胎盘后血肿和绒毛膜下血肿的临床特征及妊娠结局的对比分析

Comparative Analysis of Pregnancy Outcome and Influencing Factors of Hematoma after Placenta and Subchorionic Hematoma

目的:探讨胎盘后血肿及绒毛膜下血肿的临床特征及妊娠结局,提高对两种血肿的认识。方法:收集2013年1月至2017年3月妊娠中期发现并于大连市妇幼保健院分娩的107例宫腔内血肿病例,其中胎盘后血肿56例,绒毛膜下血肿51例。对两组患者的临床特征及妊娠结局进行分析比较。结果:胎盘后血肿组足月妊娠率明显低于绒毛膜下血肿组(55.4%vs 84.3%),流产、早产率高于绒毛膜下血肿组(21.4%vs 5.9%,23.2%vs 7.8%),差异有统计学意义(P<0.05)。绒毛膜下血肿组血肿体积大于胎盘后血肿(18284.43 mm^3vs 8871.79 mm^3),胎盘后血肿分娩孕周明显小于绒毛膜下血肿(37.17±3.34周vs 38.22±2.71周),差异有统计学意义(P<0.05)。胎盘后血肿发生胎儿窘迫的风险高于绒毛膜下血肿(13.6%vs 2.1%,RR 1.917),差异有统计学意义(P<0.05);其他并发症两组比较差异无统计学意义(P>0.05)。胎盘后血肿组胎膜早破、胎盘异常及胎盘残留发生率均高于绒毛膜下血肿组(40.9%vs 12.5%,38.6%vs 12.5%,29.5%vs 6.3%),差异有统计学意义(P<0.05)。胎盘后血肿组新生儿体质量较绒毛膜下血肿组低(3080.68±796.59 g vs 3364.58±571.10 g),并且易并发新生儿疾病(15.9%vs 2.1%),差异均有统计学意义(P<0.05)。结论:胎盘后血肿和绒毛膜下血肿两种血肿的体积、分娩孕周、妊娠结局明显不同,胎盘后血肿较绒毛膜下血肿可能更易导致不良妊娠结局的发生。

Objective：To explore the clinical features and pregnancy outcomes of the hematoma after placental hematoma and subchorionic hematoma. Methods：From January 2013 to March 2017,a total of 107 cases of intra-uterine hematoma were found in the middle of pregnancy and delivered in the maternal and child health care hospital of Da Lian,including 56 cases of retroplacental hematoma and 51 cases of subchorionic hematoma. The clinical characteristics and pregnancy outcomes of the two groups were compared. Results ：The full-term pregnancy rate in the retroplacental hematoma group was lower than that in group under the subchorionic hematoma（55. 4% vs 84. 3%, ） ,miscarriage rate and premature birth rate are higher than the subchorionic hematoma group（21.4% vs 5. 9% ,21.4% vs 7. 8%） ,the difference was statistically significant （ P 〈 0. 05）. The volume of hematoma under the chorionic film was greater than that of the retroplacental （ 18284. 43 mm3 vs 8871.79 mm3 ）, and the postpartum hematoma was significantly smaller than that of the subchorionic hematoma（37. 17 ±3. 34 weeks vs 38. 22 ± 2. 71 weeks） ,and the difference was statistically significant（ P 〈0. 05）. The risk of fetal distress after placental hematoma was higher than that of the subchorionic hematoma（ 13. 6% vs 2. 1% ） ,and the difference was statistically significant. There was no statistically significant difference in the other complications between the two groups（ P〉0. 05）. The incidence of fetal membrane rupture,placental abnormality,and placental residue were all higher than that in the subchorionic hematoma group（40. 9% vs 12. 5%, 38. 6% vs 12. 5% ,29. 5% vs 6. 3% ）, and the difference was statistically significant（ P 〈0. 05）. The neonatal body mass in the postpartum hematoma group was lower than that in the subchorionic hematoma（3080. 68 ± 796. 59 g vs 3364. 58 ±571.10 g）,and the incidence of neonatal diseases（ 15. 9% vs 2. 1% ）, and the difference was statistically significant （ P 〈0. 05）. Conclusions：The volume of hematoma,gestational age of delivery,and pregnancy outcome are significantly different between retroplacental hematoma and subchorionic hematoma patients. The risk of adverse outcome in the retroplacental hematoma was higher than that in the subchorionic hematoma.