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Title: [Risk factors and sonographic findings associated with the type of placenta accreta spectrum disorders].
Author: Zhang HJ, Dou RC, Lin L, Wang QY, Huang BE, Zhao XL, Chen DJ, Ding YL, Ding HJ, Cui SH, Zhang WS, Xin H, Gu WR, Hu YL, Ding GF, Qi HB, Fan L, Ma YY, Lu JL, Yang Y, Lin L, Luo XC, Zhang XH, Fan SR, Yang HX.
Journal: Zhonghua Fu Chan Ke Za Zhi; 2019 Jan 25; 54(1):27-32. PubMed ID: 30695903.
Abstract:
Objective: To evaluate the risk factors and sonographic findings of pregnancies complicated by placenta increta or placenta percreta. Methods: Totally, 2 219 cases were retrospectively analyzed from 20 tertiary hospitals in China from January 2011 to December 2015. The data were collected based on the original case records. All cases were divided into two groups, the placenta increta (PI) group (79.1%, 1 755/2 219) and the placenta percreta (PP) group (20.9%, 464/2 219) , according to the degree of placental implantation. The risk factors and sonographic findings of placenta increta or percreta were analyzed by uni-factor and logistic regression statistic methods. Results: The risk factors associated with the degree of placental implantation were age, gravida, previous abortion or miscarriage, previous cesarean sections, and placenta previa (all P<0.05), especially, previous cesarean sections (χ(2)=157.961) and placenta previa (χ(2)=91.759). Sonographic findings could be used to predict the degree of placental invasion especially the boundaries between placenta and uterine serosa, the boundary between placenta and myometrium, the disruption of the placental-uterine wall interface and loss of the normal retroplacental hypoechoic zone(all P<0.01). Conclusions: Previous cesarean sections and placenta previa are the main independent risk factors associated with the degree of placenta implantation. Ultrasound could be used to make a prenatal suggestive diagnosis of placenta accreta spectrum disorders. 目的： 研究影响胎盘植入程度的危险因素，并分析超声影像学表现与胎盘植入程度的相关性。 方法： 本研究为观察性病例对照研究，收集2011年1月至2015年12月全国20家三级甲等医院共2 219例胎盘植入孕妇的临床资料，根据胎盘植入肌层的深度分为植入性胎盘组（PI组）1 755例（79.1%，1 755/2 219）和穿透性胎盘组（PP组）464例（20.9%，464/2 219）。采用单因素分析及多因素logistic回归，分析胎盘植入的危险因素，及超声影像学表现与胎盘植入程度的相关性。 结果： 影响胎盘植入程度的危险因素包括孕妇年龄、孕次、流产史、既往剖宫产术史、前置胎盘等（P均<0.05），其中，既往剖宫产术史（χ(2)=157.961）和前置胎盘（χ(2)=91.759）与胎盘植入程度的相关性最为明显（P均<0.05）。超声诊断胎盘植入的影像学指标可用于预测胎盘植入的程度，其中子宫浆膜与膀胱的界限、胎盘与子宫肌层界限、子宫肌层回声连续性以及胎盘后异常血流信号与胎盘植入程度的相关性显著（P均<0.01）。 结论： 既往剖宫产术史和前置胎盘是影响胎盘植入程度最主要的危险因素；超声检查是目前诊断胎盘植入的主要手段。.

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