标题：不同胎盘附着部位引起的胎盘早剥对母婴预后的影响

      作者：张凌慧，张如星，吴淑英    (北京市房山区第一医院妇产科，北京 102400)

      卷次： 2017年28卷5期

      【摘要】 目的 探讨不同的胎盘附着部位引起的胎盘早剥对母婴预后的影响。方法 回顾性分析2007年1月至2016年6月89例于我院进行分娩的胎盘早剥患者的临床资料，根据胎盘的不同附着部位分为前壁胎盘组38例和后壁胎盘组51例。两组患者均采用剖宫产分娩；收集并对比两组患者的一般资料、手术情况、并发症及新生儿预后状况。结果 前壁胎盘组患者的阴道出血发生率、频繁宫缩发生率、胎心监护异常发生率、分娩前诊断率均显著高于后壁胎盘组，差异均有统计学意义(P<0.05)；后壁胎盘组患者的产后出血量为(796.4±261.2) mL，多于前壁胎盘组的(385.0±114.9) mL，差异有显著统计学意义(P<0.01)；后壁胎盘组患者产后大出血（产后出血量≥1 000 mL)发生率为25.5%，显著高于前壁胎盘组的0，差异有显著统计学意义(P>0.01)；后壁胎盘组输血率和弥散性血管内凝血率分别为35.3 %和13.7%，明显高于前壁胎盘组的7.9%和0，差异均有统计学意义(P<0.05)；两组患者的胎盘子宫卒中发生率、新生儿体质量和存活率比较差异均无统计学意义(P>0.05)；后壁胎盘组胎儿窘迫率和新生儿窒息率分别为45.1%和41.2%，明显高于前壁胎盘组的21.1%和10.5%，差异均有统计学意义(P<0.05)。结论 后壁胎盘胎盘早剥的临床表现不明显，给诊断带来一定的难度，且并发症严重，对母婴预后造成了很大威胁，在临床上务必要引起足够的重视。
      【关键词】 胎盘附着部位；胎盘早剥；前壁胎盘；后壁胎盘；预后
      【中图分类号】 R714.56 【文献标识码】 A 【文章编号】 1003—6350（2017）05—0758—03

Effect of placental abruption on pregnant prognosis in different placental attachment sites.
ZHANG Ling-hui,ZHANG Ru-xing, WU Shu-ying. Department of Obstetrics and Gynecology, the First Hospital of Fangshan District ofBeijing, Beijing 102400, CHINA
【Abstract】 Objective To explore the effect of placental abruption on the prognosis of the mothers and new-borns in different placental attachment sites. Methods From January 2007 to June 2016, 89 patients with placentalabruption in our hospital were recruited and divided into anterior placenta group (38 cases) and posterior placentagroup (51 cases), according to placenta attachment sites. All the patients suffered cesarean delivery. Data were collect-ed and compared between the two groups, including general information, operation, complications and neonatal prog-nosis. Results The incidences of vaginal hemorrhage, frequent contractions, abnormal fetal heart rate monitoring,and the diagnosis rate before delivery in anterior placenta group were significantly higher than those in posterior placen-ta group (P<0.05). The posterior placenta group had significantly more postpartum blood loss (796.4±261.2) mL, higherincidence of postpartum hemorrhage (≥1 000 mL, 25.5%), higher blood transfusion rate (35.3%), and higher disseminat-ed intravascular coagulation rate (13.7%), as compared with (385.0±114.9) mL, 0, 7.9%, 0 in anterior placenta group (allP<0.01). The two groups had no statistically significant difference in the incidence of uteroplacental apoplexy, neona-tal body weight, and survival rate (P>0.05). The incidences of fetal distress (45.1%) and neonatal asphyxia (41.2%) inthe posterior placenta group were significantly higher than 21.1% and 10.5% in the anterior placenta group (P<0.05).Conclusion Placental abruption caused by posterior placenta has no obvious clinical manifestations, is difficult to diag-nose, and often results in serious complications, which presents a great threat to the prognosis of mothers and newborns.
      【Key words】 Placental attachment sites; Placental abruption; Anterior placenta; Posterior placenta; Prognosis·论 著·doi:10.3969/j.issn.1003-6350.2017.05.024