不同的胎盘附着部位对胎盘早剥母婴结局的影响

Effects of different placental attachment position on maternal and infant outcomes of placental abruption

目的分析胎盘附着不同部位对胎盘早剥孕妇母婴结局的影响。方法回顾性分析2016年1月至2019年12月北京市海淀妇幼保健医院收治的213例胎盘早剥患者,根据胎盘附着位置的不同,分为观察组(胎盘附着于子宫前壁102例,附着于子宫侧壁5例)和对照组(胎盘附着于子宫后壁95例,附着于宫底11例),比较两组孕产妇一般情况、临床表现、并发症及母婴结局等情况。结果①两组间产妇平均年龄、孕产次、分娩方式及分娩孕周比较,差异均无统计学意义(均P>0.05),两组产妇诊断时间比较,差异有统计学意义(P<0.05)。②两组产妇在阴道流血、血性羊水、胎心异常或消失的发生率方面,差异均无统计学意义(均P>0.05);而观察组腹痛、频密宫缩发生率明显高于对照组(均P<0.05)。③两组产妇胎盘剥离面积、DIC及子宫胎盘卒中发生率差异均无统计学意义(P>0.05),而宫腔积血及产后出血量差异有统计学意义(P<0.05)。④两组新生儿体质量、死胎发生率及早期新生儿死亡比较差异无统计学意义(P>0.05),观察组新生儿窒息率明显低于对照组(P<0.05)。结论胎盘早剥是妊娠晚期的严重并发症,因后壁胎盘剥离时临床症状不典型,不易诊断,往往对母婴的预后造成严重的危害。因此临床上应做到早发现,早诊断,积极处理,改善母婴预后。

Objective To analyze the effects of different placental attachment position on maternal and infant outcomes of pregnant women with placental abruption.Methods The clinical data of 213 cases of placental abruption in Haidian District Maternity and Child Health of Beijing City form January,2016 to December,2019 were retrospectively analyzed.They were divided into observation group(102 cases of placenta attachment to the anterior wall and 5 cases of placenta attachment to the lateral wall)and control group(95 cases of placenta attachment to the posterior wall and 11 cases of placenta attachment to the uterine floor)according to the location of placenta attachment.The general conditions,clinical manifestations,complications and maternal and infant prognosis between the two groups were compared.Results①There was no statistically significant difference in the mean age,the number of pregnancies,the delivery mode and the gestational week between the two groups(P>0.05).There was statistically significant difference in diagnosis time between the two groups(P<0.05).②There was no statistically significant difference in the incidence of vaginal bleeding,the bloody amniotic fluid,the fetal heart abnormality or disappearance between the two groups(P>0.05).The incidence of abdominal pain and frequent contractions in observation group was significantly higher than that in control group(P<0.05).③There was no statistically significant difference in the placental dissection area,DIC and the incidence of uterine placental stroke between the two groups(P>0.05),but there was significant difference in the uterine hemorrhage and postpartum blood loss(P<0.05).④There was no statistically significant difference in the neonatal weight,the stillbirth rate and the early neonatal death between the two groups(P>0.05).The neonatal asphyxia rate in the observation group was significantly lower than that in control group(P<0.05).Conclusion Placental abruption is a serious complication in the late pregnancy.Placental abruption caused by posterior placental has no obvious clinical symptoms,is difficult to be diagnosed and often causes serious harm to the prognosis of the mother and newborn.Therefore,early detection,early diagnosis and active treatment should be done in clinical practice to improve the prognosis of maternal and infant.