40例植入性胎盘的回顾性分析

Retrospective Analysis of 40 Cases of Placenta Increta

为探讨引起胎盘植入的相关因素及治疗方法 ,回顾性分析北京妇产医院 1994年 1月至 2 0 0 3年 12月收治的 4 0例妊娠晚期胎盘植入病例 ,探讨其发病因素及诊疗情况。结果 :胎盘植入的发病率为 0 .0 99% (1∶10 11) ,相关因素为前置胎盘、剖宫产、多次人流。 4 0例中≥ 2次人流史 30例 (75 % ) ,剖宫产 11例 (2 7.5 % ) ,前置胎盘 2 2例 (5 5 % ) ,胎盘完全植入和植入直径 >5cm的出血率 (>5 0 0mL)达 6 2 .5 %。前置胎盘中 86 %发生大出血 ,胎盘植入原子宫切口者 5例 ,出血量均>2 0 0 0mL。结果提示 :胎盘植入与前置胎盘、剖宫产史、多次人流史有关 ,胎盘植入可造成产后大出血 ,尤其以植入位于子宫切口处最为凶险。治疗方法除切除子宫外保守治疗亦相当重要。

The aim was to study the factors related with placenta increta and treatment by retrospectively. The etiology of the placenta incr eta and t he treatments were studied by retrospectively analyzing 40 cases. The incidence of placenta increta in our hospital approxi mated to 1∶1 011 and the related risk factors include placenta previa, previou s cesarean delivery, and multiple induced abortion. There were about 75% cases w ith above 2 times of induced abortion, 27.5% cases with cesarean and 55% cases with placenta previa. The incidence of h emorrhage (>500 mL) was up to 62.5% when the patients had the completely placent a pr evia and the diameter of the implanted placenta >5 cm. There were about 86% case s of placen ta previa with serious hemorrhage and the amount of bleeding of above 2 000 mL in the 5 cases in which the placenta was implanted the previous cesarean sectio n scar.The incidence of placenta increta was increased with placenta previa, previous cesarean delivery, and multiple induced abortions. Placenta increta ind uces serious puerperal hemorrhage, especially, the placenta implanted in the pre v ious cesarean section scar. The conservative therapies are very important as we ll as hysterectomy.