Predictive value of ultrasound scoring system combined with serum creatine kinase,VEGF and AFP for the degree of placental implantation in parturients
10.3969/j.issn.1009-0754.2025.10.010
- VernacularTitle:超声评分系统联合血清CK、VEGF、AFP水平对胎盘植入性疾病产妇胎盘植入程度预测价值分析
- Author:
Ruihong WANG
1
;
Xiangmei ZHANG
Author Information
1. 710002 陕西 西安,西安大兴医院产科
- Keywords:
Placental implantation disorder;
Ultrasound scoring system;
Creatine kinase;
Vascular endothelial growth factor;
Alpha-fetoprotein
- From:
Journal of Navy Medicine
2025;46(10):1026-1031
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the value of ultrasound scoring system combined with serum levels of creatine kinase(CK),vascular endothelial growth factor(VEGF),and alpha-fetoprotein(AFP)in predicting the degree of placental implantation in parturients.Methods A total of 137 pregnant women with placental implantation disorders who were admitted to Xi'an Daxing Hospital from January 2020 to January 2024 were enrolled in this retrospective study.Pathological examination revealed 101 cases of adhesion type and 36 cases of implantation and penetration types.Clinical data were collected.All the patients underwent ultrasonic examination and were scored using an ultrasound scoring system.Multivariate Logistic regression analysis was employed to assess the factors influencing the degree of placental implantation.The predictive value of the ultrasound scoring system and serum markers for the degree of placental implantation was analyzed using receiver operating characteristic(ROC)curves.Results The transfusion rate of allogeneic red blood cell and ultrasound score in patients with implantation and penetration types were significantly higher than those in patients with adhesion type(55.56%vs.14.85%,5.97±1.23 vs.2.52±1.20,P<0.05).Serum levels of CK,VEGF and AFP in patients with implantation and penetration types were also significantly higher than those in patients with adhesion type([151.94±51.02]U/L vs.[121.37±43.01]U/L,[251.64±52.09]pg/mL vs.[151.67±31.08]pg/ml,[234.95±43.01]ng/mL vs.[205.64±35.12]ng/ml,P<0.05).Ultrasound findings such as the disappearance of the clear zone,abnormal placental lacunae,disruption of the bladder boundary,thinning of the myometrium,placental protrusion,extrusion of local tissue,high vascularization between the uterus and bladder,high vascularization behind the placenta,vascular bridges,and direct blood vessels in the placental bed were significantly more frequent in patients with implantation and penetration types compared to the adhesion type(P<0.05).Multivariate Logistic regression analysis indicated that allogeneic red blood cell transfusion rate,ultrasound score,and serum levels of CK,VEGF and AFP were independent risk factors for a higher degree of placental implantation,with odds ratios of 5.363,1.810,1.015,1.019,and 1.020(95%CI:1.410-20.404,1.197-2.736,1.000-1.030,1.004-1.035,1.002-1.038,P<0.05).The combined predictive value of ultrasound scoring and serum levels of CK,VEGF and AFP showed the highest sensitivity(94.40%)and specificity(97.00%)for the degree of placental implantation in patients with implantation and penetration types,with a Youden index of 0.914 and an AUC of 0.937(95%CI:0.874-0.999).Conclusion The ultrasound scoring system combined with serum CK,VEGF and AFP can effectively predict the severity of placental implantation.This combined approach offers high sensitivity and specificity for identifying high-risk cases of implantation and penetration types of placental implantation,thereby aiding clinicians in optimizing management and intervention strategies for pregnant women.
