41例胎盘早剥诊断与母婴结局分析

Diagnosis of 41 Cases of Placental Abruption and Analysis of Maternal and Infant Outcomes

目的回顾胎盘早剥的临床资料,分析早期识别胎盘早剥的临床线索及处理要点,达到改善母婴结局,降低母儿并发症发生率的目的。方法回顾性分析该院2015年1月-2018年12月收治的41例胎盘早剥患者,根据胎盘早剥病情的实际严重情况分为0级(n=19)、Ⅰ级(n=2)、Ⅱ级(n=5)、Ⅲ级(n=15)。分析发病原因、临床表现、分辨方式及产妇结局及围产儿结局。结果 41例胎盘早剥患者中32例存在明确诱因,其中比例最高的分别是妊娠期高血压疾病、胎膜早破,其次是外伤、脐带因素,腰腹胀痛、阴道流血、胎心异常是该组胎盘早剥的主要特征,合并2种以上的Ⅱ级和Ⅲ级胎盘早剥组占43.9%,0级胎盘早剥为0.0%,0级与Ⅱ、Ⅲ级胎盘早剥临床特征差异有统计学意义(P<0.05)。结论妊娠期高血压疾病、胎膜早破是胎盘早剥的主要发病原因,其次有外伤、脐带因素等。加强对医疗技术相对落后的偏远山区孕妇孕期监测,及时发现胎盘早剥,组建抢救团队并有效治疗,对合并难治性产后出血的患者果断切除子宫,能降低母儿死亡率,提高治疗效果,改善母婴结局。

Objective To review the clinical data of placental abruption and analyze the clinical clues and treatment points of early detection of placental abruption, to improve the outcome of maternal and child outcomes and reduce the incidence of maternal and child complications. Methods A retrospective analysis of 41 patients with placental abruption who were admitted to the hospital from January 2015 to December 2018 was divided into level 0(n=19) and level Ⅰ(n=2), level Ⅱ(n=5),level Ⅲ(n=15) according to the actual severity of placental abruption. Analysis of the cause of the disease and clinical manifestations, resolution and maternal outcomes and perinatal outcomes. Results Among the 41 patients with placental abruption, 32 patients had clear incentives. The highest proportions were hypertensive disorders of pregnancy and premature rupture of membranes, followed by trauma, umbilical cord factors, waist and abdomen swelling/pain, vaginal bleeding, and abnormal fetal heart rate. The main features of this group of placental abruption, combined with more than 2 kinds of level Ⅱ and Ⅲ placental abruption group accounted for 43.9%, grade 0 placental abruption was 0.0%, and the difference of 0 grade and Ⅱ, Ⅲ grade placental abruption clinical characteristics were statistically significant(P<0.05). Conclusion Hypertensive disorder of pregnancy and premature rupture of membranes are the main causes of placental abruption, followed by trauma and umbilical cord factors. Strengthen the monitoring of pregnant women in remote mountainous areas with relatively backward medical technology, timely discover the placental abruption, set up a rescue team, effectively treat, and decisively remove the uterus with refractory postpartum hemorrhage, which can reduce the maternal and child mortality, improve the treatment effect, and improve maternal and child outcomes.