52例凶险型前置胎盘合并胎盘植入的临床分析

黄金瑞等

【摘要】目的探讨凶险型前置胎盘合并胎盘植入的临床特点，提高对该病的认识和重视。方法收集2013年1月～2014年12月92例中央性前置胎盘产妇的临床资料进行回顾性分析，其中凶险型中央性前置胎盘52例为观察组，普通中央性前置胎盘40例为对照组，比较两组的产前出血情况、胎盘植入情况、术中出血量、输血量、产后出血率、子宫切除发生率、并发症发生率、分娩孕周、围生儿情况等。结果 凶险型前置胎盘植入率、术中出血量、输血量、产后出血率、子宫切除率、并发症发生率均明显高于对照组，差异有统计学意义（P<0.05或0.01）。观察组产前出血率、平均分娩孕周、围生儿情况与对照组比较，差异无统计学意义（P>0.05）。结论凶险型前置胎盘植入率高、出血量大、子宫切除率高，对孕产妇危害性极大，加强宣教，降低首次分娩剖宫产率非常重要。

【关键词】凶险型前置胎盘；胎盘植入；子宫切除；剖宫产术

中图分类号：R714.56 文献标识码：ADOI：10.3969/j.issn.10031383.2015.04.020

【Abstract】ObjectiveTo explore the clinical characteristics of pernicious placenta previa complicated with placenta implantation， so as to increase awareness and attention of the disease.Methods Retrospective analysis was conducted in clinical data of 92 central placenta previa patients who admitted to hospital from January，2013 to December，2014.52 cases of pernicious central placenta previa were selected as observation group，and 40 cases of ordinary central placenta previa as control group.Then，antepartum haemorrhage，placenta implantation，amount of bleeding and blood transfusion during operation，rate of postpartum hemorrhage，incidence of hysterectomy，incidence of complications，gestational weeks and perinatal infants of both groups were compared.Results Rate of placenta implantation，amount of bleeding and blood transfusion during operation，rate of postpartum hemorrhage，incidence of hysterectomy and incidence of complications of the observation group were significantly higher than those of the control group，so difference was statistically significant（P<0.05 or 0.01）.No statistical significance was found in the difference of antepartum haemorrhage，average gestational weeks and perinatal infants between the two groups（P>0.05）.ConclusionPernicious placenta previa has high rate of placenta implantation，large amount of bleeding and high incidence of hysterectomy，which is of great danger for delivery woman.Thus，it is of great importance to strengthen propaganda and education，and reduce rate of cesarean section in the first delivery.

【Key words】pernicious placenta previa；placenta implantation；hysterectomy；cesarean section

凶险型前置胎盘（pernicious placenta previa，PPP）的定义是1993年由Chapttopadhyay首次提出，是指附着于既往子宫下段剖宫产瘢痕处的前置胎盘，伴或不伴胎盘植入。它是前置胎盘中较为严重的一种，合并胎盘植入的概率高、风险大，常可导致孕产妇在妊娠期及分娩期发生难以预测的大出血，从而导致休克、子宫切除、凝血功能障碍等并发症的风险增加。由于剖宫产量逐渐积累，凶险型前置胎盘的发生率也有明显增加的趋势。我院凶险型前置胎盘2012年不足10例，2013年23例，2014年29例。本研究回顾性分析我院2013年1月～2014年12月52例凶险型前置胎盘的临床资料，探讨其临床特点及诊治措施。1资料与……