中央性前置胎盘合并剖宫产史对孕产妇和围产儿分娩结局的影响

Influence of central placenta previa combined with cesarean section history on pregnant women and perinatal infants

【目的】探讨中央性前置胎盘合并有剖宫产史对孕产妇和围产儿分娩结局的影响。【方法】回顾医院2014年2月至2019年1月入院分娩孕妇的临床资料,将符合入选标准的中央性前置胎盘合并剖宫产史(再次剖宫产组,A组)45例,与同期中央性前置胎盘行初次剖宫产(初次剖宫产组,B组)45例,进行回顾性比较分析。【结果】两组均行剖宫产术终止妊娠。A组患者胎盘植入(20.0%)、胎盘黏连(44.4%)、产后出血(37.8%)、先兆子宫破裂(17.8%)的发生率均高于B组,围产儿早产(60.0%)、胎儿宫内窘迫(20.0%)、新生儿窒息(28.9%)、死亡(8.9%)的发生率均高于B组,A组患者手术时间(61.3±14.5)min、术中出血量(1217.6±245.2)ml、术后2 h出血量(596.5±123.7)ml、术后24 h出血量(1622.7±159.5)ml均多于B组,差异均有统计学意义(P<0.05)。【结论】中央性前置胎盘合并剖宫产史患者再次剖宫产对孕产妇和围产儿的危险性和并发症明显高于初次剖宫产者,应对其加强管理,严密观察,以减少不良结局的发生。

【Objective】To explore the influence of central placenta previa combined with cesarean section history on pregnant women and perinatal infants,and improve the understanding of re-cesarean section for pregnant women with central placenta previa combined with cesarean section history.【Methods】The clinical data of pregnant women admitted to our hospital from February 2014 to January 2019 were reviewed,and 45 cases with central placenta previa and cesarean section history(group A)that met the inclusion criteria were retrospectively compared with 45 cases with central placenta previa undergoing primary cesarean section(group B)during the same period.【Results】The pregnancy was terminated by cesarean section in both groups.The incidences of implanted placenta,placenta adhesion,postpartum hemorrhage and aura of uterine rupture in the group A were higher than those in the group B,and the incidences of perinatal preterm labor,fetal distress,neonatal asphyxia and death were higher than those in the group B.Besides,the operative time,intraoperative blood loss,2-hour postoperative blood loss and 24-hour postoperative blood loss were all higher than those in group B.The difference was statistically significant(P<0.05).【Conclusion】The risk and complications in patients with central placenta previa combined with caesarean section history undergoing re-cesarean section are significantly higher than those undergoing first-time cesarean section.Therefore,once it is found in clinical practice,management should be strengthened and it should be closely observed to reduce the occurrence of adverse outcomes.