妊娠晚期不同类型前置胎盘高危因素及其围产结局分析

Analysis of risk factors and perinatal outcomes of different types of placenta praevia in late trimester of pregnancy

目的探讨导致妊娠晚期前置胎盘的高危因素,并分析不同类型前置胎盘的围产结局。方法对124例前置胎盘孕妇和同期产检的100例健康孕妇临床资料作回顾性分析,比较前置胎盘的高危因素以及不同类型前置胎盘的围产结局。结果观察组中≥30岁孕妇比率高于对照组(x^2=8.576,P<0.05),观察组中孕妇孕次、产次、流产次数和剖宫术次数均高于对照组(t值分别为17.815、3.610、24.628、12.176,均P<0.05)。不同类型前置胎盘间孕妇年龄、孕次、产次、流产次数和剖宫术次数有显著性差异(F值分别为3.415、16.690、5.027、27.505、126.350,均P<0.05)。完全性前置胎盘组孕妇年龄、孕次、产次、流产次数和剖宫术次数较低置胎盘组升高(F值分别为4.258、7.654、4.366、9.784、22.567,均P<0.05),部分性前置胎盘组孕妇年龄和剖宫术次数较低置胎盘组升高(F值分别为3.879、11.363,均P<0.05),边缘性前置胎盘组孕妇孕次、流产次数和剖宫术次数较低置胎盘组升高(F值分别为5.478、9.212、8.854,均P<0.05)。不同类型前置胎盘间孕妇剖宫产、产后出血、胎盘粘连、新生儿早产、新生儿体重(<2.5 kg)、新生儿5 min Apgar评分(<7分)的发生率有显著性差异(x^2值分别为54.513、29.279、10.421、30.127、15.328、13.933,均P<0.05),前置胎盘越严重,不良围产结局发生率越高。结论产科高危因素与前置胎盘形成及类型有关,减少孕次、产次、流产次数和剖宫术次数对降低前置胎盘发生率有重要意义。完全性前置胎盘的妊娠结局较其他类型前置胎盘均严重,临床应重点监测及随访。

Objective To investigate the risk factors of placenta praevia at late trimester of pregnancy and analyze the perinatal outcomes of different types of placenta praevia. Methods Retrospective analysis was conducted on the clinical data of 124 cases with placenta praevia and 100 cases of healthy women who underwent prenatal examination at the same period. The risk factors of placenta praevia and perinatal outcomes of different types of placenta praevia were compared. Results The ratio of pregnant woman with age ≥30 years in the observation group was significantly higher than that in the control group （X2 = 8. 576, P 〈 0.05）, and the gravidity, number of delivery, number of abortion and caesarean section were significantly higher than those in the control group （t value was 17. 815, 3. 610, 24. 628 and 12. 176, respectively, all P 〈 0.05 ）. There were significant differences among different types of placenta praevia in age, gravidity, number of delivery, number of abortion and caesarean section （F value was 3. 415, 16. 690, 5. 027, 27. 505 and 126. 350, respectively, all P 〈 0.05）. The age, gravidity, number of delivery, number of abortion and caesarean section in complete placenta praevia group were significantly higher than those in the low-lying placenta group （ F value was 4. 258, 7. 654, 4. 366, 9. 784 and 22. 567, respectively, all P 〈 0.05 ）. The age and number of caesarean section in partial placenta praevia group were significantly higher than those in the low-lying placenta group （ F value was 3. 879 and 11. 363, respectively, both P 〈 0.05）. The gravidity, number of abortion and caesarean section in marginal placenta praevia group were significantly higher than those in the low-lying placenta group （ F value was 5. 478, 9. 212 and 8. 854, respectively, all P 〈 0.05 ）. There was significant difference in different types of placenta praevia with regard to the rate of caesarean section, postpartum hemorrhage, adherent placenta, neonatal premature, neonatal weight （ 〈 2.5 kg） and 5 min newborn Apgar score （ 〈 7） （ X2 value was 54. 513, 29. 279, 10.421, 30. 127, 15. 328 and 13. 933, respectively, all P 〈 0.05）. The more serious the placenta praevia, the higher the incidence of adverse perinatal outcomes. Conclusion Obstetric risk factors are related with the formation and type of placenta praevia. Reducing gravidity, the number of delivery, abortion and caesarean section are important to reduce the incidence of placenta praevia. The pregnant outcomes are serious in complete placenta praevia group, and the cases with complete placenta praevia should be monitored and followed-up.