胎盘主体附着位置对凶险型前置胎盘患者术中出血量及术后并发症的影响
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摘要
目的探讨胎盘主体附着位置对凶险型前置胎盘患者术中出血量及术后并发症的影响。方法纳入2014年12月—2018年5月间四川省攀枝花市中心医院产科收治的孕晚期凶险型前置胎盘患者67例临床资料进行回顾性分析,根据胎盘主体附着位置分为研究组(胎盘主体附着于子宫前壁)37例,对照组(胎盘主体附着于子宫后壁及侧壁)30例。对比2组患者的剖宫产术中出血情况及术后母婴结局差异。结果研究组患者手术时间、术中出血量、术中输血量、术后2 h出血量、术后24 h出血量均大于对照组患者(t=8.410、11.407、19.013、16.372、18.265,P均<0.01)。研究组患者子宫切除、产后出血、产褥感染、DIC发生率高于对照组患者(χ~2=24.671、6.184、4.671、5.063,P均<0.05)。研究组新生儿体质量、1分钟Apgar评分低于对照组,早产儿、新生儿窒息发生率高于对照组(t=6.184、1.713,χ~2=4.159、4.381,P均<0.05);2组间新生儿死亡发生率差异无统计学意义(P>0.05)。结论凶险型前置胎盘患者若胎盘附着于子宫前壁,其术中出血量更大且母婴结局不佳,此类患者更应引起临床重视。
Objective To investigate the effect of placenta main attachment position on blood loss and complications in patients with dangerous placenta previa.Methods Sxity-seven cases of dangerous placenta previa in late pregnancy admitted to obstetrics department of Panzhihua Central Hospital of Sichuan Province from December 2014 to May 2018 were retrospectively analyzed. According to the placenta main attachment position, 37 cases were divided into study group(placenta main attachment to anterior wall of uterus) and 30 cases in control group(placenta main attachment to posterior wall and lateral wall of uterus). The hemorrhage during cesarean section and the maternal and infant outcomes were compared between the two groups. Results The operation time, intraoperative blood loss, intraoperative blood transfusion, intraoperative blood loss, and postoperative 24 h bleeding were higher in the study group than in the control group(t=8.410, t=11.407, t=19.013, t=16.372, t=18.26, P<0.01). The incidence of hysterectomy, postpartum hemorrhage, puerperal infection, and DIC in the study group was higher than that in the control group(χ~2=24.671, χ~2=6.184, χ~2=4.671, χ~2=5.063, P<0.05). The body weight and 1-minute Apgar score of the study group were lower than those of the control group. The incidence of asphyxia in premature infants and neonates was higher than that of the control group(t=6.184, t=1.713, χ~2=4.159, χ~2=4.381, P<0.05). There was no significant difference in the incidence of neonatal death between the 2 groups(P>0.05).Conclusion If the dangerous placenta previa is attached to the anterior wall of the uterus, the amount of bleeding during the operation is larger and the outcome of mother and infant is not good. This kind of patients should be paid more attention to clinically.
Objective To investigate the effect of placenta main attachment position on blood loss and complications in patients with dangerous placenta previa.Methods Sxity-seven cases of dangerous placenta previa in late pregnancy admitted to obstetrics department of Panzhihua Central Hospital of Sichuan Province from December 2014 to May 2018 were retrospectively analyzed. According to the placenta main attachment position, 37 cases were divided into study group(placenta main attachment to anterior wall of uterus) and 30 cases in control group(placenta main attachment to posterior wall and lateral wall of uterus). The hemorrhage during cesarean section and the maternal and infant outcomes were compared between the two groups. Results The operation time, intraoperative blood loss, intraoperative blood transfusion, intraoperative blood loss, and postoperative 24 h bleeding were higher in the study group than in the control group(t=8.410, t=11.407, t=19.013, t=16.372, t=18.26, P<0.01). The incidence of hysterectomy, postpartum hemorrhage, puerperal infection, and DIC in the study group was higher than that in the control group(χ~2=24.671, χ~2=6.184, χ~2=4.671, χ~2=5.063, P<0.05). The body weight and 1-minute Apgar score of the study group were lower than those of the control group. The incidence of asphyxia in premature infants and neonates was higher than that of the control group(t=6.184, t=1.713, χ~2=4.159, χ~2=4.381, P<0.05). There was no significant difference in the incidence of neonatal death between the 2 groups(P>0.05).Conclusion If the dangerous placenta previa is attached to the anterior wall of the uterus, the amount of bleeding during the operation is larger and the outcome of mother and infant is not good. This kind of patients should be paid more attention to clinically.
引文
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[4] Chen Z,Li J,Shen J,et al.Direct puncture embolization of the internal iliac artery during cesarean delivery for pernicious placenta previa coexisting with placenta accreta[J].Int J Gynaecol Obstet,2016,135(3):264-267.DOI:10.1016/j.ijgo.2016.05.018.
[5] 中华医学会妇产科学分会计划生育学组.剖宫产术后子宫瘢痕妊娠诊治专家共识(2016)[J].中华妇产科杂志,2016,51(8):568-572.DOI:10.3760/cma.j.issn.0529-567x.2016.08.003.
[6] 马晓丽,李莲英.凶险型前置胎盘的相关因素及围生期结局分析[J].中国计划生育学杂志,2018,26(7):618-621.DOI:10.3969/j.issn.1004-8189.2018.07.019.
[7] Fan Y,Gong X,Wang N,et al.A prospective observational study evaluating the efficacy of prophylactic internal iliac artery balloon catheterization in the management of placenta previa-accreta:A STROBE compliant article[J].Medicine (Baltimore),2017,96(45):e8276.DOI:10.1097/MD.0000000000008276.
[8] 王秀红,董立娜.凶险型前置胎盘合并胎盘植入的产前超声诊断及临床价值[J].影像研究与医学应用,2018,2(5):10-11.DOI:10.3969/j.issn.2096-3807.2018.05.006.
[9] Ishibashi H,Miyamoto M,Soyama H,et al.Marginal sinus placenta previa is a different entity in placenta previa:A retrospective study using magnetic resonance imaging[J].Taiwan J Obstet Gynecol,2018,57(4):532-535.DOI:10.1016/j.tjog.2018.06.009.
[10] Duan X,Chen P,Han X,et al.Intermittent aortic balloon occlusion combined with cesarean section for the treatment of patients with placenta previa complicated by placenta accreta:A retrospective study[J].J Obstet Gynaecol Res,2018,44(9):1752-1760.DOI:10.1111/jog.13700.
[11] Thabet M,Abdelhafez MS,Fyala EA.Intrauterine Inflated Foley's Catheter Balloon in the Management of Abnormally Invasive Placenta Previa:A Case-Control Study[J].J Obstet Gynaecol India,2018,68(3):185-191.DOI:10.1007/s13224-017-1003-6.
[12] Dai MJ,Jin GX,Lin JH,et al.Pre-cesarean prophylactic balloon placement in the internal iliac artery to prevent postpartum hemorrhage among women with pernicious placenta previa[J].Int J Gynaecol Obstet,2018,142(3):315-320.DOI:10.1002/ijgo.12559.
[13] 徐国华.不同类型凶险性前置胎盘产妇的临床特点及剖宫产结局[J].中国妇幼保健,2018,33(9):1986-1988.DOI:10.7620/zgfybj.j.issn.1001-4411.2018.09.21.
[14] 刘晓红,刘晓琴,张雅,等.植入型凶险型前置胎盘患者临床特点、子宫切除率及新生儿结局35例分析[J].实用临床医学杂志,2017,21(15):132-133.DOI:10.7619/jcmp.201715041.
[15] Jauniaux E,Bhide A.Prenatal ultrasound diagnosis and outcome of placenta previa accreta after cesarean delivery:a systematic review and meta-analysis[J].Am J Obstet Gynecol,2017,217(1):27-36.DOI:10.1016/j.ajog.2017.02.050.
[16] 黄平,李群.凶险型与非凶险型前置胎盘处理与妊娠结局的关系[J].中国妇幼健康研究,2016,27(9):1095-1097.DOI:10.3969/j.issn.1673-5293.2016.09.022.
[17] 罗志丽,何景培.67例凶险型前置胎盘的临床特点分析[J].国际医药卫生导报,2015,21(11):1530-1533.DOI:10.3760/cma.j.issn.1007-1245.2015.11.013.
[2] Jeon H,Min J,Kim DK,et al.Women with Endometriosis,Especially Those Who Conceived with Assisted Reproductive Technology,Have Increased Risk of Placenta Previa:Meta-analyses[J].J Korean Med Sci,2018,33(34):e234.DOI:10.3346/jkms.2018.33.e234.
[3] Dai MJ,Jin GX,Lin JH,et al.Pre-cesarean prophylactic balloon placement in the internal iliac artery to prevent postpartum hemorrhage among women with pernicious placenta previa[J].Int J Gynaecol Obstet,2018,142(3):315-320.DOI:10.1002/ijgo.12559.
[4] Chen Z,Li J,Shen J,et al.Direct puncture embolization of the internal iliac artery during cesarean delivery for pernicious placenta previa coexisting with placenta accreta[J].Int J Gynaecol Obstet,2016,135(3):264-267.DOI:10.1016/j.ijgo.2016.05.018.
[5] 中华医学会妇产科学分会计划生育学组.剖宫产术后子宫瘢痕妊娠诊治专家共识(2016)[J].中华妇产科杂志,2016,51(8):568-572.DOI:10.3760/cma.j.issn.0529-567x.2016.08.003.
[6] 马晓丽,李莲英.凶险型前置胎盘的相关因素及围生期结局分析[J].中国计划生育学杂志,2018,26(7):618-621.DOI:10.3969/j.issn.1004-8189.2018.07.019.
[7] Fan Y,Gong X,Wang N,et al.A prospective observational study evaluating the efficacy of prophylactic internal iliac artery balloon catheterization in the management of placenta previa-accreta:A STROBE compliant article[J].Medicine (Baltimore),2017,96(45):e8276.DOI:10.1097/MD.0000000000008276.
[8] 王秀红,董立娜.凶险型前置胎盘合并胎盘植入的产前超声诊断及临床价值[J].影像研究与医学应用,2018,2(5):10-11.DOI:10.3969/j.issn.2096-3807.2018.05.006.
[9] Ishibashi H,Miyamoto M,Soyama H,et al.Marginal sinus placenta previa is a different entity in placenta previa:A retrospective study using magnetic resonance imaging[J].Taiwan J Obstet Gynecol,2018,57(4):532-535.DOI:10.1016/j.tjog.2018.06.009.
[10] Duan X,Chen P,Han X,et al.Intermittent aortic balloon occlusion combined with cesarean section for the treatment of patients with placenta previa complicated by placenta accreta:A retrospective study[J].J Obstet Gynaecol Res,2018,44(9):1752-1760.DOI:10.1111/jog.13700.
[11] Thabet M,Abdelhafez MS,Fyala EA.Intrauterine Inflated Foley's Catheter Balloon in the Management of Abnormally Invasive Placenta Previa:A Case-Control Study[J].J Obstet Gynaecol India,2018,68(3):185-191.DOI:10.1007/s13224-017-1003-6.
[12] Dai MJ,Jin GX,Lin JH,et al.Pre-cesarean prophylactic balloon placement in the internal iliac artery to prevent postpartum hemorrhage among women with pernicious placenta previa[J].Int J Gynaecol Obstet,2018,142(3):315-320.DOI:10.1002/ijgo.12559.
[13] 徐国华.不同类型凶险性前置胎盘产妇的临床特点及剖宫产结局[J].中国妇幼保健,2018,33(9):1986-1988.DOI:10.7620/zgfybj.j.issn.1001-4411.2018.09.21.
[14] 刘晓红,刘晓琴,张雅,等.植入型凶险型前置胎盘患者临床特点、子宫切除率及新生儿结局35例分析[J].实用临床医学杂志,2017,21(15):132-133.DOI:10.7619/jcmp.201715041.
[15] Jauniaux E,Bhide A.Prenatal ultrasound diagnosis and outcome of placenta previa accreta after cesarean delivery:a systematic review and meta-analysis[J].Am J Obstet Gynecol,2017,217(1):27-36.DOI:10.1016/j.ajog.2017.02.050.
[16] 黄平,李群.凶险型与非凶险型前置胎盘处理与妊娠结局的关系[J].中国妇幼健康研究,2016,27(9):1095-1097.DOI:10.3969/j.issn.1673-5293.2016.09.022.
[17] 罗志丽,何景培.67例凶险型前置胎盘的临床特点分析[J].国际医药卫生导报,2015,21(11):1530-1533.DOI:10.3760/cma.j.issn.1007-1245.2015.11.013.