凶险性前置胎盘剖宫产119例临床分析

Clinical Analysis of 119 Cases of Pernicious Placenta Previa Caesarean Section

【目的】探讨凶险性前置胎盘围术期处理方法。【方法】回顾性分析2012年1月至2018年12月首都医科大学附属北京朝阳医院妇产科诊治的119例凶险性前置胎盘的患者临床资料,根据前置胎盘类型分为中央型前置胎盘组(中央型组)、非中央型前置胎盘组(非中央型组)。比较两组患者胎盘植入率、产后出血量、围术期输血量、手术时间及子宫切除率。【结果】中央型组胎盘植入率为36.8%( 35/95),明显高于非中央型组胎盘植入率的8.3 %(2/24);中央型组术中出血量为(1562±2253) mL,显著高于非中央型组的(637 ±1043)mL;中央型组围手术期输血率为38.9%(37/95),显著高于非中央型组的8.3%(2/24);中央型组患者手术时间(110±76)min,显著高于非中央组的(82.8±38)min,其差异均有统计学意义(P <0.05)。两组患者子宫切除率比较差异无统计学意义(P >0.05)。【结论】凶险性前置胎盘均有胎盘植入,且中央型发生率较高,出血及输血风险高。

[ Objective ] To investigate perioperative management of pernicious placenta previa.[Methods] The clinical data of 119 cases of pernicious placenta previa from January 2012 to December 2018 were analyzed retrospectively. The patients were divided into two groups: the completed placenta previa group and the noncentral type of pernicious placenta previa group. Placenta implantation rate, postpartum hemorrhage amount, perioperative blood transfusion volume, operation time and uterine resection rate were analyzed and compared between the two groups,[Results]Placental implantation rate in the central group was 36.8%(35/95), significantly higher than that in the non-central group 8.3%(2/24, P <0.01). Postpartum hemorrhage amount: The median value of postpartum hemorrhage amount was 800(200.16000)mL in the central group, the mean was 1562±2253 ml. and that in the non-central group was 300( 150.4000)mL and 637± 1043 mL, respectively. That of the central group was significantly higher than of the non-central group ( P <0.01). Perioperative blood transfusion: in the central group, the blood transfusion rate was 38.9%(37/95 ), while in the the non-central group, it was 8.3%(2/24). That of the central group was significantly higher than that of the noncentral group. Operation time: patients in the central group had significantly longer operative time (118± 76 min) than those in the non-central group (82.8±38 min)( P <0.05). There was no significant difference in uterine resection rate between the two groups.[Conclusion]Central type of pernicious placenta previa is more liable to acquire placenta increta, and the risk of hemorrhage and blood transfusion is higher than the non-central group.