前置胎盘附着位置对剖宫产后再次妊娠母婴结局的影响  

The effect of placenta position on re-pregnant women with placenta previa after cesarean section

作　　者：陈汉青[1] 邹粟花[1] 杨建波[1] 徐丽南[1] 王子莲[1] 

机构地区：[1]中山大学附属第一医院妇产科,广州510080

出　　处：《中华产科急救电子杂志》2013年第3期43-46,共4页Chinese Journal of Obstetric Emergency（Electronic Edition）

摘　　要：目的研究前置胎盘附着位置对剖宫产后再次妊娠母婴结局的影响。方法回顾性分析2008年6月至2013年6月就诊于中山大学附属第一医院产科剖宫产后再次妊娠合并前置胎盘62例患者临床资料,其中附着于子宫前壁的前置胎盘33例(前壁组),附着于子宫后壁的前置胎盘29例(后壁组),比较两组患者的一般情况、前置胎盘类型、并发症、妊娠结局及新生儿情况。计量资料采用t检验,计数资料采用x2检验。结果前壁组与后壁组患者的产前出血率分别为45.5%和17.2%(x2=4.554,P=0.033),产后出血发生率分别为69.7%和13.8%(x2=17.348,P<0.001),胎盘粘连发生率分别为48.5%和20.7%(x2=4.151,P=0.042),胎盘植入发生率分别为33.3%和10.3%(x2=4.028,P=0.045),子宫切除率分别为27.3%及0.0%(x2=8.434,P=0.004),弥散性血管内凝血(DIC)发生率分别为27.3%和0.0%(x2=8.434,P=0.004),早产发生率分别为63.6%和27.6%(x2=4.464,P=0.035)。结论剖宫产后再次妊娠合并前置胎盘中,胎盘附着于前壁者导致产前出血、产后出血、胎盘粘连、胎盘植入、子宫切除、DIC及早产的风险显著增高,分娩前应明确胎盘附着位置。Objective To explore the effect of the placenta position on re-pregnant women with placenta previa after cesarean section. Methods A retrospective study was conducted in 62 re-pregnant women with placenta previa after cesarean section. The patients were admitted to the First Affiliated Hospital of Sun Yat-sen University from June 2008 to June 2013. They were divided into anterior group （33 cases） and posterior group （29 cases）. The patients with placenta implanted the front wall of the uterus were in the anterior group ; while the others with placenta implanted the back wall of the uterus were in the posterior group. General condition, placenta position, complication, pregnancy outcomes and neonatal outcomes were analyzed using t test or Chi-square test. Results The rate of antepartum hemorrhage, postpartum hemorrhage, placenta adherence, placenta accrete, hysterectomy, disseminated intravascular coagulation, and premature birth of the two groups were 45.5% and 17.2% （ x2 =4. 554, P =0. 033） , 69.7% and 13.8%（x2=17.348, P〈0.001）,48.5% and20.7%（x2=4.151,P=0.042）, 33.3% and 10.3%（ x2 =4.028,P=0.045） , 27.3% and 0.0% （ x2 =8.434,P =0.004） , 27.3% and 0. 0% （ x2 = 8.434 ,P = 0. 004） , 63.6% and 27.6% （ x 2 = 4. 464, P = 0. 035 ） , respectively. But there were no significant differences on neonatal outcomes in the two groups. Conclusions The re-pregnant women, who had history of cesarean section, with placenta previa and placenta implanted the front wall of uterus were at more risk of antepartum hemorrhage, postpartum hemorrhage, placenta adherence, placenta accrete, hysterectomy, disseminated intravascular coagulation, and premature birth. It is necessary to diagnose placenta position before delivery.

关 键 词：前置胎盘 剖宫产术 再 胎盘位置 妊娠结局 

分 类 号：R719.8[医药卫生—妇产科学]