前置胎盘类型及产前出血与妊娠结局的分析

The types of placenta praevia,and the analysis of antepartum bleeding and pregnancy outcome

目的分析前置胎盘类型、阴道出血状况与妊娠结局的关系,探讨前置胎盘的处理以改善母婴预后。方法对本院2003年1月1日~2009年6月31日收治并分娩的112例前置胎盘伴产前出血患者的临床资料进行回顾性分析。结果近年来前置胎盘的发生率在上升;前置胎盘类型与产前出血、产后出血密切相关,中央性前置胎盘发生产前出血量最多（P〈0.01）,出血时间最早（P〈0.01）,产后出血概率越大（P〈0.01）,临床结局最严峻;边缘性前置胎盘则反之,而部分性前置胎盘则处于两者之间。结论 前置胎盘出血时间越早,出血量越多则威胁母儿生命越严重。前置胎盘患者的临床结局有很大差异,其类型及产前出血状况可预测临床结局。产前及时诊断是改善前置胎盘预后的关键因素,治疗的关键是控制出血。

Objective To analyze the relation of the pregnancy outcome between the types of placenta praevia and the vaginal bleeding,and to approach the treatment of the placenta praevia and to improve the proguosis of the mother and the infant.Methods We retrospectively analyzed the clinic data of 112 placenta praevia accompany with vaginal bleeding lying-in women from Jan.1,2003 to Jun.31,2009.Results The incidence rate of placenta praevia upgrade recently,there was close correlation between the type of placenta praevia,APH and PPH.The blood volume of APH of Placenta previa centralis is the largest（P〈0.01）,the average time of bleeding is the earliest（P〈0.01） and also the blood volume of PPH is the largest（P〈0.01）,and the clinic result is more severe.The result of marginal placenta previa is converse.Partial placenta praevia is between both.Conclusions The result of mother and infant is more severe with earlier bleeding-time and larger blood volume of placenta praevia.There are different clinic results between different patients with placenta praevia.The type and the state of bleeding could be used to anticipate the clinic result.The key factor to improve result of placenta praevia is to prompt antepartum diagnosis.The key treatment is to control bleeding.Augmentation of planning family propaganda and elevation of technical level of doctor are the utility measure to prevent and therapy placenta praevia.