胎盘早剥72例误诊与漏诊原因分析

Analysis of 72 Cases of Misdiagnosed or Missed Diagnosed Placental Abruption

目的分析胎盘早剥误诊及漏诊原因,以进一步提高产前诊断准确率。方法回顾性分析2010年10月—2011年10月在我院分娩的150例胎盘早剥的临床资料,将产前误漏诊的72例作为观察组,产前确诊的78例作为对照组,比较误漏诊的发病诱因、临床特征及母儿结局。结果本文胎盘早剥漏误诊率48%,误诊率30.7%,漏诊率17.3%。观察组和对照组在发病诱因及腹痛、阴道流血、子宫张力增高及重度胎盘早剥发生情况等方面比较差异均有统计学意义(P<0.05);两组血性羊水、胎儿窘迫发生率、休克、凝血功能障碍、子宫切除、新生儿重度窒息等方面比较,差异均无统计学意义(P>0.05);观察组早产、围生儿死亡、死胎均低于对照组(P<0.05)。结论临床对胎盘早剥的一些不典型征象应提高警惕,动态观察并反复检查,努力提高胎盘早剥产前诊断率,以改善母儿围生结局。

Objective To analyze the causes of misdiagnosed or missed diagnosed placental abruption in order to improve the accuracy of prenatal diagnosis. Methods Clinical data of 150 cases with placental abruption in our hospital during October 2010 and October 2011 were retrospectively analyzed. 150 cases were divided into therapy group （n = 72）, with antepartum misdiag- nosis or missed diagnosis, and control group （n = 78 ） with antepartum diagnosis. The precipitating factor, clinical symptoms and the maternity and neonatal fate were compared. Results The incidence rate of placental abruption was 1.9% ,in which the inci- dence rate of misdiagnosis or missed diagnosis was 48% （misdiagnosed rate： 30.7% ,missed diagnosed rate： 17.3% ）. The differ- ences of the symptoms in two groups such as causes of predisposing factors, abdominal pain, vaginal bleeding, uterus increased ten- sion and severe placental abruption were statistically significant （ P 〈 0.05 ）. The differences of two groups in hemorrhagic amniotic fluid, the incidence of fetal distress, shock, coagulation disorders, hysterectomy and severe neonatal asphyxia were not statistically significant （ P 〉 0.05 ）. The incidence rate of premature birth, perinatal death and dead fetus of therapy group was lower than that of control group （ P 〈 0.05）. Conclusion Clinicians should pay more attention to some atypical signs of placental abruption through dynamic observation and necessary examinations. We reconstruct results of ultrasonic examination but should not depend on it too much. Improved accuracy of prenatal diagnosis of placental abruption can improve the fate of perinatology.