单胎妊娠发生胎盘早剥的危险因素及母儿结局分析——一项9年的回顾性临床研究

Risk factors of placental abruption in singleton pregnancy and maternal-fetal outcomes--A 9-year retrospective study

目的探讨单胎妊娠发生胎盘早剥(PA)的危险因素及母儿结局。方法回顾性分析2009年1月至2017年12月在广州医科大学附属第三医院住院分娩的所有孕周大于20周的单胎妊娠病历资料。按照是否发生胎盘早剥,分为胎盘早剥组和非胎盘早剥组,分析两组的人口学特征、临床特征及母儿结局。结果 (1)47 963例单胎妊娠妇女中有418例发生胎盘早剥,总发生率为0.87%。(2)子痫前期(OR=8.884,95%CI:6.988~11.295)、子痫(OR=3.725,95%CI:1.651~8.402)、臀位阴道分娩(OR=3.751,95%CI:1.513~9.300)、非规律产检(OR=1.427,95%CI:1.146~1.777)、非足月胎膜早破(OR=3.402,95%CI:1.988~5.820)是胎盘早剥的独立危险因素(均P<0.05)。(3)两组母亲转诊重症监护病房(ICU)(χ2=241.697)、急性器官衰竭(χ2=64.314)、输注血制品(χ2=171.183)、臀位阴道分娩(P<0.001)、头皮牵引术(P=0.005)所占比例,以及分娩方式(χ2=168.627)、分娩孕周(t=20.080)、住院天数(t=-8.351)比较差异均有统计学意义(均P<0.05)。(4)两组早产(χ2=742.652)、流产(χ2=117.419)、死胎(χ2=154.154)、新生儿轻度窒息(χ2=213.008)、新生儿重度窒息(χ2=152.958)、胎儿生长受限(χ2=175.140)、胎儿窘迫(χ2=196.263)发生率,以及新生儿转诊率(χ2=318.391)、围产儿体重(t=23.660)比较差异均有统计学意义(均P<0.05)。结论胎盘早剥组母儿不良结局明显增加,子痫前期、非足月胎膜早破、非规律产检、臀位阴道分娩都是单胎妊娠发生胎盘早剥的独立危险因素。

Objective To investigate risk factors of placental abruption(PA) in singleton pregnancy and maternal-fetal outcomes.Methods The clinical data of all singleton pregnant women with gestational age more than 20 weeks who were admitted to the Third Affiliated Hospital of Guangzhou Medical University from January,2009 to December,2017 were retrospectively analyzed.According to whether the pregnant woman developed PA,the patients were divided into PA group or non-PA group respectively.Demographic characteristics,clinical features and maternal-fetal outcomes of the pregnant women were analyzed.Results(1) 418(0.87%) pregnant women developed PA among 47963 singleton pregnancies with an incidence rate of 0.87%.(2) Analysis revealed that preeclampsia(OR=8.884,95%CI:6.988~11.295),eclampsia(OR=3.725,95%CI:1.651~8.402),breech vaginal delivery(OR=3.751,95%CI:1.513~9.300),irregular prenatal examination(OR=1.427,95%CI:1.146~1.777),preterm premature rupture of membranes(OR=3.402,95%CI:1.988~5.820) were independent risk factors of PA(all P<0.05).(3) In incidence of referral to intensive care unit(ICU)(χ2=241.697),incidence of acute organ failures(χ2=64.314),blood products transfusion(χ2=171.183),delivery pattern(χ2=168.627),breech vaginal delivery(P<0.001),fetal scalp tractions(P=0.005),gestational age at delivery(t=20.080) and hospitalization days(t=-8.351),there were significant differences between the two groups(all P<0.05).(4) In incidence rates of prematurity(χ2 =742.652),abortion(χ2=117.419),stillbirth(χ2=154.154),mild/severe neonatal asphyxia(χ2=213.008/152.958),fetal growth restriction(χ2=175.140) and fetal distress(χ2=196.263),and neonatal referral rate(χ2=318.391) and perinatal body weight(t=23.660),there were significant differences between the two groups(all P<0.05).Conclusion Maternal and perinatal adverse outcomes increase in the PA group.Eclampsia and preeclampsia,preterm premature rupture of membranes,irregular prenatal examination,and breech vaginal delivery are independent risk factors of PA in singleton pregnancy.