胎盘早剥并发子宫胎盘卒中的危险因素分析
태반조박병발자궁태반졸중적위험인소분석
Analysis of risk factors for uteroplacental apoplexy complicating placental abruption
  • 万方数据
    中华妇产科杂志 중화부산과잡지
    CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
    2008年 8期 593-596 ,共4页

    CHENG Wei-wei%林穗青

    CHENG Wei-wei%림수청

    胎盘早剥%产后出血%先兆子痈%妊娠结局%危险因素 胎盤早剝%產後齣血%先兆子癰%妊娠結跼%危險因素
    태반조박%산후출혈%선조자옹%임신결국%위험인소
    Abruption placentae%Postpartum hemorrhage%Pre-eclampsia%Pregnancy outcome%Risk factors
    目的 探讨胎盘早剥并发子宫胎盘卒中的发病危险因素、临床特征及母儿结局.方法 收集2002年1月至2006年12月上海交通大学医学院附属国际和平妇幼保健院住院分娩的52例胎盘早剥产妇的临床资料,按是否并发子宫胎盘卒中分为两组:胎盘早剥并发子宫胎盘卒中17例为观察组,未并发子宫胎盘卒中的35例为对照组.采用回顾性研究方法对观察组子宫胎盘卒中的发病危险因素、临床特征及母儿结局进行分析,并与对照组进行比较.结果 (1)发生率:2002年1月至2006年12月共分娩35 049人次,胎盘早剥发生率为0.15%(52/35 049),胎盘早剥并发子宫胎盘卒中的发生率为0.05%(17/35 049),其中胎盘早剥产妇中子宫胎盘卒中的发生率为33%(17/52).(2)一般情况及分娩方式、分娩孕周:两组产妇的平均年龄、体重指数比较,差异无统计学意义(P>0.05).观察组产妇均以剖宫产结束分娩,而对照组产妇经阴道及剖宫产分娩为14及21例,比较两组分娩方式及分娩孕周,差异有统计学意义(P<0.01).观察组产妇早产发生率为88%(15/17),而对照组为49%(17/35),两组比较,差异有统计学意义(P<0.01).(3)发病危险因素:观察组产妇子痫前期发生率及发病持续时间分别为71%(12/17)及6.4 h,对照组分别为20%(7/35)及4.2 h,两组比较,差异均有统计学意义(P<0.01);两组产妇胎膜早破、羊水过多及其他因素比较,差异均无统计学意义(P>0.05).(4)临床特征:观察组产妇血性羊水、胎儿窘迫、宫腔积血及产后出血的发生率分别为82%(14/17)、65%(11/17)、35%(6/17)及59%(10/17),对照组分别为26%(9/35)、29%(10/35)、6%(2/35)及11%(4/35),两组比较,差异均有统计学意义(P<0.01).而两组产妇在主诉腹痛、阴道流血及腹肌张力高的发生率比较,差异均无统计学意义(P>0.05).(5)胎盘附着部位、剥离面积比较:观察组胎盘附着部位在子宫的前、后壁5例(5/17),宫底宫角12例(12/17);对照组胎盘附着部位在子宫的前、后壁24例(24/35),宫底宫角11例(11/35),两组胎盘附着宫底宫角部位发生例数比较,差异有统计学意义(P<0.01).观察组胎盘剥离面积均超过1/3,其中有9例患者剥离面积≥2/3;而对照组胎盘剥离面积≤1/3者27例,剥离面积在1/3～2/3者8例,两组比较,差异均有统计学意义(P<0.01).(6)母儿并发症及预后比较:观察组产妇发生失血性休克3例、DIC3例、子宫切除1例、死胎3例、新生儿窒息8例及新生儿死亡1例,而对照组除新生儿窒息5例及死胎2例外,其余指标均为0,两组比较,差异有统计学意义(P<0.01).结论 胎盘早剥并发子宫胎盘卒中发病的危险因素主要是子痫前期、发病持续时间长和胎盘附着宫角宫底部.胎盘早剥并发子宫胎盘卒中患者的母儿结局不良.
    목적 탐토태반조박병발자궁태반졸중적발병위험인소、림상특정급모인결국.방법 수집2002년1월지2006년12월상해교통대학의학원부속국제화평부유보건원주원분면적52례태반조박산부적림상자료,안시부병발자궁태반졸중분위량조:태반조박병발자궁태반졸중17례위관찰조,미병발자궁태반졸중적35례위대조조.채용회고성연구방법대관찰조자궁태반졸중적발병위험인소、림상특정급모인결국진행분석,병여대조조진행비교.결과 (1)발생솔:2002년1월지2006년12월공분면35 049인차,태반조박발생솔위0.15%(52/35 049),태반조박병발자궁태반졸중적발생솔위0.05%(17/35 049),기중태반조박산부중자궁태반졸중적발생솔위33%(17/52).(2)일반정황급분면방식、분면잉주:량조산부적평균년령、체중지수비교,차이무통계학의의(P>0.05).관찰조산부균이부궁산결속분면,이대조조산부경음도급부궁산분면위14급21례,비교량조분면방식급분면잉주,차이유통계학의의(P<0.01).관찰조산부조산발생솔위88%(15/17),이대조조위49%(17/35),량조비교,차이유통계학의의(P<0.01).(3)발병위험인소:관찰조산부자간전기발생솔급발병지속시간분별위71%(12/17)급6.4 h,대조조분별위20%(7/35)급4.2 h,량조비교,차이균유통계학의의(P<0.01);량조산부태막조파、양수과다급기타인소비교,차이균무통계학의의(P>0.05).(4)림상특정:관찰조산부혈성양수、태인군박、궁강적혈급산후출혈적발생솔분별위82%(14/17)、65%(11/17)、35%(6/17)급59%(10/17),대조조분별위26%(9/35)、29%(10/35)、6%(2/35)급11%(4/35),량조비교,차이균유통계학의의(P<0.01).이량조산부재주소복통、음도류혈급복기장력고적발생솔비교,차이균무통계학의의(P>0.05).(5)태반부착부위、박리면적비교:관찰조태반부착부위재자궁적전、후벽5례(5/17),궁저궁각12례(12/17);대조조태반부착부위재자궁적전、후벽24례(24/35),궁저궁각11례(11/35),량조태반부착궁저궁각부위발생례수비교,차이유통계학의의(P<0.01).관찰조태반박리면적균초과1/3,기중유9례환자박리면적≥2/3;이대조조태반박리면적≤1/3자27례,박리면적재1/3～2/3자8례,량조비교,차이균유통계학의의(P<0.01).(6)모인병발증급예후비교:관찰조산부발생실혈성휴극3례、DIC3례、자궁절제1례、사태3례、신생인질식8례급신생인사망1례,이대조조제신생인질식5례급사태2예외,기여지표균위0,량조비교,차이유통계학의의(P<0.01).결론 태반조박병발자궁태반졸중발병적위험인소주요시자간전기、발병지속시간장화태반부착궁각궁저부.태반조박병발자궁태반졸중환자적모인결국불량.
    Objective To study the clinical characteristics, the outcome of pregnancy and the risk factors of uteroplacental apoplexy complicating severe placental abruption. Methods A retropectively study of the 52 cases of placental abruption who had delivered in our hospital from Jan. 2002 to Dec. 2006 was conducted. These cases were divided into 2 groups: 17 cases of uteroplacental apoplexy complicating placental abruption as observation group, the others with no uteroplacental apoplexy as control group. The risk factors of disease, clinical characteristics and the outcome of pregnancy between the two groups were compared. Results (1)The incidence of placental abruption was 0. 15% (52/35 049) among the total deliveries patients with uteroplacental apoplexy complicating placental abruption took up 0. 05% (17/35 049) of all deliveries and 33% (17/52) of all abruption cases. (2) General information and delivery : There were no significant differences ( P > 0. 05 ) regarding their mean age and BMI in two groups. All women in observation group had C-section delivery, which were 21 in control group. 14 women had vaginal delivery. The incidence of premature labour was 88% ( 15/17 ) in observation group, and 49% (17/35 ) women in control group delivered after 37 weeks. Significant differences were observed regarding delivery methods and gestational weeks(P <0. 01 ). (3)Risk factors: the incidence of preeclampsia, 71% (12/17), and the duration of disease, 6. 4 hours, in observation group were more than those in control group, 20% (7/35) and 4. 2 hours( P < 0.01 ). There were no significant differences between two groups in premature rupture, polyhydroamnions ( P > 0. 05 ). (4) Clinical characteristics in two groups : bloody amniotic fluid, fetal distress, hematometra and postpartum hemorrhage occurred in 82% (14/17) vs 26% (9/35), 65%(11/17) vs 29% (10/35), 35% (6/17) vs 6% (2/35), and 59% (10/17) vs 11% (4/35), with a significant difference (P <0. 01), but no statistical difference existed between indices such as abdominal pain, vaginal bleeding and abdominal tension ( P > 0. 05 ). (5) Placenta sites and abruption areas: placenta sites were distributed from anterior or posterior of uterine body 5/17 vs 24/35 , the fundus or cornu of uterus 12/17 vs 11/35 ( P < 0. 01 ). All cases in observation group presented abruption areas> 1/3, and 9 cases ≥2/3, 27 cases abruption areas < 1/3 and 8 cases abruption areas 1/3 -2/3 in control group (P<0.01). (6) Other complications and outcome: Hemorrhagic shock 3 vs 0, DIC 3 vs 0, hysterectomy 1 vs 0, intrauterine fetal death 3 vs 2, neonatal asphyxia 8 vs 5 and neonatal death 1 vs 0. There were significant differences ( P < 0. 01 ) between the two groups. Conclusions Preeclampsia, long duration of disease and fundal or cornual placenta a risk factors for uteroplacental apoplexy complicating placental abruption, which may lead to a poor maternal-fetal prognosis.
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