凶险型前置胎盘对孕产妇的危害性研究

Research on the Perniciousness of Dangerous Placenta Previa on the Maternal

目的:探讨凶险型前置胎盘对孕产妇的危害性。方法:选择我院2009年3月至2012年3月收治的凶险性前置胎盘40例,对其临床资料进行回顾性分析。结果:植入型前置胎盘(植入组)占凶险型前置胎盘的55%(22例),非植入型前置胎盘(非植入组)占45%(18例)。植入组产前出血18例,占81.8%,非植入组产前出血8例,占44.4%,差异有统计学意义。植入组完全性前置胎盘17例,占77.3%;部分性4例,占18.2%;边缘性1例,占4.5%。非植入组分别为5例,占27.8%;1例,占5.6%;12例,占66.7%。两组之间比较差异具有统计学意义(P<0.05)。两组术前Hb值无明显差异(P>0.05),术后非植入组Hb水平高于植入组,手术时间、术中出血量、产后出血均显著少于植入组,差异均有统计学意义(P<0.05)。非植入组术中输血、切除子宫、应用宫腔纱条的百分率均显著低于植入组(P<0.05)。两组术中刮宫、徒手剥胎盘的百分率比较均无明显差异(P>0.05)。结论:对于凶险型前置胎盘孕产妇,产前应做好预防保健,术中加强观察,术中术后放置腹腔引流管,最大限度的降低对孕产妇的危害,确保母婴安全。

Objective：To investigate the perniciousness of dangerous placenta previa on the maternal.Methods：40 cases of dangerous placenta previa admitted in our hospital from March 2009 to March 2012 were selected,the clinical data were retrospectively analyzed.Results：The implanted placenta previa（implanted group） accounted for 55% of dangerous placenta previa,antepartum hemorrhage accounted for 81.8%,while 8 cases（44.4%） of antepartum hemorrhage occurred in non-implanted group（P0.05）.In the implanted group,complete placenta previa accounted for 77.3%;partial placenta previa accounted for 18.2%;marginal placenta previa accounted for 4.5%.which were respectively 5 cases（27.8%）;1 case（5.6%）;12 cases（66.7%） in the non-implanted group（P0.05）.No significant difference of preoperative Hb was observed between the two groups,but the postoperative Hb in non-implanted group was higher than that in the implanted group,the operative time,blood loss,postpartum hemorrhage were significantly less in non-implanted group than those in the implanted group（P0.05）.The percentages of intraoperative blood transfusion,hysterectomy,application of uterine gauze in non-implanted group were significantly lower than those in the implanted group（P0.05）.No significant difference of the percentage of intraoperative curettage and placenta by hand stripping was observed（P0.05）.Conclusion：For dangerous type of placenta previa maternal,it should strengthen the observation in surgery and place the shunt after surgery.In this way it could reduce the hazards for maternal with the maximum extent and ensure the safety of mother and child.