凶险性前置胎盘与新生儿窒息相关的临床分析

Clinical Analysis Related to Pernicious Placenta Previa and Neonatal Asphyxia

目的探讨凶险性前置胎盘与新生儿窒息相关的超声检查、高危因素及妊娠结局。方法回顾性分析2016年5月~2020年7月华中科技大学同济医学院附属同济医院收治的144例凶险性前置胎盘孕产妇的临床资料,根据新生儿情况分为未窒息组(n=91)和窒息组(n=53)。主要通过产前超声检查、术中诊断等方法,采用单因素及多因素Logistic回归分析新生儿窒息的高危因素,并比较两组新生儿的结局。结果与未窒息组比较,窒息组前壁胎盘为主、完全性前置胎盘、早产、羊水过多、胎盘穿透的发生率更高,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,前壁胎盘为主、早产、羊水过多、胎盘穿透是新生儿窒息的的独立危险因素(P<0.05,OR>1)。与未窒息组比较,窒息组出生孕周及出生体重更低,入住新生儿科的发生率更高(P<0.05)。结论凶险性前置胎盘与新生儿窒息相关的高危因素为前壁胎盘为主、早产、羊水过多、胎盘穿透。凶险性前置胎盘与新生儿窒息相关的妊娠结局更差。

Objective To investigate the ultrasonography,high-risk factors and pregnancy outcomes related to pernicious placenta previa(PPP)and neonatal asphyxia.Methods The clinical data of 144 pregnant women with PPP from Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from May 2016 to July 2020 were retrospectively analyzed.Depending on the neonatal condition,they were divided into non-asphyxia group(n=91)and asphyxia group(n=53).Mainly by prenatal ultrasound examination and intraoperative diagnosis,the high-risk factors of neonatal asphyxia were analyzed with univariate and multivariate Logistic regression analysis,and the neonatal outcomes were compared between the two groups.Results Compared with the non-asphyxia group,the incidence of placenta dominated by anterior wall,complete placenta previa,premature delivery,polyhydramnios and placenta percreta were higher in the asphyxia group,and the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that placenta dominated by anterior wall,premature delivery,polyhydramnios and placenta percreta were independent risk factors for neonatal asphyxia(P<0.05,OR>1).Compared with the non-asphyxia group,the incidence of neonatal admission was higher with lower gestational age and birth weight in the asphyxia group(P<0.05).Conclusion The risk factors related to PPP and neonatal asphyxia are placenta dominated by anterior wall,premature delivery,polyhydramnios and placenta percreta.Pregnancy outcomes related to PPP and neonatal asphyxia are worse.