凶险型前置胎盘剖宫产28例临床分析

Clinical analysis of 28 cases of dangerous type of placenta previa

目的探讨凶险型前置胎盘的诊疗规范及手术方法,减少产后出血、副损伤,降低子宫切除率。方法回顾分析2011年1月至2014年1月在我院就诊的28例凶险型前置胎盘患者的发病原因、治疗方法及预后状况。结果 28例孕妇中曾一次剖宫产21例,两次剖宫产3例,三次剖宫产1例,子宫肌瘤挖除术后1例,多次人工流产后2例。28例患者均以剖宫产终止妊娠,发生产后出血28例,子宫切除7例。其中择期手术23例,子宫切除4例;急诊手术5例,子宫切除3例,膀胱损伤2例。结论重视对凶险型前置胎盘的早诊断、早干预;规范围产期处理,术前充分评估,术中正确及时处理,是减少产后出血及副损伤,降低子宫切除率及母儿死亡率的关键。

Objective To investigate the diagnostic standard and surgical methods of dangerous type of placenta previa, and reduce postpartum hemorrhage, side effect, and hysterectomy rates. Methods The etiology, treatment and prognosis of 28 patients with dangerous type of placenta previa from January 2011 to January 2014 in our hospital were retrospectively analyzed. Results In those 28 cases, there were 21 cases with one previous cesarean section, 3 cases with two previous cesarean section, one case with three times cesarean section, one case with uterine myomectomy surgery, and two cases with repeated abortions. The pregnancy of those 28 patients were terminated by cesarean, in all of which postpartum hemorrhage occurred, and in seven cases of which hysterectomy were performed. There were 23 cases performed elective surgery, among which there were four cases with hysterectomy. There were five cases underwent emergency surgery, among which hysterectomy occurred in three cases, and bladder injury occurred in 2 cases. Conclusion Paying attention to early diagnosis and intervention of dangerous type of placenta previa, standardizing the perinatal treatment, performing adequate preoperative assessment and proper and timely intraoperative treatment are important to reduce postpartum bleeding, side injury, and mortality rate of child and mother.