胎盘早剥的临床分析

Clinical analysis of placental abruption

目的探讨胎盘早剥的发病诱因、临床表现,并分析胎盘早剥漏诊误诊原因,以提高胎盘早剥早期确诊率。方法回顾性分析29例胎盘早剥患者的临床资料。结果胎盘早剥发生率为0.37%。其中产前确诊18例(确诊组,占62.07%);漏诊误诊11例(漏诊误诊组,占37.93%)。轻型胎盘早剥19例,重型10例。有明确发病诱因者19例(65.52%),以妊娠期高血压疾病、胎膜早破、外伤性因素、脐带因素、羊水过多、仰卧睡姿综合征为主。临床表现主要为腰腹胀痛、阴道流血、胎儿窘迫、血性羊水、子宫张力过高等。确诊组腰腹胀痛、阴道出血及子宫张力过高的发生率较漏诊误诊组高(P<0.05)。B超检出率为58.62%。剖宫产24例,阴道分娩5例。结论胎盘早剥临床表现缺乏特异性,误诊漏诊率较高,应根据病史、临床症状、体征、B超以及电子胎心监护进行综合分析,及时合理处置,以降低母儿并发症发生率。

Objective To explore the predisposing causes and clinical manifestations of placental abruption（PA）,analyze the causes of misdiagnosis and missed diagnosis of PA,in order to improve the accuracy rate of early diagnosis of PA.Methods The clinical data of 29 cases of PA were retrospectively analyzed.Results The incidence rate of PA was 0.37%.Of them,the diagnosis of PA were confirmed in 18 cases prenantally（the comfirmed diagnosis group,accounting for 62.07%）,PA were misdiagnosed or the diagnosis of PA were missed in 11 cases prenatally（the misdiagnosis and missed diagnosis group,accounting for 37.93%）.Mild PA were found in 19 cases,severe PA were found in 10 cases.The main predisposing factors included hypertensive disorders complicating pregnancy,premature rupture of fetal membranes,traumatic factors and supine hypotensive syndrome.The clinical manifestations mainly included lumbar and abdominal distending pain,vaginal bleeding,bloody amniotic fluid,high uterine tension,fetal distress,etc.The incidence rates of lumbar and abdominal distending pain,vaginal bleeding and high uterine tension in the comfirmed diagnosis group were higher than those in the misdiagnosis and missed diagnosis group（P 0.05）.The detection rate of PA by B-ultrasound was 58.62%.Cesarean section were performed in 24 cases,vaginal delivery in 5 cases.Conclusion For lack of characteristic clinical manifestations,PA has a higher rate of misdiagnosis and missed diagnosis,so that it should be necessary to make a comprehensive analysis according to medical history,clinical symptoms and signs,B ultrasonic examination,and electronic fetal cardiac monitoring for timely and reasonable treatment,in order to reduce the incidence of complications of mother and infants.