凶险性前置胎盘手术治疗22例临床分析

Dangerous Placenta Previa Surgery Treatment of 22 Cases of Clinical Analysis

目的探讨凶险性前置胎盘的手术治疗及母儿并发症防治。方法回顾性分析2010年10月至2014年10月22例凶险性前置胎盘患者临床资料。结果 22例患者中21例剖宫产术,发生严重产后出血18例,并发胎盘植入12例,并发胎盘早剥1例,行子宫全切术10例,子宫次全切除术3例,均保留双侧附件。介入2例,保守治疗保留子宫成功8例。1例阴道分娩,产后发现子宫破裂行开腹子宫修补术;术后并发切口感染2例,继发贫血13例,介入患者并发肺栓塞1例,均经治疗好转痊愈出院;围生儿23例(含双胎1例)中存活20例(86.96%),出现新生儿重度窒息3例,轻度窒息6例,围产儿3例死亡。结论凶险性前置胎盘为产科严重并发症重中之危,发生汹涌性出血及子宫切除几率甚高,术前重视,及时转诊至有条件综合医院,做好一切抢救产妇和新生儿准备,评估胎盘植入风险,把握剖宫产时机和子宫切除时机,控制出血,减少并发症及母婴死亡率。

Objective To study the surgical treatment of placenta previa dangerous sex and mother son complications prevention. Methods A retrospective analysis in October 2010 to October 2010 clinical data of 22 patients with placenta previa dangerous sex. Results 21 cases of cesarean section in 22 patients, severe postpartum hemorrhage 18 cases, 12 cases were complicated with placenta increta, I case was complicated with placental abrnption, line the uterus, 10 cases were all cut method, uterus resection of all 3 cases, all keep attachment on both sides.In 2 cases, conservative treatment of 8 cases of uterus success.l case of vaginal delivery, postpartum found broken line open and repair the uterus：Postoperative concurrent incision infbction in 2 cases, secondary anenria in 13, intervention patients complicated with puhnonary embolism ira 1 case, both by treatment of recovered better treatment;Wai begat 23 cases （ including twins 1 ） live in 20 cases （ 863）6% ）, neonatal severe asphyxia （ 3 cases ）, 6 cases mild asphyxia, perinatal death in 3 cases. Conclusion Dangerons sex the risk of placenta previa for obstetric complications, turbulent hemorrhages and hysterectomy rate is very high, preoperative seriously, timely referrals to conditional general hospital, get everything ready to save maternal and newborn, assess the risk of placenta implantation, grasp the cesarean delivery timing and hysterectomy, control of bleeding, reduce complications and maternal and infimt mortality.