凶险性前置胎盘与普通型前置胎盘的临床病例分析

The Clinical Analysis of Dangerous Placenta Previa and Ordinary Placenta Previa

目的:探讨凶险性前置胎盘的临床特点及处理方法。方法:回顾性分析2012年7月—2014年6月郑州大学第二附属医院(我院)分娩的9 640例孕妇,其中瘢痕子宫孕妇1 284例,前置胎盘128例,包括普通型前置胎盘94例(占73.4%),凶险性前置胎盘34例(占26.6%),前置胎盘占同期分娩孕妇的1.3%(128/9 640),凶险性前置胎盘孕妇占同期瘢痕子宫孕妇的2.6%(34/1 284),分析患者的一般资料及胎盘植入和手术情况。结果:凶险性前置胎盘组胎盘植入率高于普通型前置胎盘组(χ2=11.04,P=0.00)。凶险性前置胎盘组手术时间、出血量及输血量大于普通型前置胎盘组(均P<0.05),术前血红蛋白(Hb)值差异无统计学意义(P>0.05),但凶险性前置胎盘组术后修订Hb值低于普通型前置胎盘组(P<0.05)。结论:凶险性前置胎盘合并胎盘植入率高,手术难度大,易导致严重的产时产后大出血,威胁母儿安全,因此在做好充分的术前准备的情况下,择期由经验丰富的产科医师进行手术是治疗成功的关键。严格把握首次剖宫产指征,以降低凶险性前置胎盘的发生率。

Objective：To analyze the clinical feature and treatment of dangerous placenta previa. Methods：The clinical data of 9 640 people who delivered in our hospital in July 2012 —June 2014 were reviewed retrospectively, including 1 284 cases with once or more history of cesarean section, accounted for 1.3%（128/9 640） of the delivery of pregnant women at the same period. 128 cases of placenta previa, accounted for 2.6%（34/1 284） of the scar uterus pregnant women at the same period.Including 94 cases（73.4%） of ordinary placenta previa and 34 cases（26.6%） of dangerous placenta previa. Results：The incidence of dangerous placenta previa complicated by placenta accreta was significantly higher than that of common placenta previa group（χ^2=11.04, P =0.00）. The duration of operation, amount of bleeding in or after operation and the amount of blood transfusion were higher than the common placenta previa group（P〈0.05）. There were no significant difference in the Hb value before operation（P〉0.05）, but the amended Hb value in dangerous placenta previa group was lower than the ordinary placenta previa group after operation（P〈0.05）. Conclusions：The rate of dangerous placenta previa complicated by placenta accreta was high, the operation was difficult, liable to accur severe intrapartum and postpartum hemorrhage, so it was dangerous to mother and perinatal fetus. Elective surgery with full preparation and by experienced obstetrician is the key to successful treatment. Strictly for the first time cesarean section pointer, in order to reduce the incidence of dangerous placenta previa.