78例中央性前置胎盘的临床分析  

Analysis of central placenta previa: a report of 78 cases

作　　者：高泳涛[1] 苏绮枫[1] 骆月娥[1] 蒋鉴芬[1] 蔡兰娣[1] 

机构地区：[1]中国福利会国际和平妇幼保健院,上海200030

出　　处：《上海医学》2004年第3期159-162,共4页Shanghai Medical Journal

摘　　要：目的　探讨中央性前置胎盘的临床处理方法。方法　回顾性分析我院 1999年 1月～ 2 0 0 3年 2月收治的 78例中央性前置胎盘的病例资料。结果　中央性前置胎盘的发生率为 0 .344 %。剖宫产术中的出血量与孕周呈正相关 (r =0 .35 ,P =0 .0 15 ) ,与胎盘主体的位置有关 ,后壁胎盘的出血量少于前壁胎盘 (P =0 .0 1)。胎盘主体在前壁者 ,术中推开胎盘边缘破膜娩出胎儿法的出血量少于切开胎盘法 (P =0 .0 2 7)。胎盘自然剥离的出血最少 ,人工剥离的出血最多 (P =0 .0 3)。结论　对于中央性前置胎盘者选择性剖宫产的时间宜在孕 35～37周。主体胎盘在前壁者 ,术中切开子宫时应尽量避免切开胎盘 ,应于推开胎盘后快速破膜娩出胎儿。胎儿娩出后若无活动性出血应尽量等待胎盘自然剥离 ,以减少手术出血量。Objective To analyze and appraise the clinical management of the central placenta previa. Methods Data of 78 cases of central placenta previa were analyzed retrospectively in our hospital from January 1999 to February 2003. Results The incidence of central placenta previa was 0.344%. The blood loss during the operation was positively correlated with the duration of gestation (r=0.35, P=0.015). It was also related with the location of the main part of the placenta, the posteriorly located placenta had less blood loss than that of the anteriorly located one (P=0.01). For anteriorly located placenta, the approach of separating the margin of the placenta with rupture the membran to deliver the infant had less blood loss than the method of incising the placenta (P=0.027). Natural separation of placenta possessed the least blood loss, while artificial separation showed the most (P=0.03). Conclusion The proper time for selective cesarean delivery is at probably 35～37 weeks gestation. Preferring with placenta reparation without incision; outcoming with rapid rupture of the membrane and infant delivery; and finally waiting for spontaneous placenta reparation under no active bleeding to save blood loss.

关 键 词：中央性前置胎盘 临床分析 剖宫产 术中出血量 

分 类 号：R714.2[医药卫生—妇产科学]