胎盘早剥漏诊分析  

Missed Diagnosis of Placental Abruption

作　　者：胡晓悦 许叶涛 孙丽洲[1] 张婷婷[1] HU Xiaoyue;XU Yetao;SUN Lizhou;ZHANG Tingting(Department of Obstetrics,the Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院产科,南京210029

出　　处：《临床误诊误治》2023年第6期21-24,共4页Clinical Misdiagnosis & Mistherapy

基　　金：国家自然科学基金青年基金项目(82001578);江苏省自然科学基金青年基金项目(BK20201078)。

摘　　要：目的 探讨胎盘早剥的高危因素及漏诊原因、防范措施。方法 回顾性分析2015年1月—2021年12月收治的单胎妊娠胎盘早剥362例的临床资料,按照明确诊断时间将其分为漏诊组(187例)和确诊组(175例),比较2组相关资料,并对胎盘早剥漏诊因素进行分析。结果 本次研究期间,胎盘早剥发生率0.85%(362/42 632),漏诊率51.66%(187/362)。漏诊组和确诊组胎盘早剥分级构成比比较差异有统计学意义(P<0.01)。漏诊组孕妇平均年龄、阴道出血、持续性腹痛和血性羊水、超声异常、胎心监测异常发生率及剖宫产率低于确诊组,平均分娩孕周和临产率大于或高于确诊组(P<0.05,P<0.01)。漏诊组产妇子宫收缩乏力和产后出血发生率低于确诊组,新生儿1和5 min Apgar评分高于确诊组(P<0.01)。结论 临产及不典型子宫收缩、阴道出血为胎盘早剥漏诊的主要原因,持续胎心监测有助于早期诊断胎盘早剥。Objective To explore the high risk factors of placental abruption,the causes of missed diagnosis and preventive measures.Methods The clinical data of 362 patients with placental abruption in single pregnancy admitted from January 2015 to December 2021 were retrospectively analyzed.According to the definite diagnosis time,they were divided into missed diagnosis group(n=187)and confirmed diagnosis group(n=175).The relevant data of the two groups were compared,and the factors of missed diagnosis of placental abruption were analyzed.Results During the study period,the incidence of placental abruption was 0.85%(362/42632)and the rate of missed diagnosis was 51.66%(187/362).There was significant difference in grading composition of placental abruption between missed diagnosis group and confirmed diagnosis group(P<0.01).The mean age of pregnant women,vaginal bleeding,persistent abdominal pain and bloody amniotic fluid,abnormal ultrasound,abnormal fetal heart monitoring and cesarean section rate in the missed diagnosis group were lower than those in the confirmed diagnosis group,and the mean gestational age and labor rate were greater or higher than those in the confirmed diagnosis group(P<0.05,P<0.01).The incidence of uterine fatigue and postpartum hemorrhage in the missed diagnosis group was lower than that in the confirmed diagnosis group,and the Apgar score of newborns at 1 and 5 min was higher than that in the confirmed diagnosis group(P<0.01).Conclusion Labor,atypical uterine contractions and vaginal bleeding are the main causes of missed diagnosis of placental abruption.Continuous fetal heart monitoring is helpful for early diagnosis of placental abruption.

关 键 词：胎盘早剥 漏诊 临产 子宫收缩 阴道出血 胎心监测 超声心动描记术 母婴结局 

分 类 号：R714.46[医药卫生—妇产科学]