160例胎盘早剥的临床分析  

Clinical analysis of 160 cases of placental abruption

作　　者：季建生 徐冬[2] 傅向红[1] 余旭良[1] 

机构地区：[1]浙江省衢州市人民医院产科,浙江衢州324000 [2]浙江大学医学院附属妇产科医院产科,浙江杭州310006

出　　处：《中国现代医生》2016年第27期58-61,共4页China Modern Doctor

基　　金：浙江省医药卫生科技计划项目(2015KYB204)

摘　　要：目的 探讨胎盘早剥的病因、特点、母婴结局的关系及产前漏诊情况。方法 回顾性分析我院2008年5月-2016年3月收治的160例胎盘早剥患者的临床资料。将研究对象分成观察组（产前漏诊）与对照组（产前确诊）,观察胎盘早剥的诱因,临床表现及母婴结局。结果 对照组患者胎盘早剥的主要诱因为妊娠高血压疾病（49.0%）,其次为外伤等机械性因素（14.6%）,观察组胎盘早剥的主要诱因为胎膜早破（26.6%）和使用药物引产（28.1%）;观察组患者在腹痛、阴道流血、子宫张力及子宫压痛,胎动胎心变化方面均低于对照组（P〈0.05）,而在急产比例方面高于对照组（P〈0.05）;观察组胎盘早剥的严重程度小于对照组（χ2=33.34,P〈0.05）;观察组剖宫产、子宫胎盘卒中、新生儿窒息、产后出血、DIC、围生期死亡率均低于对照组,差异有统计学意义（P〈0.05）。结论 胎盘早剥是孕期严重产科并发症,因部分胎盘早剥的病因及临床表现不明显,产前容易漏诊,故应对胎盘早剥保持高度警惕,动态追踪,全面分析,以减少产前漏诊。Objective To study the etiology and characteristics of placental abruption, as well as its relationship with maternal and infant outcome and antenatal missed diagnosis. Methods Clinical data of 160 patients with placental abruption who were admitted to our hospital from May 2008 to March 2016 were retrospectively analyzed. The research subjects were assigned to the observation group （prenatal missed diagnosis） and the control group （prenatal confirmed diagnosis）, and the cause of placental abruption, clinical manifestation and prognosis of mother and child were observed. Results The major causes of plaeental abruption in the control group were pregnancy-induced hypertension （49.0%）, followed by mechanical factors such as trauma（14.6%）. The main causes of observation group were premature rupture of membranes（26.6%） and drug indueed labor（28.1%）; abdominal pain, vaginal bleeding, uterine tension, uterine tenderness and changes of quickening and infant heart in the observation group were lower than those in the control group（P〈0.05）, while the proportion of acute labor was higher than that in the control group（P〈0.05）; the severity of placental ahruption in the observation group was less than that that in the control group（x2=33.34, P〈0.05）; the ineidenee rate of Cesarean section, uterine plaeental stroke, neonatal asphyxia, postpartum hemorrhage, DIC and perinatal mortality in the observation group were all lower than those in the control group, and the differences were statistically significant（P〈0.05）. Conclusion Plaeental abruption is a serious obstetric eomplication during pregnancy, because the etiology and clinieal manifestations of some plaeental abruptions are not obvious, whieh is easy to get missed diagnosis before delivery. A high degree of vigilance should be maintained for placental abruption, and dynamic tracking and comprehensive analysis are necessary, so as to reduce prenatal missed diagnosis.

关 键 词：胎盘早剥 产前漏诊 病因 母婴结局 

分 类 号：R714.2[医药卫生—妇产科学]