胎盘异常的彩超诊断评价及妊娠结局

发布时间：2018-01-24 23:04

本文关键词： 胎盘异常超声检查影响因素妊娠结局　出处：《郑州大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的分析胎盘异常对母儿的影响、胎盘异常发生的影响因素，评价胎盘异常彩超诊断的可靠性，为提高彩超诊断的准确程度并尽早开展临床干预提供参考依据。方法以2012年7月-2013年7月在某医院住院分娩且做过产前彩超诊断的10023份病历为研究材料，将产后胎盘检查结果作为金标准，研究胎盘异常检出的种类、数量、构成比。以产前彩超诊断和产后证实的结果相比较，计算彩超诊断的灵敏度、特异度、漏诊率、误诊率。从正常产妇中随机抽取300例作为对照，分析胎盘异常患者的妊娠结局和发生的影响因素。用Excel建立数据库，SPSS15.0软件包统计处理，计量资料用均数±标准差（x±s）表示，两组间均数比较采用成组t检验；计数资料用构成比、率表示，组间率的比较采用卡方检验，检验水准取α=0.05。结果（1）胎盘异常检出情况共有217例胎盘异常，检出率为2.16%（217/10023）；包括前置胎盘、胎盘植入、前置胎盘合并植入、胎盘形态异常、胎盘早剥及其他等6类异常，其中胎盘形态异常106例，所占构成比最大，，为48.8%。（2）超声检查结果产前彩超诊断胎盘异常的总体符合率为99.73%，灵敏度为88.94%，特异度为99.97%，漏诊率为11.06%，误诊率为0.03%；不同类型的胎盘异常有着不同的灵敏度、特异度、漏诊率、误诊率及符合率，其中单纯胎盘植入的漏诊率最高，为69.23%；胎盘血管瘤的灵敏度最高，为100.00%。（3）胎盘异常对妇女的影响217例胎盘异常妇女的产前出血比例为22.6%，剖宫产比例为62.2%，产后出血比例64.5%，子宫切除比例3.2%，均高于对照组，差异均有统计学意义（P0.05）。上述4项指标在不同类型胎盘异常之间的差异均有统计学意义（P0.05）。（4）胎盘异常对围产儿的影响217例胎盘异常妇女娩出新生儿232例，身长49.9±3.5cm、体重2863.7±434.1g、Apgar评分7.6±2.1，均低于对照组，差异均有统计学意义（P0.05）。早产5例，畸形3例，与对照组差异无统计学意义（P0.05）。各项指标在不同类型胎盘异常之间的差异则均无统计学意义（P0.05）。（5）胎盘异常的影响因素胎盘异常组与对照组在年龄、经产史、流产史、剖宫产史及子宫畸形等方面的差异均有统计学意义（P0.05）；不同类型胎盘异常的影响因素分别与对照组比较均高于对照组，差异有统计学意义（P0.05）。结论 1．彩超诊断胎盘异常具有较高的灵敏度、特异度。 2．彩超检查应将具有年龄偏大或曾有经产、流产、剖宫产史及子宫畸形等因素者作为筛查的重点对象。 3．胎盘异常病例中的胎盘形态异常最多见，其次为前置胎盘、胎盘早剥、胎盘植入。 4．胎盘异常对母儿均有不良影响：新生儿的身长、体重、Apgar评分均较低；孕产妇的产前出血、产后出血、剖宫产、子宫切除所占比例均较高。
[Abstract]:Purpose To analyze the influence of placental abnormality on mother and fetus, and to evaluate the reliability of the diagnosis of placental abnormality by color Doppler ultrasound, to provide reference for improving the accuracy of color Doppler ultrasound diagnosis and carrying out clinical intervention as soon as possible. Method The results of postpartum placenta examination were regarded as gold standard based on 10023 medical records that had been diagnosed by prenatal color Doppler ultrasonography from July 2012 to July 2013 in a hospital. To compare the results of prenatal ultrasonography and postpartum confirmation, the sensitivity, specificity and missed diagnosis rate of color Doppler ultrasonography were calculated. The misdiagnosis rate. The pregnancy outcome and the influencing factors of placental abnormality were analyzed in 300 cases of normal puerpera randomly selected as control. The database was established by Excel. The statistical processing of SPSS15.0 software package showed that the metrological data were expressed as mean 卤standard deviation (x 卤s). The mean value of the two groups was compared by group t test. The counting data are expressed by composition ratio and rate. The comparison of rates among groups is carried out by chi-square test, and the test level is 伪 -0.05. Results 1) there were 217 cases of placental abnormality detected, the detection rate was 2.16% and 21.7% / 10023%; There were 6 kinds of abnormal placenta, placenta previa, placenta accreta, placental abruption, placental abruption and other 6 kinds of abnormal placenta, among which 106 cases had abnormal placenta morphology, accounting for the largest proportion of 48.8%. 2) the overall coincidence rate, sensitivity, specificity, missed diagnosis rate and missed diagnosis rate were 99.73, 88.94, 99.97 and 11.06% respectively. The misdiagnosis rate was 0.03. Different types of placental abnormalities had different sensitivity, specificity, missed diagnosis rate, misdiagnosis rate and coincidence rate. The rate of missed diagnosis of simple placenta accreta was the highest (69.23%). The sensitivity of placental hemangioma was 100.00g. The effect of abnormal placenta on women: the proportion of antenatal hemorrhage, cesarean section and postpartum hemorrhage in 217 cases of women with abnormal placenta were 22.62,62.2 and 64.5% respectively. The ratio of hysterectomy was 3.2g, which was higher than that of control group. The differences were statistically significant (P 0.05) and there were significant differences among the four indexes mentioned above among different types of placental abnormalities (P 0.05). Effect of abnormal placenta on perinatal infants 232 cases of newborns were delivered with abnormal placenta. The body length was 49.9 卤3.5 cm and the body weight was 2863.7 卤434.1 g. The Apgar score was 7.6 卤2.1, which was significantly lower than that in the control group (P 0.05). There were 5 cases of premature delivery and 3 cases of malformation. There was no significant difference between the control group and the control group (P 0.05), but there was no significant difference in all indexes among different types of placental abnormalities (P 0.05). (5) there were significant differences in age, history of delivery, history of abortion, history of cesarean section and uterine malformation between the abnormal placenta group and the control group (P 0.05). The influencing factors of different types of placental abnormalities were higher than those of the control group, and the difference was statistically significant (P 0.05). Conclusion 1. Color Doppler ultrasound has high sensitivity and specificity in the diagnosis of placental abnormalities. 2. Color Doppler ultrasound should focus on those who have some factors such as older age, abortion, history of cesarean section and uterine malformation. 3. Abnormal placental morphology was most common in abnormal placenta, followed by placenta previa, placental abruption and placenta accreta. 4. The abnormal placenta had negative effects on both mother and infant: the newborn's body length, weight and Apgar score were all low, and the proportion of prenatal hemorrhage, postpartum hemorrhage, cesarean section and hysterectomy were all higher in pregnant and parturient women.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.56

【参考文献】