胎盘早剥的诊断及不同类型胎盘早剥的母婴结局

Study on the diagnosis of placental early stripping and the outcomes of mothers and neonates with different types of placenta praevia

目的分析胎盘早剥的发病因素及临床表现,探讨不同类型胎盘早剥的母婴结局。方法回顾妇产科收治的胎盘早剥58例患者的临床资料,其中轻型胎盘早剥组45例,重型胎盘早剥组13例。分析患者发病的发病因素,不同类型胎盘早剥的临床表现以及母婴结局。结果 58例胎盘早剥患者中罹患妊娠期高血压疾病的9例(15.5%),胎膜早破15例(25.9%)。重型胎盘早剥组胎盘早剥典型症状子宫板状硬伴压痛及血性羊水发生率明显高于轻型胎盘早剥组,差异有显著性(P<0.05);两组阴道出血、腹痛或腰痛、胎心监护异常或胎心音消失发生率无显著差异(P>0.05);重型胎盘早剥组产后出血、子宫胎盘卒中发生率及新生儿在出生后窒息发生率明显高于轻型胎盘早剥组,差异有显著性(P< 0. 05)。结论妊娠期高血压疾病、胎膜早破是胎盘早剥的发病原因。胎盘早剥对母婴危害极大,特别是重型胎盘早剥。不典型胎盘早剥早期诊断有一定困难,需要临床医生提高警惕性,早期诊断可以改善母婴结局。性(P<0.05)。结论妊娠期高血压疾病、胎膜早破是胎盘早剥的发病原因。胎盘早剥对母婴危害极大,特别是重型胎盘早剥。不典型胎盘早剥早期诊断有一定困难,需要临床医生提高警惕性,早期诊断可以改善母婴结局。

Objective To analyze the incidence and clinical manifestations of placental early stripping,and to explore the effect of early diagnosis on maternal and neonatal outcomes under different types of placenta praevia. Methods The clinical data of 58 patients with placental abruption in Department of Gynecology and Obstetrics,including 45 patients in mild placental abruption group,and 13 patients in severe placental abruption group were retrospectively analyzed. The risk factors in these patients with different types of placental abruption,their clinical manifesta-tions and outcomes were analyzed. Results Among 58 patients with placental abruption,9 cases（15. 5% ）complicated with hypertensive disor-der,and 15 patients with premature rupture of membrane（25. 9% ）. The incidence rates of typical symptoms in patients with severe placental ab-ruption including uterine plate hard with tenderness and bloody amniotic fluid were significantly higher than those of patients with light placental abruption group,and the difference was significant（ P 〈 0. 05）. The difference in vaginal bleeding,abdominal pain or lumbago,fetal heart rate monitoring or disappeaarance of abnormal fetal heart sound between these 2 groups was not significant（ P 〉 0. 05）. The incidence rates of post-partum hemorrhage and uteroplacental apoplexy and rate of asphyxia in neonate after birth in severe placental abruption group were significantly higher than those of mild placental abruption group,and the difference was significant（ P 〈 0. 05）. Conclusion The incidence of hypertensive disorder complicated with pregnancy and premature rupture of membranes are the causes of placental early strippng in early pregnancy. Placental early stripping is the great harm to mother and infant,especially the heavy placental praevia. There are some difficulties in the early diagnosis of atypical placental abruption,and it needs to be vigilant,and early diagnosis can improve the maternal and neonatal outcomes.