不同胎盘位置的胎盘早剥对母婴预后的影响  

Effect of placental abruption on maternal and neonatal outcomes in different piacental location

作　　者：赫东芸[1] 邹云 唐庄艳 孙磊 盛敏佳[1] HE Dong-yun;ZOU Yun;TANG Zhuang-yan(Department of Gynecology and Obstetric ,China-Japan Union Hospital of Jilin University,Changchun 130033,China;Department of Gynecology and Obstetric,Liuzhou Municipal Liutie Central Hospital ,Liuzhou 545007,China)

机构地区：[1]吉林大学中日联谊医院妇产科,吉林长春130033 [2]柳州市柳铁中心医院妇产科,广西柳州545007

出　　处：《中国实验诊断学》2019年第1期34-37,共4页Chinese Journal of Laboratory Diagnosis

摘　　要：目的探讨不同胎盘位置引起的胎盘早剥对母婴预后的影响。方法回顾性分析我院2010年6月至2017年6月收治的56例胎盘早剥患者,根据胎盘附着部位的不同分为,A组(胎盘附着于前壁者20例,胎盘附着于宫底者6例)B组(胎盘附着于后壁者28例,胎盘附着于侧壁者2例)。两组患者均通过剖宫产终止妊娠、术前或术中明确胎盘早剥诊断。对比两组患者的一般情况、临床表现、超声学表现、术中情况、并发症、婴儿预后等情况。结果其中A组患者的阴道出血发生率、板状腹发生率、超声学异常发生率、胎心监护异常发生率均显著高于B组,差异均有统计学意义(P<0.05);A组患者的漏诊及误诊率为15.4%,显著低于B组的56.6%,差异有统计学意义(P<0.05);两组患者在剥离面积、弥漫性血管内凝血(DIC)、子宫胎盘卒中发生率、子宫切除发生率均无统计学意义(P>0.05);B组的产后出血量为(914±324)ml,多于A组的(512±281)ml,差异具有统计学意义(P<0.05);A组患者的输血率为11.5%,明显低于B组的46.7%,差异具有统计学意义(P<0.05);A组胎儿窘迫及新生儿窒息率分别为11.5%和15.4%,明显低于B组的53.3%和40%,差异有统计学意义(P<0.05);两组患者在腹痛发生率、血性羊水、新生儿体重、死胎发生率比较差异无统计学意义(P>0.05)。结论胎盘早剥是妊娠晚期的严重并发症,因后壁胎盘剥离时临床症状不典型,不易诊断,往往对母婴的预后造成严重的危害。因此临床上应做到早预防、早诊断,降低母婴并发症,改善母婴预后。Objective To analyze the effect of placental abruption on maternal and neonatal outcomes in different piacental location.Methods From June 2010 to June 2017,56 patients with placental abruption in our hospital were treated and divided into Group A(20cases of placenta attachment to the anterior wall and 6cases of placenta attachment to the uterine floor)group B(28cases of placenta attachment to the posterior wall and 2cases of placenta attachment to the lateral wall),according to placenta location.Pregnancy was terminated by cesarean section and the diagnosis of placenta abruption was confirmed before or during operation in both groups.Data were compared between the two groups,including general conditions,Clinical manifestations,ultrasound manifestations,intraoperative conditions,complications and neonatal prognosis.Results The incidence rate of vaginal bleeding,tabulate venter,ultrasonography abnormality,fetal heart monitoring abnormality,and the diagnostic rate before delivery were all significantly higher in the A group than in the b group(P<0.05);The rate of missed diagnosis and misdiagnosis of patients in group A was 15.4%,significantly lower than 56.6%in group B,and the difference was statistically significant(P<0.05);The two groups had no statistical significance in the size of placental abruption area,the disseminated intravascular coagulation(DIC),the incidence of uteroplacental apoplexy and the incidence of hysterectomy(P>0.05);Postpartum hemorrhage in group B was 914.2±324ml,more than that in group A 511.7±281ml,and the difference was ststistically significant(P<0.05);The transfusion rate of patients in group A was 11.5%,significantly lower than 46.7%in group B,and the difference was statistically significant(P<0.05).The rate of fetal distress and neonatal asphyxia in group A was11.5%and 15.4%,respectively,significantly lower than 53.3%and 40%in group B(P<0.05);There was no significant difference in the incidence of abdominal pain,hemorrhagic amniotic fluid,neonatal weight and stillbirth between the t

关 键 词：胎盘早剥 前壁胎盘 后壁胎盘 母婴预后 

分 类 号：R714.43[医药卫生—妇产科学]