前置胎盘阴道流血与母婴预后的关系

目的：评价前置胎盘阴道流血与母婴预后的关系,探讨终止妊娠的时机。方法：回顾分析1992年1月—2009年1月92例前置胎盘病例的临床资料,按其孕前发生阴道流血量及次数分组（每次按出血量大于300mL计,0次—I组,1次—II组,2次—III组,3次—IV组）,分析初次出血孕周其产后出血量、新生儿体质量、新生儿评分、围产儿死亡率、新生儿远期并发症的关系。结果：I组平均产后出血量为303±32.3mL,新生儿平均体质量2712±321.5g,新生儿评分8.68±0.64,无围产儿死亡。II组平均产后出血量为406.52±22.8mL,新生儿平均体质量2616±291.5g,新生儿评分7.28±3.08,围产儿死亡1例;III组平均产后出血量为412.12±62.5mL,新生儿平均体质量2330±503.5g,新生儿评分6.95±0.5,围产儿死亡为2例;IV组平均产后出血量为408.5±88.3mL,新生儿平均体质量2020±513.5g,新生儿评分6.02±2.15,围产儿死亡3例。4组间两两比较,其产后出血量无显著差异,新生儿体质量、新生儿评分、围产儿死亡率4组间有显著差异（均P〈0.01）。初次出血孕周〈28周与〉34周相比较,其新生儿体质量、新生儿评分下降、远期并发症明显增加,有显著差异（P〈0.05）。结论：对孕龄达34周,尤其病情有恶化倾向,不待病情恶化,择期剖宫产终止妊娠,这样既提高了围产儿生存率,又避免母婴严重并发症的发生。而对于无阴道流血的前置胎盘患者,可等待至足月后再终止妊娠,以减少产后出血的发生率和提高围产儿生存率。

Clinical Study of Placenta Previa Vaginal Bleeding and Maternal -Fetal Prognosis

Objective：To evaluate the relationship between placenta previa vaginal bleeding and maternal-fetal prognosis,to explore the timing of termination of pregnancy.Methods： A total of 92 cases of placenta previa between January 1992 and January 2009 were analyed retrospectively,these cases were divided into four groups（ 300ml bleeding per time,0 time Group I,1 time Group II,2 times Group III,3 times Group IV） according to placenta previa vaginal bleeding volume and frequency occurred before delivery,and three groups（ 28 weeks-A,28-34 weeks-B,34 weeks-C） according to first bleeding time,in order to compare bleeding after dielivery,weight of newborn,score of newborn,perinatal mortality,long-term complications associated with newborn among groups.Results：Mean bleeding volume after delivery were 303±32.3ml,406.52±22.8ml,412.12±62.5ml,408.5±88.3ml in four Group I,Group II,Group III and Group IV,respectively;Average weight of newborn were 2712±321.5g,2616±291.5g,2330±503.5g,2020±513.5g,respectively;Mean score of newborn were 8.68±0.64,7.28±3.08,6.95±0.5,6.02±2.15,respectively;Perinatal mortality was 0,1,2,3,respectively.The difference of mean bleeding volume between each two groups was not significant,or the difference of the weight of newborn,score of newborn,perinatal mortality were obvious between each two groups（P0.01）.The difference of average weight of newborn,score of newborn,long-term complications between the group I and III were significant（P0.05）.Conclusions： Those cases at gestational age of 34 weeks,especially the illness is deteriorating,for example early bleeding time,repeat hemorrhage in short time,and the amount of bleeding more,should elective cesarean section.That not only improves the perinatal survival rate,but also avoids the happenness of serious complications.But the cases of placenta previa without vignal bleeding can terminat pregnancy until full term birth,in order to reduce the incidence of postpartum hemorrhage and improve the neonatal survival rate