| BackgroundPernicious Placenta Previa(PPP): At present,it is often defined as having a previous history of cesarean section,this pregnancy is placenta previa,and the placenta attached to the atrium scar site,often accompanied by placental implantation abnormality(PIA).Ultrasound as the primary inspection method for prenatal diagnosis of PPP,foreign scholars Cali et al found that ultrasound had higher positive and negative predictive value for placental implantation.The domestic scholar Zhong Zhiwen et al have put forward the placenta accretion ultrasound scoring system.The concept pointed out that the ultrasound score scale has certain clinical value in predicting the degree of placenta implantation and the type of implant,and it could predict the risk of intraoperative bleeding and hysterectomy.The unit is referred to the abovementioned placenta accreta ultrasound grading scale for a certain period of time,combined with its own clinical experience to revise,and compile our ultrasonic diagnostic rating scale and medical history rating scale to carry out comprehensive scoring to predict the risk of PPP and to discuss its guiding value for PPP surgicalplan.ObjectiveRetrospective analysis of ultrasound scoring combined with medical history in the diagnosis of PPP and the prediction of the risk degree,Preliminary discussion on the guiding value of ultrasound scoring combined with medical history for PPP surgical planning,to provide an objective basis for improving maternal and child safety during the perinatal period.Materials and methodsTo collect the clinical data of 58 cases of PPP pregnant women who were hospitalized and terminated their pregnancy in our hospital from May 2017 to December 2017.After admission,color doppler ultrasonography was used to assess the position of the placenta and placenta accreta.According to the ultrasound score scale and the medical history score scale,a comprehensive score of 18 points was obtained.According to the receiver operating characteristic curve(ROC curve),calculate the comprehensive score cut-off for various types of placenta accreta(see the results section for details).According to the cut-off value grouping: scores <8points were regarded as low risk placenta accreta group(conventional cesarean section);score ? 8 points were regarded as high risk group for placenta accrrete(intraoperative ultrasound-mediated lower abdominal aortic balloon temporary blocking surgery).According to the score,the high risk group was divided again for?12 point's group and 8-12 point's group.At the same time,26 women with normal uterine scars who had normal placenta at the same time and no pregnancy complications were randomly assigned to the normal group.Data was analyzed by using SPSS 21.0.Normally distributed measurement data used t-test.Non-normally distributed measurement data used T-test.Count data used?2-test or Fisher exact test.The comprehensive score cut-off for each type of placenta implant was calculated by the receiver operating characteristic curve(ROC curve)and the area under the curve(AUC).The difference has statistical significance P<0.05.Results1.Diagnosis of ultrasound scoring combined with history of PPP and placenta:By postoperative diagnosis,the coincidence rate of the diagnostic of PPP with placenta accreta was 93.1%(54/58),sensitivity was 94.5%(52/55),and specificity was 66.7%(2/3).2.Ultrasound scores combined with medical history to predict the cut-off value for various types of placental accreta:(1)Placenta accreta and increta: The AUC of placenta accreta and increta was calculated to be 92.5%,the score corresponding to the largest Youden index was 7.5,and the sensitivity and specificity were 76.9% and 84.6%.Therefore,the cut-off score for placenta accreta and increta was 8 points.(2)Placeenta increta and percreta: The AUC of placenta increta and percreta was calculated to be 92.7%,the score corresponding to the largest Youden index was 11.5,and the sensitivity and specificity were 89.5% and 81.8%.Therefore,the cut-off score for placenta increta and percreta was 12 points.3.Low risk placenta accreta group and normal group general situation comparison:(1)Comparison of general conditions between the two groups: There was no statistically significant difference in age,number of pregnancies,previous cesarean delivery,previous abortion and vaginal delivery,preoperative HGB,etc.(P>0.05);Weeks,low risk group was earlier than the normal cesarean section,the difference was statistically significant(P <0.001).(2)Comparison of intraoperative conditions: There were no significant differences(P>0.05)in operative time,intraoperative blood loss,neonatal Apgar score(1min,5min),etc.;On the other hand,the birth weight in newborns low risk group was lower than that in normal cesarean section,with a statistically significant difference(P<0.001).(3)Comparison of postoperative conditions: There was no significant difference in postoperative hospital stay(P>0.05).In both groups,the vital signs were stable during and after surgery,and no ICU was transfered.No postoperative complications occurred.4.Comparison of case data of ?12 point's group and 8-12 point's group:(1)Comparison of general conditions between the two groups: There was no statistically significant difference in the basic conditions of age,gestational age,pregnancy times,previous cesarean delivery,previous abortion,vaginal delivery,and preoperative HGB(P>0.05)..(2)Comparison of intraoperative conditions: There were no statistically significant differences between the two groups in terms of operation time,neonatal Apgar score(1min,5min)and neonatal body mass(P>0.05).In the amount of intraoperative blood loss,blood loss within the group of ?12 group's was significantly higher than that of the 8-12 point's group,and the difference was statistically significant(P<0.05).(3)Comparison of postoperative conditions: There was no significant difference in postoperative hospital stay(P>0.05).In the ? 12 point's group,there were 2patients was transferred to ICU,the other patients had stable vital signs.After operation,they were observed in the general ward;no postoperative complications occurred after surgery.5.Follow-up:No significantly related long-term complications occurred in the 42-day postperative review.Six months after the operation,35 cases were followed up by telephone,which of the rest 23 cases had not been followed for more than half a year.And there were 32 cases of recurrent menstruation.There was no significant change in menstrual flow,menstrual period and pre-pregnancy.Conclusions1.Ultrasound scoring combined with medical history has a very good clinical significance of PPP patients in surgical planning.< 8 points of PPP patients can be routine cesarean section,thereby reducing PPP abdominal aorta balloon vascular intervention rate.2.Ultrasound scoring combined with medical history has good clinical guidance for predicting the risk of PPP.The score of ?12 points was considered as much as possible to the penetrating placenta implantation. |
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