胎盘植入保守治疗的临床分析  

Clinical Analysis on Conservative Treatment of Placenta Implantation

作　　者：屠京慧[1] 李莹[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院妇产科,北京市100038

出　　处：《中国全科医学》2014年第18期2139-2141,共3页Chinese General Practice

摘　　要：目的探讨胎盘植入的保守治疗方法。方法回顾性分析2008—2013年本院收治的26例胎盘植入行保守治疗患者的临床资料,总结保守治疗方法、产后出血量、保守治疗效果及母婴结局。结果 26例患者中,19例行剖宫产术,其中11例切除植入胎盘,8例保留植入胎盘;7例行阴道分娩,均保留植入胎盘。19例剖宫产患者中,7例合并前置胎盘患者产后出血量大于12例胎盘位置正常患者〔(1 514.3±177.3)ml与(904.2±326.4)ml,t=4.534,P<0.05〕。7例阴道分娩患者均在阴道分娩时发现胎盘植入,产后出血量平均为1 142.9 ml;出血量超过1 000ml者6例,其中4例由基层医院转入。妊娠结局:26例胎盘植入行保守治疗患者中,无孕产妇死亡及新生儿死亡,1例手术保守治疗失败者行全子宫切除,1例合并感染患者抗感染治疗后好转。胎盘组织排出时间:12例患者产后3个月内排出,3例患者产后3个月后排出。结论胎盘植入合并前置胎盘患者产后出血量明显增多。根据胎盘植入面积大小、深浅及出血情况,制定不同类型的胎盘植入个体化保守治疗方案,加上充分的术前准备、及时正确的产时处理、严格的产后随诊等措施,可改善妊娠结局。Objective To investigate the conservative treatment method for placenta implantation. Methods The data of 26 placenta implantation patients who received conservative treatment in our hospital from 2008 to 2013 was analyzed retrospectively,the conservative treatment methods,postpartum blood loss,conservative treatment effect and outcomes of maternal and child were summarized. Results Among 26 patients,19 underwent cesarean section,the implanted placenta of 11/19 cases was removed,and the placenta implants of 8/11 cases was retained;7 underwent vaginal delivery,the implanted placenta of whom was retained. Among 19 cases who received cesarean section,the postpartum haemorrhage amount of 7 cases with placenta previa was significantly more than that of 12 patients with normal position placenta〔（1 514. 3 ± 177. 3） ml vs. （904. 2 ± 326. 4） ml, t=4. 534,P〈0. 05〕. Placenta implantation was found among 7 vaginal delivery cases during vaginal delivery,postpartum average blood loss was 1 142. 9 ml;Haemorrhage amount of 6 cases was more than 1 000 ml,including 4 cases from basiclevel hospitals. Pregnancy outcomes：among 26 patients with placenta implantation who received conservative treatment,no maternal and neonatal death occurred,the conservative treatment failed among 1 case,and the case received whole hysterectomy,1 infected case improved after anti-infective treatment;Placenta discharge time：12 patients discharged placentas organization within three months postpartum,3 patients discharged placentas organization after three months postpartum. Conclusion The postpartum haemorrhage amount of patients with placenta implantation and placenta previa is on the increase. Individualized conservative treatment plans for different types of placenta implantation according to the area size,depth and bleeding of placenta implantation,with the addition of sufficient preoperative preparation,correct intrapartum treatment in a timely manner and strict postpar-tum follow-up,the pregnancy outcome can be improved.

关 键 词：胎盘 侵入性 前置胎盘 保守治疗 妊娠结局 

分 类 号：R714.462[医药卫生—妇产科学]