探讨胎盘植入患者超声声像图特征，并分析漏诊原因。

对2014年1月至2017年5月在解放军总医院行产前超声检查并经手术病理证实的27例胎盘植入患者临床资料、超声影像学特征及漏误诊原因进行回顾性分析。

27例胎盘植入患者（首次妊娠5例，瘢痕子宫17例，5例为经产妇）术前超声主要表现为胎盘与子宫肌层间的分界不清及胎盘后间隙消失、胎盘内多发的腔隙性回声区；1例累及膀胱，超声显示子宫浆膜层及膀胱壁浆膜层高回声带不完整。术前超声诊断显示正常位置胎盘3例，前置胎盘24例（中央型前置胎盘20例，边缘性前置胎盘4例）；27例胎盘植入患者超声检查后行单纯剖宫产手术8例，剖宫产手术后子宫切除13例；活产婴儿20个，死胎或致死性引产6例（2例直接行阴式子宫切除术，1例行介入栓塞后剖宫取胎，2例行介入栓塞后钳刮术，1例院前子宫破裂胎死宫内）。术后检查显示粘连性胎盘植入3例，穿透性胎盘植入2例，胎盘植入肌层未穿透浆膜层22例。瘢痕子宫患者中3例（3/17）胎盘植入非瘢痕处，主要位于子宫左侧壁、左前壁、后壁；非瘢痕子宫患者中6例（6/10）胎盘植入子宫后壁。术后病理证实术前超声正确诊断15例，超声漏诊12例，漏诊原因主要与胎盘位置深（后壁胎盘）、胎头遮挡或胎盘植入范围较小、孕周较大、急诊超声仅注意到子宫破裂、前置胎盘或胎盘早剥等急症情况忽略同时存在的胎盘植入以及检查者的经验不足等有关。

产前超声诊断胎盘植入虽有一定局限性，但仍是胎盘植入术前首选的诊断方法和产前动态监测病情进展的重要方法。

To explore the ultrasonographic imaging characteristics of placenta increta and clinical data, and analyze the reasons for failure to make an accurate diagnosis.

By means of a retrospective analysis of 27 patients with placenta increta confirmed by operation and pathologic examination from January 2014 to May 2017 in the General Hospital of the People′s Liberation Army (also Hospital 301 for short), the reasons for missed diagnosis and misdiagnosis are comprehensively summarized.

The ultrasound examination in all the 27 cases (5 cases of first pregnancy, 17 cases of scar, 5 cases of maternal) illustrated the poorly-defined boundary between placenta and uterus mesometrium, the loss of retroplacental space, multiple lacunae echo areas, and the incomplete high-echo area of the serous membrane of placenta and bladder (involving the bladder); despite 3 normal placenta, the rest 24 were all diagnosed as placenta previa before operation, of which 20 belonged to central placenta previa and the other 4 belonged to marginal placenta previa. Twenty liveborn infants were delivered in the study, 13 of them went through abdominal hysterectomy after cesarean section surgery, 8 of them only received cesarean section surgery; 2 of them went through vaginal hysterectomy, 1 received cesarean section surgery after interventional embolization, 1 Uterine rupture in utero before got to the hospital, with the rest 2 received interventional embolization clamp scraping as a consequence of deadly induced labor or stillbirth. Postoperative placenta increta types demonstrated adhensive implantation, penetrating implantation, and implantation into muscular but not membrane layer in 3, 2, and 22 cases respectively. In terms of implanting position, only 3 patients (3/17) with cicatricial uterus did′t undergo the implantation into the scar area mainly in the left wall, left anterior wall and posterior wall, as for patients with non-scar uterus, posterior wall implantation was the main mode presented in 6 cases (6/10). Fifteen of all the involved 27 cases were identified while 12 cases failed to be distinguished. The deep reasons of misdiagnosis were placental location (placenta adheres to the posterior wall), fetal head shelter, or small placental placement, gestational age, larger range of placenta implantation, emergency ultrasound only pay attention to the emergency situation and ignore the exist at the same time, experience of inspectors with placenta increta and so on.

Although there are some limitations in prenatal ultrasound diagnosis of placenta, it is still an important method for the diagnosis and prenatal dynamic monitoring of the condition before the placenta implantation.