidence rate of the diagnosis of pernicious placenta previa and placenta accreta,the sensitivity,and the specificity was 93.1%（54/58）,94.5%（52/55）,and 66.7%（2/3） respectively.According to the ROC curve,AUC of the adhesion type and the implant type was 92.5%.The corresponding value of the maximum index was 7.5 points,and the sensitivity and specificity was 76.9% and 84.6% respectively.Therefore,the boundary value of the adhesions and implants was 8 points.AUC of the implants and penetrating was 92.7%,and the corresponding value of the largest one was 11.5 points,and the sensitivity and specificity was 89.5% and 81.8% respectively.Therefore,the boundary value of the implants and penetrating types was 12 points.Conclusion For pregnant women who are suspected to the pernicious placenta previa during the third trimester,ultrasound score combined with medical history can be used to predict the degree of risk before delivery.So,it can make the corresponding treatment plans in advance,to improve the quality of maternal and child perinatal life as much as possible.
作者
杨德兰
朱宝菊
YANG De-lan;ZHU Bao-ju(Department of Gynecology and Obstetrics,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014,China)
出处
《中国当代医药》
2018年第17期8-11,15,共5页
China Modern Medicine
基金
河南省医学科技攻关计划项目(201601009)
关键词
凶险型前置胎盘
超声评分
病史
凶险程度
Pernicious placenta previa
Uhrasound score
Medical history
Risk degree
