凶险性前置胎盘母儿不良结局及管理

发布时间：2018-05-02 17:38

本文选题：凶险性前置胎盘 + 胎盘植入　；参考：《大连医科大学》2017年硕士论文

【摘要】：目的:通过分析凶险性前置胎盘患者的临床资料,探讨凶险性前置胎盘对妊娠结局的影响及凶险性前置胎盘的管理对改善母儿预后重要性。方法:本文以2012年1月至2016年12月大连医科大学附属大连市妇幼保健院住院剖宫产分娩的68凶险性前置胎盘患者为研究对象。根据凶险性前置胎盘是否伴有胎盘植入,分为凶险性前置胎盘伴胎盘植入组(A组,n=33),凶险性前置胎盘无胎盘植入组(B组,n=35);根据手术时机分为择期手术组(C组,n=56),急诊手术组(D组,n=12)。结果:1.近5年大连市妇幼保健院瘢痕子宫再分娩人数比例逐年上升,由4.53%增长至9.14%。凶险性前置胎盘的发病率由2012年的0.02%逐年上升至2016年的0.16%,5年间PPP发病率升高8倍。2.凶险性前置胎盘患者中年龄35岁多于年龄≥35岁(60.29%/39.71%),有流产史的患者多于无流产史患者(79.45%/20.59%)。剖宫产间隔5-10年的患者多于时间间隔不足5年及大于10年的患者(50.00%/23.53%/26.47%)。3.A组患者术中失血量及血液制品使用率高于B组,差异有统计学意义(P0.05)。D组患者术中失血量及血液制品使用率与C组比较,差异无统计学意义(P0.05)。4.A组患者产后出血、失血性休克、DIC、子宫切除及产褥期感染等发生率均明显高于B组,两组比较差异有统计学意义(P0.05)。A组产后出血的发生率随着分娩孕周的延长而升高,两者之间存在显著相关性(R=0.926,P=0.00)。D组患者产后出血、DIC、膀胱损伤、子宫切除及产褥期感染等发生率与C组比较,差异无统计学意义(P0.05)。D组失血性休克发生率高于C组,两组比较差异有统计学意义(P0.05)。5.A组早产、转入NICU的发生率、新生儿并发症及新生儿体重与B组比较,差异无统计学意义(P0.05)。D组早产、转入NICU的发生率及新生儿并发症与C组比较,差异无统计学意义(P0.05)。结论:1.凶险性前置胎盘发病率逐年升高。2.凶险性前置胎盘发生胎盘植入的风险大,当伴有胎盘植入时术中更易发生难控性大出血,致失血性休克、DIC、子宫切除及产褥期感染等发生率升高。3.凶险性前置胎盘应尽量择期手术。PPP伴有胎盘植入时,可考虑将分娩孕周提前至36周前,如继续延长孕周,发生产后出血的风险明显增加。
[Abstract]:Objective: to investigate the influence of dangerous placenta previa on pregnancy outcome and the importance of management of dangerous placenta previa to improve the prognosis of mother and infant by analyzing the clinical data of patients with dangerous placenta previa. Methods: from January 2012 to December 2016, 68 patients with perilous placenta previa in Dalian Maternal and Child Health Hospital, Dalian Medical University, were studied. According to the risk of placenta previa associated with placenta accreta, it was divided into two groups: group A with severe placenta previa with placenta accreta, group A with severe placenta previa without placenta accreta, group B with placenta accreta without placenta previa group B, group B with placenta accreta group B, group B with no placenta accreta, group C with group C and group D with emergency operation group n125A according to the timing of operation. The result is 1: 1. In the past 5 years, the proportion of scar uterus redelivery in Dalian Maternal and Child Health Hospital increased year by year, from 4.53% to 9.14%. The incidence of menacing placenta previa has risen from 0. 02% in 2012 to 0. 16% in 2016. The incidence of PPP has risen eightfold in five years. In the patients with dangerous placenta previa, 35 years old and more than 35 years old, 60.29 / 39.71% and 79.45% / 20.59% had a history of abortion more than those without a history of abortion. The number of patients with cesarean section between 5 and 10 years was more than those with less than 5 years and more than 10 years. The blood loss and utilization rate of blood products in group A were higher than those in group B. There was no significant difference in blood loss and utilization rate of blood products between group D and group C. The incidence of postpartum hemorrhage, hemorrhagic shock and DICs, hysterectomy and puerperal infection in group A were significantly higher than those in group B. There was significant difference between the two groups in the incidence of postpartum hemorrhage with the prolongation of gestational weeks, and there was a significant correlation between the two groups. There was a significant correlation between the two groups in postpartum hemorrhage and bladder injury. The incidences of hysterectomy and puerperal infection in group C were not significantly higher than those in group C (P 0.05). The incidence of hemorrhagic shock in group D was higher than that in group C. There was a significant difference between the two groups in the incidence of premature delivery and transfer to NICU in group P0.05. 5. There was no significant difference in neonatal complications and neonatal body weight between group B and group B (P 0.05). There was no significant difference in the incidence of neonatal complications and neonatal complications compared with group C (P 0.05). Conclusion 1. The incidence of dangerous placenta previa increased year by year. The risk of placenta accreta is high in dangerous placenta previa. It is more likely to occur intractable hemorrhage during the operation when placenta accreta is accompanied by placenta placenta. The incidence of hemorrhagic shock and DICs, hysterectomy and puerperal infection are increased by 0.3%. When severe placenta previa should be operated on for as long as possible. PPP with placenta accreta may consider advancing the gestational week of delivery to 36 weeks. If the gestational weeks are prolonged, the risk of postpartum hemorrhage will increase significantly.
【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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