凶险性前置胎盘20例临床分析  

Clinical Analysis of 20 Cases of Pernicious Placenta Previa

作　　者：严小丽[1] 陈诚[1] 常青[1] 王琳[1] 阎萍[1] 

机构地区：[1]第三军医大学第一附属医院,重庆400038

出　　处：《实用妇产科杂志》2013年第9期704-707,共4页Journal of Practical Obstetrics and Gynecology

基　　金：重庆市攻关课题(编号:CSTC2012ggyyjs10056)

摘　　要：目的:探讨凶险性前置胎盘的诊治及与孕妇年龄、流产次数和剖宫产次数的关系。方法:2006年6月至2012年12月我院收治前置胎盘患者226例,其中凶险性前置胎盘20例,比较凶险性前置胎盘组(20例)和非凶险性前置胎盘组(206例)在孕妇年龄、流产次数和剖宫产次数的差异,回顾性分析20例凶险性前置胎盘的诊治情况。结果:①凶险性前置胎盘组孕妇年龄≥35岁、流产次数≥3次、剖宫产次数≥2次的发生率明显高于非凶险性前置胎盘组,差异有统计学意义(P<0.01)。②术前诊断凶险性前置胎盘的准确率为100.0%,20例凶险性前置胎盘B超诊断胎盘植入的敏感度为88.9%(8/9),特异度为90.9%(10/11),MRI检查敏感度为100.0%(3/3),特异度为100.0%(5/5)。③20例凶险性前置胎盘均采用手术治疗,其中2例因术中出现失血性休克立即行子宫切除,其余18例术中生命体征平稳,均先采用保守性手术,3例因保守性手术治疗无效行子宫切除,子宫切除率为25.0%(5/20)。结论:凶险性前置胎盘术前应通过超声及MRI进行充分评估有无胎盘植入,从而制定相应的手术方案;在病情允许的情况下可先行保守性手术,如无效时应及时行子宫切除。高龄孕妇、多次剖宫产及多次人工流产史与凶险性前置胎盘有关。Objective：To explore the diagnosis and management of pernicious placenta previa and the relationship between pernicious placenta previa and maternal age, number of abortion and cesarean section number. Methods： Retrospectively analyzed all the 226 cases of placenta previa hospitalized in The First Affiliated Hospital of The Third pernicious placenta previa. Results：~The incidence of more than 35 years old, not less than thrice abortions and previous cesarean delivery in the pernicious placenta previa significantly higher than the not pernicious placenta previa（ P 〈0. 01 ）. ② The sensitivity and specificity of the ultrasound and MRI diagnosis of placenta implantation were 88.9% （8/9） 90. 9% （ 10/11 ）, and 100.0% （3/3）, 100.0% （5/5）, respectively. ③Surgical treatment was done in all pernicious placenta previa patients （2 cases received cesarean hysterectomy because of hemorrhagic shock; stable vital signs, 18 cases were used the conservative operation;the remaining 3 cases of conservative treatment is invalid operation for hysterecto- my）, uterine resection rate was 25. 0% （5/20）. Conclusions： Pernicious placenta previa patients should be fully accessed by ultrasound and MRI,so as to formulate the corresponding operation plan;the conservative operation chould be used if the condition permitting,timely hysterectomy should be give if the conservative operation was invalid;high age of pregnant women, repeated cesarean section and repeatedly the history of artificial abortion have a relationship with the pernicious placenta previa.

关 键 词：前置胎盘 胎盘植入 瘢痕子宫 产后出血 

分 类 号：R714.56[医药卫生—妇产科学]