胎盘早剥332例临床分析

Clinical analysis of 332 cases with placental abruption

目的探讨胎盘早剥的诱因、临床特点和胎盘早剥对围产儿和母体的影响。方法回顾性分析332例胎盘早剥患者的临床资料。结果 332例胎盘早剥患者中,有明确发病诱因者223例,占67.17%,其中妊娠期高血压疾病119例(35.84%),羊水过多87例(26.20),胎膜早破16例(4.82%),为胎盘早剥的主要诱因;332例孕产妇均存活,其中行剖宫产终止妊娠者297例(89.45%),手术原因包括:术前考虑胎盘早剥者261例(78.61%),术前发现死胎13例(3.91%),术前发现胎儿窘迫18例(5.42%);3例新生儿抢救失败死亡,占0.90%,余294例抢救后存活。332例胎盘早剥患者中轻型胎盘早剥者34例,重型胎盘早剥者298例,重型胎盘早剥者产后出血发生率显著高于轻型胎盘早剥者(x^2=28.376,P=0.000),而胎死宫内、新生儿窒息、转新生儿重症监护室、患者子宫切除发生率均无显著性差异(x^2值分别为1.544、0.001、0.579、1.420,均P>0.05)。结论积极治疗妊娠期高血压疾病,避免外伤和胎膜早破是防治胎盘早剥的有效措施,早期诊断与治疗胎盘早剥并发症是改善预后的重要方法。

Objective To explore the causes and clinical characterisitics of placental abruption and its effect on perinatal and maternal outcomes. Methods The clinical information of 332 patients with placental abruption was retrospectively analyzed. Results There were 223 cases with definite inducement （67. 17%）, including the major causes of gestational hypertension in 119 cases （35. 84%）, polyhydramnios in 87 cases （26.20%） and premature rupture of membrane in 16 cases （4.82%）. All of the cases were survived and 297 cases （89.45%） terminated pregnancy by cesarean section. The operation causes included preoperative consideration of placental abruption in 261 cases （78.61%）, stillbirth found before surgery in 13 cases （3.91%）, and preoperative fetal distress in 18 cases （5.42%）. Three cases of neonates died, accounting for 0.90%. The rest 294 neonates were successfully rescued. Among 332 cases of placental abruption, there were 34 cases with moderate or mild placental abruption and 298 cases with severe placental abruption. The incidence of postpartum hemorrhage in cases with severe placental abruption was significantly higher than that in moderate or mild cases （χ^2 = 28. 376, P = 0. 000 ） , but the incidence rate of fetal death, neonatal asphyxia, transferring to neonatal intensive care unit, and uterine resection showed no significant difference between two groups （χ^2 value was 1. 544, 0. 001, 0. 579 and 1. 420, respectively, all P 〉 0.05 ）. Conclusion Active treatment of hypertensive disorders in pregnancy, avoiding injury and premature rupture of membrane are effective measures for prevention and treatment of placental abruption. Early diagnosis and treatment of placental abruption complications is an important method to improve prognosis.