疤痕子宫合并胎盘植入44例临床分析

Clinical Analysis Of Scar Uterine Induced Placenta Accreta 44 Cases

目的:探讨疤痕子宫合并胎盘植入的高危因素,早期诊断的可能性和有效的治疗措施。方法:回顾性分析2010年1月～2011年10月广州医学院第三附属医院44例疤痕子宫合并胎盘植入的年龄、孕周、合并前置胎盘率、胎盘位于前壁率、B超及MRI诊断率、临床诊治和围生期结局进行分析。结果:疤痕子宫合并胎盘植入的发生率为0.5%,80%为30岁以上孕妇,合并前置胎盘率79.5%,其中为前壁中央型前置胎盘占75%。植入性胎盘占31.8%,穿透性胎盘占40.9%。产前诊断率52.3%,其中B超和MRI的敏感性分别为43.6%、48%。发生产后出血率84.1%,早产率47.7%,新生儿不足2 500 g占36.4%,子宫切除率34.1%。结论:疤痕子宫是胎盘植入的主要高危因素,易形成凶险型前置胎盘,而产前难以诊断,母婴危害极大。及时采取了防治措施及适时实施子宫切除术,尤其对凶险型胎盘植入采用经后路子宫切除术,有效减少了产后出血量,避免了产妇死亡。

Objective： To investigate risk factors, early diagnosis of the possibility and effective treatment measures of scar uterine with placenta accrete. Methods： A total of 44 patients of scar uterine with placenta accrete were recruited from the Third Affiliated Hospital of Guangzhou Medical College, during January, 2010 to October, 2011. Then to make a retro- spective analysis of general situation including age and gestational weeks, incidence rate of placenta praevia, placenta previa centralis and placenta located at the uterine anterior wall, diagnosis rate of ultrasonography and MRI, diagnosis and treatment and perinatal stage outcomes. Results：Incidence rate of scar uterine with placenta accrete is 0.5%, 80% for 30 years of pregnant women, 79.5% of those are placenta praevia. The rate of placenta increta and penetrating per- creta is 31.8% and 40.9% . prenatal diagnosis rate is 52.3%, sensibility of ultrasonic and MRI is 43.6% and 48%, postpartum hemorrhage rate is 84.1% , premature birth rate was 47.7%, the newborn of less than 2500 g is 36.4%, hystereetomia rate is 34.1%. Conclusion： The cesarean scar is a main risk factor for placenta accrete, easy to form dan- gerous praevia. Prenatal diagnosis is difficult, a great harm to mother and infant. To take preventive measures and do an effective posterio hysterectomy, especially for dangerous placenta accreta, will effectively reduce postpartum hemorrhage to avoid maternal death.