家庭病床和住院处理前置胎盘期待疗法的随机对照研究

目的：探讨家庭病床处理前置胎盘期待疗法的安全性和效果。方法选择2010年1月～2012年12月广东省海珠区妇幼保健院妇产科收治的70例妊娠28～34周单胎妊娠因首次阴道流血入院期待治疗的边缘性、部分性前置胎盘孕妇为研究对象，病情稳定后随机均分为家庭病床组和住院治疗组（n=35），继续进行期待治疗。比较2组孕妇期待治疗的天数、期待治疗住院天数、阴道再次流血次数、孕妇输血率、新生儿出生体重、阿氏评分。结果家庭病床组和住院治疗组分别有1例和2例期待治疗期间因复查B超检查证实胎盘上移为正常位置而剔出研究。2组期待治疗的时间、阴道再次流血次数、孕妇输血率、新生儿出生体重、阿氏评分等比较，差异均无统计学意义。家庭病床组和住院治疗组期待治疗平均住院天数分别是（3.56±2.64）d和（22.69±5.47）d，2组比较差异有统计学意义（P＜0.01）。结论家庭病床处理前置胎盘期待疗法安全、有效，对孕期合并前置胎盘的孕妇可行家庭病床期待治疗。

Objective To study the safety and efficacy of expectant treatment of placenta previa by family ward management. Methods Seventy pregnant women of 28-34 gestational weeks with partial and marginal placenta praevia who received expectant treatment because of vaginal bleeding from Jan 2010 to Dec 2012 were randomly divided into family ward group and inpatient treatment group. Each group had 35 patients. The time of expectant treatment,average hospitalization days of expectant treatment,number of vaginal bleeding,the rate of blood transfusion,neonatal birth weight and apgar scores between two groups were compared. Results One and two patients were excluded out the research in family ward group and inpatient treatment group respectively for regaining the normal place of placenta conformed by follow-up ultrasound examination. There was no significant difference in the time of expectant treatment,number of vaginal bleeding,the rate of blood transfusion,neonatal birth weight and apgar scores between the two groups. The average days of hospitalization were expectant treatment between family bed group and treatment group hospitalization, respectively （3.56±2.64） and （22.69±5.47） days, the difference was statistically significant （P〈0.01）. Conclusion Family ward management for placenta praevia is safe and effective. For those appropriate placenta praevia patients can be treated by family ward.