246例完全性胎盘前置出血的临床观察及对妊娠结局的影响

Clinical Observation and Outcomes Analysis for Total Placenta Praevia and Bleeding in 246 Patients

目的:探究预防及降低孕产妇及胎儿死亡率的有效方法。方法:选取笔者所在医院诊治的246例完全性胎盘前置患者为病例组,随机选择同期笔者所在医院妇产科收住的246例非病理性妊娠妇女为对照组,观察两组妊娠结局的情况。结果:完全性前置胎盘患者中反复妊娠患者42.7%,有人工流产史患者占74.8%,而有31.7%剖宫产史患者发生此情况。病例组246例中,有4例患者使用子宫全切,原因均为术中大量出血,同时也导致有2例出现死胎。大量出血患者孕周、保胎时间、新生儿体重中均明显少于中少量出血的患者(P<0.05),而发生贫血的情况则相反;但是在新生儿Apgar的评分与出血量的多少无明显关联(P>0.05)。病例组子宫切除、早产、保胎治疗时间、剖宫产的使用率、新生儿评分及新生儿贫血的发生情况均明显高于对照组(P<0.05);但在体重及终止妊娠时间方面明显少于对照组(P<0.05)。结论:反复妊娠、人工流产史及剖宫产史可能是导致前置胎盘的高危因素,前置胎盘的妊娠结局较差,需要适时终止妊娠。

Objective： To explore the effective method of prevent and reduce that patients who had pre-placental maternal and fetal mortality.Method： Select 246 cases of patients that diagnosis complete placenta previa and treatment in our hospital as the case group, randomly selected 246 cases of the patients who had non-pathological pregnant women for the control group, to contrast the outcome of pregnancy in two groups.Result： In patients with complete placenta previa in patients with recurrent pregnancy 42.7%, 74.8% in patients with a history of abortion, this situation occurs in patients with a history of cesarean section in 31.7%. In this group of 246 cases, 4 cases of patients with hysterectomy, reason for bleeding during surgery, but also result in 2 cases were still.Pregnancy week, fetus protection and neonatal birth weight were significantly lower in patients with massive hemorrhage than patients with a small amount of bleeding（P〈0.05）, anemia was the opposite; but in neonatal Apgar score and bow much blood loss were no clear relation（P〉0.05）.Hysterectomy, preterm delivery, fetus protection treatment time and rate of use of caesarean section, neonatal scores, and the incidence of neonatal anaemia in case group were significantly higher than that in the control group（P〈0.05）; but the terms of weight and pregnancy termination time in case group were significantly less than the control group（P〈0.05）.Condusion： History of cesarean section, history of repeated pregnancy and abortion may be the risk factors for placenta previa, pregnant outcomes is bad for patients with placenta previa, it should timely cesarean section termination of pregnancy.