妊娠中晚期完全性前置胎盘患者阴道试产结局及影响因素分析

Analysis of the outcome and influencing factors of vaginal trial delivery in patients with complete placenta previa in the middle and late stages of pregnancy

目的探究妊娠中晚期完全性前置胎盘(CPP)患者阴道试产结局及其影响因素。方法收集选择阴道试产终止妊娠的68例妊娠中晚期CPP患者临床资料,统计其阴道试产结局,分析影响试产成功与否的相关因素。结果纳入者中53例成功阴道分娩终止妊娠,阴道试产成功率为78%,15例阴道试产失败而转为剖宫产终止妊娠,失败率22%;其中阴道试产失败者中接受输血和子宫动脉栓塞处理者占比均明显高于阴道试产成功者(P<0.05),产后24 h内出血量和住院费用均明显多于阴道试产成功者,住院时间明显长于阴道试产成功者(P<0.05)。年龄小、胎盘位于子宫后壁、试产前阴道反复出血为阴道试产成功的保护性因素,孕晚期、胎盘植入/粘连为阴道试产成功的危险因素(P<0.05)。结论妊娠中晚期发生CPP者,若患者年龄小、胎盘位于子宫后壁、孕期出现反复阴道出血或处于妊娠中期,在排除胎盘植入/粘连和需要期待治疗保胎等情况时,患者可尝试通过阴道试产终止妊娠,以降低身体损伤,缩短住院时间。

Objective To explore the outcome and influencing factors of vaginal labor in patients with complete placenta previa(CPP)in the middle and late stages of pregnancy.Methods The clinical data of 68 patients with CPP in the middle and late stages of pregnancy who chose vaginal trial delivery to terminate their pregnancy were collected as the research objects.Results Fifty-three cases of the research objects were successfully terminated by vaginal delivery,the success rate of vaginal trial delivery was 78%,15 cases of vaginal trial delivery failed and turned to cesarean section to terminate the pregnancy,the failure rate was 22%.The blood transfusion rate and the rate of uterine artery embolism in the failed vaginal trial delivery were significantly higher than those in the successful vaginal trial delivery(P<0.05),the bleeding volume and hospitalization expenses within 24 hours after delivery were greater than the successful ones,and the hospital stay was longer than the successful ones(P<0.05).Young age,placenta located on the posterior wall of the uterus,and repeated uterine bleeding before trial delivery were protective factors for successful vaginal trial delivery.In the third trimester,placental implantation/adhesion were risk factors for successful vaginal trial delivery(P<0.05).Conclusion For patients with CPP in the middle and late stages of pregnancy,if the patient is young,the placenta is located on the posterior wall of the uterus,repeated vaginal bleeding during pregnancy,or in the second trimester,the patients can try to be terminated pregnancy by vaginal delivery when excluding placental accretion/adhesion and expectant treatment to preserve the fetus,to reduce physical damage,shorten hospitalization time,and reduce positive pressure.