胎盘早剥65例临床分析

Clinical analysis of 65 cases of placental abruption

目的分析胎盘早剥的原因,提高早期确诊率,降低母婴并发症。方法回顾性分析广州医科大学附属深圳沙井医院2012年1月至2013年12月胎盘早剥患者的临床资料,其中早产34例,足月产31例,分析两组临床表现、母婴结局。结果产科胎盘早剥发生率为0.49%(65/13 365),以妊娠期高血压疾病、胎膜早破为主。临床表现主要为腹胀或腹痛、阴道流血、血性羊水。B超检出率为41.67%。早产儿组和足月儿组胎盘早剥发病诱因、临床表现和母婴结局有显著性差异(χ2值分别为23.62、44.74、96.00,均P<0.05),而分娩方式无显著性差异(χ2=0.03,P>0.05)。结论胎盘早剥临床表现易与先兆早产/临产或胎儿窘迫等混淆,超声容易漏诊,动态观察病情、及时诊断及治疗是关键。

Obtective To analyze the causes of placental abruption so as to improve early diagnosis rate and reduce maternal and neonatal complications. Methods The clinical data of 65 cases of placental abruption admitted during the period of January 2012 to December 2013 in Shenzhen Shajing Affiliated Hospital of Guangzhou Medical University were retrospectively reviewed, including 34 cases of preterm infants and 31 cases of term infants. Clinical manifestations and maternal and neonatal results were analyzed. Results The incidence of placental abruption was 0.49% （65/13 365 ）, and hypertensive disorders of pregnancy and premature rupture of membrane predominated. The main clinical manifestations included lower abdomen pain, vaginal hemorrhage and bloody amniotic fluid. The detection rate with B- ultrasonography was 4l. 67%. Risk factors, clinical manifestations and pregnancy outcomes were significantly different between two groups （X2 value was 23.62, 44.74 and 96.00, respectively, all P 〈 0.05 ）, but there was no significant difference in delivery mode （X2 = 0.03, P 〉 0.05 ）. Conclusion The clinical manifestations of placental abruption are easily confused with threatened preterm labor/labor or fetal distress. Missed diagnosis of ultrasonic examination often happens, so dynamically monitoring clinical symptoms, timely diagnosis and treatment are the keys.