妊娠34周后凶险性前置胎盘终止妊娠时机对手术安全性及母儿结局的影响  

The effect of the timing of terminating pregnancy with pernicious placenta previa after 34 weeks on the safety of surgery and the outcome with mother and child

作　　者：夏小龙 齐卫红[1] Xia Xiaolong;Qi Weihong(Department of Obstetrics,Laoshan Campus of the Affiliated Hospital of Qingdao University,Shandong Qingdao 266000,China)

机构地区：[1]青岛大学附属医院崂山院区产科,266000

出　　处：《中国医师进修杂志》2021年第6期543-546,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨妊娠34周后凶险性前置胎盘终止妊娠时机对手术安全性及母儿结局的影响。方法选择2018年3月至2019年3月在青岛大学附属医院崂山院区住院的凶险性前置胎盘患者84例,入院分娩妊娠时间均超过34周,妊娠34~36周的40例产妇作为研究组,超过36周的44例产妇作为对照组,比较两组产妇及胎儿的妊娠结局。结果研究组产后出血量以及介入手术率低于对照组[(754.58±20.35)ml比(1449.26±512.32)ml、17.5%(7/40)比52.27%(23/44)](P<0.05)。两组分娩后红细胞压积与分娩前的变化量、分娩后血红蛋白与分娩前的变化量、宫纱填塞率、卡前列素氨丁三醇注射液使用率、子宫切除率、输血率、术后ICU转入率比较差异无统计学意义(P>0.05)。研究组新生儿出生体质量低于2500 g率以及转入新生儿科率高于对照组[75.0%(30/40)比11.36%(5/44)、80.0%(32/40)比11.36%(5/44)](P<0.05)。两组新生儿出生后Apgar评分以及新生儿死亡率比较差异无统计学意义(P>0.05)。结论在妊娠36周之前对凶险性前置胎盘产妇进行终止妊娠对于产妇以及胎儿的健康更有保障,如胎儿发育速度较慢,则需要适当根据产妇以及胎儿的实际情况适当将分娩时间延长,但是切不可超过36周。Objective To explore the effect of different pregnancy termination timings on the delivery safety of maternal women with pernicious placenta previa after 34 weeks.Methods A total of 84 patients with pernicious placenta previa in Laoshan Campus of the Affiliated Hospital of Qingdao University from March 2018 to March 2019 were selected.The time of admission for delivery was more than 34 weeks.Forty women who pregnant from 34 weeks to 36 weeks of pregnancy was in the study group,44 women who pregnant over 36 weeks was in the control group,and the pregnancy outcomes of the maternal fetuses of the two groups were compared.Results The postpartum hemorrhage and the incidence of interventional surgery in the study group were less than those in the control group:(754.58±20.35)ml vs.(1449.26±512.32)ml,17.5%(7/40)vs.52.27%(23/44),the differences were statistically significant(P<0.05).The changes in hematocrit after delivery and before delivery,the amount of hemoglobin after delivery and before delivery,the rate of uterine gauze packing,the rate of Xinmupei,the rate of hysterectomy,the incidence of blood transfusion,the rate of postoperative ICU transfer between two groups hand no significant differences(P>0.05).The incidence of neonatal birth weight less than 2500 g and the proportion of transfer to neonatology in the study group were higher than those in the control group:75.0%(30/40)vs.11.36%(5/44),80.0%(32/40)vs.11.36%(5/44),the differences were statistically significant(P<0.05).There was no significant differences in Apgar scores and mortality rate of newborns after birth between the two groups(P>0.05).Conclusions When the pernicious placenta previa is delivered after 34 weeks,the termination of pregnancy before 36 weeks of gestation is more secure for maternal and fetal health.If the fetal development rate is slow,it is necessary to appropriately extend the delivery time,but don′t exceed 36 weeks.

关 键 词：前置胎盘 妊娠结局 终止妊娠 时机 

分 类 号：R713[医药卫生—妇产科学]