中央性前置胎盘剖宫产术大出血相关因素分析

Correlative factors analysis of complete placental previa with massive postpartum hemorrhage during cesarean section

目的探讨中央性前置胎盘剖宫产术中大出血的相关危险因素及适宜的临床处理方法。方法回顾性分析我院1999年6月至2004年9月收治的中央性前置胎盘162例。分为两组,剖宫产术中及术后出血≥1000 ml的81例作为大出血组,随机抽取同期手术中及术后出血<1000 ml的81例作为对照组,对相关因素进行比较分析。结果大出血组的孕次和产次均明显多于对照组(P<0.01)。大出血组有刮宫史和剖宫产史者所占比例明显高于对照组(P<0.01和0.05)。胎盘附着于前壁的出血量为(1652.7±296.4)ml,明显多于附着于后壁的出血量(778.7±107.1)ml及附着于侧壁的出血量(660.0±235.9)ml(P<0.01)。大出血组胎盘粘连和胎盘植入的发生率均明显高于对照组(P<0.01)。结论剖宫产史、刮宫史(尤其>3次)及前壁胎盘是中央性前置胎盘剖宫产术中及术后大出血的高危因素。

Objective To appraise the risk factors inducing massive postpartum hemorrhage （PPH） in complete placental previa during cesarean section. Methods There were 162 cases of complete placental previa with PPH from June 1999 to September 2004 were divided into two groups with of each 81 cases： study group, of which the blood loss of PPH exceeded 1000 ml, control group, of which the blood loss of PPH was less than 1000 ml. The risk factors were analyzed. Results The number of parity and placental increta or accrete in the study group were more than those in the control group, and so was the number of anterior placenta. The blood loss of cases with anterior placenta was more than that with posterior ones [（1652. 7±296. 4） ml vs （778. 7±107.1） ml, P〈0. 01] or lateral placentas E（1652. 7± 296. 4） ml vs （660. 0± 235. 9） ml, P〈0. 01]. Conclusions History of cesarean section , anterior placenta and parity （especially more than three times） are high-risk factors of massive PPH in complete placental previa. （Shanghai Med J, 2005, 28：734-736）