胎盘早剥漏诊31例临床分析

Clinical analysis of 31 cases of misdiagnosed placenta abruption

目的探讨胎盘早剥漏诊的相关因素,提高对不典型病例的认识,减少胎盘早剥的漏诊或误诊。方法回顾性分析1999年1月至2008年9月在上海浦东新区人民医院住院分娩的67例胎盘早剥患者的临床资料,将产前漏诊的31例作为漏诊组,产前确诊的36例作为对照组,比较漏诊的危险因素、临床特征和母儿结局。结果胎盘早剥发生率0.27%(67/24848),其中漏诊率46.27%(31/67),围生儿死亡率22.39%(15/67)。漏诊组发生阴道出血、子宫张力增高、重度胎盘早剥发生率低于对照组(P分别<0.001,0.01和0.05)。漏诊组胎儿窘迫发生率高于对照组(P<0.05)。两组腹痛、血性羊水、子宫卒中发生率比较,差异无统计学意义(P>0.05)。漏诊组B超检出率10%,明显低于对照组的76.92%(P<0.01)。两组患者的休克、凝血功能障碍、子宫切除、新生儿重度窒息比较,差异无统计学意义(P>0.05)。漏诊组早产、围生儿死亡、死胎低于对照组(P<0.05)。结论早期识别胎盘早剥的不典型征象,注意动态观察,可降低母婴危险。

Objective To explore the related factors of misdiagnosis of placenta abruption （PA）,thus to decrease the rate of missed diagnosis and misdiagnosis.Methods Clinical data of 67 patients with PA who were treated in Pudong People＇s Hospital from Jan. 1999 to Sep. 2008 were analyzed retrospectively. 31 cases of misdiagnosed composed misdiagnosed group,the other 36 cases were in control group.Results ① The incidence of placenta abruption was 0.27%（67/24 848）,among them the misdiagnosed rate was 46.27% and the perinatal mortality rate was 22.39%.② Incidence of vaginal hemorrhage,hypertonic uterus and severe PA in misdiagnosed group were statistically lower than control group （ P0.001,P0.01,P0.05,respectively）,but the rate of fetal distress in misdiagnosed group was higher than that in control group （ P0.05）. Moreover,rate of pain in the lower abdomen,bloody amniotic fluid,uterine apoplexy in the two groups had no significant difference （P0.05）. ③ 10% cases were detected by ultrasound in misdiagnosed group while 76.92% were detected in control group （ P0.01）. ④ The complications and prognosis of hemorrhagic shock,blood coagulation dysfunction and hysterectomy had no significant difference between the two groups （P0.05）. The mortality rate of premature infant,perinatal infant and fetal death in misdiagnosed group were lower than that in control group （ P0.01,P0.05）. However,the incidence of severe asphyxiated newborn infants had no significant difference （P0.05）.Conclusion Early identification of atypical placenta abruption is the effective way to decrease the perinatal mortality rate.