61例胎盘早剥临床分析

目的:分析胎盘早剥的发病诱因、临床表现、辅助检查及母儿结局,以提高早期确诊率,降低母儿并发症。方法:回顾性分析2009年1月至2011年12月我院确诊并治疗的61例胎盘早剥患者的临床资料,分析其发病诱因、临床症状、辅助检查及母儿结局。结果:我院胎盘早剥发生率0.67%,其中轻型37例,重型24例;有明确发病诱因者38例,其中合并妊娠高血压疾病者居多。临床表现多为腹痛、阴道流血、阴道流液。B超诊断率50.82%。剖宫产52例,经阴分娩9例,产后出血13例,子宫胎盘卒中10例,DIC7例,行子宫B-lynch缝合术9例,轻型与重型胎盘早剥剖宫产率无统计学差异(P>0.05),但产后出血、子宫胎盘卒中、DIC、行子宫B-lynch缝合术有统计学差异(P<0.05)。围产儿死亡10例,新生儿窒息8例,转新生儿科23例,轻型与重型围产儿死亡率有显著统计学差异(P<0.01),新生儿转科率及新生儿窒息发生率则无统计学差异(P>0.05)。结论:胎盘早剥临床表现复杂,早期识别诊断,及时处理,可改变围生期母婴结局。对B超检查提示胎儿脐动脉血流S/D高的患者需重视。     

重型胎盘早剥对妊娠结局的影响

目的分析重型胎盘早剥对妊娠结局的影响。方法选取2012年7月~2015年6月我院收治的胎盘早剥患者116例,根据病情将其分为轻型组65例与重型组51例,同期选取在我院进行分娩的健康产妇60名为对照组。回顾性分析所有研究对象的临床资料,观察三组产妇的分娩方式、结局及胎儿的结局。结果重型组剖宫产率、早产率、产后出血率、子宫胎盘卒中发生率、弥散性血管内凝血发生率、子宫次全切除率、胎儿窘迫发生率、新生儿窒息发生率及围生儿死亡率均明显高于对照组和轻型组(P0.05),新生儿体质量、新生儿Apgar评分明显低于对照组和轻型组(P0.05)。结论重型胎盘早剥对分娩方式、产妇结局及胎儿结局的影响均比较大,临床上应早发现、早诊断、早治疗。     

胎盘早剥并发子宫胎盘卒中的危险因素分析

目的 探讨胎盘早剥并发子宫胎盘卒中的发病危险因素、临床特征及母儿结局.方法 收集2002年1月至2006年12月上海交通大学医学院附属国际和平妇幼保健院住院分娩的52例胎盘早剥产妇的临床资料,按是否并发子宫胎盘卒中分为两组:胎盘早剥并发子宫胎盘卒中17例为观察组,未并发子宫胎盘卒中的35例为对照组.采用回顾性研究方法对观察组子宫胎盘卒中的发病危险因素、临床特征及母儿结局进行分析,并与对照组进行比较.结果 (1)发生率:2002年1月至2006年12月共分娩35 049人次,胎盘早剥发生率为0.15%(52/35 049),胎盘早剥并发子宫胎盘卒中的发生率为0.05%(17/35 049),其中胎盘早剥产妇中子宫胎盘卒中的发生率为33%(17/52).(2)一般情况及分娩方式、分娩孕周:两组产妇的平均年龄、体重指数比较,差异无统计学意义(P>0.05).观察组产妇均以剖宫产结束分娩,而对照组产妇经阴道及剖宫产分娩为14及21例,比较两组分娩方式及分娩孕周,差异有统计学意义(P<0.01).观察组产妇早产发生率为88%(15/17),而对照组为49%(17/35),两组比较,差异有统计学意义(P<0.01).(3)发病危险因素:观察组产妇子痫前期发生率及发病持续时间分别为71%(12/17)及6.4 h,对照组分别为20%(7/35)及4.2 h,两组比较,差异均有统计学意义(P<0.01);两组产妇胎膜早破、羊水过多及其他因素比较,差异均无统计学意义(P>0.05).(4)临床特征:观察组产妇血性羊水、胎儿窘迫、宫腔积血及产后出血的发生率分别为82%(14/17)、65%(11/17)、35%(6/17)及59%(10/17),对照组分别为26%(9/35)、29%(10/35)、6%(2/35)及11%(4/35),两组比较,差异均有统计学意义(P<0.01).而两组产妇在主诉腹痛、阴道流血及腹肌张力高的发生率比较,差异均无统计学意义(P>0.05).(5)胎盘附着部位、剥离面积比较:观察组胎盘附着部位在子宫的前、后壁5例(5/17),宫底宫角12例(12/17);对照组胎盘附着部位在子宫的前、后壁24例(24/35),宫底宫角11例(11/35),两组胎盘附着宫底宫角部位发生例数比较,差异有统计学意义(P<0.01).观察组胎盘剥离面积均超过1/3,其中有9例患者剥离面积≥2/3;而对照组胎盘剥离面积≤1/3者27例,剥离面积在1/3～2/3者8例,两组比较,差异均有统计学意义(P<0.01).(6)母儿并发症及预后比较:观察组产妇发生失血性休克3例、DIC3例、子宫切除1例、死胎3例、新生儿窒息8例及新生儿死亡1例,而对照组除新生儿窒息5例及死胎2例外,其余指标均为0,两组比较,差异有统计学意义(P<0.01).结论 胎盘早剥并发子宫胎盘卒中发病的危险因素主要是子痫前期、发病持续时间长和胎盘附着宫角宫底部.胎盘早剥并发子宫胎盘卒中患者的母儿结局不良.     

探讨43例不典型胎盘早剥漏诊原因及母胎预后

目的分析不典型胎盘早剥产前易漏诊的原因，改善母胎预后。方法回顾性分析17年间胎盘早剥产前未确诊的43例（观察组）患者的资料，并与同期产前确诊为胎盘早剥的63例（对照组）比较。结果观察组临床表现主要为腰酸、腹胀或胎心监护异常，早剥面积及总出血量均明显低于对照组。而死胎、死产、新生儿死亡、新生儿窒息及早产儿出生率与对照组比较差异无统计学意义。产科DIC等并发症与对照组比较差异无统计学意义。结论胎盘早剥漏诊的主要原因为发病诱因和临床症状不典型，虽轻型早剥占较大比例，但对母胎仍具有较大危害。     

胎盘早剥30倒临床分析

目的:探讨胎盘早剥发生的原因、临床表现、对母婴预后的影响。方法:回顾性分析我院2011年1月1日～2011年9月30日收治的30例胎盘早剥患者临床资料。结果:30例孕产妇胎盘早剥轻型占60%、胎盘早剥重型占40%;胎盘早剥并发产后出血为50%、并发子宫胎盘卒中为20%、并发弥漫性血管内凝血为13%、无孕产妇死亡;发生新生儿窒息为23%,死胎率为13%;30例胎盘早剥患者孕周小于34周者占23%、孕34—37周者占33%、孕周大于37周者占43%;30例患者中妊娠期高血压疾病占30%、胎膜早破占20%。结论:妊娠期高血压疾病及胎膜早破是胎盘早剥的主要诱因;胎盘早剥是死胎的主要原因。     

彩色多普勒超声对胎盘早剥的诊断与分析

目的：探讨胎盘早剥的超声诊断图像特征，临床表现，提高诊断水平。方法：收集我院2011年4月至2014年3月收治3500例产妇中29例胎盘早剥患者的临床超声资料，进行回顾性分析。结果：轻型18例，占62．06％；重型11例，占37．94％。超声诊断符合率约93．1％；误诊2例，属于轻型早剥，误诊率6．9％。结论：超声诊断该病有很高的诊断符合率，是首选的影像学诊断方法。     

胎盘早剥漏诊31例临床分析

目的探讨胎盘早剥漏诊的相关因素,提高对不典型病例的认识,减少胎盘早剥的漏诊或误诊。方法回顾性分析1999年1月至2008年9月在上海浦东新区人民医院住院分娩的67例胎盘早剥患者的临床资料,将产前漏诊的31例作为漏诊组,产前确诊的36例作为对照组,比较漏诊的危险因素、临床特征和母儿结局。结果胎盘早剥发生率0.27%(67/24848),其中漏诊率46.27%(31/67),围生儿死亡率22.39%(15/67)。漏诊组发生阴道出血、子宫张力增高、重度胎盘早剥发生率低于对照组(P分别0.001,0.01和0.05)。漏诊组胎儿窘迫发生率高于对照组(P0.05)。两组腹痛、血性羊水、子宫卒中发生率比较,差异无统计学意义(P0.05)。漏诊组B超检出率10%,明显低于对照组的76.92%(P0.01)。两组患者的休克、凝血功能障碍、子宫切除、新生儿重度窒息比较,差异无统计学意义(P0.05)。漏诊组早产、围生儿死亡、死胎低于对照组(P0.05)。结论早期识别胎盘早剥的不典型征象,注意动态观察,可降低母婴危险。     

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。     

胎盘早期剥离并发症的诊断与处理

胎盘早期剥离(placenta abruptio)是孕晚期出血的重要原因之一，是妊娠期严重并发症，往往起病急、发展快、如果处理不及时，可威胁平儿生命。轻型胎盘早剥临床上常无典型症状，而重型胎盘早剥常出现凝血功能障碍、肾功能衰竭、子宫胎盘卒中及产后出血等并发症，本文就上述并发症的诊断及处理作一简述。     

124例胎盘植入高危因素分析

目的:探讨产妇发生胎盘植入的相关危险因素,为有效控制及减少胎盘植入的发生提供依据。方法:回顾分析124例胎盘植入产妇的临床资料,分析引起胎盘植入的相关危险因素。结果:胎盘植入的发生率为0.19%(124/66000),其中粘连性胎盘植入占7.26%(9/124),植入性胎盘植入占73.39%(91/124),穿透性胎盘植入占19.35%(24/124)。单因素分析结果显示,孕妇年龄≥30岁、孕前BMI≥24kg/m2、流产史、孕次≥2次、宫腔操作史、前置胎盘、疤痕子宫、早孕期阴道出血史是胎盘植入发生的危险因素(P0.05或P0.01)。多因素Logistic回归分析显示,合并有前置胎盘、疤痕子宫、早孕期阴道出血史是引起胎盘植入的独立危险因素(P0.01)。结论:应对前置胎盘、疤痕子宫、早孕期阴道出血史的孕妇进行干预,以降低胎盘植入的发生。     

胎盘早剥的早期临床诊断

目的探讨胎盘早剥临床漏诊的原因,提高胎盘早剥的早期诊断。方法对近5年在我院产科发生的40例胎盘早剥的临床资料进行回顾性分析。结果胎盘早剥的发生率为0.60%。19例合并妊娠高血压疾病（47.5%）,16例孕妇没有任何胎盘早剥的高危因素（40%）。大部分孕妇临床表现不典型。前壁胎盘B超诊断率高于后壁胎盘（P〈0.05）,重度胎盘早剥B超诊断率高于轻度胎盘早剥（P〈0.05）。结论识别胎盘早剥的高危因素,根据病史、临床症状和体征,结合B超以及电子胎心监护,进行综合分析判断是提高胎盘早剥诊断的有效手段。     

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。     

The relationship between clinical diagnosis and placental findings in 561 placentae delivered less than 32 weeks' of gestation

The relationship between clinical diagnosis and placental findings for 561 consecutive cases of delivery at 24 to 31 weeks' gestation were analyzed, and the following results were obtained. 1) The incidence of premature rupture of the membranes (PROM), threatened premature delivery, toxemia and abruption placentae were 40.6, 36.4, 7.8 and 3.0%, respectively. 2) The incidence of chorioamnionitis, retroplacental hematoma (RPH) and placental infarction were 35.1, 18.0, and 13.0%, respectively. 3) Chorioamnionitis of the placenta was found 58.3% in PROM and 26.0% of cases of threatened premature delivery. 4) RPH was found in 70.6% of placenta of abruption and 36.4% of toxemia. 5) Placental infarction was found in 86.4% of toxemia cases and 35.3% of abruption. Each clinical diagnosis was related specifically to each placental finding in cases delivered at 24 to 31 weeks of gestation.     

Prepregnancy risk factors for placental abruption

BACKGROUND: To define the prepregnancy risk factors for placental abruption. METHODS: One hundred and ninety-eight women with placental abruption and 396 control women without placental abruption were retrospectively identified among 46,742 women who delivered at a tertiary referral university hospital between 1997 and 2001. Relevant historical and clinical variables were compared between the groups. Multivariate logistic regression analysis was applied to identify independent risk factors. RESULTS: The overall incidence of placental abruption was 0.42%. Placental abruption recurred in 8.8% of the cases. The independent risk factors were smoking (OR 1.7; 95% CI 1.1, 2.7), uterine malformation (OR 8.1; 1.7, 40), previous cesarean section (OR 1.7; 1.1, 2.8), and history of placental abruption (OR 4.5; 1.1, 18). CONCLUSIONS: Although univariate analysis identified many risk factors, only smoking, uterine malformation, previous cesarean section, and history of placental abruption remained significant after multivariate analysis, increasing the risk of placental abruption in subsequent pregnancy. It may be possible to approximate the risk for placental abruption based on these simple prepregnancy risk factors.     

子痫前期患者胎盘早剥发病危险因素分析

目的 探讨子痫前期患者胎盘早剥发病的危险因素.方法 对1994年1月至2008年12月的15年间,在北京大学第三医院住院并分娩的219例患者的临床资料进行回顾性分析,根据病情分为3组:子痫前期早剥组,52例,为重度子痫前期发生胎盘早剥的患者;子痫前期组,130例,为重度子痫前期未发生胎盘早剥的患者;原因不明早剥组,37例,为非子痫前期发生胎盘早剥的患者.选择同期无并发症的正常分娩产妇178例为对照组(按1∶2病例对照研究方法选择).采用单因素及多因素回归分析方法,分析子痫前期患者胎盘早剥的发病危险因素.结果 (1)与对照组比较,单因素分析结果显示,孕次、产次、子痫前期病史、中晚期妊娠丢失史、自身免疫性疾病史、慢性高血压病史、此次孕期无规律产前检查、胎儿生长受限(FGR)及脐动脉收缩期最大血流速度(S)与舒张末期血流速度(D)的比值(S/D)异常是子痫前期患者胎盘早剥发病的危险因素;多因素回归分析显示,孕期无规律产前检查(OR=45.348,95%CI为17.096～120.288,P=0.000)、FGR(OR=27.087,95%CI为5.585～131.363,P=0.000)及中晚期妊娠丢失史(OR=16.068,95% CI为1.698～152.029,P=0.015)是子痫前期患者胎盘早剥发病的独立危险因素.(2)与子痫前期组比较,子痫前期病史(OR=3.715,95% CI为1.096～12.596,P=0.035)及孕期无规律产前检查(OR=2.509,95%CI为1.173～5.370,P=0.018)是子痫前期患者胎盘早剥发病的独立危险因素.结论 孕期无规律产前检查、子痫前期病史、中晚期妊娠丢失史及FGR是影响子痫前期患者胎盘早剥发病的危险因素.     

Analysis of 62 placental abruption cases: Risk factors and clinical outcomes

Objective

This study aimed to explore the clinical characteristics and outcomes of placental abruption.

Elevated maternal second-trimester serum alpha-fetoprotein as a risk factor for placental abruption

OBJECTIVE: To analyze the association of second-trimester maternal serum alpha-fetoprotein (MSAFP) and free beta human chorionic gonadotrophin (MSbeta-hCG) levels to placental abruption. METHODS: Fifty-seven women with placental abruption and 108 control women without placental abruption were tested for second-trimester MSAFP and MSbeta-hCG levels as a part of a trisomy 21 screening program. Discriminatory cutoff levels for MSAFP were sought to predict placental abruption. RESULTS: The median of the MSAFP multiples of median (MoM) (1.21) was significantly higher in the abruption group than in the control group (1.07) (p = 0.004). In multivariate analysis, elevated MSAFP remained an independent risk factor for placental abruption when adjusting for other risk factors (parity >/= 3, smoking, previous placental abruption, preeclampsia, bleeding in II or III trimester, and placenta previa). MSAFP >/= 1.5 MoM had a sensitivity of 29% and a false-positive rate of 10%. The levels of the MSbeta-hCG MoM did not differ between the cases and the controls. CONCLUSION: Although second-trimester MSAFP levels are higher in women with subsequent placental abruption, the clinical usefulness of this test is limited due to low sensitivity and high false-positive rate.     

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.