完全性前置胎盘并发胎盘植入的高危因素分析及其对母婴结局影响

Clinical risk factors and the influence on maternal and neonatal outcomes of complete placenta previa with placenta increta

目的分析完全性前置胎盘并发胎盘植入的高危因素和母婴结局,为及时干预、减少并发症及改善母婴结局提供依据。方法回顾性分析2014年1月至2018年12月该院收治的318例完全性前置胎盘患者,根据产前超声和剖宫产手术证实,完全性前置胎盘并发胎盘植入组109例(植入组),未伴胎盘植入组209例(无植入组),对两组患者的年龄、生育状况、剖宫产史、母婴结局、住院时间和住院费用等进行统计学分析。结果该院最近5年完全性前置胎盘的发生率为1.47%(318/21606),完全性前置胎盘并发胎盘植入的发生率为34.28%(109/318)。完全性前置胎盘并发胎盘植入的高危因素主要是剖宫产史,而植入组的孕妇年龄、生育状况与无植入组相比,差异均无统计学意义(P>0.05);植入组患者的累计出血量明显多于无植入组(P<0.05),而植入组的早产儿和低体重儿与无植入组相比,差异无统计学意义(P>0.05)。此外,植入组患者的住院费用明显高于无植入组(P<0.05),而住院时间两者差异无统计学意义(P>0.05)。结论有剖宫产史的完全性前置胎盘孕妇应警惕并发胎盘植入,术前预测和诊断,制定手术方案,充分做好术前准备,改善母婴结局。

【Objective】To analyze clinical risk factors of complete placenta previa with placenta increta and its the influence on maternal and neonatal outcomes.【Methods】A total of 318 cases of complete placenta previa hospitalized in the Jiangmen Central Hospital from January 2014 to December 2018 were analyzed retrospectively.One hundred and nine cases complicated with placenta increta were grouped into placenta increta group,and 209 cases not complicated with placenta increta were grouped into non-placenta increta group.The age,delivery experience,history of cesarean section,maternal and neonatal outcomes,hospital stays,and hospital expense of the two groups were statistically analyzed.【Results】The incidence of complete placenta previa was 1.47%(318/21606)in recent 5 years,and the morbidity of placenta increta among women with complete placenta previa was 34.28%(109/318).High risk factor of the complete placenta previa with placenta increta was mainly previous cesarean section;the age and delivery experience of patients between the two groups was not significantly different(P>0.05).The amount of postpartum hemorrhage in placenta increta group was significantly higher than that in non-placenta increta group(P<0.05).There was no significant difference in preterm and low birth weight infants between placenta increta group and non-placenta increta group(P>0.05).The hospital expense in the placenta increta group was significantly higher than that in the non-placenta increta group(P<0.05),however there was no significant difference in the hospital stays between the placenta increta group and non-placenta increta group(P>0.05).【Conclusion】Placenta increta must be considered if the pregnant woman with complete placenta previa complicated with previous cesarean delivery.In order to improve maternal and neonatal outcomes,preoperative prediction and diagnosis,making surgical protocol and peripartum clinical management is necessary.