630例前置胎盘的主体附着位置及疤痕子宫对母儿结局的影响

The effects of placental position in 630 cases of placental previa and scar uterus

目的探讨前置胎盘的主体附着位置及疤痕子宫对母儿结局的影响。方法收集2009年1月至2015年6月630例前置胎盘患者的临床资料并进行回顾性分析。根据胎盘主体附着位置和有无剖宫产史,将630例前置胎盘分为前壁胎盘合并疤痕子宫组(n=145)、前壁胎盘无合并疤痕子宫组(n=129)、后壁胎盘合并疤痕子宫组(n=95)和后壁胎盘无合并疤痕子宫组(n=261)四组。比较四组患者的一般情况、并发症、妊娠结局及新生儿情况。结果四组患者的产前出血量差异无统计学意义(P>0.05),而终止孕周、分娩方式、胎盘植入发生程度、输血量、产后出血量差异有统计学意义(P<0.05)。四组患者的新生儿体重、新生儿5 min Apgar评分差异无统计学意义(P>0.05),而新生儿早产发生率差异有统计学意义(P<0.05)。结论前置胎盘的主体附着位置及疤痕子宫对母儿结局的影响存在差异性,尤其应注意胎盘植入发生程度、输血量、产后出血量等不良妊娠结局的出现影响母儿健康。

Objective To explore the effects of placental position in 630 cases of placental previa and scar uterus.Methods 630 cases of placental previa at the third affiliated Hospital of Guangzhou Medical University from January 2009 to June 2015 were retrospectively analyzed. They were divided into four groups according to different location of the main part of the placenta and the history of cesarean section： the anterior placenta with scar uterus group（n=145）,the anterior placenta without scar uterus group（n=129）,the posterior placenta with scar uterus group（n=95） and the posterior placenta without scar uterus group（n=261）. The general situation,complication,pregnancy outcome and its newborn of these four groups were compared. Results There had no significant differences of antenatal blood loss among four groups（P〉0.05）.There had significant differences of termination of the gestational weeks,delivery mode,the degrees placenta invade in uterine myometrium,blood transfusion,postpartum hemorrhage among four groups（P〈0.05）. There had no significant differences of newborn birth weight,5 min newborn APGAR score among four groups（P〉0.05）. There had significant differences of the incidence of prematurity among four groups（P〈0.05）. Conclusion The effects of placental position in placental previa and scar uterus have difference in maternal-fetal outcome. Especially we should pay attention to adverse pregnancy outcomes such as the degrees of placenta invade in uterine myometrium,blood transfusion and postpartum hemorrhage,which can affect the health of mother and newborn.