胎盘体积、胎盘面积和宫颈长度预测胎盘植入的价值

doi:10.3877/cma.j.issn.2095-3259.2025.03.008

目的

探讨以胎盘体积、胎盘面积和宫颈长度预测完全性前置胎盘患者合并胎盘植入的价值。

方法

(1)研究方法：采用回顾性研究方法，对2016年1月至2023年12月8年间在南京医科大学附属苏州医院定期产检并住院分娩的926例完全性前置胎盘患者的临床资料进行分析；(2)分组：符合纳入标准的90例完全性前置胎盘合并胎盘植入的患者作为研究组，同时选取90例完全性前置胎盘不合并胎盘植入的患者为对照组；(3)分析指标：两组患者的年龄、体质指数、孕产次、磁共振成像(magnetic resonance imaging, MRI)图像胎盘面积和体积及宫颈长度、分娩孕周以及术中出血量和输血量等。

结果

研究组与对照组比较，(1)在孕次[3(3，4)次与3(2，4)次，Z＝2.13]、产次[2(1，2)次与2(1，2)次，Z＝3.06]、分娩孕周[(35.51±1.45)周与(36.35±1.77)周，t＝3.48]方面，差异均有统计学意义(P<0.05)；(2)手术时长、术中出血和输血量分别为(94.27±33.57)min与(63.04±27.58)min(t＝6.82)、(2 358.46±537.29)ml与(1 350.27±364.22)ml(t＝14.74)、(1 725.27±410.55)ml与(836.58±357.29)ml(t＝15.49)，差异均有统计学意义，P值均<0.01；(3)子宫动脉栓塞率(23.22%与3.33%)( χ²＝4.96)、新生儿出生体重(2 419.52±410.27)g与(2 715.26±385.17)g(t＝4.99)，差异有统计学意义，P值均<0.05；(4)胎盘面积(82.52±12.95)cm²与(63.50±13.55)cm²(t＝9.63)和胎盘体积(1 003.68±211.52)cm³与(812.66±219.50)cm³(t＝5.95)均大于对照组，P值均<0.05；研究组宫颈长度(1.89±0.49)cm，小于对照组的(2.76±0.54)cm(t＝11.32)，P值均<0.05；(5)胎盘体积、胎盘面积和宫颈长度MRI特征的最大曲线下面积(area under the curve，AUC)均>0.80，其中胎盘体积的诊断价值AUC为0.88，联合3个MRI特征对前置胎盘合并胎盘植入的预测价值AUC为0.93。

结论

胎盘体积、胎盘面积和宫颈长度能够有效评估完全性前置胎盘患者是否合并胎盘植入，有利于产科医师做好充分的术前准备，挽救孕产妇生命。

关键词: 前置胎盘, 侵入性胎盘, 磁共振成像, 子宫, 瘢痕

Objective

To investigate the predictive value of placental volume, placental area and cervical length for placenta accreta (PAS) in patients with complete placenta previa.

Methods

A retrospective study was conducted on 926 patients with complete placenta previa who received regular antenatal examination and delivered in the Affiliated Suzhou Hospital of Nanjing Medical University from January 2016 to December 2023. Among them, 90 patients meeting inclusion criteria with complete placenta previa and PAS were enrolled as the study group, and 90 patients with complete placenta previa without PAS were selected as controls. Maternal age, body mass index (BMI), gravidity and parity, placental area and volume measured by magnetic resonance imaging (MRI), cervical length, gestational age at delivery, intraoperative blood loss, and transfusion volume were compared between groups.

Results

(1) The gravidity [3(3, 4) vs 3(2, 4), Z=2.13] and parity [2(1, 2) vs 2(1, 2), Z=3.06] in the study group was higher than that in the control group, and the difference was statistically significant (P<0.05). The gestational age of delivery in the study group was smaller than that in the control group [(35.51±1.45) weeks vs (36.35±1.77) weeks, t=3.48], and the difference was statistically significant (P<0.05). (2)The operation time [(94.27±33.57) min vs (63.04±27.58) min, t=6.82], blood loss [(2 358.46±537.29)ml vs(1 350.27±364.22)ml, t=14.74] and blood transfusion [(1 725.27±410.55)ml vs (836.58±357.29)ml, t=15.49] in the study group were higher than those in the control group, and the differences were statistically significant(P<0.01). (3)The uterine artery embolization rate (23.22% vs 3.33%, χ²=4.96) in the study group was higher than those in the control group, the difference was statistically significant (P<0.05). The neonatal weight of the study group was lower than that of the control group [(2 419.52±410.27)g vs (2 715.26±385.17) g, t=4.99], and the difference was statistically significant (P<0.05). (4) The placental area [(82.52±12.95) cm² vs (63.50±13.55)cm², t=9.63] and placental volume [(1 003.68±211.52)cm³ vs (812.66±219.50)cm^3, t=5.95] of the study group were higher than those of the control group, and the difference was statistically significant (P<0.05). The cervical length of the study group was smaller than that of the control group [(1.89±0.49) cm vs (2.76±0.54) cm, t=11.32], and the difference was statistically significant (P<0.05). (5) The MRI features of placenta volume, placenta area and cervical length included in this study have certain predictive value for whether patients with placenta accreta, and the AUC of the three MRI features were all >0.80, and the diagnostic value of placenta volume was the largest (AUC=0.88). The combination of three MRI features had high value in the prediction of placenta accreta in placenta previa (AUC=0.93).

Conclusions

The placental volume, placental area and cervical length are effective predictors of PAS in patients with complete placenta previa, aiding obstetricians in preoperative preparation and improve maternal outcomes.

Key words: Complete placenta previa, Placenta accreta, Magnetic resonance imaging, Uterus, Cicatrix

表1 两组患者的一般情况比较

组别	例数	年龄(岁，±s)	体质指数(kg/m²，±s)	孕次[次，M(P₂₅，P₇₅)]	产次[次，M(P₂₅，P₇₅)]	MRI检查孕周(周，±s)	分娩孕周(周，±s)
研究组	90	32.57±4.15	27.25±4.15	3(3，4)	2(1，2)	32.76±2.75	35.51±1.45
对照组	90	31.68±3.97	26.67±3.96	3(2，4)	2(1，2)	33.32±2，29	36.35±1.77
统计值		t＝1.47	t＝0.96	Z＝2.13	Z＝3.06	t＝1.50	t＝3.48
P值		0.14	0.34	0.03	<0.01	0.14	<0.01

表1 两组患者的一般情况比较

组别	例数	年龄(岁，±s)	体质指数(kg/m²，±s)	孕次[次，M(P₂₅，P₇₅)]	产次[次，M(P₂₅，P₇₅)]	MRI检查孕周(周，±s)	分娩孕周(周，±s)
研究组	90	32.57±4.15	27.25±4.15	3(3，4)	2(1，2)	32.76±2.75	35.51±1.45
对照组	90	31.68±3.97	26.67±3.96	3(2，4)	2(1，2)	33.32±2，29	36.35±1.77
统计值		t＝1.47	t＝0.96	Z＝2.13	Z＝3.06	t＝1.50	t＝3.48
P值		0.14	0.34	0.03	<0.01	0.14	<0.01

图1 完全性前置胎盘患者胎盘面积、宫颈长度和胎盘体积的测量图像　A．完全性前置胎盘患者正中矢状位胎盘面积(蓝色区域)；B.完全性前置胎盘患者宫颈长度(线段c)；C.完全性前置胎盘患者胎盘体积三维图像正面观；D.完全性前置胎盘患者胎盘体积三维图像侧面观

表2 两组患者分娩结局的比较

组别	例数	手术时长(min，±s)	术中出血量(ml，±s)	术中输血量(ml，±s)	子宫动脉栓塞[例(%)]	子宫切除[例(%)]	膀胱损伤[例(%)]	新生儿体重(g，±s)	住院时间(d，±s)
研究组	90	94.27±33.57	2 358.46±537.29	1 725.27±410.55	11(23.22)	4(4.44)	3(3.33)	2 419.52±410.27	8.36±3.21
对照组	90	63.04±27.58	1 350.27±364.22	836.58±357.29	3(3.33)	1(1.11)	1(1.11)	2 715.26±385.17	6.52±2.34
统计值		t＝6.82	t＝14.74	t＝15.49	χ²＝4.96	χ²＝1.85	χ²＝1.02	t＝4.99	t＝4.39
P值		<0.01	<0.01	<0.01	0.026	0.17	0.31	<0.01	<0.01

表2 两组患者分娩结局的比较

组别	例数	手术时长(min，±s)	术中出血量(ml，±s)	术中输血量(ml，±s)	子宫动脉栓塞[例(%)]	子宫切除[例(%)]	膀胱损伤[例(%)]	新生儿体重(g，±s)	住院时间(d，±s)
研究组	90	94.27±33.57	2 358.46±537.29	1 725.27±410.55	11(23.22)	4(4.44)	3(3.33)	2 419.52±410.27	8.36±3.21
对照组	90	63.04±27.58	1 350.27±364.22	836.58±357.29	3(3.33)	1(1.11)	1(1.11)	2 715.26±385.17	6.52±2.34
统计值		t＝6.82	t＝14.74	t＝15.49	χ²＝4.96	χ²＝1.85	χ²＝1.02	t＝4.99	t＝4.39
P值		<0.01	<0.01	<0.01	0.026	0.17	0.31	<0.01	<0.01

图2 前置胎盘合并胎盘植入患者MRI胎盘体积、胎盘面积和宫颈长度图像特征预测胎盘植入的ROC曲线图

[1]	李丹，何志晖. 严重产后出血及与其相关的子宫切除危险因素分析[J/OL]. 中华产科急救电子杂志，2021，10(4)：220-224.
[2]	Lee JY, Ahn EH, Kang S, et al. Scoring model to predict massive post-partum bleeding in pregnancies with placenta previa: a retrospective cohort study[J]. J Obstet Gynaecol Res，2018，44(1)：54-60.
[3]	Jauniaux E, Chantraine F, Silver RM, et al. FIGO consensus guidelines on placenta accreta spectrum disorders: epidemiology[J]. Int J Gynaecol Obstet，2018，140(3)：265-273.
[4]	Jha P, Pōder L, Bourgioti C, et al. Society of Abdominal Radiology (SAR) and European Society of Urogenital Radiology (ESUR) joint consensus statement for MR imaging of placenta accreta spectrum disorders[J]. Eur Radiol，2020，30(5)：2604-2615.
[5]	Hong S, Le Y, Lio KU, et al. Performance comparison of ultrasonography and magnetic resonance imaging in their diagnostic accuracy of placenta accreta spectrum disorders: a systematic review and meta-analysis[J]. Insights Imaging，2022，13(1)：50.
[6]	Jauniaux E, Ayres-de-Campos D, Langhoff-Roos J, et al. FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders[J]. Int J Gynaecol Obstet，2019，146(1)：20-24.
[7]	Jauniaux E, Bunce C, Grønbeck L, et al. Prevalence and main outcomes of placenta accreta spectrum: a systematic review and meta-analysis[J]. Am J Obstet Gynecol，2019，221(3)：208-218.
[8]	Ghaem Maghami N, Helfenstein F, Manegold-Brauer G, et al. Risk factors for postpartum haemorrhage in women with histologically verified placenta accreta spectrum disorders: a retrospective single-centre cross-sectional study[J]. BMC Pregnancy Childbirth，2023，23(1)：786.
[9]	Einerson BD, Gilner JB, Zuckerwise LC. Placenta accreta spectrum[J]. Obstet Gynecol，2023，142(1)：31-50.
[10]	Lucidi A, Jauniaux E, Hussein AM, et al. Urological complications in women undergoing Cesarean section for placenta accreta spectrum disorders: systematic review and meta-analysis[J]. Ultrasound Obstet Gynecol，2023，62(5)：633-643.
[11]	Salama K, Holt R, Puryear LJ. Mental health and placenta accreta spectrum[J]. Am J Perinatol，2023，40(9)：1009-1012.
[12]	Teixeira B, Pinto PV, Realista R, et al. Placenta accreta spectrum disorders-the impact of the creation of a multidisciplinary team on maternal outcomes in Portugal[J]. Rev Bras Ginecol Obstet，2023，45(12)：e747-753.
[13]	Moradi B, Azadbakht J, Sarmadi S, et al. Placenta accreta spectrum in early and late pregnancy from an imaging perspective. A scoping review[J]. Radiologia (Engl Ed)，2023，65(6)：531-545.
[14]	Saxena U, Rana M, Tripathi S, et al. Prediction of placenta accreta spectrum by prenatal ultrasound staging system in women with placenta previa with scarred uterus[J]. J Obstet Gynaecol India，2023，73(Suppl 2)：191-198.
[15]	Shaamash AH, AlQasem MH, Al Ghamdi DS, et al. Placenta accreta spectrum in major placenta previa diagnosed only by MRI: incidence, risk factors, and maternal morbidity[J]. Ann Saudi Med，2023，43(4)：219-217.
[16]	岳永飞，朱利平，王晓艳. 磁共振成像技术在预测胎盘植入性疾病患者剖宫产术中出血量的研究[J/OL]. 中华产科急救电子杂志，2023，12(3): 167-172.
[17]	Maurea S, Verde F, Romeo V, et al. Prediction of placenta accreta spectrum in patients with placenta previa using a clinical, US and MRI combined model: a retrospective study with external validation[J]. Eur J Radiol，2023，168：111116.
[18]	Polat M, Kahramanoglu I, Senol T, et al. Shorter the cervix, more difficult the placenta percreta operations[J]. J Matern Fetal Neonatal Med，2016，29(14)：2327-2331.
[19]	Zaitoun MM, El Behery MM, Abd El Hameed AA, et al. Does cervical length and the lower placental edge thickness measurement correlates with clinical outcome in cases of complete placenta previa？[J]. Arch Gynecol Obstet，2011，284(4)：867-873.
[20]	Jung EJ, Cho HJ, Byun JM, et al. Placental pathologic changes and perinatal outcomes in placenta previa[J]. Placenta，2018，63：15-20.
[21]	Lu T, Wang Y, Guo A, et al. The MRI estimations of placental thickness and cervical length correlate with postpartum hemorrhage (PPH) in patients with risk for placenta accreta spectrum (PAS) disorders[J]. Placenta，2022，126：76-82.
[22]	Yue Y, Wang X, Zhu L, et al. Placental volume as a novel sign for identifying placenta accreta spectrum in pregnancies with complete placenta previa[J]. BMC Pregnancy Childbirth，2024，24(1)：52.
[23]	Altraigey A, Ellaithy M, Barakat E, et al. Cervical length should be measured for women with placenta previa: cohort study[J]. J Matern Fetal Neonatal Med，2021，34(13)：2124-2131.

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The value of placental volume, placental area, and cervical length in predicting placental accreta

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The value of placental volume, placental area, and cervical length in predicting placental accreta