胎盘植入156例临床分析  

The clinical analysis of 156 cases of placenta increta

作　　者：赵玉荣[1] 何续芳[1] 

机构地区：[1]首都医科大学附属复兴医院产科,北京100038

出　　处：《中国医刊》2017年第6期46-51,共6页Chinese Journal of Medicine

基　　金：首都医科大学基础-临床科研合作项目(17JL56)

摘　　要：目的总结分析胎盘植入的高危因素,以减少胎盘植入导致的不良妊娠结局。方法回顾2014年1月至2016年12月于本院分娩的胎盘植入孕产妇的病例资料,分析患者年龄、产次、孕龄、分娩方式、胎盘植入类型、高危因素、产后治疗方法、出血及输血情况、术后并发症及母婴结局。结果 3年内有病历记载的胎盘植入病例156例,其中孕周<28周5例,≥28周151例;产前诊断胎盘植入14例,产时诊断胎盘植入136例,晚期诊断(分娩24小时后)胎盘植入6例;有流产清宫史的患者发生胎盘植入147例,合并前置胎盘11例,有孕激素保胎史、辅助生殖受孕和宫腔粘连手术史的患者分别发生胎盘植入37例、21例和21例;发生严重产后出血69例,重度继发性贫血54例,失血性休克29例。结论人工流产史和前置胎盘是胎盘粘连的主要高危因素,但近年来宫腔手术史却为引起胎盘植入的重要因素,如宫腔粘连分离术、子宫纵隔切除术、剖宫产术和宫腔镜子宫肌瘤切除术等。Objective To discuss the risk factors, etiology, diagnosis, treatment of placenta increta. To improve the quality of obstetrics. Method Retrospective analysis was made on the date of 156 cases of maternal age, parity, gestational age, mode of delivery, type of placenta implantation, risk factors, postpartum treatment, and bleeding after placental implantation, postoperative complications and maternal outcomes in our hospital in 3 years. Result There were 156 cases of placenta accreta in 3 years. Of which 〈28 weeks in 5 cases, 〉/28 weeks in 151 cases. There were 14 cases of prenatal diagnosis of placenta, 136 cases were implanted in the placenta, and 6 cases were implanted in the placenta after a late diagnosis （24 hours after birth）. There were 147 cases of abortion in patients with a history of miscarriage, combination of placenta previa in 11 cases, has a history of progesterone spuc conception, assisted reproduction and caused by intrauterine adhesions surgery patients with a history of 37 cases of placenta increta, 21 cases respectively and 21 cases. There were 69 cases of severe postpartum hemorrhage, 54 cases of severe secondary anemia, and 29 cases of hemorrhagic shock. Conclusion History of abortion and placenta previa is the main risk factors for placental adhesions, but in recent years, intrauterine surgery has become an important cause of placenta accreta, such as uterine adhesions, uterine septal resection, cesarean section, endoscopic uterine myoma resection.

关 键 词：妊娠结局 胎盘植入 诊断 

分 类 号：R714.462[医药卫生—妇产科学]