確診及漏誤診胎盤早剝產婦的臨床分析

Clinical analysis of pregnant women diagnosed,misdiagnosed,missed diagnosed as placental abruption

目的探討減少胎盤早剝(placental abruption,PA)對孕產結局不良影響的產前臨床處理方案。方法回顧性分析2018年10月~2021年10月於本院婦產科診斷為胎盤早剝的單胎產婦。按照產前與產後診斷的符合性,將產婦分為確診組和漏誤診組。結果PA發生率為1.3%。漏診率為56.56%,誤診率0.82%。確診組產婦0級和Ⅰ級PA的比例分別顯著低於和高於漏誤診組產婦。確診組胎膜早破的比例顯著高於漏誤診組,而催引產的比例顯著低於漏誤診組產婦。確診組組產婦在產前陰道流血、持續腹痛、子宮張力增加的發生百分率顯著高於漏誤診組;而宮縮過頻和血性羊水的比例兩組無差異。確診組產婦胎心監護異常比例、剖宮產比例、助產百分比均高於漏誤診組產婦;確診組順產比例顯著低於漏誤診組;而胎盤超聲結果、產後出血比例、產後出血量及新生兒窒息百分比,兩組均沒有顯著差異。結論在重視胎盤早剝的高危因素的同時結合臨床表現及超聲等輔助檢查結果,加強對胎盤早剝的認識。在催引產過程中,密切觀察孕婦的臨床表現有助於早期診斷胎盤早剝,以改善胎盤早剝患者的預後。

Objective Investigate perinatal clinical procedures to reduce the negative effects of placental abruption(PA)on pregnant women and newborns'clinical results.Methods A retrospective analysis was conducted in women with singleton pregnancies who delivered at Kiang Wu Hospital from October 2018 to October 2021.According to the consistency of prenatal and postnatal diagnoses,the patients were divided into 2 groups.The diagnosis group(D group)and the missed diagnosis and misdiagnosis group(MM group).Results The incidence of PA was 1.33%.The missed diagnosis and misdiagnosis ratios were 56.56%and 0.82%,respectively.The incidences of 0-degree and I-degree PA in the D group were significantly lower and higher than those in the MM group,respectively.The incidences of premature rupture of membranes(PROM)and induced labor were significantly higher and lower than those in the MM group,respectively.The incidences of prelabor vaginal bleeding,persistent abdominal pain and uterine tenderness in the D group were significantly higher than those in the MM group.However,the incidences of uterine contraction and bloody amniotic fluid were similar between the two groups.The abnormal rate of fetal heart rate monitoring and the rate of cesarean section and induced labor were significantly higher in the D group than in the MM group.There was no significant difference in the rate of abnormal ultrasound findings,postpartum hemorrhage,blood loss or neonatal asphyxia between the 2 groups.Conclusion It is important to take both the PA risk factors and the clinical manifestations/lab results into account when making a diagnosis.Clinicians should pay close attention to the patient’s clinical symptoms to diagnose PA as early as possible to improve the prognosis of PA during induced labor.