胎盘滞留38例临床分析

Clinical analysis on 38 patients with retained placenta

目的探讨预防和正确处理胎盘滞留方法,减少产后出血及产褥感染。方法回顾性分析38例胎盘滞留的临床资料,其中在输液或输血下行徒手剥离胎盘术成功13例;在麻醉下顺利行徒手剥离或取出胎盘术22例;胎盘植入3例,在麻醉下先行剥离胎盘成功1例,发现宫壁与胎盘之间没有分界线2例,考虑有胎盘植入后停止剥离,行子宫切除术。结果 38例胎盘滞留患者出血量最少50 ml,最多1 250 ml,平均出血量为542.5 ml。术后宫腔继续出血及产褥感染各2例,无其它并发症,无死亡病例,38例患者均治愈出院,住院时间7～17 d,平均9.5 d。结论在阴道分娩过程中,针对不同类型胎盘滞留采取不同处理方法,对预防产后大出血和减少产褥感染具有重要意义。

Objective To explore the methods of preventing and correctly handling retained placenta in order to decrease postpartum hemorrhage and puerperal infection. Methods The clinical data of 38 patients with retained placenta were retrospectively analyzed. Of them manual removal of placenta were successfully performed in 35 patients. In 3 patients with placenta implantation, manual removal of placenta was successfully perfomed in 1 patient, 2 patients were treated by hysterectomy because no dividing hne was found between the uterine wall and the placenta and placenta implantation was considered. Results In 38 patients with retained placenta, blood loss was 50 ~ 1 250 ml; average blood loss was 542.5 ml. Postpartum hemorrhage were found in 2 patients ; puerperal infection in 2 patients. No other complications and mortality occurred. Thirty-eight patients with retained placenta were cured through treatments. The hospital stay period was 7 ~ 17 d ; average hospital stay was 9.5 d. Conclusion Among the natural labor, decideing conservative treatment or hysterectomy according to the specific conditions of patients, has important value in preventing postpartum hemorrhage and puerperal infection.