112例胎盘早剥的临床分析

Clinical anylisis of placental abruption in 112 cases

目的探讨胎盘早剥的诱因、临床表现、漏误诊原因及防范措施,提高早期诊断率,改善母儿结局。方法回顾性分析该院2009—2013年胎盘早剥患者的临床资料。结果阴道分娩12例(10.7%),剖宫产100例(89.3%);子宫胎盘卒中9例,死胎2例,新生儿重度窒息16例。B超检出32例(28.6%);胎盘早剥误(漏)诊率为39.3%;有明确发病诱因91例(81.3%),以妊娠期高血压疾病、胎膜早破及使用缩宫素为主。临床表现主要为腹痛或腰腹胀、阴道流血、胎心率异常。重型胎盘早剥组妊高症的患病率、腹痛的发生率、首发临床表现到就诊时限明显高于轻型胎盘早剥组。分娩方式、子宫胎盘卒中及新生儿窒息在I度胎盘早剥与Ⅱ/Ⅲ度胎盘早剥两组间差异有统计学意义(P<0.05)。分娩方式、子宫胎盘卒中及新生儿死亡在确诊组以及漏误诊组胎盘早剥两组间差异有统计学意义(P<0.05)。结论胎盘早剥产前诊断应结合诱因、临床表现和B超等进行综合分析。加强围产期保健,早发现,早治疗。

Objective To enhance the accuracy of early diagnosis and decrease the complication of mother and fetus through studying motivation,clinical manifestation, the causes about missed diagnosis and misdiagnosis and prevention measures of placental abruption. Methods Clinical data of patients with placental abruption were retrospectively analyzed in The First People＇ s Hospital of Hefei from 2009 to 2013. Results The results showed vaginal delivery in 12 cases （ 10.7% ） ,cesarean section performed in 100 cases （ 89.3% ）, uteroplacental apoplexy in 9 cases, dead fetus in 2 cases, and heavy asphyxiation in 16 cases. The detection rate of placental abruption by uhrasonography was 28.6% （32 cases）. The missed diagnosis and misdiagnosis rate was 39.3%. About 91 cases had the identified pre- disposing factors （81.3 % ）, mainly including hypertensive disorders in pregnancy, premature rupture of membrane and the use of oxyto- cin. The main clinical manifestations included lower abdomen pain, vaginal hemorrhage and fetal heart rate abnormalities. The severe pla- cental group was significantly higher in the prevalence of pregnancy - induced hypertension, abdominal pain and the incidence of first clinical manifestation to treatment than the mild group. Mode of delivery, uteroplacental apoplexy and neonatal asphyxia in I and II/III of placental abruption degrees were significantly different between the two groups （ P 〈 0. 05 ）. Mode of delivery, uteroplacental apoplexy and neonatal deaths were also significantly different between the misdiagnosis group and control group （ P 〈 0. 05 ）. Conclusions Placental abruption prenatal diagnosis should be combined with predisposing factors, clinical manifestations and uhrasonography analysis. Perinatal health care should be strengthened with early detection, early treatment.