凶险型前置胎盘43例临床分析

Clinical analysis of 43 cases of pernicious placenta previa

目的:探讨凶险型前置胎盘的临床特点,预防产后出血发生率,降低严重产后出血和子宫切除的风险,提高围生儿的存活率,降低孕产妇死亡率。方法:对43例凶险型前置胎盘中的中央型组与非中央型组孕产妇妊娠结局进行回顾性分析。结果:中央型组与非中央型组严重产后出血率、胎盘植入率、DIC发生率、子宫切除率比较差异有统计学意义(P<0.05),而两组围产儿结局差异无统计学意义(P>0.05)。结论:中央型凶险型前置胎盘比非中央型凶险型前置胎盘植入率高,更容易发生严重的产时出血。提前彩超预测、术前充分识别评估风险及产时有效控制出血是治疗的关键。防止DIC发生,减少子宫切除事件及瘢痕子宫的发生,严格掌握剖宫产指征,搞好计划生育,注重产检及营养指导,降低剖宫产率,控制社会因素瘢痕子宫的发生可预防凶险型前置胎盘发生。

Objective： To explore the clinical characteristics of pernicious placenta previa, prevent the rate of postpartum hemor- rhage, decrease the risks of serious postpartum hemorrhage and hysterectomy, increase the survival rate of perinatal, decrease the mortality. Methods： Pregnant outcome of 43 cases of pernicious placenta previa （ central and non - central type subgroups） were collected and retrospectively analyzed. Results： There were significant differences in serious postpartum hemorrhage, rate of placenta implantation, DIC and hysterectomy between central and non - central type of pernicious placenta previa subgroups （ P 〈 0. 05 ）, while there was no signifi- cant difference in outcome of prenatal （ P 〉 0. 05 ） . Conclusion ： Rate of placenta implantation in central type of pernicious placenta previa is higher than that of non - central type of pernicious placenta previa, postpartum hemorrhage more often occur in central type of pernicious placenta previa. Key therapeutic measures include early Colour Doppler Ultrasound prediction, full recognition and valuation the danger be- fore operation, control bleeding effectively. They may prevent pernicious placenta previa, to prevent DIC, decrease hysterectomy and uterine scar, master strictly indicators of cesarean, do well family planning, pay more attention to antenatal care and nutrition indication, decrease the rate of cesarean, control the development of social uterine scar.