| Objective:1.To investigate the ultrasonographic characteristics of pernicious placenta previa with placenta accreta.2.To evalute the application value of ultrasound scoring of placenta in the diagnosis of pernicious placenta previa,and to provide certain imaging diagnostic basis for the use of reasonable treatment.Methods:1.The clinical data of 64 patients with pernicious placenta previa(PPP)with placenta accreta who were admitted to the Third Clinical College of Shanxi Medical University from October 2018 to August 2022 and diagnosed as placenta accreta after surgery and pathology were selected.The patients were examined before surgery in the obstetrics and gynecology outpatient department of our hospital and ultrasound obstetric room,and placenta ultrasound scoring method was used to score and evaluate the implantation Type,The surgical delivery of patients was followed up and recorded,and the sensitivity,specificity and accuracy of placental ultrasound scoring in the diagnosis of PPP with severe placental accreta were evaluated with the results of placental histopathological examination as the gold standard.2.The ultrasonic characteristics of PPP patients were retrospectively analyzed,and Chi-square test was used for statistical analysis.3.The amount of intraoperative blood loss,whether the patients underwent arterial catheter presetting,ureteral stenting,total hysterectomy,and whether the bladder or other organs were involved were recorded.ROC curve and correlation analysis were used to evaluate the predictive value of placental ultrasound scoring for different implantation types and adverse pregnancy outcomes in PPP patients.4.spearman correlation analysis was used to explore the correlation between placental ultrasound score and intraoperative blood loss in PPP patients.Results:1.The diagnostic accuracy of placental ultrasound scoring method for PPP with severe placenta accreta was 90.63%,and the sensitivity and specificity were 92.59% and 80.00%,respectively.2.The thickening of placenta,interruption of postplacental space,formation of placental lacunae,rich blood flow at the interface between placenta and uterus,interruption of the interface between uterus and bladder,and incomplete cervix in the severe placenta accreta group were higher than those in the adhesion group,and the differences were statistically significant(P<0.05).3.Placental ultrasound score for predicting PPP with severe placenta acacia: the area under curve(AUC)=0.819(95%CI0.706～0.933),the maximum score was 7,sensitivity61.10%,specificity 100%.4.Placenta ultrasound score predicted adverse pregnancy outcome: the AUC was0.907(95% CI 0.829～0.985),and the Youden index was the highest with 80.66% sensitivity and 97.00% specificity when the score was 8;When 0<score<5,the probability of adverse pregnancy outcome was 0%(0/10);5≤score≤9,the probability of adverse pregnancy outcome was 60.00%(20/33);If the score was≥10,the probability of adverse pregnancy outcome was 100%(11/11).5.There was a significant correlation between the total ultrasound score of placenta and the amount of intraoperative blood loss(r=0.628,P<0.05).Conclusions:1.Ultrasonic scoring method has high specificity and sensitivity for the diagnosis of pernicious placenta previa with severe placenta accreta,and can be used as the first choice for preoperative assessment of the risk of placenta accreta by early prediction of intraoperative bleeding and hysterectomy.2.Ultrasonic scoring method has high diagnostic accuracy in predicting pernicious placenta previa with severe accreta and adverse pregnancy outcomes.When the score was7,the possibility of combined implantation was higher,and when the score was 8,the possibility of combined adverse pregnancy outcome was higher.3.The higher the score is,the greater the postpartum blood loss and the more difficult the operation is.When the score is 8,preoperative arterial catheter prepositioning and other preventive interventions are recommended. |
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