妊娠晚期胎盘早剥81例回顾性分析

Retrospective analysis of 81 cases of late pregnancy placental abruption

目的:回顾性分析不同分型妊娠晚期胎盘早剥的首发临床征象、发病相关因素及围产结局差异。方法:2009年1月-2013年12月收治妊娠晚期胎盘早剥患者81例,其中重型组43例为A组,轻型组38例为B组,观察并比较两组患者的首发临床征象、发病相关因素及围产结局差异。结果:A组首发临床征象腹痛22例(52.2%),阴道出血4例(9.3%),宫缩频繁11例(25.6%),胎心异常13例(30.2%);B组首发临床征象腹痛3例(7.9%),阴道出血27例(71.1%),宫缩频繁7例(18.4%),胎心异常11例(28.9%);两组患者首发临床征象比较差异有统计学意义(P<0.05);A组发病相关因素主要为妊娠期高血压疾病,B发病相关因素主要为脐带过短和缠绕;A组围产儿死亡9例(20.9%),新生儿窒息21例(48.8%),产后出血13例(30.2%),B组围产儿死亡0例,新生儿窒息7例(18.4%),产后出血3例(7.9%),两组患者围产结局比较差异有统计学意义(P<0.05)。结论:不同分型的妊娠晚期胎盘早剥的首发临床征象、发病相关因素及围产结局存在明显差异,值得在临床上加以分辨鉴别。

Objective:To retrospective analyze the difference of the initial clinical signs,onset of related factors and perinatal outcome between different types of late pregnancy placental abruption.Methods:81 cases with late pregnancy placental abruption were selected from January 2009 to December 2013.43 case were moderate to severe as A group,and 38 cases were light as B group.The initial clinical signs,onset of related factors and perinatal outcome of the two groups were observed and compared.Results:In the initial clinical signs of A group,22 cases(52.2%) were abdominal pain,4 cases(9.3%)were vaginal bleeding,11cases(25.6%) were frequently uterine contraction,and 13 cases(30.2%) were abnormal fetal heart rate.In the initial clinical signs of B group,3 cases(7.9%) were abdominal pain,27 cases(71.1%) were vaginal bleeding,7 cases(18.4%) were frequently uterine contraction,11 cases(28.9%) were abnormal fetal heart rate.The difference of the initial clinical signs between the two groups was statistically significant(P<0.05).The onset of related factor of A group was hypertensive disorder complicating pregnancy,the onset of related factor of B group was too short and winding umbilical cord.In A group,9 cases(20.9%) were perinatal death,21cases(48.8%) were neonatal asphyxia,13 cases(30.2%) were postpartum hemorrhage.In B group,0 case was perinatal death,7cases(18.4%) were neonatal asphyxia,3 cases(7.9%)were postpartum hemorrhage.The difference of perinatal outcome of patients between the two groups was statistically significant(P<0.05).Conclusion:The initial clinical signs, onset of related factors and perinatal outcome between different types of late pregnancy placental abruption have visible difference.It should be distinguish and identify in clinical.