凶险型与非凶险型前置胎盘妊娠结局的比较分析
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摘要
目的探讨凶险型与非凶险型前置胎盘孕妇的分娩情况及其对新生儿的影响。方法选取2016年3月至2018年2月在温州市中心医院产科收治的105例前置胎盘孕妇的临床资料。根据有无剖宫产史及胎盘位置,将入组孕妇分为凶险型组(55例)和非凶险型组(50例),比较分析两组患者的分娩情况及新生儿妊娠结局的差异。结果凶险型组和非凶险型组患者前置胎盘类型比较无显著差异,且均以中央性为主(χ~2=0.28,P=0.87);凶险型组的剖宫产、产后出血、出血量、输血量均显著高于非凶险型组(χ~2或t值分别5.78,7.43,15.054,11.991,均P<0.05);凶险型组中的早产、新生儿窒息、气管插管、死亡比例也显著高于非凶险型组,差异均有统计学意义(χ~2值分别为4.37,11.17,6.81,5.20,均P<0.05)。结论凶险型前置胎盘孕产妇的剖宫产率、产后出血风险,以及新生儿早产、窒息、死亡风险均显著高于非凶险型前置胎盘。因此,应对有剖宫产史的孕妇应加强宣教,重视孕期产检,及时进行预防性处置,以改善母婴结局。
Objective To investigate the delivery situation of pregnant women with pernicious and non-pernicious placenta previa and their effects on newborns. Methods The clinical data of 105 pregnant women with placenta previa who admitted to the Department of Obstetrics in Wenzhou Central Hospital from March 2016 to February 2018 were selected, and they were divided into pernicious group(55 cases) and non-pernicious group(50 cases) according to history of cesarean section and position of placenta. The delivery situation and neonatal outcomes were compared between two groups. Results There was no significant difference in the placenta previa between pernicious group and non-pernicious group, and they were mainly central placenta previa(χ~2=0.28, P=0.87). The number of cesarean section and the postpartum hemorrhage, amount of bleeding, and blood transfusion volume in pernicious group were significantly higher than those in non-pernicious group(χ~2 or t value was 5.78, 7.43, 15.054 and 11.991, respectively, all P<0.05). The incidence of premature birth, neonatal asphyxia, tracheal intubation, and death rate in pernicious group were also significantly higher than non-pernicious group, and the differences were statistically significant(χ~2 value was 4.37, 11.17, 6.81 and 5.20, respectively, all P<0.05). Conclusion The risk of cesarean section rate, postpartum hemorrhage, and the risk of preterm birth, neonatal asphyxia and death in women with pernicious placenta previa are significantly higher than those with non-pernicious placenta previa. Therefore, education should be strengthened for pregnant women with a history of cesarean section. It is necessary to pay attention to pregnancy check-ups and timely preventive treatment to improve maternal and child outcomes.
Objective To investigate the delivery situation of pregnant women with pernicious and non-pernicious placenta previa and their effects on newborns. Methods The clinical data of 105 pregnant women with placenta previa who admitted to the Department of Obstetrics in Wenzhou Central Hospital from March 2016 to February 2018 were selected, and they were divided into pernicious group(55 cases) and non-pernicious group(50 cases) according to history of cesarean section and position of placenta. The delivery situation and neonatal outcomes were compared between two groups. Results There was no significant difference in the placenta previa between pernicious group and non-pernicious group, and they were mainly central placenta previa(χ~2=0.28, P=0.87). The number of cesarean section and the postpartum hemorrhage, amount of bleeding, and blood transfusion volume in pernicious group were significantly higher than those in non-pernicious group(χ~2 or t value was 5.78, 7.43, 15.054 and 11.991, respectively, all P<0.05). The incidence of premature birth, neonatal asphyxia, tracheal intubation, and death rate in pernicious group were also significantly higher than non-pernicious group, and the differences were statistically significant(χ~2 value was 4.37, 11.17, 6.81 and 5.20, respectively, all P<0.05). Conclusion The risk of cesarean section rate, postpartum hemorrhage, and the risk of preterm birth, neonatal asphyxia and death in women with pernicious placenta previa are significantly higher than those with non-pernicious placenta previa. Therefore, education should be strengthened for pregnant women with a history of cesarean section. It is necessary to pay attention to pregnancy check-ups and timely preventive treatment to improve maternal and child outcomes.
引文
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[2] Ni X,Ding Y,Li J.Effects of abdominal aortic balloon occlusion on caesarean section of pernicious placenta previa with different implantation degree[J].Progress in Obstetrics & Gynecology,2018,27(3):175-178.
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[6]Vahanian S A,Lavery J A,Ananth C V,et al.Placental implantation abnormalities and risk of preterm delivery:a systematic review and metaanalysis[J].American Journal of Obstetrics & Gynecology,2015,213(4):78-90.
[7]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.
[8] Eller A G,Bennett M A,Sharshiner M,et al.Maternal morbidity in cases of placenta accreta managed by a multidisciplinary care team compared with standard obstetric care[J].Obstetrics and gynecology,2011,117(2):331-337.
[2] Ni X,Ding Y,Li J.Effects of abdominal aortic balloon occlusion on caesarean section of pernicious placenta previa with different implantation degree[J].Progress in Obstetrics & Gynecology,2018,27(3):175-178.
[3]凶险型前置胎盘的妊娠结局探讨[J].中国妇幼健康研究,2014,25(5):799-801.
[4] Cao Y,Geng X Y,Zhao C Y.Application value of prenatal sonography in diagnosis of pernicious placenta previa combined with placenta implantation[J].Maternal & Child Health Care of China,2017,32(10):2237-2240.
[5] Lal A,Gao W,Hibbard J.Placenta previa:an outcome-based cohort study in a contemporary obstetric population[J].Archives of Gynecology & Obstetrics,2015,292(2):299-305.
[6]Vahanian S A,Lavery J A,Ananth C V,et al.Placental implantation abnormalities and risk of preterm delivery:a systematic review and metaanalysis[J].American Journal of Obstetrics & Gynecology,2015,213(4):78-90.
[7]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.
[8] Eller A G,Bennett M A,Sharshiner M,et al.Maternal morbidity in cases of placenta accreta managed by a multidisciplinary care team compared with standard obstetric care[J].Obstetrics and gynecology,2011,117(2):331-337.