胎盘早剥36例高危因素及妊娠结局临床分析(1)
[摘要] 目的 探讨胎盘早剥的高危因素及对妊娠结局的影响和诊治方法。 方法 对2011年6月～2015年7月因胎盘早剥在我院分娩36份病例进行回顾性分析，了解胎盘早剥的发病原因和对母婴结局的影响。 结果 经阴道分娩1例，剖宫产终止妊娠者35例，36例胎盘早剥中合并妊娠期高血压疾病者20例(55.56%)，为第一诱因；其中发生产前出血29例，腹痛30例，血性羊水14例，产后出血者7例，其中子宫卒中4例；新生儿窒息16例(44.44%)，早产29例(80.56%)，死胎9例(25.00%)，尤以Ⅲ度为甚，死胎达46.67%，差异有高度统计学意义(P<0.01)。胎盘早剥围生儿结局差，早产率、窒息率高，而Ⅲ胎盘早剥死胎率和产后出血率明显较Ⅰ度、Ⅱ度高，尤其发生子宫卒中者更甚。 结论 对妊娠期高血压疾病需做好产前检查，尽早治疗，减少胎盘早剥的发生。提高胎盘早剥的诊断准确率，早发现，早治疗，适时终止妊娠，选择合适的终止妊娠方式，避免耽误治疗时机，导致母婴不良结局。
[关键词] 胎盘早剥；高危因素；妊娠结局；子宫卒中；漏诊误诊
[中图分类号] R714.4 [文献标识码] B [文章编号] 1673-9701(2015)32-0048-03
[Abstract] Objective To discuss the high risk factors of placental abruption and the effects on pregnancy outcome and the diagnoses and treatments. Methods A total of 36 cases of placental abruption hospitalized and labored in our hospital from June 2011 to July 2015 were reviewed and the causes of placental abruption and the effects on pregnancy outcome were explored. Results One case was vaginal delivery and 35 cases were cesarean delivery. Twenty cases (55.56%) of the 36 placental abruption cases were combined with HDCP， which was the primary inducement. Among the 35 cases， 29 cases had antenatal hemorrhage， 30 cases had stomachache， 14 cases had bloody amniotic fluid， and 7 cases had postpartum hemorrhage with 4 cases of uterine apoplexy. There were 16 cases of neonatal asphyxia (44.44%)， 29 cases of premature delivery (80.56%)， and 9 cases of stillbirth (25.00%)， especially for grade Ⅲ， the still birth rate was 46.67% with significant difference (P<0.01). The perinatal outcome of placental abruption was unfavorable with high premature delivery rate and asphyxia rate. The still birth rate and postpartum hemorrhage rate of grade Ⅲ placental abruption were evidently higher than those of grade Ⅰ and Ⅱ， especially in patients with uterine apoplexy. Conclusion Prenatal examination of HDCP is essential and once diagnoses， treatment should be conducted as early as possible， to reduce the incidence of placental abruption. It is vital to improve the diagnosis accuracy of placental abruption to realize early detection and early management， including timely termination of pregnancy and choosing appropriate method of pregnancy termination， to avoid delaying treatment and causing adverse clinical outcome.
[Key words] Placental abruption； High risk factors； Pregnancy outcome； Uterine apoplexy； Misdiagnose
胎盘早剥是指妊娠20周后或分娩期，正常位置的胎盘在胎儿娩出前，部分或全部从子宫壁剥离[1]，是妊娠晚期的一种严重并发症[2]，起病急，进展快，尤其是重型胎盘早剥，而不典型的胎盘早剥诊断困难，漏诊误诊率高，若处理不及时可危及母婴生命。胎盘早剥发病率在国外为1%～2%，国内为0.46%～2.1%[3]。本文通过回顾性分析我院自2011年6月～2015年7月间的36例胎盘早剥病例，了解胎盘早剥的病因及对妊娠结局的影响，提高对胎盘早剥的认识，降低母婴危害。现报道如下。, 百拇医药(刘金艳 王艳丽 石进 唐俊)
[关键词] 胎盘早剥；高危因素；妊娠结局；子宫卒中；漏诊误诊
[中图分类号] R714.4 [文献标识码] B [文章编号] 1673-9701(2015)32-0048-03
[Abstract] Objective To discuss the high risk factors of placental abruption and the effects on pregnancy outcome and the diagnoses and treatments. Methods A total of 36 cases of placental abruption hospitalized and labored in our hospital from June 2011 to July 2015 were reviewed and the causes of placental abruption and the effects on pregnancy outcome were explored. Results One case was vaginal delivery and 35 cases were cesarean delivery. Twenty cases (55.56%) of the 36 placental abruption cases were combined with HDCP， which was the primary inducement. Among the 35 cases， 29 cases had antenatal hemorrhage， 30 cases had stomachache， 14 cases had bloody amniotic fluid， and 7 cases had postpartum hemorrhage with 4 cases of uterine apoplexy. There were 16 cases of neonatal asphyxia (44.44%)， 29 cases of premature delivery (80.56%)， and 9 cases of stillbirth (25.00%)， especially for grade Ⅲ， the still birth rate was 46.67% with significant difference (P<0.01). The perinatal outcome of placental abruption was unfavorable with high premature delivery rate and asphyxia rate. The still birth rate and postpartum hemorrhage rate of grade Ⅲ placental abruption were evidently higher than those of grade Ⅰ and Ⅱ， especially in patients with uterine apoplexy. Conclusion Prenatal examination of HDCP is essential and once diagnoses， treatment should be conducted as early as possible， to reduce the incidence of placental abruption. It is vital to improve the diagnosis accuracy of placental abruption to realize early detection and early management， including timely termination of pregnancy and choosing appropriate method of pregnancy termination， to avoid delaying treatment and causing adverse clinical outcome.
[Key words] Placental abruption； High risk factors； Pregnancy outcome； Uterine apoplexy； Misdiagnose
胎盘早剥是指妊娠20周后或分娩期，正常位置的胎盘在胎儿娩出前，部分或全部从子宫壁剥离[1]，是妊娠晚期的一种严重并发症[2]，起病急，进展快，尤其是重型胎盘早剥，而不典型的胎盘早剥诊断困难，漏诊误诊率高，若处理不及时可危及母婴生命。胎盘早剥发病率在国外为1%～2%，国内为0.46%～2.1%[3]。本文通过回顾性分析我院自2011年6月～2015年7月间的36例胎盘早剥病例，了解胎盘早剥的病因及对妊娠结局的影响，提高对胎盘早剥的认识，降低母婴危害。现报道如下。, 百拇医药(刘金艳 王艳丽 石进 唐俊)