| Objective:Because placenta implantation can cause many adverse perinatal pregnancy complications,this disease has been classified as a critical disease in gynecology and obstetrics.According to authoritative literature,90% of women with blood loss during childbirth exceed 3000 ml,10% of women with blood loss over 10000 ml during childbirth,the hysterectomy rate of patients is 55%,and the mortality rate of patients is7%.Based on this,this study intends to establish a prediction model for the combined score of placenta implantation and analyze the threshold for the diagnosis of placenta implantation according to the recognized ultrasonic scoring scale of placenta implantation.According to the combined score prediction model,patients whose diagnostic results ≥5 points were estimated to be placenta implantation were screened and ultrasound-guided abdominal aortic balloon was applied to all of this patients.The success rate and clinical effect of balloon placement were analyzed.To investigate the feasibility and safety of ultrasound-guided preimplantation of abdominal aortic balloon.It is intended to provide a complete set of clinical diagnosis and treatment for placenta implantation.Methods:1.Retrospective analysis of 120 patients with postpartum confirmed placenta previa in our hospital from January 2016 to August 2020.This patients were divided into groups according to caesarean section operation or pathological results as the diagnostic gold standard,Including normal、adhesion group(normal placenta previa without implantation in 52 cases,adhesion placenta implantation in 25 cases)and implantation group(implantation placenta in 38 cases,penetration placenta implantation in 5cases).Clinical data and ultrasonic examination indexes of patients between the two groups were analyzed.The combined score prediction model was constructed,and the diagnostic threshold,sensitivity and specificity,positive and negative predictive value,missed diagnosis and misdiagnosis rate of the model were analyzed.Kappa test was used to compare the consistency of the two methods in disease diagnosis.2.Among the model diagnosis results,39 pregnant women whose score ≥5 was estimated to be placenta implantation,and 19 of them were selected for inclusion in this study.All of the 19 patients underwent intraoperative ultrasound-guided balloon occlusion of abdominal aorta in our hospital.The blood loss during caesarean section,hysterectomy and other related indexes of 19 patients were analyzed.Results:1.Combined with the actual situation,the unit analyzed the acoustical characteristics and high risk factors of placenta implantation recognized at home and abroad,compiled the recognized ultrasonic scoring scale of placenta implantation,and established the combined scoring prediction model.The statistical items in the model included placenta thickness,continuity of placenta and uterine slough interface,thickness of lower vocal cords in the myometrium at placenta covering area,placental blood sinus,blood flow signal in the myometrium in placenta and behind placenta,bladder line,history of cesarean section,and history of vaginal delivery or abortion,each of which was assigned 2 points,with a total score of 16 points.2.Ultrasound image characteristics and medical history of 120 pregnant women were assigned according to the combined score prediction model.In the normal and adhesion groups,the median score was 2,and the 25 th and 75 th percentiles were 1 and3,respectively.In the implantation group,the median score was 6,and the 25 th and75th percentiles were 5 and 9,respectively,P<0.001.When the cut-off value of ROC curve analysis was 5 points,the Youden index reached the maximum of 0.762,indicating the best diagnostic efficiency.In other words,when the diagnostic result of the combined scoring model was ≥5 points,it was estimated to be placenta implantation,and when < 5 points,it was predicted to be normal placenta or adherent placenta.According to the diagnostic threshold of 5,81 cases were diagnosed as normal adhesion group and 39 cases were diagnosed as implantation group.The gold standard confirmed that 77 cases were normal and adhesion group,and 43 cases were implantation group.The diagnostic sensitivity and specificity were 81.4% and 94.8%,respectively.The positive and negative predictive values were 89.7% and 90.1%,respectively.The missed diagnosis rate was 18.6%,and the misdiagnosis rate was5.2%.Kappa test was used to analyze the consistency between the combined score prediction model for diagnosis of placenta implantation and the gold standard results of diagnosis.K value was 0.778,P<0.001,indicating that the two diagnosies were consistent with good consistency.3.The successful rate of balloon placement in 19 selected patients undergoing balloon interventional surgery was 100%,which was consistent with the data recorded in most articles.The blood loss during caesarean section was 820(620,1600)ml,with an average of(1216.3±769.2)ml,which was significantly lower than the reported blood loss of 3000 ml in literature.The rate of hysterectomy was 26.3%(5/19),which was lower than the 55% rate reported in the literature.Conclusion:1.Combined score prediction model analysis results ≥5 points were classified as implantation group,< 5 points were classified as normal and adhesion group,The diagnostic sensitivity was 81.4%,the specificity was 94.8%,the positive and negative predictive values were 89.7% and 90.1% respectively,the missed diagnosis rate was18.6%,and the misdiagnosis rate was 5.2%.Combined score prediction model is of great significance to help obstetricians to understand the condition of pregnant women in advance and make the most appropriate treatment plan for the condition of pregnant women.2.When the combined score prediction model analysis results ≥5 points,the selection of ultrasound-assisted balloon intervention can not only reduce the maternal blood loss during childbirth,but also reduce the rate of genital organ resection,maternal and fetal safety can also be guaranteed.Through the follow-up,it was found that the depth of the placenta implantation into the myometrium and the extent of the invasion had a great influence on the choice of subsequent treatment.3.When the combined score prediction model is used for diagnosis,the misdiagnosis of placenta previa,which is located on the posterior wall of the uterus,and the complicated pregnancy history,such as cesarean section delivery and abortion termination,is more likely to occur.At this time,the examiner should make a diagnosis based on his own experience and actual situation,and combine MRI for diagnosis if necessary to improve the diagnostic accuracy. |
PDF Full Text Request