不典型胎盘早剥的产前漏诊原因分析

Analysis of Misdiagnosis Causes of Prenatal Atypical Abruption Placentae

目的分析不典型胎盘早剥的产前漏诊原因,以指导临床诊断。方法以2010-01~2014-01间我院收治的180例胎盘早剥患者为研究对象,对其行回顾性分析,按是否出现产前漏诊将其划分为漏诊组（n=48）和确诊组（n=132）。对比两组发病诱因、临床症状与体征、胎盘早剥面积、总出血量、胎盘附着位置,分析产前漏诊的原因。结果漏诊组存在明确诱因者较确诊组明显更少（P〈0.05）,且漏诊组诱因以引产及催产为主;漏诊组临床症状及体征表现为腹痛及阴道出血者占比明显低于确诊组（P〈0.05）,且漏诊组多表现为胎心监护异常;漏诊组胎盘早剥面积、总出血量均明显低于确诊组（P〈0.05）;漏诊组胎盘附着于子宫后壁者所占比例明显高于确诊组（P〈0.05）。结论不典型胎盘早剥多因引产及催产导致,临床症状及体征表现不明显,临床确诊需采取多种检测方案、结合病史,进行鉴别诊断。

Objective To analyze the causes of prenatal misdiagnosis of atypical abruption placentae,in order to guide clinical diagnosis. Methods 180 abruption placentae patients accepted by the hospital from January,2010 to January,2014 were selected as the research object,and retrospective analysis was done. According to the diagnosis results,they were divided into Misdiagnosis Group（ n = 48）and Diagnosis Group（ n = 132）. The predisposing factors,clinical symptoms and signs,placental abruption area,the total amount of bleeding and placental location of two groups were compared. Results Patients with predisposing factors in Misdiagnosis Group was significantly less than in Diagnosis Group（ P〈0. 05）. And the main predisposing factors in Misdiagnosis Group were odinopoeia and hasten parturition. Patients with clinical symptoms and signs,such as abdominal pain and vaginal bleeding in Misdiagnosis Group was significantly less than in Diagnosis Group（ P〈0. 05）. And the main clinical symptoms and signs in Misdiagnosis Group was fetal heart monitoring abnormal. The placental abruption area and the total amount of bleeding in Group Misdiagnosis were significantly lower than that of Diagnosis Group（ P〈0. 05）. Patients whose placenta were attached to the posterior wall of the uterus were significantly more than in Diagnosis Group（ P〈0. 05）. Conclusion The causes of atypical abruption placentae are mainly due to odinopoeia and hasten parturition. Most patients＇ clinical symptoms and signs are not obvious. During clinical diagnosis,various detection schemes should be adopted,and the history be combined,in order to make right diagnosis.