26例前置胎盘分娩方式临床分析

[目的 ]探讨前置胎盘分娩方式的选择及分娩过程中减少出血的方法。 [方法 ]对 2 6例前置胎盘病例的发病率、诊断方法、胎盘分型、分娩方式、出血情况及剖宫产术子宫切口方式与出血的关系几个方面进行回顾性分析。[结果 ]2 6例中手术率为 96 .1 5 % ,阴道分娩率为 3.85 % ,1例阴道分娩出血量为 6 0 0mL ,剖宫产术平均出血量为 6 74 .5 5mL ;剖宫产术中切口方式选择推开胎盘与避开胎盘出血量比较 ,差异无显著性 (P >0 .0 5 ) ,切开胎盘与推开胎盘出血量比较及切开胎盘与避开胎盘的出血量比较 ,差异均有显著性 (P均 <0 .0 1 )。[结论 ]剖宫产术可成为前置胎盘终止妊娠的主要方法 ,同时原则上应避开胎盘选择切口     

71例初产妇前置胎盘与人工流产相关性分析

目的:探讨初孕人工流产与再孕后前置胎盘发生率的相关性。方法:对1992年1月～2001年12月住院分娩的4046例初孕人工流产进行回顾分析,对影响前置胎盘发生率的因素进行x~2检验。结果:初产妇前置胎盘发生率为1.75％;人工流产次数越多,末次人工流产术后至本次妊娠时间间隔越短;人工流产术后有生殖道感染史者,前置胎盘发生率明显增高。结论:人工流产术是前置胎盘的高危因素,应加强育龄妇女的生殖健康宣传和教育,做到有计划受孕,减少非意愿妊娠的发生。     

Neutrophil and endothelial cell activation in the vasa vasorum in vasculo-Behçet disease

AIM: The aim of this study was to analyse the immunopathological mechanisms of vasculo-Beh?et disease, which were also compared to cases of Takayasu's arteritis and inflammatory aneurysm to evaluate differences in inflammatory mechanisms. METHOD AND RESULTS: We reviewed six cases of vasculo-Beh?et disease, four of Takayasu's arteritis and seven inflammatory aneurysms which underwent surgical repair. Immunohistochemical studies were performed on paraffin-embedded tissue using a labelled streptavidin-biotin method, as was in-situ hybridization for Epstein-Barr virus. Microscopically, neutrophils and lymphocytes accumulated around the vasa vasorum. Neutrophils were prominent as compared to Takayasu's arteritis and inflammatory aneurysm. Elastic fibres were not severely destroyed. Endothelial cells (ECs) of most vasa vasorum expressed HLA-DR. The number of vasa vasorum around which inflammatory infiltrating cells were observed in vasculo-Beh?et disease was significantly greater than in inflammatory aneurysms and Takayasu's arteritis (P < 0.001). The cytokines IL-1alpha, TNF-beta and IFN-gamma were expressed in neutrophils and lymphocytes which were distributed around vasa vasorum, as well as neutrophils adherent to HLA-DR positive ECs. CONCLUSION: Our results suggest that vasculo-Beh?et disease should be classified as a neutrophilic vasculitis targeting the vasa vasorum. Aneurysm formation may be related to degeneration of arterial wall caused by inflammation of the vasa vasorum.     

磁共振成像对前置胎盘的临床诊断价值

目的：探究磁共振成像（MRI）对前置胎盘的诊断价值。方法：选取2018年1月至2021年6月新疆生产建设兵团医院接诊的基于临床症状诊断为前置胎盘孕妇79例,所有孕妇均在手术前行盆腔MRI扫描,观察胎盘厚度、宫颈长度、胎盘T2低信号带、宫颈边缘窦、膀胱隆起、子宫肌层变薄信号,分析上述MRI征象、指标对前置胎盘的诊断价值。结果：79例孕妇中,最终经手术病理证实为前置胎盘的患者52例。MRI征象中的胎盘T2低信号带、宫颈边缘窦、膀胱隆起、子宫肌层变薄均可有效诊断前置胎盘（P <0.05）;检出率由高到低依次为：胎盘T2低信号带>宫颈边缘窦>子宫肌层变薄>膀胱隆起;胎盘厚度≥10 mm时,胎盘厚度与前置胎盘呈正相关（r=0.852,P=0.016）;胎盘厚度<10 mm时,胎盘厚度与前置胎盘无相关性（r=0.201,P=0.052）。宫颈长度≥30 mm时,宫颈长度与前置胎盘无相关性（r=0.376,P=0.071）;宫颈长度<30 mm时,宫颈长度与前置胎盘呈负相关（r=–0.721,P=0.036）。结论：MRI征象（胎盘T2低信号带、宫颈边缘窦、膀胱隆...     

剖宫产术中大出血的原因分析与治疗

目的探讨剖宫产术中大出血的原因及治疗.方法回顾性分析39例剖宫产术中出血≥1000ml作为研究组,出血＜1 000ml,且＞500ml者作为对照组1,出血≤500ml者600例作为对照组2.结果研究组中出血首位原因主要为前置胎盘和低置胎盘,占53.85%(21/39),显著高于对照组1中的10.67%(27/253),P＜0.01.在药物控制出血失败后,11例子宫动脉结扎中8例治疗成功、29例宫腔填塞纱条中28例治疗成功,得以保留子宫,2例行子宫切除术.结论前置胎盘和低置胎盘是剖宫产术中大出血的主要原因,宫腔填塞纱条治疗剖宫产术中大出血有良好效果.     

上海市剖宫产出血计量研究

目的研究剖宫产手术至术后24h出血总量.方法上海市6所医院用吸引器抽吸及纱布称重法分阶段测量剖宫产手术,术后2h,术后4h及术后24h以及两者的出血总量.结果539例剖宫产手术至术后24h失血总量为(494.34±211.16)ml,失血总量大于500ml、600ml及700ml者各为43.79%,23.94%及12.44%.6所医院剖宫产至术后24h失血量在(387.94±161.32)ml至(797.7±205.52)ml,手术中的失血量约占总失血量的三分之二,失血量与前置胎盘及巨大儿有明显关系,并可能与促子宫收缩剂的剂量有关.结论本研究的剖宫产手术至术后24h平均失血总量约为500ml,建议剖宫产的产后出血定义应修改为≥600ml.     

The relationship of placenta previa and history of induced abortion.

OBJECTIVES: We evaluated the risk of placenta previa being associated with a history of induced abortion by different surgical procedures. METHODS: Cases (n=192) were women who had a singleton delivery complicated by placenta previa at a major obstetric care hospital in western Washington state between April 1, 1990 and December 31, 1992. Controls (n=622) were women with singleton deliveries not complicated by placenta previa or abruption. Odds ratios, determined by logistic regression, approximate the relative risks. RESULTS: Vacuum aspiration abortion was not associated with an increased risk of placenta previa (OR 0.9, 95% CI 0.6-1.5). However, the risk of placenta previa increased with the number of sharp curettage abortions (OR 2.9, 95% CI 1.0-8.5 for > or =3). CONCLUSIONS: Risk of placenta previa may be increased in a dose response fashion by multiple sharp curettage abortions. However, vacuum aspiration does not confer an increased risk, and may be a better alternative.     

前置胎盘的高危因素及围产儿结局

目的探讨前置胎盘发生的高危因素及其对妊娠结局的不良影响。方法回顾性分析6年间分娩的78例单胎前置胎盘病例(前置组)和156例单胎非前置胎盘对照产妇(对照组)的临床资料。结果前置胎盘发生率为0．94%(78/8318例)。前置组产妇年龄大于对照组(≥35岁,OR=8．76,P＜0．001),胎次(≥3次,OR=5．80,P＜0．001)、产次(≥2次,OR=6．87,P＜0．001)、流产次数(≥3次,OR=7．06,P＜0．001)、前次剖宫产史(P＜0．01)均多于对照组。前置组新生儿早产发生率高于对照组(47．44%比7．05%,P＜0．01),早产者1min Apgar评分低于对照组[(7．08±2．08)分比(9．09±0．82)分,P＜0．01],新生儿出生体重低于对照组(P＜0．01)；两组新生儿出生性别的差异无显著性。结论高龄(≥35岁)、多产(≥2次)、多胎(≥3次)、多次流产(≥3次)及前次刮宫产史的孕妇前置胎盘发生率高,且易导致早产和新生儿窒息,是产前重点监护的对象。     

中央性前置胎盘剖宫产术中应用卡前列素氨丁三醇时机的疗效研究

目的 探讨中央性前置胎盘剖宫产术中应用卡前列素氨丁三醇的时机对疗效的影响.方法 将148例中央性前置胎盘产妇按就诊顺序号分为观察组和对照组,每组74例.观察组注射卡前列素氨丁三醇的时间为断脐后,对照组则为胎盘娩出后.比较两组术中和术后24h内出血量、手术时间、胎盘自娩率及不良反应发生率等.结果 观察组的术中出血量明显少于对照组[（503.5±320.8） ml比（672.1 ±409.6） ml],胎盘自娩率明显高于对照组[79.73％（59/74）比54.05％（40/74）],手术时间明显短于对照组[（42± 15） min比（55±16） min],差异均有统计学意义（P＜ 0.05或＜ 0.01）;两组术后24h内出血量和不良反应发生率比较差异均无统计学意义（P＞0.05）.结论 中央性前置胎盘产妇行剖宫产术时,于断脐后即将卡前列素氨丁三醇注射入宫体可提高胎盘自娩率,缩短手术时间,减少术中出血量,值得临床借鉴和推广.     

中晚孕期出血原因分析及产前超声对中晚孕期出血妊娠结局的影响

【摘要】目的：研究分析中晚孕期出血原因，并探究产前超声对中晚孕期出血妊娠结局的影响。方法：选择我院收治的妊娠中晚孕期出血产妇129例，记为观察组。再选择同时期我院的妊娠正常产妇100例，记为对照组。对比两组前置胎盘等情况的发生率，确定出血原因，再深入探究前置胎盘的危险因素。最后对比产前超声检查和常规CT检查对中晚孕期出血的诊断结果，并统计分析妊娠结局的影响。结果：前置胎盘的主要危险因素是年龄、文化程度、流产史以及剖宫产史。产前超声检查准确度、敏感性以及特异性均显著高于常规CT检查，并且超声检查漏诊率低于CT检查。观察组剖宫产、早产、胎儿窘迫以及新生儿窒息比例显著高于对照组，差异均有统计学意义（均P＜0.05）。结论：中晚孕期出血的主要原因是前置胎盘、胎盘早剥等，年龄、流产史等是引起前置胎盘的危险因素。产前超声检查能高效检出中晚孕期出血，敏感度以及特异性都较高。