凶险性前置胎盘对妊娠结局的影响及术前管理对母儿预后的改善作用

The effect of pernicious placenta previa on pregnancy outcome and preoperative management on improving the prognosis of mother and child

目的:回顾性分析凶险性前置胎盘对妊娠结局的影响并探讨术前管理对改善母儿预后的重要性。方法:选取2015年1月至2017年1月在本院治疗的50例凶险性前置胎盘患者,根据是否伴有胎盘植入分为伴胎盘植入组(24例)和无胎盘植入组(26例)研究凶险性前置胎盘对妊娠结局的影响;根据术前是否进行管理分为择期组(34例)和急诊组(16例)探讨术前管理对母儿预后的改善作用。分析患者术中失血及输血状况,并对比母儿术后并发症发生状况。结果:伴胎盘植入组术中平均失血量显著高于无胎盘植入组(P<0.05),择期组患者术中平均失血量显著低于急诊组患者(P<0.05);伴胎盘植入组产后出血、弥散性血管内凝血(DIC)、失血性休克及产褥期感染发生率显著高于无胎盘植入组,急诊组失血性休克发生率高于择期组(P<0.05)。结论:凶险性前置胎盘发生植入风险较大,伴胎盘植入时出现大出血概率较高,且DIC、失血性休克及产褥期感染等发生率较高,应对患者进行择期手术,提前分娩,降低产后出血风险。

Objective:To retrospectively analyze the influence of pernicious placenta previa on pregnancy outcome and the importance of preoperative management to improve the prognosis of mother and child.Methods:Fifty patients with pernicious placenta previa were enrolled in our hospital from January 2015 to January 2017.They were divided into placenta accreta group(24 cases)and non placenta accreta group(26 cases)to explore the effect of pernicious placenta previa on pregnancy outcomes;according to the preoperative management the patients were divided into selective group(34 cases)and emergenr group(16 cases)to explore the effect of preoperative management on the prognosis of mothers and infants.The blood loss and blood transfusion status of the patients were analyzed,and the postoperative complications of the mothers and infants were compared.Results:The mean blood loss of the placenta accreta group was significantly higher than that of non placenta accreta group(P<0.05).The incidence of postpartum hemorrhage,disseminated intravascular coagulation(DIC),hemorrhagic shock,hysterectomy and puerperal infection in the placenta accreta group were significantly higher than that in non placenta accreta group,and the incidence of hemorrhagic shock in emergent group was higher than that in selective group(P<0.05).Conclusion:The risk of placenta accreta in patients with pernicious placenta previa is high,and the incidence of massive bleeding,DIC,hemorrhagic shock,puerperal infection and hysterectomy is either high.Elective operation must be performed for gain low risk of postpartum hemorrhage.