Hématome rétroplacentaire. Diagnostic,prise en charge et pronostic maternofœtal : étude rétrospective de 100 cas

ObjectivesTo update knowledge on placental abruption because there are few recent series published although the perinatal care has progressed.Patients and methodsA retrospective observational study has been conducted on 100 consecutive cases of abruptio placentae, occurring from January 2008 to June 2011, in the two maternity units of the University Hospital of Strasbourg (France).ResultsOne hundred and five births among which five twin pregnancies were included. Clinical context was evident in 91% of cases, but the classic clinical triad was present in only 4% of cases. Clots were found at immediate placenta examination in 77% of cases. Pathological diagnosis was directly in accordance with clinical diagnosis in half the cases. Mean date of childbirth was 33 weeks of amenorrhea and 6 days. Sixty-seven patients gave birth prematurely. Among them, 50 patients delivered before 34 weeks. Sixty caesareans were performed in emergency before labor, including 47 with general anesthesia. Twelve patients had post-partum haemorrhage and ten coagulation disorders. There was no maternal death. Perinatal mortality was 19% with 13 fetal deaths in utero (12.4%), four children born in an apparent death state with resuscitation failure (3.8%) and three neonatal deaths (2.8%).Discussion and conclusionPlacental abruption is a serious and unpredictable situation. Joint medical care of obstetricians and intensivists is often required. Perinatal mortality mainly occurs in utero.     

胎盘早剥的声像图表现及妊娠结局分析

目的 探讨胎盘早剥声像图特征及妊娠结局。方法 收集132例经产后诊断为胎盘早剥孕妇的产前超声检查资料,分析其声像图表现及妊娠并发症。结果 超声检出胎盘早剥48例,检出率36.36%（48/132）,漏诊率63.64%（84/132）。胎盘早剥声像图表现为胎盘增厚29例、胎盘实质回声异常16例、胎盘后方回声异常9例、胎盘边缘回声异常6例、胎盘胎儿面回声异常4例、宫壁与胎膜间回声异常2例以及羊水池内回声异常7例;主要并发症为剖宫产、子宫胎盘卒中、弥漫性血管内凝血、产后出血、早产、新生儿重度窒息及围生儿死亡,经超声检出胎盘早剥者以上并发症发生率均高于超声未检出者（P均<0.05）。结论 胎盘早剥产前超声检出率低;超声检出胎盘早剥者妊娠结局较差。     

胎盘早剥21例临床分析

目的 研究多囊卵巢综合症（PCOS）纤溶酶原激活物抑制因子-1（PAI-1）基因启动子区4G5G多态性的分布,探讨其与PCOS发病关系.方法 96例PCOS患者和50例对照组,用PCR方法测定PAI-1基因启动子区4G5G基因多态性;ELISA法检测血浆PAI-1水平.结果 PCOS组4G/4G基因型明显高于对照组,而5G/5G基因型显著少于对照组.PCOS组的PAI-1水平较对照组明显升高（29.32±2.37ng/mL与22.42±0.65ng/mL,P〈0.05）.结论 PCOS患者PAI-1基因启动子区4G/4G基因型频率增高,致血浆PAI-1水平升高,其与PCOS的发病有关.     

不同程度胎盘早剥产妇所生新生儿的临床特征

目的　探讨和强调不同程度胎盘早剥产妇所生新生儿的临床特征和危险性。　方法　回顾对照分析 1994年 7月～ 1998年 6月本科收治的 141例不同程度胎盘早剥产妇所生新生儿的临床资料。　结果　胎盘早剥产妇所生新生儿中早产儿为 94.3% ,低出生体重儿为 80 .9% ,窒息儿为79.4% ;入院时缺氧缺血性脑病 (HIE)为 6 3.1% ,心肌损害为 5 6 .0 % ,休克为 5 6 .7% ,贫血为 6 1.7% ,弥漫性血管内凝血 (DIC)为 83.0 % ,酸中毒为 6 6 .0 % ,呼吸窘迫综合征 (RDS)为 5 0 .4% ,呼吸暂停为5 1.1% ,均在 5 0 %以上。母胎盘早剥轻型组与重型组之间 ,入院日龄、性别、产式、胎龄、出生体重例数分布差异无显著意义 ,但各病症检出率均以重型组为高。其中窒息儿主要是重度窒息 ,检出率以重型组为高 ;DIC中 ,高凝期检出率以轻型组为高 ,低凝期检出率以重型组为高 ;轻型组新生儿中各相关危重症检出率虽然较重型组显著为低 ,但也分别达 43.4%～ 77.4%。　结论　印证了上述病症是胎盘早剥产妇所生新生儿的临床特征 ;表明了重型胎盘早剥产妇所生新生儿病情更复杂、更严重 ,但轻型产妇所生新生儿也具一定危险性 ,均应引起高度重视。     

胎盘早剥漏诊原因分析

目的了解不典型胎盘早剥产前漏诊的原因。方法回顾性分析10年间胎盘早剥产前未确诊的165例（观察组）患者的临床资料,并与同期产前确诊为胎盘早剥的124例（对照组）比较,分析漏误诊原因。结果观察组发病诱因以催产素等方法引产或催产为最多,临床表现主要为产程中胎心率或胎心监护异常,早剥面积及总出血量均明显低于对照组,总产程〈5小时为103例,其中死产及新生儿死亡15例。结论催产素使用不当是胎盘早剥的诱因,症状不典型、产程活跃期进展过快是早剥漏诊的主要原因。     

胎盘早期剥离31例临床分析

目的：探讨胎盘早期剥离(早剥)的发病因素、临床表现及治疗。方法：回顾性分析31例胎盘早剥的临床资料、治疗及预后。结果：胎盘早剥的发生率为0．8％，机械性因素17例(54．8％)，妊娠高血压综合征引起的13例(41．9％)，以中重度为主。临床症状主要以腹痛、阴道流血为多见，分别为64．5％、54．8％，但有部分病例仅表现胎动消失或胎死子宫内，术前确诊较困难。临床类型轻重比例相近，病理类型以隐性和混合性多见，分别为45．2％、51．6％。分娩方式以剖宫产为主(83．9％)，围生儿死亡率54．8％。结论：胎盘早剥的发病因素以机械性因素和中重度妊娠高血压综合征为多见，临床表现以腹痛、阴道流血多见，围生儿病死率高，应做好孕期保健工作，积极推行孕期健康教育。     

Raised uterine resting tone in patients with abruptio placentae

Uterine contractions were studied in 21 patients with abruptio placentae and intrauterine death. Contractions were examined in four 10-minute windows taken immediately prior to delivery, 30 and 60 minutes before delivery and at the beginning of the recording. Mean resting tone values for the 4 periods fluctuated between 23 and 25 mmHg. The mean contraction frequency for all the windows was 8 per 10 minutes. It is postulated that the high resting tone and frequent uterine contractions contribute to the high perinatal mortality associated with abruptio placentae.     

Spectroscopic and chromatographic evidences of NADPH in human placental extract used as wound healer

An aqueous extract of human placenta, which is used as wound healer, has been investigated in terms of fluorescence properties. When excited at 340 nm, it results in fluorescence emission having maxima around 436 nm, which is fairly specific for nicotinamide adenine dinucleotide, reduced form (NADH) and nicotinamide adenine dinucleotide phosphate, reduced form (NADPH). The excitation spectra, having emission at 440 nm, show patterns comparable to these nucleotides. Thin layer chromatography and reversed-phase (RP) HPLC confirm presence of only NADPH in the extract. The emission and excitation patterns of NADPH purified after HPLC resemble exactly with the reference compound. Its content has been estimated to be 0.018±0.003 mg/ml based on fluorescence emission with respect to a standard calibration curve (n=6). Biological functionality of NADPH in the extract has been confirmed by glutathione reductase assay (n=5).     

Abruptio placentae: Perinatal outcome in normotensive and hypertensive patients

OBJECTIVE: The objective of this study was to compare perinatal outcomes of hypertensive and normotensive women experiencing abruptio placentae. Our hypothesis is that hypertensive women have a less favorable perinatal outcome than do normotensive women. STUDY DESIGN: Women with the diagnosis of abruptio placentae delivered between July 1, 1988, and May 31, 1992, composed the study group (n = 226) in this case-control study. The incidence of abruptio placentae was 0.7% during this time. Those women with either multifetal gestations (n = 4) or delivery before 20 weeks' gestation (n = 2) were excluded from data analysis. The remaining 220 patients were divided according to their hypertensive (n = 29) or normotensive (n = 191) status. Maternal and neonatal medical records were reviewed and abstracted for demographic variables, antepartum complications, delivery route, abruptio placentae grade, neonatal gender, birth weight, Apgar score, cord pH, and perinatal mortality. These perinatal outcome variables were compared between the hypertensive and normotensive patient groups. RESULTS: Black women with abruptio placentae were significantly more likely to be hypertensive (p = 0.0078). Hypertensive women with abruptio placentae had the antepartum complication diabetes mellitus significantly more often than did normotensive women (p = 0.032). However, they were similar to normotensive women with regard to the frequency of positive urine drug screen and trauma. Hypertensive women were no more likely to be delivered before 32 or 37 weeks' gestation, have neonates weighing <1500 or 2500 gm, or to be delivered by cesarean section. Abruptio placentae grades 2 and 3 occurred more often in hypertensive women (p = 0.053), as did significantly lower umbilical cord artery (p = 0.005) and venous (p = 0.003) pH values. Neonates from hypertensive women were no more likely to have low 5-minute Apgar scores or to die than those from normotensive women. CONCLUSION: Although hypertensive women experiencing abruptio placentae are more likely to have higher-grade abruptio placentae and lower umbilical cord pH values, the overall perinatal outcome was not significantly different from that of normotensive women experiencing abruptio placentae. (AM J Obstet Gynecol 1994;170:1595-9.)