【摘要】目的探讨瘢痕子宫不全破裂的早期诊断、处理及预防。方法2006年1月2009年1月发生瘢痕子宫不全破裂13例,术前临床症状加B超检查确诊,手术从原切口进入宫腔,取出胎儿,修剪原切口周围瘢痕组织,10可吸收线连续缝合浆肌层,再间断包埋缝合切口,术后常规预防感染,加强宫缩治疗;胎盘植入2例尽量取出胎盘,修整切口,活动性出血明显者用10可吸收线“8”字缝扎止血,术后加服米非司酮150 mg/d共3 d。结果母婴均痊愈出院。42 d后来院复查,B超探查8例子宫下段处有线状较强回声,肌层回声均匀,余未发现异常;胎盘植入2例，随防3个月血绒毛膜促性腺激素呈阴性。结论早期B超检查能提高瘢痕子宫不全破裂确诊率,确诊后急诊剖宫产,胎盘部分植入者加服米非司酮并预防感染。
ObjectiveTo discuss the value of diffusion weighted imaging (DWI) in the diagnosis of placenta increta. MethodsThe clinical data of 42 patients with placenta increta admitted to Sichuan Provincial Hospital for Women and Children between May 2012 and January 2014 were retrospectively analyzed. All the patients were examined by prenatal magnetic resonance scans and DWI scans for subsequent comparison between ADC of the local convex placental region and ADC of the normal placental region and between the results of the two imaging methods. ResultsADC of the implantation area was significantly different from that of the normal placenta, so it could be used as a quantitative index. DWI had a higher sensitivity of diagnosis than conventional MRI. ConclusionCompared with conventional magnetic resonance imaging, DWI is more valuable in the clinical diagnosis of placenta increta, which provides a reliable basis for clinical treatment.
Objective To explore the value of lower abdominal aorta compression in emergent hysterectomy during cesarean section because of pernicious placenta previa. Method We retrospectively analyzed the clinical data of four patients who underwent hysterectomy for pernicious placenta previa with the assistance of lower abdominal aorta compression between January 2016 and March 2017 in Sichuan Provincial Hospital for Women and Children. Result The four patients were cured successfully, and the mothers and babies were all well with no pelvic organ damage or complications related to lower abdominal aorta compression. Conclusions Lower abdominal aorta compression in hysterectomy for pernicious placenta previa during cesarean section is a feasible procedure; it can effectively reduce the amount of bleeding, less affect maternal blood circulation, make surgery area clear, and give the operators the chance to do hysterectomy calmly. Lower abdominal aorta compression presents more and more advantages to treat pernicious placenta previa and may be an effective emergency measure to reduce hemorrhage during perioperative period especially under the circumstances of no chance to carry out vascular intervention treatment.
ObjectiveTo explore the significance of ultrasound combined with magnetic resonance imaging (MRI) in the diagnosis of pernicious placenta previa (PPP).MethodsA total of 101 patients with suspected PPP admitted to Chengdu Women’s and Children’s Central Hospital from January 2016 to February 2019 were retrospectively analyzed. The surgical results were used as the gold standard, and the diagnostic value of ultrasound, MRI, ultrasound combined with MRI was compared.ResultsSurgery results showed that among the 101 patients with suspected PPP, 79 patients had positive PPP diagnosis and 22 patients had negative PPP diagnosis. There was no significant difference in the diagnostic sensitivity, negative predictive value, or diagnostic coincidence rate of PPP among ultrasound, MRI, and ultrasound combined with MRI (P>0.05). The diagnostic specificity of the series combination of ultrasound and MRI (86.36%) was higher than that of ultrasound (59.10%), MRI (59.10%), and the parallel combination of ultrasound and MRI (31.32%), and the differences were statistically significant (P<0.05). The diagnostic coincidence rates of abnormal placental attachment of MRI (96.20%) and the parallel combination of ultrasound and MRI (96.20%) were higher than that of ultrasound (87.34%) and the series combination of ultrasound and MRI (87.34%) (P<0.05).ConclusionsUltrasound combined with MRI has a high diagnostic value for PPP. If necessary, ultrasound combined with MRI can be considered to improve the diagnostic efficiency.