30例胎盘早剥病例回顾性分析

A retrospective analysis on 30 cases of placental abruption

目的探讨胎盘早剥高危因素,做到早预防、早发现、早诊断、早处理。方法对2007～2012年在重庆市红十字会医院(江北人民医院)诊治的30例胎盘早剥的病例进行回顾性分析,发现胎盘早剥的高危因素、原因、诱因。结果 30例患者中有19例(63.3%)胎盘早剥发生在入院之前;11例(36.7%)发生在住院期间。在30.0例患者中有10例(33.3%)为Ⅲ度胎盘早剥;12例(40.0%)为Ⅱ度胎盘早剥;8例(26.7%)为Ⅰ度胎盘早剥。10例Ⅲ度胎盘早剥中,其中8例(80.0%)发生在院外;2例(20.0%)发生在住院期间。入院前的19例胎盘早剥:6例患重度子痫前期;8例受机械外力作用;5例有胎膜早破。入院后的11例中:3例患重度子痫前期,发生在静滴硫酸镁解痉治疗3h后;5例患前置胎盘(2例为部分性,3例为边缘性),发生在静滴硫酸镁抑制宫缩期待治疗过程中;2例为疤痕子宫先兆早产,用硫酸镁保胎治疗过程中;还有1例为中孕引产患者,未应用硫酸镁。结论胎盘早剥病因除了与孕妇血管病变,机械性外力因素,宫腔内压力骤减,子宫静脉压增高等因素有关外,还与低置或前置胎盘、子宫刺激增加、长期仰卧、胎膜早破、硫酸镁解痉扩血管、高龄孕妇等有关。

Objective To explore risk factors of placental abruption,so that to early prevention,early detection,early diagnosis and early treatment.Methods 30 cases of placental abruption cases were retrospectively analyzed in The Red Cross Hospital in Chongqing From 2007 to 2012,high-risk factors,reasons,inducement of placental abruption were evaluated.Results In 30 cases,19 cases（63.3%） occurred in prior to admission;11 cases（36.7%） occurred after hospitalization;10 cases（30.0%） as Ⅲ of placental abruption,12（40.0%） as the Ⅱ of placental abruption,8 case（26.7%） as Ⅰ of placental abruption.Among 10 cases Ⅲ of placental abruption,8 cases（80%）occurred outside the home,2 case（20%） occurred after admission.19 cases of placental abruption before admission,in which 6 cases were severe preeclampsia,8 cases were external mechanical forces,another 5 cases are premature rupture of membranes.among 11 cases after hospitalization,3 case were severe preeclampsia intravenous magnesium sulfate antispasmodic 3 hours after treatment;5 cases are placenta previa（2 case were partial,another 3 cases were the marginal） magnesium sulfate inhibits Palace shrink later complicated by premature rupture of membranes occurred;2 case were uterine scar of threatened premature labor with magnesium sulfate tocolysis occurred in third days;another 1 case of induced abortion in pregnant patients without the application of magnesium sulfate.Conclusion Placental abruption might be not only related to pregnant women with vascular disease,mechanical external factors,intrauterine pressure droped,uterine venous pressure increased and so on,but also related to low-set or placenta previa,uterine stimulation increased,long-term sit,membranes break early,by antispasmodic and vasodilator magnesium sulfate,and advanced maternal age.