凶险型与非凶险型前置胎盘处理与妊娠结局的关系

发布时间：2018-12-14 10:42

【摘要】：目的：对凶险型与非凶险型前置胎盘孕妇基本情况进行比较,明确凶险型前置胎盘发病的危险因素；分析湘雅医院2011-2013年凶险型及非凶险型前置胎盘围手术期处理上的变化,探讨其与妊娠结局的关系。方法：采用病例-对照(case-control study,CCT)研究,收集2011年1月-2013年12月在中南大学湘雅医院产科病房住院并终止妊娠的前置胎盘单胎孕产妇345例的临床资料并对其进行回顾性分析,其中凶险型100例,非凶险型245例。收集的资料包括患者基本情况,临床特点,围手术期处理及新生儿结局等。结局：1.对凶险型前置胎盘基本情况行单因素分析,其中7个因素有统计学意义,分别为文化程度、居住地、孕次、产次、剖宫产次、人流次数、是否行辅助生殖技术等。多因素分析中有3个因素进入多因素回归模型。分别是居住地、剖宫产次、是否行辅助生殖技术。其中剖宫产次是凶险型前置胎盘的危险因素,比值比(odds ratio,OR)为20.294。2.凶险型前置胎盘胎盘植入的发生率明显高于非凶险型前置胎盘(P0.05),超声是诊断胎盘植入的主要辅助工具。3.2011年-2013年我院收治的前置胎盘患者逐年增加,其中2013年较2011年凶险型前置胎盘增加12倍,非凶险型前置胎盘增加60%。4.2011-2013年前置胎盘患者术前及术后血红蛋白、分娩孕周等方面比较差异无统计学意义(P0.05)。5.2011-2013年前置胎盘子宫动脉介入栓塞、宫腔填塞纱条等方面比较差异有统计学意义(P0.05)。其中三年凶险型前置胎盘患者子宫切除发生率、出血量、输血量比较差异有统计学意义(P0.05)。6.2011-2013年前置胎盘患者新生儿结局比较差异无统计学意义(P0.05)。结论： 1.凶险型前置胎盘的发生与剖宫产次有关。 2.凶险型前置胎盘具有较高的胎盘植入率；超声是诊断胎盘植入的主要辅助工具。 3.2011-2013年前置胎盘发生率增加,其中凶险型前置胎盘增加明显。 4.围手术期处理的进步及子宫下段环形缝扎术的应用,使得凶险型前置胎盘孕妇子宫切除发生率、产后出血量、输血量明显降低。
[Abstract]:Objective: to compare the basic conditions of pregnant women with dangerous placenta previa and to identify the risk factors of placenta previa. The changes of perioperative management of placenta previa in Xiangya Hospital from 2011 to 2013 were analyzed and the relationship between them and pregnancy outcome was discussed. Methods: a case-control (case-control study,CCT) study was used. From January 2011 to December 2013, 345 pregnant women with single placenta previa who were hospitalized and terminated in the obstetrical ward of Xiangya Hospital of Central South University were collected and analyzed retrospectively, including 100 cases of dangerous type and 245 cases of non-dangerous type. The data collected include the patient's basic condition, clinical features, perioperative management and neonatal outcome. Outcome: 1. Univariate analysis was carried out on the basic condition of the dangerous placenta previa. Seven factors were statistically significant: education degree, place of residence, pregnancy, labor, cesarean section, number of abortion, assisted reproductive technique, etc. In multivariate analysis, three factors entered the multivariate regression model. Place of residence, cesarean section, whether to use assisted reproductive technology. Cesarean section was a dangerous risk factor for placenta previa, and the ratio (odds ratio,OR) was 20.294.2. The incidence of severe placenta previa was significantly higher than that of non-ferocious placenta previa (P0.05), and ultrasound was the main auxiliary tool for the diagnosis of placenta accreta. 3. The number of placenta previa patients admitted to our hospital from 2011 to 2013 increased year by year. In 2013, there was a 12-fold increase in the number of placenta previa and 60 times more hemoglobin in patients with placenta previa from 2011 to 2013. There was no significant difference in pregnancy weeks (P0.05). 5. There was significant difference in placenta previa uterine artery interventional embolization and uterine cavity packing gauze (P0.05) from 2011 to 2013. Among them, the incidence of hysterectomy, the amount of blood loss and the amount of blood transfusion were significantly different in three years of dangerous placenta previa (P0.05). 6. There was no significant difference in neonatal outcome of placenta previa in 2011-2013 (P0.05). Conclusion: 1. The occurrence of dangerous placenta previa is related to cesarean section. 2. Placenta previa has a high rate of placenta accreta and ultrasound is the main assistant tool for the diagnosis of placenta accreta. 3. The incidence of placenta previa increased significantly in 2011-2013, especially in dangerous placenta previa. 4. The progress of perioperative management and the application of circular suture in lower uterine segment resulted in a significant decrease in the rate of hysterectomy, postpartum hemorrhage and blood transfusion in the pregnant women with dangerous placenta previa.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.2

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