280例胎盘绒毛膜血管病的临床特点及胎儿结局分析

目的:探讨胎盘绒毛膜血管病的发病机制及常见的母体合并症及并发症,提高产科医生对该病的认识。方法:选择2017年11月至2018年10月在我院分娩,胎盘病理诊断绒毛膜血管病的280例病例资料进行回顾性分析。结果:胎盘绒毛膜血管病的发生率为18.1%(280/1547),常见的合并症及并发症前5位为:糖尿病82例(29.3%)、绒毛膜羊膜炎62例(22.1%)、妊娠期高血压疾病39例(13.9%)、胎儿生长受限34例(12.1%)、胎盘早剥27例(9.6%)。新生儿窒息21例(6.9%),其中死亡2例,NICU入住率77.6%(236/304)。结论:胎盘绒毛膜血管病是产前慢性缺氧的一个表现,常合并妊娠期糖尿病、绒毛膜羊膜炎、妊娠期高血压疾病、胎儿生长受限、胎盘早剥,引起国产儿死亡及新生儿窒息的原因之一。     

急诊床旁超声诊断胎盘早剥的体会

目的对急诊床旁超声诊断胎盘早剥的体会进行分析,为临床诊断提供参考依据。方法选择2014年6月~2015年4月我院收治的急诊床旁超声诊断的胎盘早剥患者28例作为研究对象,对其临床资料、超声影像图特征展开回顾性分析。结果本组患者产前超声确诊为胎盘早剥23例,漏诊3例,误诊2例;23例确诊患者经超声检查可观察到胎盘部位明显增厚,最大厚度8 cm,实质回声的强弱表现不是十分均匀,胎盘基底板与子宫肌层之间有一定的分离表现,可观察到不规则无回声,内液不清楚。结论经急诊床旁产前超声对胎盘早剥诊断的临床价值显著,可将其作为胎盘早剥的早期检查手段,从而提高临床诊断率,为临床及时有效治疗提供可靠的参考依据。     

胎盘早剥的早期临床诊断

目的探讨胎盘早剥临床漏诊的原因,提高胎盘早剥的早期诊断。方法对近5年在我院产科发生的40例胎盘早剥的临床资料进行回顾性分析。结果胎盘早剥的发生率为0.60%。19例合并妊娠高血压疾病（47.5%）,16例孕妇没有任何胎盘早剥的高危因素（40%）。大部分孕妇临床表现不典型。前壁胎盘B超诊断率高于后壁胎盘（P〈0.05）,重度胎盘早剥B超诊断率高于轻度胎盘早剥（P〈0.05）。结论识别胎盘早剥的高危因素,根据病史、临床症状和体征,结合B超以及电子胎心监护,进行综合分析判断是提高胎盘早剥诊断的有效手段。     

轮状胎盘的临床探讨

轮状胎盘也称绒毛膜外胎盘,是由于胎盘的绒毛膜向外发育超过绒毛膜板,使羊膜不能平坦地与壁蜕膜相移行,胎盘边缘呈轮状隆起,该轮状隆起使胎膜呈现向胎儿面中心凹陷状态。轮状胎盘自妊娠中期后,由于边缘的持续剥离出血,可引起羊膜绒毛膜炎、早产、胎膜早破。5年间在产科分娩的14258例中轮状胎盘36例,发生率为0. 25%。36例中早产19例(52. 8%)中15例同时合并胎膜早破。IUGR、胎死宫内、胎盘早剥的发生率分别为16. 7%,8. 3%、11. 1%。还有11例为无症状性阴     

限定性胎盘嵌合性

限定性胎盘嵌合性为细胞遗传学异常，它只影响胎盘的组织特异性染色体嵌合性。ＣＰＭ通常是通过绒毛膜绒毛采样检测及产前检测而作为诊断。估计在ＣＰＭ妊娠中，有１６％￣２１％显著出产前或围产期并发症。     

宫腔镜电切治疗子宫纵隔临床分析

目的 探讨官腔镜电切术在治疗子宫纵隔中的作用。方法对39例子宫纵隔患者的诊断及在B超监护下行官腔镜子宫纵隔电切术的效果进行回顾性分析。结果B超诊断符合率82．05％(32／39)，子宫输卵管造影诊断符合率51．28％(20／39)，宫腔镜诊断符合率100％(39／39)。术中均采用B超监护，手术顺利，无并发症发生。术后随访39例，流产率由术前的89．74％降至术后的43．24％(16／37)，妊娠率为94．87％(3。7／39)，其中11例已足月妊娠分娩。结论官腔镜检查是诊断子宫纵隔的最准确的方法，B超监护下的宫腔镜电切术是治疗子宫纵隔的理想方法。     

胎盘绒毛膜血管瘤六例临床分析

胎盘绒毛膜血管瘤较罕见，国内外文献报道例数均较少。大多数文献只是肯定了彩色多普勒超声检查对胎盘绒毛膜血管瘤的诊断价值，但有关如何加强产前监测，及早发现并发症以确定最佳分娩时机、改善围产儿预后却少有报道。本研究通过分析我院收治的6例胎盘绒毛膜血管瘤患者的临床资料，重点对其并发症的产前监测进行探讨。     

巨大胎盘绒毛膜血管瘤致胎儿水肿一例并文献复习

一、病例摘要患者26岁,主因＂停经32周,B超发现胎盘绒毛膜血管瘤1个月,胎儿水肿1周＂于2010年9月1日收住院。患者末次月经2010年1月20日,预产期2010年10月27日。孕1产0。孕18周首次行B超检查,胎盘无异常,孕27周当地医院B超提示胎盘下缘可见7.7cm×5.7cm的低回声,考虑胎盘绒毛膜血管瘤,     

脐静脉穿刺用于产前诊断230例分析

目的：探讨B超引导下游离脐带穿刺术成功率和安全性。方法：对230例因各种原因行产前诊断的孕妇进行B超引导下游离脐静脉穿刺术。结果：102例18－21周孕妇穿刺成功率为90．5％，72例22－28周孕妇成功率97．8％，56例28周以上的成功率为100．0％，总成功率96．1％；169例穿刺经过胎盘，胎盘渗血29．2％（49／168），脐带穿刺后渗血17．8％（41／230）。胎心过缓者占5．2％（12／230）。术后未出现早产、宫内感染等并发症。结论：B超引导下脐带穿刺术用于产前诊断是一项成功率高且安全的方法。     

宫腔镜联合B超检查诊断异常子宫出血的临床探讨

目的 探讨宫腔镜与B超联合检查在各种异常子宫出血中的诊断价值。方法 2001年7月至2002年7月应用宫腔镜联合B超检查异常子宫出血176例，术中行定位取材或诊断性刮宫。结果 宫腔镜联合B超诊断子宫内膜增生过长46例，符合率为63．04％；子宫内膜息肉45例，符合率为95．56％；子宫粘膜下肌瘤8例，符合率为87．50％；子宫内膜癌3例，符合率为75．00％。结论 宫腔镜联合B超检查异常子宫出血，可以提高子宫内膜息肉及子宫粘膜下肌瘤的诊断率。尽管对子宫内膜增生过长及子宫内膜癌的敏感性与单纯诊刮相似，但可观察到更详细的形态学变化。     

Clinical presentation and risk factors of placental abruption

BACKGROUND: To study the risk factors of placental abruption during the index pregnancy. METHODS: One hundred and ninety-eight women with placental abruption and 396 control women were identified among 46,742 women who delivered at a tertiary referral university hospital between 1997 and 2001. Clinical variables were compared between the groups. Multivariate logistic regression analysis was applied to identify independent risk factors. The clinical manifestations of placental abruption were also studied. RESULTS: The overall incidence of placental abruption was 0.42%. The independent risk factors were maternal (adjusted OR 1.8; 95% CI 1.1, 2.9) and paternal smoking (2.2; 1.3, 3.6), use of alcohol (2.2; 1.1, 4.4), placenta previa (5.7; 1.4, 23.1), pre-eclampsia (2.7; 1.3, 5.6), and chorioamnionitis (3.3; 1.0, 10.0). Vaginal bleeding (70%), abdominal pain (51%), bloody amniotic fluid (50%), and fetal heart rate abnormalities (69%) were the most common manifestations. Neither bleeding nor pain was present in 19% of the cases. Overall, 59% had preterm labor (OR 12.9; 95% CI 8.3, 19.8), and 91% were delivered by cesarean section (34.7; 20.0, 60.1). Of the newborns, 25% were growth restricted. The perinatal mortality rate was 9.2% (OR 10.1; 95% CI 3.4, 30.1). Retroplacental blood clot was seen by ultrasound in 15% of the cases. CONCLUSIONS: Maternal alcohol consumption and smoking, and smoking by the partner turned out to be independent risk factors for placental abruption. Smoking by both partners multiplied the risk. The liberal use of ultrasound examination contributed little to the management of women with placental abruption.     

The risk of placental abruption and placenta previa in pregnant women with chronic hepatitis B viral infection: A systematic review and meta-analysis

Introduction

Several epidemiological studies have found a positive association between chronic hepatitis B virus (CHB) infection and the risk of placental abruption and placenta previa, but various studies have reported conflicting findings. The objective was to systematically review the literature to determine a possible association between CHB infection and these two placental complications.

Methods

We conducted a computerized search in electronic database through March 1, 2014, supplemented with a manual search of reference lists, to identify original published research on placental abruption and placenta previa rates in women with CHB infection. Data were independently extracted, and relative risks were calculated. The meta-analysis was performed using Stata version 10.0 software.

Results

Five studies involving 9088 placenta previa cases were identified. No significant association between CHB infection and placenta previa was identified (OR = 0.98, 95% CI = 0.60–1.62). Five studies involving 15571 placental abruption cases were identified. No significant association between CHB infection and placental abruption was identified (OR = 1.42, 95% CI, 0.93–2.15).

Discussion

The immune response against the virus represents a key factor in determining infection outcomes. No observation of significant increased risk of the placental complications could be partially explained by the complex immune response during CHB infection.

Conclusions

Our meta-analysis found no evidence of significant associations between CHB infection and increased risk of placental abruption as well as placenta previa. Further well-designed studies were warranted to assess any potential association between CHB infection and increased risk of placental abruption as well as placenta previa.     

Doppler blood flow changes and placental morphology in pregnancies with third trimester hemorrhage.

Combined real-time ultrasound and pulsed Doppler ultrasound examinations were performed in 67 patients with third trimester hemorrhage and other symptoms related to placental abruption, starting from the onset of symptoms to delivery. In 52 of the cases, placental morphology was investigated by light microscopy. Thirteen patients were ultimately given the diagnosis abruptio placentae. None of the morphological placental changes considered had any statistical relationship to placental abruption. Patients with placental centrocotyledon hemorrhages and infarction more often had abnormal umbilical artery flow velocity waveforms at the onset of symptoms, and more frequent abnormal arcuate artery flow velocity waveforms were found among those with placental infarction alone. Abnormal flow velocity waveforms in the umbilical and arcuate arteries were associated with placental abruption, both at the onset of symptoms and at the final examination before delivery. The results indicate an increased risk for placental abruption if the arcuate and/or umbilical artery flow velocity waveforms are abnormal in patients with third trimester hemorrhage.     

Analysis of 62 placental abruption cases: Risk factors and clinical outcomes

Objective

This study aimed to explore the clinical characteristics and outcomes of placental abruption.

探讨43例不典型胎盘早剥漏诊原因及母胎预后

目的分析不典型胎盘早剥产前易漏诊的原因，改善母胎预后。方法回顾性分析17年间胎盘早剥产前未确诊的43例（观察组）患者的资料，并与同期产前确诊为胎盘早剥的63例（对照组）比较。结果观察组临床表现主要为腰酸、腹胀或胎心监护异常，早剥面积及总出血量均明显低于对照组。而死胎、死产、新生儿死亡、新生儿窒息及早产儿出生率与对照组比较差异无统计学意义。产科DIC等并发症与对照组比较差异无统计学意义。结论胎盘早剥漏诊的主要原因为发病诱因和临床症状不典型，虽轻型早剥占较大比例，但对母胎仍具有较大危害。     

胎盘早剥并发子宫胎盘卒中的危险因素分析

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.     

The relationship between clinical diagnosis and placental findings in 561 placentae delivered less than 32 weeks' of gestation

The relationship between clinical diagnosis and placental findings for 561 consecutive cases of delivery at 24 to 31 weeks' gestation were analyzed, and the following results were obtained. 1) The incidence of premature rupture of the membranes (PROM), threatened premature delivery, toxemia and abruption placentae were 40.6, 36.4, 7.8 and 3.0%, respectively. 2) The incidence of chorioamnionitis, retroplacental hematoma (RPH) and placental infarction were 35.1, 18.0, and 13.0%, respectively. 3) Chorioamnionitis of the placenta was found 58.3% in PROM and 26.0% of cases of threatened premature delivery. 4) RPH was found in 70.6% of placenta of abruption and 36.4% of toxemia. 5) Placental infarction was found in 86.4% of toxemia cases and 35.3% of abruption. Each clinical diagnosis was related specifically to each placental finding in cases delivered at 24 to 31 weeks of gestation.     

Predicting placental abruption and previa in women with a previous cesarean delivery

The purpose of this study was to determine if placental abruption or previa in women with a history of a prior cesarean delivery (CD) can be predicted. A retrospective cohort study of pregnant women with previous CD was conducted in 17 centers between 1996 and 2000. Women developing placenta previa or abruption in the subsequent pregnancy were compared with those without these complications. Bivariate and multivariable techniques were used to develop predictive models for placenta previa or abruption. The area under the receiver-operator characteristic curves, sensitivity, specificity, and accuracy of the models were compared. Among 25,076 women with prior CD, there were 361 (15 per 1000 births) with placenta previa and 309 (13 per 1000 births) with abruption. The significant risk factors for these complications include advanced maternal age, Asian race, increased parity, illicit drug use, history of spontaneous abortion, and three or more prior cesarean deliveries. Prediction models for abruption and previa had poor sensitivity (12% and 13% for abruption and previa, respectively). In women with at least one prior cesarean delivery, the risk factors for placental previa and abruption can be identified. However, prediction models combining these risk factors were too inefficient to be useful.     

Clinical significance of pregnancies with circumvallate placenta

AIM: This study examined the clinical significance of patients complicated by circumvallate placenta in comparison with patients with a normal placenta. METHODS: Data were collected from 139 singleton deliveries complicated by circumvallate placenta and from 7666 unaffected controls managed at Japanese Red Cross Katsushika Maternity Hospital between 2002 and 2005. RESULTS: The incidence of premature delivery, oligohydramnios, non-reassuring fetal status on cardiotocogram, placental abruption and intrauterine fetal death in patients complicated by circumvallate placenta were significantly higher than those in control patients. The odds ratio of placental abruption in patients complicated by circumvallate placenta was 13.1 (95% confidence limits: 5.65-30.2). CONCLUSION: A circumvallate placenta is associated with a higher incidence of serious perinatal complications such as placental abruption.