凶险性前置胎盘的妊娠结局及其与产后出血的高危因素分析

发布时间：2018-04-01 16:47

本文选题：凶险性前置胎盘　切入点：妊娠结局　出处：《实用妇产科杂志》2017年10期

【摘要】：目的:探讨凶险性前置胎盘(PPP)的母婴结局及其与产后出血的高危因素。方法:回顾性分析2011年1月至2015年12月上海市第六人民医院住院分娩的前置胎盘患者181例,PPP患者72例(PPP组,其中发生产后出血34例,非产后出血38例),无剖宫产史妊娠的前置胎盘患者109例(非PPP组)。比较PPP组和非PPP组孕妇的年龄、孕周、孕次、产后出血率、输血率、胎盘植入率、子宫切除率、早产率、新生儿窒息率之间的差异;采用单因素与二项分类Logistic回归分析PPP组发生产后出血的高危因素。结果:PPP妊娠总占比0.44%;PPP组孕妇年龄、孕次、产次、前壁胎盘率、中央型前置胎盘率、胎盘粘连率、胎盘植入率、产后出血量、产后出血发生率、子宫切除率、输血率、早产率均明显高于非PPP组(P0.05),PPP组分娩孕周与新生儿体质量明显低于非PPP组(P0.05)。单因素分析显示:PPP患者产后出血组胎盘粘连率、胎盘植入率、中央型前置胎盘率、二级及以下医院剖宫产史占比、非产程中剖宫产史占比、前置胎盘史占比明显高于无产后出血组(P0.05);Logistic回归分析显示:胎盘粘连与中央型前置胎盘是PPP患者产后出血的独立危险因素(P0.05)。结论:产后出血与早产是PPP主要的不良妊娠结局;对于前次剖宫产史此次妊娠合并中央型前置胎盘或胎盘粘连患者,应警惕产后出血发生;降低剖宫产率是防止PPP发生与减少产后出血的关键因素。
[Abstract]:Objective: to investigate the maternal and infant outcomes of perilous placenta previa placenta previa (PPP) and the high risk factors of postpartum hemorrhage.Methods: from January 2011 to December 2015, 181 patients with placenta previa in Shanghai sixth people's Hospital and 72 patients with PPP were analyzed retrospectively, including 34 cases of postpartum hemorrhage.There were 38 cases of non-postpartum hemorrhage and 109 cases of placenta previa without history of cesarean section (non-PPP group).The age, gestational age, gestational age, pregnancy time, postpartum hemorrhage rate, blood transfusion rate, placenta accreta rate, hysterectomy rate, premature delivery rate and neonatal asphyxia rate were compared between PPP group and non-#en1# group.Univariate and binomial Logistic regression analysis was used to analyze the risk factors of postpartum hemorrhage in PPP group.Results the total proportion of pregnancy was 0.44% in the PPP group: age, pregnancy, delivery, placenta rate of anterior wall, placenta rate of central type previa, placenta adhesion rate, placental accretion rate, postpartum hemorrhage volume, incidence of postpartum hemorrhage, hysterectomy rate, transfusion rate.The preterm delivery rate was significantly higher than that in the non PPP group (P 0.05) and the body weight of the newborn was significantly lower than that of the non PPP group.Univariate analysis showed that the placental adhesion rate, placental accretion rate, central placenta previa rate, cesarean section history in secondary and lower hospitals, and cesarean section history in non-labor stage were higher than those in non-labor group.Logistic regression analysis showed that placenta adhesion and central placenta previa were independent risk factors of postpartum hemorrhage in PPP patients.Conclusion: postpartum hemorrhage and premature delivery are the main adverse pregnancy outcomes in PPP.Reducing cesarean section rate is the key factor to prevent PPP and reduce postpartum hemorrhage.
【作者单位】：上海交通大学附属第六人民医院上海市产科重症监护中心妇产科研究所;
【基金】：国家科技部“十二五”支撑计划项目(编号:2014BAI05B05)
【分类号】：R714.461

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