胎盘早剥并发弥散性血管内凝血28例临床分析

Severe placental abruption complicated with disseminated intravascular coagulation：clinical analysis of 28 cases

目的 提高胎盘早剥并发弥散性血管内凝血（DIC）的诊断及处理水平。方法 回顾性分析胎盘早剥并发DIC 28例的诊断及处理的临床资料。结果 28例中,妊娠期高血压疾病（15例）为主要诱因,持续性下腹痛、阴道流血为最常见的主诉。6例经阴道分娩,22例剖宫产结束分娩。并发失血性休克9例,占32.1%。并发死胎20例,占71.4%。28例中活产儿8例,分娩后并发新生儿重度窒息6例中2例死亡,4例存活。子宫次全切除或子宫全切共6例,占21.4%。并发肾功能衰竭2例,无孕产妇死亡。结论 胎盘早剥并发DIC严重威胁母婴生命,临床诊断后应立即终止妊娠。DIC不是切除子宫的指征,补充凝血因子纠正凝血障碍,可以保留子宫,维护产妇的身心健康。

Objective To analyze the clinical characteristic of disseminated intravascular coagulation（DIC） complicated by placental abruption,improving the diagnosis and treatment level.Methods A retrospective analysis of clinical data of placental abruption complicated by DIC was made in 28 cases.Results In 28 cases,hypertensive disorders in pregnancy（n=15） was the main cause,persistent abdominal pain and vaginal bleeding was the most common complaint.There were 6 cases delivery through vaginal,and 22 cases delivery by cesarean section,complicated by hemorrhagic shock in 9 cases,accounting for 32.1%,concurrent stillbirth in 20 cases,accounting for 71.4%.In 28 cases,there were live births in 8 cases,after childbirth and newborn severe asphyxia in 6 cases,including 2 cases after the rescue of neonatal death,and another 4 patients after the rescue of neonatal survival.The occurrence of uterine subtotal or total hysterectomy was in 6 cases,accounting for 21.4%,acute renal failure in 2 cases,no maternal death.Conclusions Placental abruption complicated with DIC made a serious threat to maternal and child life and health,and the pregnancy should be terminated immediately after clinical diagnosis.DIC was not a hysterectomy indications,coagulation factors can help to correct the coagulation disorders,and to preserve the uterus and maintain the maternal physical and mental health.