不同胎盘位置的胎盘早剥对母婴预后的影响
|
摘要
目的探讨不同胎盘位置引起的胎盘早剥对母婴预后的影响。方法回顾性分析我院2010年6月至2017年6月收治的56例胎盘早剥患者,根据胎盘附着部位的不同分为,A组(胎盘附着于前壁者20例,胎盘附着于宫底者6例)B组(胎盘附着于后壁者28例,胎盘附着于侧壁者2例)。两组患者均通过剖宫产终止妊娠、术前或术中明确胎盘早剥诊断。对比两组患者的一般情况、临床表现、超声学表现、术中情况、并发症、婴儿预后等情况。结果其中A组患者的阴道出血发生率、板状腹发生率、超声学异常发生率、胎心监护异常发生率均显著高于B组,差异均有统计学意义(P<0.05);A组患者的漏诊及误诊率为15.4%,显著低于B组的56.6%,差异有统计学意义(P<0.05);两组患者在剥离面积、弥漫性血管内凝血(DIC)、子宫胎盘卒中发生率、子宫切除发生率均无统计学意义(P>0.05);B组的产后出血量为(914±324)ml,多于A组的(512±281)ml,差异具有统计学意义(P<0.05);A组患者的输血率为11.5%,明显低于B组的46.7%,差异具有统计学意义(P<0.05);A组胎儿窘迫及新生儿窒息率分别为11.5%和15.4%,明显低于B组的53.3%和40%,差异有统计学意义(P<0.05);两组患者在腹痛发生率、血性羊水、新生儿体重、死胎发生率比较差异无统计学意义(P>0.05)。结论胎盘早剥是妊娠晚期的严重并发症,因后壁胎盘剥离时临床症状不典型,不易诊断,往往对母婴的预后造成严重的危害。因此临床上应做到早预防、早诊断,降低母婴并发症,改善母婴预后。
Objective To analyze the effect of placental abruption on maternal and neonatal outcomes in different piacental location.Methods From June 2010 to June 2017,56 patients with placental abruption in our hospital were treated and divided into Group A(20cases of placenta attachment to the anterior wall and 6cases of placenta attachment to the uterine floor)group B(28cases of placenta attachment to the posterior wall and 2cases of placenta attachment to the lateral wall),according to placenta location.Pregnancy was terminated by cesarean section and the diagnosis of placenta abruption was confirmed before or during operation in both groups.Data were compared between the two groups,including general conditions,Clinical manifestations,ultrasound manifestations,intraoperative conditions,complications and neonatal prognosis.Results The incidence rate of vaginal bleeding,tabulate venter,ultrasonography abnormality,fetal heart monitoring abnormality,and the diagnostic rate before delivery were all significantly higher in the A group than in the b group(P<0.05);The rate of missed diagnosis and misdiagnosis of patients in group A was 15.4%,significantly lower than 56.6%in group B,and the difference was statistically significant(P<0.05);The two groups had no statistical significance in the size of placental abruption area,the disseminated intravascular coagulation(DIC),the incidence of uteroplacental apoplexy and the incidence of hysterectomy(P>0.05);Postpartum hemorrhage in group B was 914.2±324ml,more than that in group A 511.7±281ml,and the difference was ststistically significant(P<0.05);The transfusion rate of patients in group A was 11.5%,significantly lower than 46.7%in group B,and the difference was statistically significant(P<0.05).The rate of fetal distress and neonatal asphyxia in group A was11.5%and 15.4%,respectively,significantly lower than 53.3%and 40%in group B(P<0.05);There was no significant difference in the incidence of abdominal pain,hemorrhagic amniotic fluid,neonatal weight and stillbirth between the two groups(P>0.05).Conclusion Placental abruption is a serious complication in late pregnancy.Placental abruption caused by posterior placenta has no obvious clinical manifestations,difficult to be diagnosed,and often causes serious harm to the prognosis of mother and newborn.Therefore,early prevention and early diagnosis should be done in clinic to reduce materal and neonatal complications ahd improve materal and neonatal prognosis.
Objective To analyze the effect of placental abruption on maternal and neonatal outcomes in different piacental location.Methods From June 2010 to June 2017,56 patients with placental abruption in our hospital were treated and divided into Group A(20cases of placenta attachment to the anterior wall and 6cases of placenta attachment to the uterine floor)group B(28cases of placenta attachment to the posterior wall and 2cases of placenta attachment to the lateral wall),according to placenta location.Pregnancy was terminated by cesarean section and the diagnosis of placenta abruption was confirmed before or during operation in both groups.Data were compared between the two groups,including general conditions,Clinical manifestations,ultrasound manifestations,intraoperative conditions,complications and neonatal prognosis.Results The incidence rate of vaginal bleeding,tabulate venter,ultrasonography abnormality,fetal heart monitoring abnormality,and the diagnostic rate before delivery were all significantly higher in the A group than in the b group(P<0.05);The rate of missed diagnosis and misdiagnosis of patients in group A was 15.4%,significantly lower than 56.6%in group B,and the difference was statistically significant(P<0.05);The two groups had no statistical significance in the size of placental abruption area,the disseminated intravascular coagulation(DIC),the incidence of uteroplacental apoplexy and the incidence of hysterectomy(P>0.05);Postpartum hemorrhage in group B was 914.2±324ml,more than that in group A 511.7±281ml,and the difference was ststistically significant(P<0.05);The transfusion rate of patients in group A was 11.5%,significantly lower than 46.7%in group B,and the difference was statistically significant(P<0.05).The rate of fetal distress and neonatal asphyxia in group A was11.5%and 15.4%,respectively,significantly lower than 53.3%and 40%in group B(P<0.05);There was no significant difference in the incidence of abdominal pain,hemorrhagic amniotic fluid,neonatal weight and stillbirth between the two groups(P>0.05).Conclusion Placental abruption is a serious complication in late pregnancy.Placental abruption caused by posterior placenta has no obvious clinical manifestations,difficult to be diagnosed,and often causes serious harm to the prognosis of mother and newborn.Therefore,early prevention and early diagnosis should be done in clinic to reduce materal and neonatal complications ahd improve materal and neonatal prognosis.
引文
[1]Predictors of perinatal mortality associated with placenta previa and placental abruption:an experience from a low income country[J].J Pregnancy,2014,2014:307043.
[2]谢幸,苟文丽.妇产科学[M].第8版.北京:人民卫生出版社,2013,131-133.
[3]Mukherjee S,Bawa AK,Sharma S,et al.Retrospective study of risk factors and maternal and fetal outcome in patients with abruptio placentae[J].Journal of Natural Science Biology&Medicine,2014,5(2):425.
[4]Downes KL,Grantz KL,Shenassa ED.Maternal,Labor,Delivery,and Perinatal Outcomes Associated with Placental Abruption:A Systematic Review[J].American Journal of Perinatology,2017,34(10):935.
[5]Shinde GR,Vaswani BP,Patange RP,et al.Diagnostic Performance of Ultrasonography for Detection of Abruption and Its Clinical Correlation and Maternal and Foetal Outcome[J].Journal of Clinical&Diagnostic Research Jcdr,2016,10(8):QC04.
[6]Nagayama,Suzuki S.Influence of placental position on outcome in inpatients with placental abruption[J].J Nippon MedSch,2006,73(6):351.
[7]Kasai M,Aoki S,Ogawa M,et al.Prediction of perinatal outcomes based on primary symptoms in women with placental abruption[J].J Obstet Gynaecol Res,2015,41(6):850.
[8]DeRoo Lisa A,Skjaerven Rolv,Wilcox Allen J,et al.[130-POS]:Placental abruption and long-term maternal cardiovascular disease mortality:A population-based registry study in Norway and Sweden[J].Pregnancy Hypertension:An International Journal of Women's Cardiovascular Health,2015,5(1):68.
[2]谢幸,苟文丽.妇产科学[M].第8版.北京:人民卫生出版社,2013,131-133.
[3]Mukherjee S,Bawa AK,Sharma S,et al.Retrospective study of risk factors and maternal and fetal outcome in patients with abruptio placentae[J].Journal of Natural Science Biology&Medicine,2014,5(2):425.
[4]Downes KL,Grantz KL,Shenassa ED.Maternal,Labor,Delivery,and Perinatal Outcomes Associated with Placental Abruption:A Systematic Review[J].American Journal of Perinatology,2017,34(10):935.
[5]Shinde GR,Vaswani BP,Patange RP,et al.Diagnostic Performance of Ultrasonography for Detection of Abruption and Its Clinical Correlation and Maternal and Foetal Outcome[J].Journal of Clinical&Diagnostic Research Jcdr,2016,10(8):QC04.
[6]Nagayama,Suzuki S.Influence of placental position on outcome in inpatients with placental abruption[J].J Nippon MedSch,2006,73(6):351.
[7]Kasai M,Aoki S,Ogawa M,et al.Prediction of perinatal outcomes based on primary symptoms in women with placental abruption[J].J Obstet Gynaecol Res,2015,41(6):850.
[8]DeRoo Lisa A,Skjaerven Rolv,Wilcox Allen J,et al.[130-POS]:Placental abruption and long-term maternal cardiovascular disease mortality:A population-based registry study in Norway and Sweden[J].Pregnancy Hypertension:An International Journal of Women's Cardiovascular Health,2015,5(1):68.