植入性胎盘的产前诊断及处理的临床价值(附103例分析)

Clinical value of prenatal diagnosis and management of placenta accreta:An analysis of 103 cases

目的分析产前诊断及处理植入性胎盘的临床价值。方法回顾分析2个医疗单位从2003年3月~2010年3月被临床和产后病理诊断为植入性胎盘（PA）103例患者。分为2组：研究组为产前被诊断有＂植入性胎盘＂,对照组产前未能诊断出＂植入性胎盘＂。研究组孕34~37周时,术前2 d用地塞米松促胎儿肺成熟,2 d后择期剖宫产,手术方式为胎儿娩出后不剥离胎盘即行全子宫切除术;对照组于剖宫产胎盘剥离时发现为PA并出现大出血而行子宫切除术,对2组产妇及新生儿有关情况作对照分析。结果本样本数共103例,其中39例产前诊断有PA,64例未能诊断PA。产前诊断有PA的患者,产后出血量和产后输血量均少于对照组。结论产前诊断出植入性胎盘并择期手术能减少产妇分娩时出血的发病率,诊断出植入性胎盘在孕34~37周择期剖宫产分娩不会增加新生儿的发病率。

Objective To analyze the clinical value of prenatal diagnosis and management of placenta accreta.Methods A retrospective review was conduced to 103 patients who had been clinically and pathologically confirmed during the postpartum period having placenta accreta（PA） at two medical centers between March 2003 to March 2010.All the patients were divided into two groups.The study group consisted of patients with confirmed PA in prenatal diagnosis,while the control group did not be confirmed having PA.The study group was administered dexamethason 2 days before surgery to promote fetal lung maturity between 34th and 37th week of gestation.Elective cesarean section was conducted 2 days later.The scheduled surgical method was total hysterectomy without placental separation.When PA was identified with massive bleeding during placental separation in cesarean section,hysterectomy was performed.Finally,comparative analysis of maternal and neonatal situations in the two groups was carried out.Results Among the 103 patients,39 were diagnosed with PA before delivery while 64 were not.Postpartum hemorrhage and blood transfusion in the study group were less than in the control group.Conclusion Prenatal diagnosis of PA and elective cesarean section could decrease incidence of maternal hemorrhage.Confirmation of PA followed by elective caesarean section between 34th and 37th week of gestation does not increase neonatal morbidity.