前置胎盘合并剖宫产史临床分析

目的探讨前置胎盘合并剖宫产史患者的临床特点及处理。方法回顾性分析2003年1月至2011年10月北京协和医院前置胎盘合并剖宫产史（再次剖宫产组,RCS组）患者母婴结局,并与同期前置胎盘行初次剖宫产（初次剖宫产组,FCS组）进行比较。结果 RCS组及FCS组分别有29例及243例患者。两组的平均年龄、孕周差异无统计学意义（P〉0.05）。RCS组患者手术时间长,产后出血量多,早产、产后出血、胎盘植入、输血、弥漫性血管内凝血和产科子宫切除的发生率均高于FCS组,差异有统计学意义（P〈0.05）,RCS组早产儿、新生儿窒息发生率及围产儿死亡率均高于FCS组（P〈0.05）。结论前置胎盘合并剖宫产史更易发生胎盘植入,产后出血、产科子宫切除及围产儿病率高,需要高度重视。

Clinical analysis of placenta previa complicated with previous caesarean section

Objective To investigate the clinical features and treatment of placenta previa complicated with previous caesarean section.Methods Twenty-nine cases of placenta previa complicated with previous caesarean section (RCS group) treated in Peking Union Medical College Hospital from 2003to 2011were retrospectively reviewed and compared with 243cases of placenta previa complicated without previous caesarean section (FCS group) at the same time.Results The mean age and the average gravidity of RCS group and FCS group had no difference.The RCS group had longer operation time , more preterm birth , postpartum hemorrhage volume , blood transfusion , placenta accreta , disseminated intravascular coagulation and obstetric hysterectomy than FCS group (P<0.05) .The preterm infant rate , neonatal asphyxia rate and perinatal mortality rate of RCS group were higher than FCS group (P<0.05) .Conclusions Placenta previa with previous caesarean section has more placenta accreta , postpartum hemorrhage , obstetric hysterectomy and perinatal morbidity rate.We need to pay more attention to these cases.