胎盘早剥153例临床分析  

Clinical analysis of 153 cases of placental abruption

作　　者：王莉[1] 丁翔[1] 

机构地区：[1]北京市海淀区妇幼保健院,北京100080

出　　处：《中国妇幼健康研究》2016年第6期742-744,共3页Chinese Journal of Woman and Child Health Research

摘　　要：目的探讨胎盘早剥发生的危险因素、临床特征、产前诊断、处理及母儿结局。方法对2011年1月至2014年12月北京市海淀区妇幼保健院发生胎盘早剥的153例患者的临床资料进行回顾性分析。结果胎盘早剥发生率为0.38%,其中Ⅰ度88例(57.5%),Ⅱ度35例(22.9%),Ⅲ度30例(19.6%);3组胎盘早剥产妇临床症状比较,腹痛、阴道流血及子宫张力高等症状,Ⅲ度的发生率明显高于Ⅰ度与Ⅱ度(χ2腹痛=28.241、χ2阴道流血=11.278、χ2子宫张力高=35.254,均P<0.01);产前诊断率为64.1%,B超检出率为62.4%,其中Ⅱ度和Ⅲ度胎盘早剥产前诊断率明显高于Ⅰ度(χ2=14.098,P=0.001);发生产后出血(χ2=6.690,P<0.05)、子宫胎盘卒中(χ2=44.558,P<0.01)、DIC(P<0.01)、死胎(χ2=36.269,P<0.01)、新生儿窒息(χ2=11.560,P<0.01)及围产儿死亡发生率(P<0.01),胎盘早剥Ⅲ度明显高于Ⅰ度和Ⅱ度。结论重视胎盘早剥的高危因素,根据病史、临床症状,结合B超等辅助检查,综合分析,提高胎盘早剥的早期诊断,防止并发症,改善母儿预后。Objective To explore the risk factors,clinical characteristics,prenatal diagnosis,treatment and outcomes of pregnancy of placental abruption. Methods The clinical data of 153 parturient women with placental abruption in Haidian District Maternity and Child Health of Beijing City from January 2011 to December 2014 were retrospectively analyzed. Results The incidence of placental abruption was 0. 38%,including 57. 5% of degree I（ 88 cases）,22. 9% of degree II（ 35 cases） and 19. 6% of degree Ⅲ（ 30 cases）. Compared to cases of degree Ⅰ and Ⅱ,those of degree Ⅲ had higher incidence of abdominal pain,vaginal bleeding and high uterine tension,and the differences were significant（ χ2value was 28. 241,11. 278 and 35. 254,respectively,all P〈0. 01）. The accuracy of prenatal diagnosis was 64. 1%,and the detection rate of ultrasonographic diagnosis was 62. 4%. The prenatal diagnosis of placental abruption of degree Ⅱand Ⅲwas significantly higher than degree I（ χ2= 14. 098,P = 0. 001）. The incidence of postpartum hemorrhage,uteroplacental apoplexy,DIC,fetal death,neonatal asphyxia and perinatal mortality was higher in placental abruption of degree Ⅲ than degree Ⅰ and Ⅱ（ χ2value was 6. 690,44. 558,36. 269,11. 560,respectively,all P〈0. 01）. Conclusion To improve the early diagnosis of placental abruption,to prevent complication and to improve the prognosis of mother and neonate,attention should be paid to risk factors,history,clinical manifestations and ultrasonography examination for complex analysis.

关 键 词：胎盘早剥 危险因素 诊断时间 围产结局 

分 类 号：R714.4[医药卫生—妇产科学]