瘢痕子宫合并中央性前置胎盘48例分析

48 Cases Analysis of Scar Uterus with Central Placenta Previa

目的分析瘢痕子宫合并中央性前置胎盘妊娠及分娩过程中的处理方式。方法回顾性分析2005年1月1日-2014年12月31日瘢痕子宫合并中央性前置胎盘患者48例临床病理资料。结果瘢痕子宫合并中央性前置胎盘者42例,占全部瘢痕子宫住院孕妇约1.5%,占同期中央性前置胎盘住院孕妇的20.1%,是以无痛性出血为主要表现;前壁胎盘24例,后壁胎盘18例,侧壁胎盘6例;超声仅16例考虑胎盘植入,行子宫切除患者30例,胎盘位于前壁者60%患者切除子宫,42例出血>1 500 ml者中30例患者切除子宫。全部孕妇无一例死亡。结论瘢痕子宫合并中央性前置胎盘者病情凶险,尤其以前壁胎盘者为最,出血>1 500 ml时,若仍出血汹涌,应考虑切除子宫,挽救产妇生命。

Objective To analyze the approach of scar uterus with central placenta previa during pregnancy and delivery. Methods Clinical and pathological data of 48 patients with uterine scar and central placenta previa during 1 January, 2005 to December 31,2014 were retrospectivey andalyzed. Results There were 42 cases with uterine scar with central placenta previa, accounted for nearly 1.5% of hospitalized pregnant women with uterine scar, accounting for nearly 20.1% of pregnant women with central placenta previa in the same period. Painless bleeding was still mainly performance, anterior placenta, accounted for 24 cases; posterior placenta, 18 cases; uterine sidewall palcenta, 6 cases; ultrasound consider 16 cases of placenta accreta were found by ultrasonic testing, which the patients of the 60% of were anterior placenta 30 in 42 cases bleeding more than 1 500 ml were carried out hysterectomy. No death for all pregnant women. Conclusion Uterine scar with central placenta previa was dangerous, especially anterior placenta. Hysterectomy would be carried out in the cases with bleeding more than 1 500 ml blood to save maternal life.