胎盘附着位置对胎盘早剥妊娠结局的影响

Influence of placental position on pregnancy outcome in patients with placental abruption

目的分析胎盘早剥过程中不同胎盘附着位置的临床特点及其对母儿结局的影响。方法收集2012年1月~2016年12月成都市妇女儿童中心医院住院分娩的单胎胎盘早剥并行剖宫产术662例患者的临床资料,按胎盘附着部位分为前壁组139例,后壁组83例。采用回顾性研究方法对两组的一般情况、临床特征及母儿结局进行分析比较。结果前壁组入院到确诊时间(1.64±1.52)h短于后壁组(3.22±2.11)h;前壁组的术前诊断率高于后壁组(75.5%vs61.4%);前壁组的产后出血量(523.8±114.4)ml低于后壁组(749.6±181.7)ml;前壁组的阴道出血大于1000ml者低于后壁组(32.7%vs 47.0%),前壁组新生儿窒息率低于后壁组(27.7%vs 42.2%),前壁组转儿科治疗率低于后壁组(31.2%vs 45.9%),差异均有统计学意义(P<0.05)。两组腹痛、血性羊水、子宫卒中、新生儿出生体重及围产儿死亡率比较差异无统计学意义(P>0.05)。结论附着后壁的胎盘早剥病例临床症状不典型,分娩前诊断低于附着前壁者,临床上应密切观察,做到早期诊断,早期干预,避免漏诊误诊,降低围产期并发症,改善母儿预后。

Objective To analyze the clinical significance of placenta location in placental abruption. Methods The clinical data of patients with placental abruption in Chengdu women and children＇s Hospital were collected from January 2012 to December 2016. The patients were divided into anterior placenta group and posterior placenta group according to placental location. The clinical features and outcome of the two groups were retrospectively compared. Results Time in- terval（between onset of symptoms and C-section）of anterior placenta group was shorter than that of posterior placenta group（1.64± 1.52h vs 3.22 ± 2.1 l h）. The rate of correct diagnosis before operation of anterior placenta group was high- er than that of posterior placenta group（75.5% vs 61.4%）. Rate of postpartum hemorrhage anterior placenta group was less than that posterior placenta group（523.8± 114. 4ml vs 749.6±181.7 ml）. The incidence of postpartum hemorrhage anterior placenta group was less than that posterior placenta group（32.7% vs 47.0%）. The incidence of neonatal as- phyxia in anterior placenta group was less than that posterior plaeenta group（27.7% vs42.2% ）. The rate of neonates ad- mitted in NICU anterior placenta group was less than that posterior placenta group（31.2 % vs 45.9 %）. Above all, the differences were statistically significant（P〈0.05）. There were no differences between the two groups in incidences of ab- dominal pain, vaginal bleeding, uterine apoplexy, and fetal weight, perinatal mortality（P〉0.05）. Conclusion Clinical symptoms of posterior placenta placental abruption were atypical. More attention should be paid to the patients with pos- terior placental location, in order to make correct diagnosis and quick treatment, thus improve the outcomes of maternal- fetal prognosis.