胎盘早剥并发子宫胎盘卒中45例分析

Analysis of 45 cases of uteroplacental apoplexy after placental abruption

目的探讨胎盘早剥并发子宫胎盘卒中与发病高危因素、临床特征、胎盘附着部位和剥离面积、母婴结局之间的关系。方法选择2007年1月至2011年10月于广东医学院附属西乡人民医院住院分娩经手术证实胎盘早剥的患者45例,胎盘早剥并发子宫胎盘卒中为观察组(n=18),未并发子宫胎盘卒中为对照组(n=27)。采用回顾性研究方法对两组患者的发病危险因素、临床特征、胎盘附着部位和剥离面积及母儿结局进行分析比较。结果胎盘早剥发生率为0.67%(83/12376),其中并发子宫胎盘卒中的发生率为40%(18/45)。两组子痫前期发生率及发病持续时间分别为28%(5/18)和15%(4/27)及6.4和4.2h,差异均无统计学意义(P>0.05)。两组在子宫张力高、宫体压痛、宫腔积血、胎死宫内发生率方面比较差异有统计学意义(P<0.01)。观察组和对照组胎盘附着位于宫底宫角分别为13和9例,差异有统计学意义(P<0.01);胎盘剥离面积超过l/3的分别有16和8例,差异有统计学意义(P<0.01)。两组在产后出血、DIC、死胎的发生率方面比较差异有统计学意义(P<0.05)。结论子痫前期患者胎盘早剥易并发子宫胎盘卒中,胎盘附着宫底宫角部发生早剥,或剥离面积超过l/3时易出现子宫胎盘卒中,其临床特征典型。胎盘早剥并发子宫胎盘卒中患者的母儿结局不良。

Objective To analyze the risk factors, clinical characteristics, parts and areas which the placenta in divesting and maternal and fetal outcome in the uteroplacental apoplexy after placental abruption. Methods 45 cases of confirmed placental abruption were collected from our hospital and specificed hospitals from January 2007 to October 2011. According to the occurrence uteroplacental apoplexy after placental abruption, the patients were divided into two groups, Observation group of 18 with uteroplacental apoplexy after placental abruption and contrast group of 27 without uteroplacental apoplexy after placental abruption. The risk factors,clinical characteristics,parts and areas which the placenta in divesting and maternal and fetal outcome were analyzed. Results The rates of pre-eclampsia of the 2 groups were 71%（5/18） and 20%（4/27）, while the seizures durations were 6.4 and 4.2 h, respectively. The differences between 2 groups showed no statistical significance （P〉0.05）.The high tension of the uterus, the pain of uterus,and the blood in the uterus showed significant differences between 2 groups （P〈0.01）. 13 cases of the observation group and 9 cases of the contrast group had uterine fundus and horn of uterus. The occurance of uteroplacental apoplexy in these 2 groups was significant difference （P〈0. 01）. There were 16 cases in the observation group and 8 cases in the contrast group showed the area of placental separation more than 1/3. The difference was statistically significant （P〈 0.01 ）.The rate of postpartum hemorrhage, DIC and fetal death in these 2 groups showed statistical significances （P〈 0.05）. Conclusions The patients of pre-eclampsia had high risk of uteroplacental apoplexy after placental abruption. Uteroplacental apoplexy was easily happened in uterine fundus and horn of uterus with placental abruption or the sepearation area more than 1/3, showing a typical clinical symtome.The maternal and fetal outcomes were bad among the patients with uteroplacental apoplexy after placental abruption.