凶险性前置胎盘的母婴结局及其产后出血的危险因素分析

Analysis of maternal and infant outcomes of fatal placenta praevia and its risk factors for postpartum haemorrhage

目的探讨产妇发生凶险性前置胎盘(PPP)后的母婴结局,分析导致PPP及其产后出血的危险因素。方法选取2019年1月至2022年12月于本院就诊的104例前置胎盘患者进行回顾性研究。整理所纳入患者的一般及临床资料,分析可能导致产妇发生PPP的相关因素,并分析PPP产妇的母婴结局及其产后出血的危险因素。结果产妇PPP的发生率为23.08%(24/104,例),发生PPP的产妇在新生儿窒息、早产、产后出血、羊水污染、低体重儿及死胎的发生率均显著高于未发生PPP的产妇(P<0.05)。年龄(≥35,岁)、孕次(≥3,次)、产次(≥3,次)、剖宫产次数(≥3,次)、距上次剖宫产时间(≥3,年)、双胎妊娠及子宫形态异常均是导致产妇发生PPP的独立危险因素(P<0.05)。PPP产后出血的发生率为58.33%(14/24,例)。胎盘植入、胎盘粘连、前置胎盘类型、前次前置胎盘、距上次剖宫产时间是PPP产后出血的独立危险因素(P<0.05)。结论产妇发生PPP时婴儿出现窒息、低体重及死亡的发生率显著升高。年龄、孕次、产次等均是导致产妇发生PPP的独立危险因素。胎盘植入、胎盘粘连、前置胎盘类型、前次前置胎盘、距上次剖宫产时间是PPP产后出血的独立危险因素。

Objective To investigate the maternal and infant outcomes following the development of an aggressive placenta praevia(PPP)and to analyze the risk factors leading to PPP and its postpartum hemorrhage.Methods A retrospective study of 104 patients with PPP who attended our hospital from January 2019 to December 2022 was selected.The general and clinical data of the included patients were collated,the factors associated with the possible development of PPP in mothers were analyzed,and the maternal and infant outcomes of mothers with PPP and their risk factors for postpartum hemorrhage were analyzed.Results The incidence of maternal PPP was 23.08%(24/104)and the incidence of neonatal asphyxia,preterm labour,postpartum hemorrhage,amniotic fluid contamination,low-body mass babies and stillbirth was significantly higher in women with PPP than in women without PPP(P<0.05).Age(>35 y),pregnancy(>3 times),delivery(>3 times),number of caesarean sections(>3 times),time since last caesarean section(>3 y),twin pregnancies and abnormal uterine morphology were all independent risk factors for PPP(P<0.05).the incidence of postpartum hemorrhage in PPP was 58.33%(14/24).Placental implantation,placental adhesions,type of placenta praevia,previous placenta praevia and time since last caesarean section were independent risk factors for postpartum hemorrhage in PPP(P<0.05).Conclusion The incidence of asphyxia,low birth weight and death of the infant is significantly.Age,pregnancy and delivery are all independent risk factors for maternal PPP.Placental implantation,placental adhesions,type of placenta praevia,previous placenta praevia,and time since last caesarean section were independent risk factors for postpartum hemorrhage in PPP.