彩色超声对胎盘早剥的诊断及临床价值

目的:评价彩色多普勒超声(CDFI)及彩色多普勒能量超声(CDE)对胎盘早剥的诊断价值及临床意义。方法:回顾分析2000年1月至2003年12月本院收治的71例胎盘早剥声像特征及母儿结局。结果:彩色超声诊断胎盘早剥63例,符合率89%,漏误诊8例(占11%),71例胎盘早剥孕妇剖宫产63例,阴道分娩8例。活婴59例,其中早产儿家属放弃治疗1例,死胎12例伴子宫卒中3例。结论:CDE及CDFI对胎盘早剥的诊断准确率较高,能减少母儿并发症,降低围生儿死亡率,可作为胎盘早剥的首选检查方法。     

前置胎盘与胎盘早剥的诊断及鉴别诊断

产科出血是导致母儿病率的主要原因。前置胎盘和胎盘早剥又是两个最常见的产前出血原因,处理不当可危及母儿生命安全。     

未足月胎盘早剥49例临床分析

胎盘早剥是妊娠中晚期一种严重的并发症,早期诊断和正确处理是降低母儿并发症及死亡的关键。本文对本院2007年1月至2009年4月收治的86例胎盘早剥病例资料进行回顾性分析,以探讨胎盘早剥的早期诊断方法。     

胎盘早剥78例临床分析

胎盘早剥是产科的危重症之一,早期诊断、及时治疗能有效地改善母儿预后。本文回顾性分析2000年1月至2008年12月于本院诊治的78例胎盘早剥患者的临床资料,以探讨胎盘早剥的综合诊断方法,从而有助于改善母婴结局。     

妊娠晚期出血终止妊娠的时机及方式的选择

妊娠晚期出血是产科的常见并发症,主要包括前置胎盘、胎盘早剥、血管前置及胎盘边缘血窦破裂,其中以前置胎盘和胎盘早剥最常见。这些并发症往往起病急、进展快、病情重,若处理不当可直接威胁母儿生命安全。正确选择终止妊娠的时机和方式,可明显降低母儿围产期病死率。     

胎盘早剥的早期诊断

胎盘早剥最常见的症状是伴有疼痛性的阴道流血。预后的关键在于早期诊断和及时治疗。要提高对胎盘早剥的早期诊断能力,必须重视诱因和不典型的临床表现,并结合实验室检查早期诊断胎盘早剥,同其他重要的孕晚期出血疾病进行鉴别,及时处理,以改善母儿预后。     

《中国实用妇科与产科杂志》2011年第2期中心内容预告

中心内容:产科急重症处理加强产科急重症患者管理,降低母儿死亡率重型胎盘早剥的诊断和处理     

胎盘早剥52例临床分析

胎盘早剥是妊娠晚期严重并发症，具有起病急、发展快特点，若处理不及时可危及母儿生命。我院1995年1月～2005年1月共收治胎盘早剥患者52例，现分析总结如下。     

胎盘早剥155例临床分析

胎盘早剥是危及母儿生命的产科急危重症之一,围产儿死亡率高,剖宫产率高。其并发症如：子宫胎盘卒中、失血性休克、ＤＩＣ、肾功能衰竭等威胁母亲的生命安全。我院自１９８９年８月至１９９７年８月,８年中共发生１５５例胎盘早剥,我们对本组资料进行回顾性分析,旨在探讨其防治措施,降低母儿病死率,提高母儿的生存质量。一、资料与方法１－资料来源：（１）８年中在我院共分娩１２２４６例,发生胎盘早剥１５５例,发病率为１－２７％。围产儿死亡４５例,死亡率为２９０．３２‰。４５例围产儿死亡中,其中３０例入院时已有胎死宫内…     

胎盘早剥与前置胎盘高危新生儿的临床特征

胎盘早剥与前置胎盘是妊娠晚期出血的主要原因，起病急。进展快，可危及母儿生命。本文就近5年来从我院产科转入我科收治的胎盘早剥、前置胎盘新生儿的临床资料进行回顾性分析，以探讨胎盘早剥与前置胎盘高危新生儿的临床特征。     

Incidence,obstetric risk factors and pregnancy outcome of preterm placental abruption: a retrospective analysis

Objective: To determine obstetric risk factors for the occurrence of preterm placental abruption and to investigate its subsequent perinatal outcome. Study design: A retrospective comparison of all singleton preterm deliveries complicated with placental abruption, between the years 1990-1998, to all singleton preterm deliveries without placental abruption, in the Soroka University Medical Center. Results: Placental abruption complicated 300 (5.1%) of all preterm deliveries (n = 5934). A back-step multivariable analysis found the following factors to be independently correlated with the occurrence of preterm placental abruption: grandmultiparity (more than five deliveries), early gestational age, severe pregnancy-induced hypertension, previous second-trimester bleeding and non-vertex presentation. These pregnancies had a significantly lower rate of preterm premature rupture of membranes than preterm pregnancies without placental abruption. Pregnancies complicated with preterm placental abruption had significantly higher rates of cord prolapse, non-reassuring fetal heart rate patterns, congenital malformations, Cesarean deliveries, perinatal mortality, Apgar scores lower than 7 at 5 min, postpartum anemia and delayed discharge from the hospital than did preterm deliveries without placental abruption. In order to assess whether the increased risk for perinatal mortality was due to the placental abruption, or due to its significant association with other risk factors, a multivariable analysis was constructed with perinatal mortality as the outcome variable. Placental abruption (OR 3.0, 95% CI 2.1-4.1) as well as cord prolapse, previous perinatal death, low birth weight and congenital malformations were found to be independent risk factors for perinatal mortality. Conclusion: Preterm placental abruption is an unpredictable severe complication associated with significant perinatal morbidity and mortality. Factors found to be independently associated with placental abruption were grandmultiparity, severe pregnancy-induced hypertension, malpresentation, earlier gestational age and a history of second-trimester vaginal bleeding.     

Clinical significance of pregnancies with circumvallate placenta

AIM: This study examined the clinical significance of patients complicated by circumvallate placenta in comparison with patients with a normal placenta. METHODS: Data were collected from 139 singleton deliveries complicated by circumvallate placenta and from 7666 unaffected controls managed at Japanese Red Cross Katsushika Maternity Hospital between 2002 and 2005. RESULTS: The incidence of premature delivery, oligohydramnios, non-reassuring fetal status on cardiotocogram, placental abruption and intrauterine fetal death in patients complicated by circumvallate placenta were significantly higher than those in control patients. The odds ratio of placental abruption in patients complicated by circumvallate placenta was 13.1 (95% confidence limits: 5.65-30.2). CONCLUSION: A circumvallate placenta is associated with a higher incidence of serious perinatal complications such as placental abruption.     

33例胎盘早剥的B超诊断

目的对产前B超检查产后证实为胎盘早剥的病例进行分析，以提高B超对胎盘早剥的确诊率。方法对我院1988年1月至2003年4月间33例胎盘早剥的声像图表现及临床资料进行回顾性分析。结果产前B超诊断胎盘早剥符合率为84．8％(28例)，其中前壁胎盘及重度胎盘早剥符合率高(93．7％，100％)，而后壁胎盘及轻度早剥无临床症状符合率低(72．77％；0)。胎盘早剥的超声图像特征为胎盘与子宫壁间为暗区、低回声，中等回声或混合回声15例，胎盘局部增厚6例，胎盘边缘或绒毛膜板下突出肿块8例(误为绒毛膜血管瘤1例)。彩色多普勤血流显像显示胎盘剥离区无血流信号。结论产前B超捡查对诊断胎盘早剥具有很重要的临床价值，为临床处理及分娩方式的选择提供了依据。     

Obstetric prognosis after placental abruption

OBJECTIVE: To assess obstetric outcome in women with a history of placental abruption. METHODS: We utilised the population-based birth registry data of Kuopio University Hospital to investigate pregnancy outcome in 59 women with prior placental abruption. The general obstetric population was used as a reference group in logistic regression analysis. RESULTS: Recurrent placental abruption and associated adverse neonatal outcome occurred in 11.9% (7:59) of the women. If the disease did not recur, a history of placental abruption had no significant effects on birth weight, fetal distress or prematurity rate, whereas the incidence of pre-eclampsia was found to be increased. CONCLUSIONS: Women in whom placental abruption does not recur have a good outcome in their subsequent delivery, almost comparable to that in the general obstetric population. However, the recurrence rate of 11.9% is high (OR: 16.9, 95% CI: 8.2-34.9) when compared with the background incidence of placental abruption (0.7%).     

Factor V Leiden in pregnancies complicated by placental abruption

Objective Recent studies suggest an increased prevalence of obstetric complications in female carriers of hereditary or acquired thrombophilias. The aim of the study was to determine if carriership of the factor V (FV) Leiden mutation (activated protein C [APC] resistance) is higher in women who have had of placental abruption during pregnancy.
Design A retrospective case–control study.
Setting University Hospital MAS, Malmö, Sweden.
Methods A comparison of 102 women with placental abruption with 2371 prospectively collected controls. Carriership of FV Leiden was determined and the women were interviewed.
Main outcome measures Proportion of FV Leiden carriership, first degree heritage of thrombosis and previous placental abruption in cases and controls.
Results Carriage of FV Leiden was found in 15.7% of women who have had placental abruption as compared with 10.8% of controls (   P = 0.12, odds ratio [OR] = 1.5, 95% confidence interval [CI] = 0.9–2.7  ). Around 20% of women with placental abruption reported first degree heritage for venous thrombosis, as compared with 6.7% of controls (   P ≤ 0.001  ).
Conclusions FV Leiden carriership was not significantly different in women with placental abruption. However, there was an increased prevalence of first degree heritage for venous thrombosis in women with placental abruption, indicating a higher prevalence of thrombophilia among women with placental abruption.     

The effect on the likelihood of further pregnancy of placental abruption and the rate of its recurrence

Objective To assess the effect of having a placental abruption on 1. the probability of having further pregnancies, and 2. the rate of recurrence in such pregnancies.
Design A cohort study based on the Medical Birth Registry of Norway.
Results From 1967 to 1989, placental abruption occurred in 218/4951 subsequent deliveries after a placental abruption index case. After placental abruption with perinatal survival in the first delivery 59% of women had a further delivery, compared with 71% who did not have placental abruption at delivery. After a perinatal loss corresponding rates were 83% and 85%, respectively. Odds ratios of recurrence of abruption, crude and adjusted for maternal age, birth order and time period were 7.1 and 6.4, respectively. No secular trends were found. Caesarean section rates increased and were higher in pregnancies with recurrent placental abruption and in subsequent pregnancies without placental abruption than in the total birth population.
Conclusions Women who have placental abruption are less likely than other women to have another pregnancy. For women who do have subsequent pregnancies placental abruption occurs significantly more frequently.     

Frequency of selected thrombophilias in women with placental abruption

OBJECTIVE: There is a growing view that inherited or acquired thrombophilia may predispose a woman towards an adverse pregnancy outcome. The aim of this study was to investigate whether risk factors for placental abruption because of such thrombophilias (such as carriership of factor V Leiden (FVL), prothrombin G20210A gene mutation and homozygous MTHFR C677T) might be used as a predictor for placental abruption. METHODS: A retrospective case-control study conducted at the University Hospital, Palacky University, Olomouc, Czech Republic. One hundred and eighty women with placental abruption out of 20,175 deliveries (0.79%) were compared to 196 unselected gravidae. A detailed medical history was taken with special reference to factors related to hypercoagulation and blood was drawn for polymerase chain reaction analysis. The prevalence of FVL, prothrombin G20210A and MTHFR C677T was related to placental abruption. RESULTS: The heterozygous form of FVL was present in 20of 142 cases (14.1%) in the placental abruption group, compared to ten of 196 (5.1%) in the control group (odds ratio 3.0, 95% confidence interval 1.4-6.7). CONCLUSIONS: We found that factor V Leiden is a significant risk factor for placental abruption.     

Placental abruption

Placental abruption complicates approximately 1% to 2% of all pregnancies and remains a significant cause of both maternal and fetal morbidity. Proposed pathophysiology of both acute placental abruption and the more common partial placental separation are discussed. The contribution of placental abruption to both preterm labor and preterm premature rupture of membranes is discussed. Recent evidence supporting maternal hypertensive disorders, maternal tobacco and cocaine use, age and parity, multiple gestations, maternal thrombophilias, and an unexplained elevated maternal serum alphafetoprotein as risk factors for abruption is reviewed. Emergency management of acute abruption is outlined. Finally, particular emphasis is given to the management of partial placental separation, including both immediate and delayed delivery and the use of tocolysis. TARGET AUDIENCE: Obstetricians and Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader will be able to define the condition of placental abruption, list the conditions associated with abruption, and outline potential management options for patients with placental abruption.     

Evaluation of blunt abdominal trauma in the third trimester of pregnancy: maternal and fetal considerations

With the active life-style of today's pregnant women, the effects of trauma have become an important obstetric concern. A protocol was developed to monitor pregnancies complicated by major blunt abdominal trauma in the third trimester, looking specifically for delayed placental and/or fetal problems. Of the 84 pregnancies studied, the most serious complication was placental abruption. Although abruption occurred in only two cases, one case was associated with a ruptured uterus and fetal death. There were no cases of delayed abruption or delayed fetal compromise. The most common complication was preterm labor, occurring in 28% of cases when the traumatic insult happened before 37 weeks' gestation. Of these 17 patients, 15 were successfully treated with tocolysis. There were no cases of direct fetal injury or Rh-isoimmunization. A revised protocol is recommended for limited outpatient observation with nonstress testing and screening ultrasonography to rule out preterm labor and placental abruption and to document fetal well-being.