胎盘附着部位与凶险性前置胎盘产后出血的相关性及其危险因素分析

The correlation between placental attachment and dangerous postpartum hemorrhage of placenta previa and its risk factors

目的探讨胎盘附着部位与凶险性前置胎盘产后出血的相关性及危险因素。方法选择2015年3月—2018年8月在蚌埠医学院第一附属医院妇产科治疗的剖宫产后再次妊娠的凶险性前置胎盘患者90例作为研究对象,根据胎盘附着部位分为对照组(n=42例,胎盘附着位置未跨越子宫疤痕)和观察组(n=48例,胎盘附着在子宫疤痕部位)。入院后完善相关检查,查阅病例资料,统计并分析2组产妇年龄、孕次、产次、本次妊娠距离上次剖宫产时间、末次妊娠结局、终止妊娠孕周、产前出血史、前次剖宫产医院级别等,对上述危险因素进行单因素及多因素Logistic分析;统计并记录2组娩出后早产儿、低体质量儿及新生儿窒息发生率。结果观察组产后出血率52.08%,高于对照组的11.90%(χ~2=8.573,P=0.038);单因素及多因素Logistic分析结果表明:不同胎盘附着部位患者凶险性前置胎盘出血率与本次妊娠距离上次剖宫产时间、末次妊娠结局、产前出血史、前次剖宫产医院级别均具有相关性(χ~2=5.361、6.892、5.195、7.835,P<0.05);2组娩出后早产儿、低体质量儿发生率差异均无统计学意义(P>0.05);观察组新生儿窒息发生率、子宫切除率、产后抑郁及羊水过多发生率均高于对照组(χ~2=5.757、7.993、5.109、4.512,P=0.041、0.029、0.017、0.023)。结论胎盘附着部位与凶险性前置胎盘产后出血存在相关性,应根据危险因素制定有效的干预措施,降低产后出血率。

Objective To explore the correlation and risk factors between placental attachment and dangerous postpartum hemorrhage of placenta previa.Methods Ninety patients with dangerous placenta previa who were treated in gynecology and obstetrics department of the First Affiliated Hospital of Bengbu Medical College from March 2015 to August 2018 were divided into control group(n=42 cases,placenta attachment did not cross the uterine scar)and observation group(n=48 cases,placenta attachment to the uterine scar).After admission,relevant examinations were improved,case data were consulted,and the age,number of pregnancies,number of births,the distance between this pregnancy and the last cesarean section,the outcome of the last pregnancy,the gestational week of termination of pregnancy,the history of prenatal hemorrhage,the level of the previous cesarean section hospital,etc.were analyzed by single factor and multi-factor logistic analysis.The incidence of asphyxia in quality infants and neonates.Results The postpartum hemorrhage rate of the observation group was 52.08%,which was 11.90%higher than that of the control group(χ^2=8.573,P=0.038).The results of single factor and multivariate logistic analysis showed that the risk of placental placenta bleeding in patients with different placenta attachment sites and this time Pregnancy was associated with the last cesarean section time,the final pregnancy outcome,the history of prenatal bleeding,and the previous cesarean section hospital grade(χ^2=5.361,χ^2=6.892,χ^2=5.195,χ^2=7.835,P<0.05).There was no significant difference in the incidence of premature infants and low birth weight infants between the two groups(P>0.05).The incidence of neonatal asphyxia,hysterectomy rate,postpartum depression and polyhydramnios was higher in the observation group than in the control group(χ^2=5.757,χ^2=7.993,χ^2=5.109,χ^2=4.512,P=0.041,P=0.029,P=0.017,P=0.023).Conclusion There is a correlation between placental attachment sites and postpartum hemorrhage in sinister placenta previa.Effective intervention measures should be developed according to risk factors to reduce postpartum hemorrhage rate.