植入性与非植入性凶险性前置胎盘临床特点分析

Clinical analysis of pernicious placenta previa with and without placenta accrete

目的 分析植入性与非植入性凶险性前置胎盘的临床特点,探讨其围生期处理策略.方法 收集2010年5月至2015年1月于首都医科大学附属北京安贞医院分娩的22例凶险性前置胎盘产妇的临床资料,其中植入性凶险性前置胎盘14例（植入组）,非植入性凶险性前置胎盘8例（非植入组）,比较2组产妇一般临床资料、妊娠结局及产后出血处理方式.结果 植入组孕次多于非植入组,差异有统计学意义[（3.8±1.1）次比（3.1±1.1）次,P＜0.05],年龄、孕周、流产次数及剖宫产次数植入组与非植入组差异均无统计学意义[（35±6）岁比（36 ±4）岁,（34.4 ±0.0）周比（35.3±1.5）周,（1.6±1.2）次比（1.1±1.1）次,（1.1±0.3）次比（1.0±0.0）次;均P ＞0.05].植入组产后出血例数、产后出血量、输血例数及子宫切除例数均多于非植入组,差异有统计学意义[13例比4例,（4 057 ±3 963） ml比（400±214） ml,13例比2例,7例比0例;P＜0.05].17例发生产后出血患者中7例行子宫切除术,均为植入性凶险性前置胎盘患者,其中2例行次全子宫切除术、5例行全子宫切除术.结论 植入性凶险性前置胎盘产妇产后出血和子宫切除率高,应术前明确胎盘位置及有无植入,制定抢救预案,以保证孕产妇生命安全.

Objective To analyze the clinical features of placenta previa with and without placenta accrete,and to explore the treatment strategies.Methods Clinical data of 22 patients with pernicious placenta previa,including 14 cases with placenta accreta （accreta group） and 8 cases without placenta accreta （non-accreta group） from May 2010 to January 2015,was collected.The general data,pregnancy outcomes and treatment methods of postpartum hemorrhage were analyzed.Results The pregnant time in accreta group was （3.8 ± 1.1） times,more than that in non-accreta group [（3.1 ± 1.1） times,P 〈0.05];the age,gestational age,abortion times and cesarean section times had no significant differences between accreta group and non-accreta group [（35 ±6） years vs （36 ±4） years,（34.4±0.0） weeksvs （35.3 ±1.5） weeks,（1.6±1.2） times vs （1.1 ±1.1） times,（1.1 ±0.3） times vs （1.0 ± 0.0） times,all P 〉 0.05].In accreta group,the number of postpartum hemorrhage,amount of hemorrhage,the number of blood transfusion and hysterectomy were all more than those in non-ccreta group [13 vs 4,（4 057 ± 3 963） ml vs （400 ±214） ml,13 vs 2,7 vs 0,all P 〈0.05）.In 17 cases of postpartum hemorrhage,7 received hysterectomy,all being placenta previa with placenta accrete,including 2 of subtotal hysterectomy and 5 of complete hysterectomy.Conclusion Patients of placenta previa with placenta accrete have a high rate of postpartum hemorrhage and hysterectomy;the placental location and the situation of implantation should be diagnosed before surgery;the rescue plans should be predetemined to ensure the safety of pregnant women.