胎盘植入患者临床特征及其妊娠结局的临床研究

Clinical characteristics and pregnancy outcome in patients with placenta accrete

目的分析孕产妇胎盘植入情况的临床特征并探讨其妊娠结局。方法研究纳入2011年1月至2013年6月期间南方医科大学南方医院就诊的104例孕产妇,依据胎盘植入诊断分为有胎盘植入组53例和无胎盘植入组51例,收集孕产妇的年龄、分娩孕周、孕产史(孕次/产次/流产史/剖宫产史)、胎盘植入史、其他胎盘植入高危因素(年龄>35岁/合并前置胎盘/子宫内膜损伤史等)、产后并发症等临床资料进行比较。结果胎盘植入组孕产妇平均年龄、高龄孕产妇比例,产次≥2次、流产≥2次、子宫内膜损伤史及其剖宫产史比例较无胎盘植入组更高,差异有统计学意义(P<0.05)。妊娠结局方面胎盘植入组中孕产妇流产、引产的比例更高,产后并发症感染、腹部切口愈合不良、失血性休克、膀胱损伤比例更高,且胎儿发生死胎的比例在胎盘植入组更高,差异均有统计学意义(P<0.05)。结论孕产妇妊娠高龄、较多的产次/流产次数、剖宫产次数可能为胎盘植入的风险因素,该病容易导致妊娠流产、死胎,分娩期间合并感染、失血性休克及膀胱损伤等并发症,对孕产妇及胎儿具有较大的安全威胁。

Objective The clinical characteristics and pregnancy outcome of placenta accrete patients were retrospectively analyzed.Methods 104 cases of maternal data was collected from the Nanfang Hospital between January 2011 and June2013.According to the diagnosis of placental implantation,the patients were divided into two groups:with placenta accrete(n=53)and without placenta accrete(n=51).The clinical data were compared including maternal age,gestational weeks of delivery,history of pregnancy and delivery(pregnancy,parity,abortion history,and cesarean section),history of placenta accreta,other high risk factors of placenta accreta(age>35 years old,with placenta previa,and endometrial injury history),and postpartum complications.Results In the with placenta accrete group,the average age,the proportion of older pregnant women,the number of births≥2 times,miscarriages≥2 times,the history of endometrial injury and the history of cesarean section were higher than those of the without placenta accrete group;the differences were statistical significance(P<0.05).In terms of pregnancy outcomes,the with placenta accrete group had a higher rate of maternal abortion and induction of labor,postpartum complication infections,poor abdominal incision healing,hemorrhagic shock,and bladder injury;and the rate of stillbrith was higher in with placenta accrete group;the differences were statistically significant(P<0.05).Conclusions The maternal age of pregnancy,more births/abortions and cesarean section may be risk factors for placenta accrete.The disease could easily lead to pregnancy abortion,stillbirth,and complications(such as infection,hemorrhagic shock and bladder injury during delivery).All those were a greater security threat to pregnant women and fetus.