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目的:探讨超声对植入胎盘诊断的敏感性及特异性及血清AFP、HCG和不同胎盘植入类型的相关性。方法:选取孕晚期前置胎盘产妇208例,按孕周1:1匹配,选取入无前置胎盘无胎盘植入的产妇208例为对照组。产前对所有研究对象进行胎盘超声学检查,根据术后病理将胎盘植入类型分为粘连性胎盘、植入性胎盘和穿透性胎盘组。同时测定产前、产后3 d、产后4 w血清AFP和HCG水平。结果:208例前置胎盘最终病理确诊胎盘植入67例,占32.21%(其中粘连性胎盘组31例、植入性胎盘组19例、穿透性胎盘组17例),产前超声诊断62例。超声对胎盘植入诊断总的敏感性86.56%,特异性97.16%。对照组、前置胎盘并胎盘植入组、单纯胎盘前置组胎盘厚度平均(2.34±0.63)cm、(3.27±0.78)cm、(2.42±0.61)cm,差异有统计学意义(P<0.05)。粘连性胎盘植入组、植入性胎盘组、穿透性胎盘组产前、产后3 d、产后4 w各时间点血清AFP、β-HCG均明显高于对照组和前置胎盘组,差异有统计学意义(P<0.05)。穿透性胎盘组产前、产后3 d、产后4 w各时间点血清AFP、β-HCG高于粘连性胎盘组和植入性胎盘组,差异有统计学意义(P<0.05)。结论:超声对穿透性胎盘植入诊断具有较高的特异性和敏感性,但对粘连性胎盘植入诊断的敏感性和特异性不高,血清AFP和HCG水平和胎盘植入类型有一定关系,联合检测有助于胎盘植入类型的诊断。
Objective: To investigate the sensitivity and specificity of ultrasound in the diagnosis of placenta accreta and the correlation between serum AFP, HCG and different types of placenta accreta. Methods: 208 pregnant women with placenta previa in the third trimester were enrolled. According to a 1: 1 match of gestational age, 208 pregnant women without placenta previa were selected as the control group. Prenatal ultrasound examination of all subjects placenta, according to postoperative pathology will be divided into placenta accreta type placenta accreta, implanted placenta and penetrating placenta group. At the same time, the levels of serum AFP and HCG in prenatal and postpartum 3 days and 4 weeks postpartum were measured. Results: There were 67 cases of placenta accreta in 208 cases of placenta previa, accounting for 32.21% (including 31 cases of adhesive placenta, 19 cases of placenta accreta and 17 cases of penetrating placenta), prenatal diagnosis of 62 example. The overall sensitivity of ultrasound diagnosis of placenta accreta 86.56%, specificity 97.16%. The placenta thickness in the control group, placenta previa and placenta accreta placenta group were (2.34 ± 0.63) cm, (3.27 ± 0.78) cm and (2.42 ± 0.61) cm respectively, with significant difference (P <0.05 ). Adhesion placenta accreta, implanted placenta group, penetrating placenta group prenatal, postnatal 3 d, 4 w postpartum serum AFP, β-HCG were significantly higher than the control group and placenta previa, the difference There was statistical significance (P <0.05). The levels of AFP and β-HCG in previa, postnatal 3 days and postnatal 4 w were significantly higher in penetrating placenta than in adhering placenta and placenta accreta (P <0.05). Conclusion: Ultrasonography has high specificity and sensitivity in the diagnosis of penetrating placenta accreta. However, the sensitivity and specificity of diagnosis of adhesive placenta accreta are not high. The level of serum AFP and HCG and the type of placenta accreta Relationship, joint testing contributes to the diagnosis of placenta accreta type.