本文關(guān)鍵詞： 胎盤異常 超聲檢查 影響因素 妊娠結(jié)局　出處：《鄭州大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的 分析胎盤異常對母兒的影響、胎盤異常發(fā)生的影響因素，評價胎盤異常彩超診斷的可靠性，為提高彩超診斷的準(zhǔn)確程度并盡早開展臨床干預(yù)提供參考依據(jù)。 方法 以2012年7月-2013年7月在某醫(yī)院住院分娩且做過產(chǎn)前彩超診斷的10023份病歷為研究材料，將產(chǎn)后胎盤檢查結(jié)果作為金標(biāo)準(zhǔn)，研究胎盤異常檢出的種類、數(shù)量、構(gòu)成比。以產(chǎn)前彩超診斷和產(chǎn)后證實的結(jié)果相比較，計算彩超診斷的靈敏度、特異度、漏診率、誤診率。從正常產(chǎn)婦中隨機抽取300例作為對照，分析胎盤異�；颊叩娜焉锝Y(jié)局和發(fā)生的影響因素。用Excel建立數(shù)據(jù)庫，SPSS15.0軟件包統(tǒng)計處理，計量資料用均數(shù)±標(biāo)準(zhǔn)差（x±s）表示，兩組間均數(shù)比較采用成組t檢驗；計數(shù)資料用構(gòu)成比、率表示，組間率的比較采用卡方檢驗，檢驗水準(zhǔn)取α=0.05。 結(jié)果 （1）胎盤異常檢出情況共有217例胎盤異常，檢出率為2.16%（217/10023）；包括前置胎盤、胎盤植入、前置胎盤合并植入、胎盤形態(tài)異常、胎盤早剝及其他等6類異常，其中胎盤形態(tài)異常106例，所占構(gòu)成比最大，，為48.8%。 （2）超聲檢查結(jié)果產(chǎn)前彩超診斷胎盤異常的總體符合率為99.73%，靈敏度為88.94%，特異度為99.97%，漏診率為11.06%，誤診率為0.03%；不同類型的胎盤異常有著不同的靈敏度、特異度、漏診率、誤診率及符合率，其中單純胎盤植入的漏診率最高，為69.23%；胎盤血管瘤的靈敏度最高，為100.00%。 （3）胎盤異常對婦女的影響217例胎盤異常婦女的產(chǎn)前出血比例為22.6%，剖宮產(chǎn)比例為62.2%，產(chǎn)后出血比例64.5%，子宮切除比例3.2%，均高于對照組，差異均有統(tǒng)計學(xué)意義（P0.05）。上述4項指標(biāo)在不同類型胎盤異常之間的差異均有統(tǒng)計學(xué)意義（P0.05）。 （4）胎盤異常對圍產(chǎn)兒的影響217例胎盤異常婦女娩出新生兒232例，身長49.9±3.5cm、體重2863.7±434.1g、Apgar評分7.6±2.1，均低于對照組，差異均有統(tǒng)計學(xué)意義（P0.05）。早產(chǎn)5例，畸形3例，與對照組差異無統(tǒng)計學(xué)意義（P0.05）。各項指標(biāo)在不同類型胎盤異常之間的差異則均無統(tǒng)計學(xué)意義（P0.05）。 （5）胎盤異常的影響因素胎盤異常組與對照組在年齡、經(jīng)產(chǎn)史、流產(chǎn)史、剖宮產(chǎn)史及子宮畸形等方面的差異均有統(tǒng)計學(xué)意義（P0.05）；不同類型胎盤異常的影響因素分別與對照組比較均高于對照組，差異有統(tǒng)計學(xué)意義（P0.05）。 結(jié)論 1．彩超診斷胎盤異常具有較高的靈敏度、特異度。 2．彩超檢查應(yīng)將具有年齡偏大或曾有經(jīng)產(chǎn)、流產(chǎn)、剖宮產(chǎn)史及子宮畸形等因素者作為篩查的重點對象。 3．胎盤異常病例中的胎盤形態(tài)異常最多見，其次為前置胎盤、胎盤早剝、胎盤植入。 4．胎盤異常對母兒均有不良影響：新生兒的身長、體重、Apgar評分均較低；孕產(chǎn)婦的產(chǎn)前出血、產(chǎn)后出血、剖宮產(chǎn)、子宮切除所占比例均較高。
[Abstract]:Purpose To analyze the influence of placental abnormality on mother and fetus, and to evaluate the reliability of the diagnosis of placental abnormality by color Doppler ultrasound, to provide reference for improving the accuracy of color Doppler ultrasound diagnosis and carrying out clinical intervention as soon as possible. Method The results of postpartum placenta examination were regarded as gold standard based on 10023 medical records that had been diagnosed by prenatal color Doppler ultrasonography from July 2012 to July 2013 in a hospital. To compare the results of prenatal ultrasonography and postpartum confirmation, the sensitivity, specificity and missed diagnosis rate of color Doppler ultrasonography were calculated. The misdiagnosis rate. The pregnancy outcome and the influencing factors of placental abnormality were analyzed in 300 cases of normal puerpera randomly selected as control. The database was established by Excel. The statistical processing of SPSS15.0 software package showed that the metrological data were expressed as mean 鹵standard deviation (x 鹵s). The mean value of the two groups was compared by group t test. The counting data are expressed by composition ratio and rate. The comparison of rates among groups is carried out by chi-square test, and the test level is 偽 -0.05. Results 1) there were 217 cases of placental abnormality detected, the detection rate was 2.16% and 21.7% / 10023%; There were 6 kinds of abnormal placenta, placenta previa, placenta accreta, placental abruption, placental abruption and other 6 kinds of abnormal placenta, among which 106 cases had abnormal placenta morphology, accounting for the largest proportion of 48.8%. 2) the overall coincidence rate, sensitivity, specificity, missed diagnosis rate and missed diagnosis rate were 99.73, 88.94, 99.97 and 11.06% respectively. The misdiagnosis rate was 0.03. Different types of placental abnormalities had different sensitivity, specificity, missed diagnosis rate, misdiagnosis rate and coincidence rate. The rate of missed diagnosis of simple placenta accreta was the highest (69.23%). The sensitivity of placental hemangioma was 100.00g. The effect of abnormal placenta on women: the proportion of antenatal hemorrhage, cesarean section and postpartum hemorrhage in 217 cases of women with abnormal placenta were 22.62,62.2 and 64.5% respectively. The ratio of hysterectomy was 3.2g, which was higher than that of control group. The differences were statistically significant (P 0.05) and there were significant differences among the four indexes mentioned above among different types of placental abnormalities (P 0.05). Effect of abnormal placenta on perinatal infants 232 cases of newborns were delivered with abnormal placenta. The body length was 49.9 鹵3.5 cm and the body weight was 2863.7 鹵434.1 g. The Apgar score was 7.6 鹵2.1, which was significantly lower than that in the control group (P 0.05). There were 5 cases of premature delivery and 3 cases of malformation. There was no significant difference between the control group and the control group (P 0.05), but there was no significant difference in all indexes among different types of placental abnormalities (P 0.05). (5) there were significant differences in age, history of delivery, history of abortion, history of cesarean section and uterine malformation between the abnormal placenta group and the control group (P 0.05). The influencing factors of different types of placental abnormalities were higher than those of the control group, and the difference was statistically significant (P 0.05). Conclusion 1. Color Doppler ultrasound has high sensitivity and specificity in the diagnosis of placental abnormalities. 2. Color Doppler ultrasound should focus on those who have some factors such as older age, abortion, history of cesarean section and uterine malformation. 3. Abnormal placental morphology was most common in abnormal placenta, followed by placenta previa, placental abruption and placenta accreta. 4. The abnormal placenta had negative effects on both mother and infant: the newborn's body length, weight and Apgar score were all low, and the proportion of prenatal hemorrhage, postpartum hemorrhage, cesarean section and hysterectomy were all higher in pregnant and parturient women.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R714.56

【參考文獻】

相關(guān)期刊論文 前10條

1 黃知芳;副胎盤前置漏診1例[J];中國超聲診斷雜志;2001年06期

2 張偉峰,王山米;帆狀胎盤在產(chǎn)科臨床中的意義[J];中國婦產(chǎn)科臨床;2003年06期

3 徐元春;康程;王細(xì)先;李柯瑾;;重度胎盤早剝的處理時限與妊娠結(jié)局[J];中國婦產(chǎn)科臨床雜志;2011年03期

4 陳小燕;張敏;趙世怡;黎坤儉;;球拍狀胎盤并臍血管破裂胎盤早剝的超聲表現(xiàn)1例[J];中國超聲診斷雜志;2005年11期

5 梁萍;郝潔;;經(jīng)腹與經(jīng)會陰超聲聯(lián)合診斷孕晚期前置胎盤的探討[J];海南醫(yī)學(xué);2007年03期

6 弓麗琪;李燦宇;;帆狀胎盤48例臨床分析[J];鄭州大學(xué)學(xué)報(醫(yī)學(xué)版);2007年04期

7 周小媛;俞群軍;;副胎盤及其異常的超聲診斷與分析[J];醫(yī)學(xué)臨床研究;2006年05期

8 羅紅;羅揚;;胎盤早剝的超聲診斷分析[J];四川大學(xué)學(xué)報(醫(yī)學(xué)版);2008年04期

9 馬麗;李云霞;;球拍狀胎盤并前置血管不全破裂一例誤診[J];臨床誤診誤治;2011年02期

10 張愛蘭,鄭莉萍;胎盤早期剝離發(fā)病時間與母嬰結(jié)局關(guān)系的探討[J];浙江臨床醫(yī)學(xué);2002年02期

本文編號：1461275