中期妊娠阴道流血60例临床分析

Clinical Analysis of 60 Cases of Second-trimester Vaginal Bleeding

【目的】探讨中期妊娠阴道流血的病因、诊断、处理及妊娠结局。【方法】回顾性的分析了2003年1月至2008年4月本院收治的60例中期妊娠阴道流血病例的临床资料,并与同期分娩的孕期无阴道出血的80例病例进行对照,比较两组的妊娠结局。【结果】60例中期妊娠阴道流血病例中胎盘前置状态有42例(占70%),其次是胎盘早剥有6例(占10%),另有黏膜下子宫肌瘤4例,宫颈炎症8例,不明原因3例;其平均人工流产次数为(2.52±0.80)次,经产妇占63.33%;其终止妊娠时平均孕周为(35.30±0.84)周,早产率为58.33%,剖宫产率66.67%,平均新生儿出生体重(2.24±0.85)kg,围生儿病死率13.33%,两组相比有明显的差异(P<0.01)。新生儿5'Apgar评分为(8.75±0.82)分,新生儿重度窒息率为9.09%,两组相比差异无显著性(P>0.05)。【结论】既往孕产次的增加是中期妊娠阴道流血发生率升高的主要原因。中期妊娠阴道流血的患者不良的妊娠结局显著增加。

[Objective]To explore the cause,diagnosis,treatment and pregnancy outcome in patients with second-trimester vaginal bleeding.[Methods] A retrospective study was performed in Minhang district center hospital of Shanghai between January 2003 and April 2008 including 60 cases of second-trimester vaginal bleeding.Eighty cases of deliveries without vaginal bleeding during the same period served as control.Perinatal outcome between two groups were compared.[Results] Among 60 patients,there were 42 cases of placenta previa（70%）,6 cases of placenta abruption（10%）,4 cases of submucous myoma（6.67%）,8 cases of cervicitis（8.33%） and 3 cases of unknown origin（5.00%）.Average induced abortion times were（2.52±0.80） times,and multiparity was common in patient with bleeding than that in control group（63.33% vs 33.75%）.Average gestational age at delivery was（35.30±0.84） weeks,and preterm delivery rate was 58.33%,cesarean section rate was 66.67%,average perinatal birth weigh was（2.24±0.85）kg,and perinatal mortality was 13.33%.There was significant difference between two groups（P〈0.01）.Perinatal 5＇ Apgar score was（8.75±0.82） scores and severe neonatal asphyxia was 9.09% in patients,and there was no significant difference between two groups（P〉0.05）.[Conclusion]The important cause of second-trimester vaginal bleeding is associated with the increase of previous abortion and multiparity.Worse pregnancy outcome is significantly increased in patients with second-trimester vaginal bleeding.