胎盘早剥合并胎死宫内分娩方式的探讨

Delivery Mode of Placental Abruption Complicated with Fetal Death

目的:探讨胎盘早剥合并胎死宫内的临床处理方案及分娩方式。方法:回顾性分析1994年1月至2011年7月于北京大学第三医院产科治疗的胎盘早剥合并胎死宫内患者23例。其中阴道分娩11例(阴道分娩组),剖宫产12例(剖宫产组),比较两组年龄、分娩方式、出血量、产时及产后并发症,评价阴道分娩的安全性。结果:23例患者中,11例(47.8%)行阴道分娩,12例因阴道试产失败或因其他原因直接行剖宫产手术,其中16.7%(2/12)因术中出血多,保守治疗无效而行次全子宫切除术。两组均无孕产妇死亡病例发生;两组患者的年龄、孕周、妊娠次数、产前出血量、产前合并症比较,差异均无统计学意义(P>0.05);剖宫产组产后出血发生率(91.7%)、出血量(1986.4±1653.3ml)均高于阴道分娩组的54.5%和928.0±737.8ml,但差异均无统计学意义(P=0.069;P=0.076)。结论:胎盘早剥合并胎死宫内的患者选择恰当的时机和分娩方式可减少对患者的进一步损伤,阴道试产是一个值得肯定的分娩方式,可以尝试在严密监测和纠正凝血功能的情况下经阴道分娩。

Objective：To explore the management and delivery mode of placental abruption complicated with fetal death.Methods：23 cases of placental abruption complicated with fetal death, occurring in Department of Obstetrics of Peking University Third Hospital from January 1994 to July 2011, were retrospectively reviewed and analyzed. During them, vaginal delivery was 11 cases （vaginal delivery group） and cesarean section was 12 cases （cesarean section group）. The parameters, including age,delivery mode, complications in delivery or postpartum, and blood loss, were analyzed in order to estimate the safety of vaginal delivery.Results：Among 23 cases, 11 cases was vaginal delivery （47.8%） and 12 cases underwent cesarean section because of failed trial of vaginal labor or other causes. 2 cases underwent subtotal hysterectomy due to massive hemorrhage. No maternal deaths occurred in both groups. There was no significant difference between two groups in age, gestational week, gravidity, amount of antepartum hemorrhage and antepartum complication （P0.05）.The postpartum hemorrhage rate in cesarean section group was 91.7%, in vaginal delivery group was 54.5%,there was no statistical significant difference（P=0.069）.The amount of hemorrhage in cesarean group was 1986.4±1653.3 ml, in vaginal delivery group was 928.0±737.8 ml （P=0.076）.Conclusions：Vaginal delivery is feasible and preferable for placental abruption complicated with fetal death and stands trial with close supervision and aggressive correction of coagulopathy. Vaginal deliveries can reduce trauma in patients, and the clinical value should be confirmed by more research.