13例重度胎盘早剥临床分析

Clinical Analysis of 13 Cases of Severe Placental Abruption

目的探讨重度胎盘早剥的发病风险因素、早期识别诊断,管理以及评估孕产妇和母婴结局。方法对我院2012年1月—2016年12月来诊断13例重度胎盘早剥患者病情进行回顾性分析。结果最近5年在院分娩重度胎盘早剥发生率为0.092%。首位诱发因素重度子痫前期8例(61.54%),不明原因3例(23.08%),其它有脐带缠绕、外伤性因素、胎膜早破等因素。全部剖宫产终止妊娠;子宫胎盘卒中7例,凝血功能障碍5例,产后出血11例,积极正确处理后13例产妇无一例死亡;新生儿7例,其中发生重度HIE并发颅内大量出血在NICU死亡1例,流产或死胎6例。结论重度胎盘早剥致围产儿病死率高,产妇大出血率高,应引起临床医生高度重视,密切关注症状、胎心变化及产程进展,接诊医生思维应广阔,早期发现、早期诊断,及时正确干预,可提高围生儿和产妇预后。

Objective To explore the risk factors, early identification and management of severe placental abruption, and to evaluate and evaluate the outcomes of pregnant women, mothers and infants. Methods Retrospective analysis of 13 cases of severe placental abruption diagnosed in our hospital from January 2012 to December 2016. Results The incidence of severe placental abruption in the past 5 years in hospital was 0.092%. The firstpredisposing factors were severe preeclampsia in 8 cases（61.54%）, unknown causes in 3 cases（23.08%）, other factors such as umbilical cord entanglement, traumatic factors, premature rupture of membranes and other factors. All the cesarean section, 7 cases of uteroplacental apoplexy, 5 cases of blood coagulation dysfunction, 11 cases of postpartum hemorrhage, 13 cases of maternal positive after treatment, no one of neonatal death. 7 cases of newborn, severe HIE complicated with intracranial hemorrhage in 1 case of death in a large number of NICU, 6 cases of abortion or stillbirth. Conclusion Severe placental abruption caused by perinatal mortality, maternal bleeding rate is high, so clinicians should pay more attention to the progress, pay close attention to symptoms, the fetal heart rate and birth process, doctors should be thinking of the broad, early detection, early diagnosis and timely intervention can improve the perinatal and maternal outcomes.