胎盘早剥经阴道分娩临床病例探讨

Clinical analysis on placental abruption in vaginal delivery

目的:探讨胎盘早剥经阴道分娩的处理方法及观察指标,以期减少胎盘早剥对母体的损伤,为患者再次妊娠提供有利条件。方法:回顾性分析105例2007年7月～2010年3月在北京妇产医院产科经阴道分娩的胎盘早剥患者的临床资料。结果:新生儿轻度窒息5例,重度窒息6例,死胎15例(4例为双胎),死产3例(2例为放弃胎儿,1例孕27周);产后出血6例,DIC 2例,肺水肿1例,无孕产妇死亡。产程时间及孕产妇结局与胎盘早剥类型间无统计学相关性。胎盘早剥的不同类型与发病孕周间有统计学相关性,轻型早剥多发生于孕足月(≥37周),重型早剥以早产偏多(28～37周)。胎盘早剥发病孕周与围产儿预后间有统计学相关性。结论:胎盘早剥经阴道分娩,母婴预后与结束分娩的时间无关,而在于产程的严密监护。胎盘早剥患者选择阴道分娩时,应综合考虑孕龄、出血、凝血功能、胎儿宫内状况等。

Objective： To explore the indication and disposal of placental abruption in vaginal delivery and improve the pregnancy outcome. Methods： The clinical data of 105 cases of placental abruption in vaginal delivery from July 2007 to Mar. 2010 were retrospectively analyzed. Results： There were 5 cases with weak asphyxia of newborn, 6 cases with heavy asphyxia, 15 cases with fetal death and 3 cases with stillbirth. There was not maternal death. There was no statistically significant between abruption type and labor time, the ending of maternal. There was statistically significant between the different types of placental abruption and the gestational age of onset, that light abruption happened almost in full - term pregnancy, while heavy abruptions in preterm. The placental abruption gestational age with the prognosis of prenatal infants were obvious differences. Conclusion： Prognosis of maternal and infant with vaginal delivery dose not relate to the length of labor time but relates closely monitoring of labor. Choicing of placental abruption patients which diliver in labor, should be taken into account in the gestational age, hemorrbage, blood clotting, fetus condition and so on.