产前超声评分对前置胎盘剖宫产手术评估及母儿预后的影响

The Effect of Prenatal Ultrasound Score on the Evaluation of Cesarean Section with Placenta Previa and the Prognosis of Mother and Child

摘要: 目的：探讨产前超声评分对前置胎盘剖宫产手术评估及母儿预后的影响。方法：选取我院2017年2月~2021年2月期间收治的前置胎盘产妇200例，根据产妇进行剖宫产术以产后出血量的不同，将其分为大出血组(≥1500 mL)和无大出血组，所有产妇均采用经腹、会阴或阴道产前多普勒超声检查，明确胎盘类型、有无植入或粘连、透明带、胎盘缺损以及血流信号异常；记录胎儿分娩前阴道出血量、分娩孕周、产后出血量、感染率、新生儿Apgar评分和出生体重。根据所有产妇的前置胎盘类型，将其分为完全性前置胎盘组、部分性前置胎盘组、边缘性前置胎盘组，采用单因素和多因素Logistic回归分析筛选前置胎盘的危险因素。结果：1) 对两组患者的产前超声结果进行分析，内容包括：前置胎盘类型、胎盘植入情况、透明带、胎盘缺损以及血流信号异常，大出血组各项产前超声结果均显著高于无大出血组患者(P < 0.05)；2) 对两组患者妊娠结局进行分析和对比，内容包括：术中及产后出血量、感染率、分娩孕周、新生儿Apgar评分及新生儿出生体重，无大出血组产妇妊娠结局显著优于大出血组产妇(P < 0.05)；3) 对导致前置胎盘大出血的因素进行多因素Logistic回归分析，发现年龄、孕次、产次、前次剖宫产史数比较差异具有统计学意义(P < 0.05)，其中大出血组的年龄、孕次、产次、前次剖宫产史数明显高于无大出血组(P < 0.05)。结论：1) 孕妇年龄、既往剖宫产和流产史与前置胎盘的发病密切相关。减少剖宫产及流产率且正确处理前置胎盘可有助于降低母婴并发症及死亡率。2) 产前超声评估前置胎盘类型、植入严重程度对预测剖宫产术中大出血、子宫丢失以及妊娠结局十分具有价值。

Abstract: Objective: To explore the effect of prenatal ultrasound score on the evaluation of cesarean section with placenta previa and the prognosis of mother and child. Methods: 200 cases of placenta previa admitted to our hospital from February 2020 to February 2021 were selected. According to the difference in the amount of postpartum bleeding caused by the cesarean section, they were divided into major hemorrhage group (≥1500 mL) and In the non-mammary group, all the parturients were examined by transabdominal, perineal or vaginal prenatal Doppler ultrasound to determine the location, type, implantation or adhesion, zona pellucida, placental defect, and abnormal blood flow signal; record fetal delivery prevaginal bleeding, gestational week after delivery, postpartum bleeding, infection rate, newborn Apgar score and birth weight. According to the type of placenta previa of all parturients, they are divided into complete placenta previa group, partial placenta previa group, and marginal placenta previa group. Single factor and multivariate Logistic regression analysis is used to screen the risk factors of placenta previa. Results: 1) The prenatal ultrasound results of the two groups of patients were analyzed, including: placenta attachment position, type of placenta previa (complete, partial, marginal), placenta accreta, zona pellucida, placental defect, and blood. The flow signal was abnormal, and there were 24 patients with postpartum hemorrhage. The prenatal ultrasound results of the hemorrhage group were significantly higher than those of the patients without hemorrhage (P < 0.05); 2) Analyze and compare the pregnancy outcomes of the two groups of patients, including: vaginal bleeding, postpartum hemorrhage, infection rate, gestational week of delivery, neonatal Apgar score and neonatal birth weight. The maternal pregnancy outcome of the non-maternal hemorrhage group was significantly better than that Parturients in the massive hemorrhage group (P < 0.05); 3) Multi-factor Logistic regression analysis was conducted on the factors that lead to placenta previa, and it was found that the data of age, pregnancy times, parity, and previous cesarean section history had statistically significant differences (P < 0.05). The data of age, pregnancy times, parity, and previous cesarean section history in the massive hemorrhage group was higher than that of the non-massive hemorrhage group (P < 0.05). Conclusion: 1) Maternal age, previous cesarean section and abortion history are closely related to the incidence of placenta previa. Reducing the rate of cesarean section and miscarriage and correct handling of placenta previa can help reduce mother and infant complications and mortality. 2) Prenatal ultrasound accurately assesses the type, implantation, defect and blood flow signal of placenta previa, which has very important application value in predicting hemorrhage after cesarean section and pregnancy outcome.