前置胎盘的相关因素分析及其对妊娠结局

目的:探讨前置胎盘的相关危险因素分析及其对妊娠结局的影响。方法:我院于2010年8月～2011年8月对接收的住院分娩产妇进行临床分析与观察。结果:本文中住院分娩产妇3228例,发生前置胎盘58例,发生率为1.80%。发生前置胎盘的研究组产妇的年龄、体重指数(BMI)、经产史、刮宫史、剖宫产史以及6个月内末次人流史与正常对照组产妇相比有明显差异,且差异具有统计学意义(t或X~2=3.24、2.68、23.91、3.92、5.05、9.66,P均<0.05)。发生前置胎盘的研究组与正常对照组产前出血、结束孕周、保胎天数、剖宫产和新生儿体重相比有明显差异,且差异有统计学意义(t或X~2=38.16、3.88、4.51、9.83、3.11,P均<0.05)。结论:加强孕前卫生知识的宣教,避免过多的宫腔操作,前置胎盘的类型不能预测结局,积极保胎,延长胎龄,适时终止妊娠,积极采取止血措施,减少子宫切除,保证生存质量,降低孕产妇及围产儿的死亡率。     

前置胎盘的相关因素分析及其对妊娠结局

目的:探讨前置胎盘的相关危险因素分析及其对妊娠结局的影响。方法:我院于2010年8月～2011年8月对接收的住院分娩产妇进行临床分析与观察。结果:本文中住院分娩产妇3228例,发生前置胎盘58例,发生率为1.80%。发生前置胎盘的研究组产妇的年龄、体重指数(BMI)、经产史、刮宫史、剖宫产史以及6个月内末次人流史与正常对照组产妇相比有明显差异,且差异具有统计学意义(t或X~2=3.24、2.68、23.91、3.92、5.05、9.66,P均<0.05)。发生前置胎盘的研究组与正常对照组产前出血、结束孕周、保胎天数、剖宫产和新生儿体重相比有明显差异,且差异有统计学意义(t或X~2=38.16、3.88、4.51、9.83、3.11,P均<0.05)。结论:加强孕前卫生知识的宣教,避免过多的宫腔操作,前置胎盘的类型不能预测结局,积极保胎,延长胎龄,适时终止妊娠,积极采取止血措施,减少子宫切除,保证生存质量,降低孕产妇及围产儿的死亡率。     

前置胎盘类型与妊娠结局

目的:探讨前置胎盘(PP)类型与妊娠结局的关系.方法:收集2005年11月至2010年3月四川大学华西第二医院前置胎盘患者1121例的临床资料进行回顾性分析.根据产前超声检查结果将其分为完全性前置胎盘组(完全性PP组)、部分性前置胎盘组(部分性PP组)和边缘性前置胎盘组(边缘性PP组).比较3组的产科危险因素、母亲妊娠...     

前置胎盘67例的临床探讨

<正>前置胎盘是妊娠期的严重并发症之一,发生出血时间早、出血量大,处理不当可危及母儿生命。我院2005年～2009年间共收治前置胎盘67例,本文对其临床资料及母婴预后进行回顾性分析,现报告如下。     

前置胎盘的期待治疗

前置胎盘期待疗法已有70多年的历史,随着围产医学的发展,胎儿临护手段的进步,使期待疗法更增添了积极的因素。期待治疗和采用放宽剖宫产指征是处理前置胎盘,降低母儿病死率最关键的两上要点^[1]。     

凶险型前置胎盘期待治疗

随着临床剖宫产率的升高,凶险型前置胎盘的发生率亦明显增高。就目前国内外临床诊疗进展,建议对于孕周较小,胎儿发育不成熟,一般情况稳定的凶险型前置胎盘孕妇行期待治疗,其中包括抑制宫缩,促胎肺成熟,纠正贫血,加强胎儿宫内检测,适当延长孕周,择期剖宫产终止妊娠,改善母儿预后。     

前置胎盘伴瘢痕子宫分娩结局分析

目的:探讨不同类型的前置胎盘伴瘢痕子宫的分娩结局。方法:选取陕西省核工业215医院2012年1月—2015年12月收治的279例前置胎盘伴瘢痕子宫患者临床资料进行回顾性分析,按前置胎盘类型分为完全性前置胎盘组(72例)、部分性前置胎盘组(95例)、边缘性前置胎盘组(67例)、低置前置胎盘组(45例),分析4组分娩结局。结果:完全性前置胎盘、部分性前置胎盘患者的产后出血率分别均高于边缘性前置胎盘和低置前置胎盘患者(P0.05);完全性前置胎盘组的剖宫产、胎盘植入、胎盘粘连、子宫切除的发生率均高于边缘性前置胎盘组和低置前置胎盘组(P0.05);完全性前置胎盘组早产率高于部分性前置胎盘组、边缘性前置胎盘组和低置前置胎盘组(P0.05);完全性前置胎盘组新生儿体质量低于部分性前置胎盘组、边缘性前置胎盘组和低置前置胎盘组(P0.05),部分性前置胎盘组新生儿体质量低于边缘性前置胎盘组和低置前置胎盘组(P0.05),4组新生儿的1 min、5 min Apgar评分和围生儿病死率比较差异无统计学意义(P0.05)。结论:完全性前置胎盘患者的不良妊娠结局、早产儿发生率较高,应加强监测并采取及时的救治措施。     

抗磷脂综合征和前置胎盘的相关性研究

目的:探讨抗磷脂综合征(APS)和前置胎盘的关系。方法:选取我院180例APS孕妇,并随机选取同期正常孕妇360例作为对照组,分析两组前置胎盘的发生率,以及比较APS合并前置胎盘孕妇与单纯前置胎盘孕妇的妊娠结局。结果:APS组的前置胎盘发生率显著高于对照组(P<0.05);APS合并前置胎盘组的早产发生率、1分钟Apgar评分、羊水污染、产时出血量较单纯前置胎盘组显著增高(P<0.05)。结论:APS孕妇的前置胎盘的发生率以及早产、产后出血等较正常孕妇及单纯前置胎盘孕妇显著增高,早期诊治APS可减少不良妊娠结局的发生。     

89例前置胎盘患者临床结局的回顾性分析

目的探讨前置胎盘的类型、阴道出血状况与妊娠结局的关系。方法将89例前置胎盘分为轻度组(43例)及重度组(46例),对其临床表现及妊娠结局做回顾性分析。结果重度组初次出血及诊断时孕周均明显小于轻度组(P＜0.05);而产前出血发生率、出血次数及大出血例数无显著性差异(P＞0.05)。有产前出血者其诊断及分娩时的孕周、新生儿体重均显著低于无出血者(P＜0.01);急诊剖宫产率显著高于无出血者(P＜0.01)。结论前置胎盘患者妊娠结局有很大的差异,没有典型的临床特征可循。其类型及产前出血状况不能预测其结局,也不能据此提前做出处理方案。     

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

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。     

Critical analysis of risk factors and outcome of placenta previa

Objective  

To investigate risk factors and pregnancy outcome of patients with placenta previa.     

Previous cesarean section and abortion as risk factors for developing placenta previa.

OBJECTIVE: To determine the risk of subsequent occurrence of placenta previa in women with a history of previous cesarean sections and/or spontaneous and induced abortions. METHODS: A retrospective analysis of all single gestation deliveries at National University Hospital of Singapore from 1993-1997 was done. Women with placenta previa were identified by clinical or ultrasonographic diagnosis. RESULTS: Of the 16,169 singleton deliveries, 164 women (1.0%) had placenta previa. Women with placenta previa had a significantly higher incidence of previous cesarean sections (p < 0.001). Among the 164 women with placenta previa, women with 1, 2, and 3 previous cesarean sections had 2.2 (95% CI 1.4, 3.4), 4.1 (95% CI 1.9, 8.8) and 22.4 (95% CI 6.4, 78.3) times increased risk of developing placenta previa respectively. Similarly, women with 2 or more previous abortions had a 2.1 (95% CI 1.2, 3.5) times increased risk of subsequently developing placenta previa. CONCLUSION: There is a strong association between previous cesarean section and risk of subsequent development of placenta previa. This risk increased with the number of previous cesarean sections. Increasing frequency of abortions was also found to predispose a woman to placenta previa.     

Obstetric history and the risk of placenta previa

OBJECTIVE: To evaluate secular trends in the occurrence of placenta previa and whether placenta previa is associated with the outcome of previous pregnancies, cesarean section, and sociodemographic factors. DESIGN: A cohort study based on the Medical Birth Registry of Norway. Placenta previa in the second pregnancy was investigated for associations with outcomes in the first pregnancy and sociodemographic factors. RESULTS: In birth orders 1 and 2 the occurrence of placenta previa was 1.2 and 2.2 per 1,000, respectively, with no secular trend. The occurrence increased with maternal age and was lowest in women aged 20-29 years. The recurrence rate was 23 per 1,000 (adjusted odds ratio (OR) of recurrence=9.7). In women with prior delivery at < or =25 gestational weeks the risk of placenta previa was 6.7 per 1,000 (adjusted OR=3.0). In women with prior placental abruption the risk was 5.8 per 1,000 (OR=2.6). In women with prior perinatal death the risk was 4.4 per 1,000 (adjusted OR= 1.8). No independent relationship emerged with socio-economic factors, previous birthweight, and a history of pregnancy induced hypertension. Cesarean section was associated with subsequent development of placenta previa (adjusted OR= 1.3). CONCLUSIONS: We found no secular trends in the occurrence of placenta previa. Placenta previa is associated with previously described risk factors for placental abruption. The increased risk of placenta previa subsequent to placental abruption supports the theory of a shared etiologic factor. However, placenta previa and placental abruption do not share a common etiology in relation to a history of pregnancy induced hypertension, fetal growth retardation, and socio-economic factors.     

Induced abortion: A risk factor for placenta previa

A threefold increase in the incidence of placenta previa, from one in 318 deliveries (0.3%) in 1972–1974 to one in 109 deliveries (0.9%) in the twelve-month period ending June 30, 1980, was noted at Vanderbilt University Hospital. Two large groups of patients not present in 1972–1974 were found to be responsible for this increased incidence of placenta previa: one-way maternal transports and women who had had induced first trimester abortions. The frequency of maternal transports having placenta previa was 3.3% (p < 0.0001), and the frequency of placenta previa in women after an induced first trimester abortion was 3.8% (p < 0.0001). When correction for maternal transports was made, the endogenous induced first trimester abortion population had a frequency of placenta previa of 2.1% (p < 0.004), whereas the remainder of the endogenous population had an incidence of placenta previa similar to that found in the years 1972–1974. Induced first trimester abortion is seen as a significant factor predisposing to placenta previa.     

Antepartum risk factors associated with peripartum cesarean hysterectomy in women with placenta previa

The objective of this study was to identify antepartum risk factors for peripartum hysterectomy in women with placenta previa. The medical records of women with placenta previa who underwent cesarean section (C/S) were reviewed retrospectively. Data regarding the reproductive history and peripartum outcomes were analyzed. Multivariable analysis was used to identify factors independently associated with hysterectomy. During an 8.5-year period, 346 cases of placenta previa were identified in 24,987 deliveries (1.4%). An emergent hysterectomy was performed in 31 patients (9.0%). Multiparity, total previa, history of abortion, C/S, and placenta previa was more common in the hysterectomy group. An increasing number of abortions and C/S were associated with a higher frequency of hysterectomy. By the multivariable analysis, previous abortion, previous C/S, and total previa were significant risk factors for hysterectomy. We concluded that in women with placenta previa, history of abortion as well as prior C/S, and a total previa are strong antepartum risk factors for peripartum hysterectomy.     

Risk factors for placenta previa in an Asian population.

OBJECTIVE: To identify the risk factors for placenta previa in an Asian population. METHODS: This retrospective cohort study involved Taiwanese women delivered between July 1990 and December 2003 at Chang Gung Memorial Hospital, Taipei, Taiwan. Pregnancies complicated by multiple gestation and fetal anomalies were excluded. RESULTS: There were 457 cases of placenta previa (1.2%) among the 37,702 pregnancies analyzed. Risk factors for placenta previa included a prior preterm birth (OR, 6.6; 95% confidence interval [CI], 4.1-10.6); technology-assisted conception (OR, 4.8; 95% CI, 2.9-7.8); smoking (OR, 3.3; 95% CI, 1.2-9.1) or working (OR, 3.8; 95% CI, 2.8-5.3) during pregnancy; maternal age of, or greater than 35 years (OR, 2.0 to 2.2; 95% CI, 1.3-3.7); and previous induced abortions (OR, 1.3-3.0; 95% CI, 1.1-7.1). CONCLUSION: The risk factors for placenta previa were found to be the same for Asian women as those previously recorded for American and European women, but additional factors were detected.     

The epidemiology and clinical history of asymptomatic midtrimester placenta previa

The current case-controlled study examines the epidemiologic factors and subsequent clinical history in 139 patients with asymptomatic low placentation and 137 patients with normal placental position diagnosed in the second and third trimesters by gray-scale ultrasonography. Increased maternal age or parity and previous endometrial or myometrial damage were significantly associated with asymptomatic midtrimester low implantation. Three percent of early low implantations persisted as instances of placenta previa at term. However, in low implantation, the antepartum course was associated with perinatal complications in 45% of patients. Statistically significant increases in third-trimester bleeding, abruptio placentae, and suspected intrauterine growth retardation were shown in the patients with low implantation, when compared to the control patients. Forty-two percent of the patients with low implantation were delivered by cesarean section. The need for cesarean delivery, loss of blood, and prolonged hospitalization were statistically increased in the patients with low implantation. Infants born to mothers with low implantation showed statistically significant increases in prematurity, low birth weight, and perinatal mortality when compared to infants born to control patients.