胎盘前置状态和低置状态对于妊娠结局的影响

发布时间：2018-01-09 02:10

本文关键词：胎盘前置状态和低置状态对于妊娠结局的影响　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:分析胎盘前置状态和低置状态的转归及妊娠结局,探讨妊娠中期胎盘前置状态和低置状态的临床意义。方法:采用回顾性研究方法,选取自2014~2016年于大连妇产医院分娩住院的28周前胎盘前置状态和低置状态孕妇50例作为观察组,选取同期于我院住院分娩的28周前胎盘位置正常的孕妇40例作为对照组。将观察组的50例患者分为中央性胎盘前置状态、部分性胎盘前置状态、边缘性胎盘前置状态、胎盘低置状态4组类型。收集90例孕妇的年龄、孕产次、宫腔操作史(刮宫、流产、子宫内膜手术)、子宫手术史(剖宫产、子宫肌瘤核除术)、体外受精-胚胎移植史(IVF-ET)、妊娠期糖尿病(GDM)、胎儿性别、妊娠早期体重指数(BMI)、产前贫血、妊娠晚期胎盘的位置、分娩方式、胎盘粘连/植入、产后出血发病情况、新生儿窒息的发生率、新生儿出生体重和新生儿出生后1min、5min Apgar评分。分别进行比较,探讨晚期胎盘转归及妊娠结局。结果:1、两组患者基本情况的比较:年龄、宫腔操作史、产次、妊娠早期BMI、IVF-ET史及子宫手术史差异有统计学意义(P0.05)。孕次、GDM及胎儿性别无统计学意义(P0.05)。2、两组孕妇妊娠结局比较:(1)观察组和对照组阴道分娩率分别为30%和55%,前者阴道分娩率低于后者,差异有统计学意义(P0.05)。(2)观察组和对照组产前贫血发生率分别为32%和12.5%(P0.05),差异有统计学意义。(3)两组患者发生胎盘粘连/植入的几率分别为12%和7.5%,其差异无统计学意义(P0.05)。(4)两组患者发生产后出血的几率分别为22%和2.5%(P0.05),其差异有统计学意义。3、两组新生儿情况比较:观察组和对照组早产、新生儿出生体重2500g、出生后1分钟阿氏评分和出生后5分钟Apgar评分、入新生儿科治疗比较,其中早产、入新生儿科治疗、新生儿出生体重2500g差异有统计学意义(P0.05)。出生后1分钟和5分钟Apgar评分的比较差异无统计学意义(P0.05)。4、中央性胎盘前置状态、部分性胎盘前置状态、边缘性胎盘前置状态及胎盘低置状态4种不同类型母儿不良结局的比较,其中产前贫血和产后出血的差异均有统计学意义(P0.05),4组组间比较,早产率和剖宫产率差异均无统计学意义(P0.05)。5、中央性胎盘前置状态、部分性胎盘前置状态、边缘性胎盘前置状态及胎盘低置状态4组的胎盘转归情况:转归率分别为33.33%、70%、72.22%和70%。中央性胎盘前置状态组转归率明显低于其余三组,差异有统计学意义,其余三组组间比较无统计学意义。6、妊娠中期不同附着部位的胎盘转归情况的比较:16例前壁胎盘前置状态中11例分娩时胎盘位置正常,转归率69%,34例后壁胎盘前置状态中18例分娩时胎盘位置正常,转归率53%。结论:1、年龄、宫腔操作史、产次、妊娠早期BMI、IVF-ET史、子宫手术史是胎盘前置状态和低置状态的高危因素;2、观察组剖宫产率高于对照组;3、观察组不良母儿妊娠结局发生率高于对照组;4、四种类型胎盘前置状态的产妇产前贫血和产后出血比较,产前贫血发生率:完全性胎盘前置状态部分性边缘性低置状态,产后出血发生率:完全性胎盘前置状态部分性低置状态边缘性胎盘前置状态;5、四种类型胎盘前置状态转归的比较,其中中央性胎盘前置状态转归率最小,预后最差,应该引起重视;6、妊娠中期胎盘不同附着部位转归的比较,前壁胎盘转归率高于后壁胎盘。
[Abstract]:Objective: to analyze the prognosis and outcome of pregnancy with placenta previa and lower status, to investigate the clinical significance of placenta previa and mid lower state of pregnancy. Methods: a retrospective study, selected from 2014~2016 years in Dalian maternity hospital inpatient delivery before 28 weeks before the placenta state and 50 cases of pregnant women as a state of low the observation group, pregnant women were selected in our hospital 28 weeks before the placenta in normal position in 40 cases as control group. 50 cases of the observation group were divided into the central placenta previa, partial placenta previa, marginal placenta pre state, placenta lower status of the 4 types of collected 90 cases of pregnant women. Age, pregnancy, intrauterine operation history (curettage, abortion, uterine surgery), uterine surgery (caesarean myomectomy), in vitro fertilization and embryo transfer (IVF-ET), a history of gestational diabetes (GDM), fetal sex, pregnancy Early pregnancy body mass index (BMI), prenatal anemia in late pregnancy, placental location, mode of delivery, placenta accreta / implant, the incidence of postpartum hemorrhage, the incidence of neonatal asphyxia, neonatal birth weight and neonatal Apgar score 1min, 5min respectively. Compared to the human placental outcomes and pregnancy outcome. Results: 1, compare the basic situation of the two groups were: age, history of uterine cavity operation, production time, BMI in early pregnancy, there were statistically significant differences in IVF-ET history and history of uterine surgery (P0.05). GDM times of pregnancy, and fetal sex was statistically significant (P0.05.2), compared two groups of pregnant women and pregnancy outcome: (1) the observation group and the control group vaginal delivery rate were 30% and 55%, the vaginal delivery rate was lower than the latter, the difference was statistically significant (P0.05). (2) the observation group and the control group prenatal anemia incidence rates were 32% and 12.5% (P0.05), the difference was statistically significant. (3) two groups of patients Born in placenta accreta / implantation probability were 12% and 7.5%, the difference was not statistically significant (P0.05). (4) two groups of patients with postpartum hemorrhage rates were 22% and 2.5% (P0.05), the difference was statistically significant.3, compared two groups of neonates: observation group and control group, premature birth, neonatal the birth weight of 2500g, 1 minutes after birth a's birth and score 5 minutes after the Apgar score comparison, in neonatal treatment the preterm birth, neonatal birth weight in the treatment of neonatal 2500g, difference was statistically significant (P0.05). No significant difference was born after 1 minutes and 5 minutes Apgar score (P0.05).4, central placenta previa, partial placenta previa placenta previa, comparison and marginal placenta lower status of 4 different types of maternal and fetal adverse outcomes, including differences in prenatal anemia and postpartum hemorrhage were statistically significant (P0.05, 4) Comparison between group, the preterm birth rate and cesarean section rate showed no significant difference (P0.05).5, central placenta previa, partial placenta previa placenta and placenta previa, marginal low home state 4 group outcomes: placenta outcome rates were 33.33%, 70%, 72.22% and 70%. central placenta previa group turnover rates were lower than the other three groups, the difference was statistically significant, the remaining three groups had no statistically significant.6, different parts of the second trimester placenta attached comparison outcome: 16 cases of anterior wall in 11 cases of placenta previa placenta childbirth normal location, the recovery rate of 69%, 34 cases of posterior wall of placenta previa in 18 cases of placenta childbirth normal location, the recovery rate of 53%. conclusion: 1, age, history of uterine cavity operation, production time, early pregnancy BMI, IVF-ET history, history of uterine surgery is placenta previa and lower state risk factors; 2, the observation group of cesarean section The yield is higher than the control group; 3, the observation group of adverse pregnancy outcomes was higher than control group; 4, four types of placenta previa maternal prenatal anemia and postpartum hemorrhage, the incidence of prenatal anemia: complete placenta previa part of lower marginal status, postpartum hemorrhage rate: complete placenta previa part of the state of the state of low marginal placenta previa; 5, compare the outcome of four types of placenta previa, including central placenta previa. The lowest rate, the worst prognosis, should pay attention to; 6, mid pregnancy outcomes were compared with different placenta attachment site, anterior placenta outcome rate is higher than the posterior wall placenta.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.2

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