不同附着位置前置胎盘产妇临床诊疗效果对比分析

Clinical diagnosis and treatment of placenta previa with different implantation sites

目的:对比不同附着位置的前置胎盘患者的临床诊疗效果。方法:本院5年来收治148例前置胎盘患者,其中附着于子宫前壁者46例(前壁组),附着于后壁者102例(后壁组)。对比两组相关因素、临床类型、围产期并发症及新生儿情况。结果:1附着于子宫前壁与后壁的前置胎盘患者的年龄以及生产时的孕周无明显差异;前壁组孕次(3.41±2.6/2.18±1.5)和瘢痕子宫明显高于后壁组[45.65%、18.63%,(P<0.05)],多为完全性前置胎盘(69.57%),而后壁组多为边缘性和部分性前置胎盘(46.08%,33.33%);2两组产前出血无明显差异[(321.3±127.4)ml/(333.3±130.5)ml,P>0.05],前壁组产后出血和产褥感染明显多于后壁组(988.9±119.7/477.1±109.9,13.04%/5.89%,P<0.05),Apgar评分较低(8.4±0.6/9.1±0.4,P<0.05),RDS发生率较高(13.04%/3.92%,P<0.05),而体重则较轻[(2.53±1.51)kg/(3.74±1.16)kg,P<0.05]。结论:附着于子宫前壁的前置胎盘患者与多次妊娠、瘢痕子宫有关,且多为完全性前置胎盘;其产妇围产期并发症多,新生儿状况较后壁组差,故临床诊疗中应采用多种综合措施。

Objective： To compare the clinical data of placenta previa with different implantation sites, and to provide reference for diagnosis and treatment of this disease. Method： Data of 148 women suffering from placenta previa in our hospital were collected in the past 5 years, and 46 women had placental implantation site on the anterior （anterior group） and 102 women on the posterior uterine wall （posterior group）. The related factors, clinical types, perinatal complications and neonatal status were compared between the two groups. Result.. There were no significant difference in the age and the gestational age between the two groups; the average times of pregnancy （3.41±2.6） and the incidence of uterine scar （45.65%） in the anterior group were significantly higher than those of the posterior group [（2.18 ±1.5）, 18.63%, P〈0.05]. There were more complete placenta previa in the anterior group （69.57%）, and there were more marginal placenta previa and partial placenta previa in the posterior group （46.08%, 33.33%）. There was no significant difference in the incidence of antepartum hemorrhage between the two groups [（321.3±127.4） ml vs. （333.3±130.5） ml, P〉0.051 ]; Compared with the posterior group, the amount of postpartum hemorrhage was more [（988.9±119.7） vs. （477.1±109.9）, P〈0.05], the incidence of puerperal infection was higher （13.04% vs. 5.89%, P〈0.05）, Apgar score was lower [（8.4±0.6） vs. （9.1±0.4）, P〈0.05], the incidence of respiratory distress syndrome was higher （13.04% vs. 3.92%, P〈0.05）, and the neonatal weight was lighter [（2.53± 1.51）kg vs. （3.74±1.16）kg, P〈0.05] in the anterior group. Conclusion： Multiple pregnancy and uterine scar would be risk factors of placenta previa with placental implantation site on the anterior uterine wall, in which the incidence of maternal perinatal complications is more, and the neonatal status is worse. Therefore, comprehensive measures should be conducted in clinical diagnosis and treatment of this disease.