目的 探讨孕中期前置胎盘患者超声表现及对提早剖宫产的临床决策。方法 选取2020年8月至2022年8月于我院就诊的前置胎盘孕妇296例，均行多普勒超声对孕妇产前检测，依据是否为提早剖宫产分为两组，提早剖宫产组(165例)和足月择期剖宫产组(131例)，比较两组孕妇的一般临床资料、妊娠结局、围生儿结局、超声表现等情况，影响提早剖宫产的相关危险因素进行单因素Logistic回归分析;采用多因素Logistic回归分析超声指标PI、PS、VI、VIF、IF指标与不良妊娠风险的相关性;R软件构建列线图预测模型;利用建模组数据集作受试工作者特征(ROC)曲线和校准曲线对模型区分度和准确度进行评价，利用验证组数据集对模型进行外部评价。结果 提早剖宫产组的孕妇产前出血和转儿科治疗比例明显高于足月择期剖宫产组，而新生儿体重、5 min Apgar评分明显低于足月择期剖宫产组(P＜0。05)。提早剖宫产组的超声指标PI、PS、VI、VIF、IF均高于足月择期剖宫产组，而RI低于足月择期剖宫产组(P＜0。05)。入院出血、宫颈内口上方胎盘的厚度≥5 cm、怀孕次数＜3次、宫颈长度＜31 mm、流产史、宫颈受累、PI≥3。14、PS≥25。61、VI≥9。87、VFI≥3。41、FI≥33。52和RI＜0。76均为孕妇提早剖宫产的独立影响因素(P＜0。05)，且PI、PS、VI、VIF、IF从低到高五分位数组趋势性检验差异有统计学意义(P＜0。001);建模组和验证组ROC曲线和校准曲线结果均显示预测模型具有较好的区分度和准确度。结论 孕中期前置胎盘患者超声表现对前置胎盘孕妇紧急提早剖宫产有重要的预测价值，此外，有高危因素者，应该加强围产期管理，避免妊娠不良结局。
Ultrasonographic findings of placenta previa in the second trimester and clini-cal decision for early cesarean section
Objective To investigate the ultrasonographic findings of placenta previa in the second trimester and clinical decision of premature cesarean section.Methods A total of 296 pregnant women with placenta previa who visited our hospital from August 2020 to August 2022 were selected.According to the prenatal detection of pregnant women by Doppler ultrasound,they were divided into two groups according to whether it was premature cesarean section(165 cases)and term elective cesarean section(131 cases).The general clinical data,preg-nancy outcome,perinatal outcome and ultrasound findings of the two groups of pregnant women were compared,and the risk factors affecting early cesarean section were analyzed by single-factor logistic regression.Multivariate logistic regression was chosen to analyze risk betwwen PI、PS、VI、VIF、IF and adverse pregnancy outcomes.R software builds a line graph prediction model;The model group data set was used as the receiver operating char-acteristic(ROC)curve and calibration curve to evaluate discrimination and accuracy of the model,and the vali-dation group data set was used to evaluate the model externally.Results The proportion of prenatal bleeding and transfer to pediatrics in the early cesarean section group was significantly higher than that in the elective cesarean section group,while the newborn weight and 5 min Apear score were significantly lower than those in the elective cesarean section group,which were statistically significant(P＜0.05).The ultrasonographic indexes PI,PS,VI,VIF and IF of early caesarean section group were higher than those of elective full-term caesarean section group,while RI was lower than those of elective full-term caesarean section group,the difference was statistically significant(P＜0.05).Admission bleeding,the thickness of the placenta above the inner opening of the cervix≥5 cm,number of pregnancies＜3,cervical length＜31 mm,abortion history,cervical involvement,PI ≥3.14,PS ≥25.61,VI≥9.87,VFI≥3.41,FI ≥33.52 and RI＜0.76 were independent influencing factors for early cesarean section(P＜0.05).And there is a statistically significant difference in the trend test of the quintile arrays of PI,PS,VI,VIF,and IF from low to high(P＜0.001).The ROC curve and calibration curve results of modeling group and verification group showed that the prediction model had good discrimination and accuracy.Conclusion Ultrasound findings of placenta previa patients in the second trimester have important predictive value for emergency early cesarean section of placenta previa pregnant women.In addition,perinatal management should be strengthened for those with high risk factors to avoid adverse pregnancy outcomes.
万方数据
维普
