前置胎盘合并胎盘植入的临床分析

Clinical analysis of placenta previa complicated with placenta accreta

目的探讨前置胎盘合并胎盘植入的高危因素、临床特点、诊断及治疗。方法对日照市中医医院4年间8964例产妇中12例前置胎盘合并胎盘植入的患者资料进行分析。结果在8964例产妇中前置胎盘发生率为0．97％（87／8964）；87例前置胎盘患者均为多孕次产妇，经产妇占58．62％（51／87），高龄产妇占65．52％（57／87）。前置胎盘合并胎盘植入的发生率为0．13％（12／8964），占前置胎盘的13．79％（12／87），有前次剖宫产史者占83．33％（10／／12），凶险型前置胎盘并胎盘植入至原子宫切口瘢痕处3例，占25．00％（3／12）。植入组前次剖宫产史率明显高于对照组（X^2=17．789，P〈0．01）。结论随着剖宫产率的提高，前置胎盘合并胎盘植入发生率也在不断升高，前置胎盘合并胎盘植入的发生与瘢痕子宫密切相关，因此要重视对其进行早期诊断及合理治疗。改善母婴结局。

Objective To investigate the risk factors, clinical features, diagnosis and treatment of placenta previa complicated with placenta accrete. Methods 12 eases of placenta previa complicated with placenta accreta diagnosed in Rizhao Hospital of Traditional Chinese Medicine in recent 4 years were analyzed. Results Among 8 964 deliveries,the incidence of placenta previa was 0.97% （87/8 964）. All of 87 cases of placenta previa were multiple pregnancy women. Multipara occupied 58.62% （51/87） and elder gravida occupied 65.52% （57/87）. The incidence of placenta previa complicated with placenta accreta was 0.13% （ 12/8 964）, occupying 13.79% （12/87） of the placenta previa. Patients with previous cesarean section history accounted for 83.33% （10/12）. There were 3 cases of dangerous placenta previa complicated with placenta accreta at original uterine incesion scar, occuping 25.00% （3/12）. The rate of previous cesarean section history in the group with placenta accreta was obviously higher than that in control group （X^2 = 17. 789, P 〈 0.01 ）. Conclusion The occurrence of placenta previa combined with placenta accrete, which is closely related with scarred uterus, is increasing with the increase of rate of cesarean section, so we should pay attention to early diagnosis and reasonable treatment so as to improve the maternal and infant outcomes.