不典型胎盘早剥的临床特点分析

Clinical Feature Analysis of Atypical Placental Abruption

目的分析不典型胎盘早剥的临床特点,早期发现及诊断不典型胎盘早剥,降低母儿并发症。方法回顾性分析北京市海淀区妇幼保健院妇产科2010年1月至2012年11月收治的50例不典型胎盘早剥患者(不典型组)及53例典型胎盘早剥患者(典型组)的临床资料,对两组患者的发病诱因、临床表现及母儿预后进行比较。结果不典型组患者使用缩宫素和普贝生、胎膜早破的发生率高于典型组(P<0.05),而妊娠期高血压疾病、外伤史发生率低于典型组(P<0.05)。不典型组胎心监护异常、子宫高张、持续性下腹痛、阴道出血、血性羊水的比例低于典型组(P<0.05),而先兆早产或临产、宫缩频强或产程短的比例高于典型组(P<0.05)。不典型组剖宫产、子宫胎盘卒中、新生儿窒息、产后出血、弥散性血管内凝血、围生期死亡的发生率均低于典型组(P<0.05)。结论规范使用缩宫素防止宫缩过频过强、重视胎膜早破,加强先兆早产、妊娠期高血压疾病的监测,动态观察病情变化,做到早期诊断、减少并发症发生。

Objective To analyze the clinical features of atypical placental abruption. Methods Retrospectively analyzed the clinical data of 50 cases （ atypical group） of atypical placental abrnption and 53 cases （typical group） of typical placental abrnption in Beijing Haidian Maternal ＆ Children Health Hospital from Jan. 2010 to Nov. 2012. The etiology, clinical features and maternal and fetal prognosis were compared between the two groups. Results Atypical patients were given oxytocin and propess, and the rate of premature rupture of membranes was higher than that of the typical group （P 〈 0.05 ） , and incidence of hypertensive disorder complicating pregnancy, history of trauma was lower than the typical group （ P 〈 0.05 ）. The proportions of abnormal fetal heart rate, hypertonic uterine, persistent abdominal pain, vaginal bleeding, and bloody amniotie fluid of the atypical group were lower than the typical group, with statistically significant differences（P 〈 0.05 ）, and the proportions of threatened premature labor or near-labor, higher uterine contraction frequency or shorter labor coursewere higher than the typical group （ P 〈 0.05 ）. Incidence of Cesarean seetion,uteroplacental apoplexy, neonatal asphyxia, postpartum hemorrhage, disseminated intravascular coagulation, perinatal death were lower than the typical group （ P 〈 0.05 ）. Conclusion We should standardize the use of oxytoein to prevent frequent and strong contractions, pay attention to the monitoring of premature rupture of membranes, threatened preterm labor and hypertensive disorders in pregnancy, and observe the illness dynamically so as to early diagnose the disease and reduce complications.