凶险性前置胎盘23例临床分析

Clinical Analysis of Pernicious Placenta Previa： A Report of 23 Cases

目的：探讨凶险性前置胎盘对孕产妇的危害性，提高对凶险性前置胎盘的认识。方法：2003年1月～2012年2月我科收治凶险眭前置胎盘孕妇23例为观察组，既往剖宫产（1．7±0．4）次；选择同期收治的非凶险性前置胎盘孕妇57例为对照组，既往剖宫产（1．4±0．2）次。对两组患者的临床资料进行对比分析。结果：观察组23例，胎盘粘连、植入14例（60．87％）；剖宫产术中产后出血20例（86．96％），出血量（2785±263）ml；全子宫切除术14例（60．87％），其中死亡1例（4．35％）。对照组57例，胎盘粘连、植入3例（5．26％）；剖宫产术中产后出血19例（33．33％），出血量（850±340）ml；全子宫切除术3例（5．26％）；无一例死亡。观察组既往剖宫产次数、手术时间、胎盘粘连植入的发生率、产后出血量及子宫切除率均高于对照组，差异具有统计学意义（P〈0．05）。45例患者获随访，随访时间1～6个月，平均5个月。随访期间仅1例全子宫切除患者于术后半个月出现阴道残端少量流血，予止血治疗后痊愈，其余患者均恢复良好。结论：凶险性前置胎盘对孕产妇危害严重，减少剖宫产次数可降低凶险性前置胎盘的发生率。提高对凶险性前置胎盘危害的认识，选择正确的围手术期处理方法是保证孕产妇生命安全的关键。

Objective：To study the pernicious placenta praevia for pregnant and lying - in woman so as to better understand the pernicious placenta praevia. Methods ：23 women with pernicious placenta praevia were received from January 2003 to February 2012 as the observation group. The cesarean section amount of these patients were 1.7 ± 0.4. Meanwhile 57 women without pernicious placenta praevia were taken as the control group. The cesarean section amount of these patients were 1.4 ± 0.2. Comparative analysis of clinical data was conducted for the two groups. Results：Observation group： 14 （60.87%） cases of adherent placenta and implan- tation ; during cesarean section and postpartum hemorrhage of 20 （ 86.96% ） which amount of bleeding was （2785 ± 263 ） ml; 14 （60.87%） of panhysterectomy （ one death accounted for 4.35% ）. Control group ： 3 （5.26%） cases of adherent placenta and implantation; during cesarean section and postpartum hemorrhage of 19（33.33% ） which amount of bleeding was （850 ± 340） ml; 3 （5.26%） cases of panhysterectomy （zero death）. The observation group had higher cesarean section amount, operation duration, incidence rate of adher- ent placenta and implantation, postpartum hemorrhage and panhysterectomy ratio than the control group. This difference had statistical significance （P 〈 0.05 ）. 45 cases in two groups had follow - up with duration of one or six months, 5 in average. In the follow- up, only one woman who had panhysterectomy bled a little in the vagina half month after the operation. However, she recovered after stopping the bleeding. The rest recovered well. Conclusions：Pernicious placenta praevia impacts the pregnant and lying - in woman severely. Reducing the amount of cesarean section will lower the incidence rate. The key to ensure the life safety of the pregnant and lying - in woman is to better understand the pernicious placenta praevia and select the correct methods in perioperative period.