胎盘早剥167例发生原因及母婴结局分析

Clinical analysis of placental abruption in 167 cases

目的探讨胎盘早剥高危因素、发病诱因、临床表现及母婴结局。方法收集2007-01~2012-12在武汉市妇女儿童医疗保健中心住院确诊的胎盘早剥167例患者的临床资料并进行回顾性分析。结果胎盘早剥发生率为0.56%,有明确发病诱因者占62.87%(105/167),以胎膜早破(premature rupture of fetalmembranes,PROM)、妊娠期高血压疾病、机械性因素、双胎、催产等为主。临床表现主要为阴道流血、腹痛、腰痛、胎心监护异常或宫缩过频等。B超检出率为39.74%。Ⅰ度胎盘早剥占54.49%(91/167),Ⅱ度占22.75%(38/167),Ⅲ度占22.75%(38/167)。从患者出现临床症状到其来医院就诊、从来医院到手术或阴道分娩时间Ⅱ、Ⅲ度胎盘早剥组均长于Ⅰ度胎盘早剥组,但差异无统计学意义(P>0.05)。产后出血30例,子宫胎盘卒中31例,子宫次全切除4例,弥散性血管内凝血(disseminated intravascular coagulation,DIC)3例;死胎死产10例,早产及新生儿窒息转新生儿监护病房(neonatal intenisve care unit,NICU)71例。结论胎盘早剥临床表现无特异性,部分患者有临床高危因素;超声容易漏诊;从发病到临床处理时间是影响胎盘早剥程度及母婴预后的重要因素。

[Abstract] Objective To explore the high-risk factors, pathogenesis and clinical manifestions of placental abruption.Methods The clinical data of 167 cases with placental abruption in Wuhan Children Hospital from January 2007 to December 2012 were retrospectively reviewed.Results The incidence of placental abruption was 0.56% in 167 cases,among whom 105 cases had the main predisposing factors（62.87%）, including premature rupture of fetalmembranes（PROM）, hypertensive disorders, complicating pregnancy, traumatic factors, twins and hasten parturition. The main clinical manifestations included vaginal hemorrhage, abdomen pain, fetal heart rate abnormalities and uterine hypertonia. The ultrasonography detection rate was 39.74%. The first-degree placental abruption rate was 54.49%. The second-degree placental abruption rate was 22.75%, and the third-degree placental abruption rate was 22.75%. It needed more time for the patients with the second and the third degree of placental abruption from the onset of the initial clinical sign to the treatment than the patients with the first degree of placental abruption, but there was no significant difference in the time between the two groups（P〉0.05）. After the delivery, postpartum hemorrhage occurred in 30 cases,uteroplacental apoplexy in 31 cases, subtotal hysterectomy in 4 cases, disseminated intravascular coagulation（DIC） in 3 cases, fetal death in 10 cases. and 71 premature neonates were transferred to the neonatal intenisve care unit（NICU）.Conclusion There are nonspecific clinical manifestations of placental abruption. Some cases have high-risk factors while others are misdiagnosed by ultrasound examination. The time from onset of the initial clinical signs to the treatment affects the prognosis of placental abruption.