胎盘植入及植入深浅对母婴的影响

目的:探讨胎盘植入及植入深浅对孕妇及胎儿的影响及其临床特点。方法:回顾分析2008年1月~2010年12月我院产科收治的266例单胎胎盘植入(病例组)及266例单胎非胎盘植入(对照组)患者的临床资料。将病例组再分为浅层侵入组(191例)和深层侵入组(75例)。深层侵入组由植入性胎盘和穿透性胎盘组成,浅层侵入组由粘连性胎盘组成。结果:病例组和对照组的输血治疗、产后出血、早产、新生儿窒息和入住NICU、胎儿死亡方面均差异显著(P0.05);但两组在有剖宫产史、实施剖宫产术终止妊娠、胎儿性别等方面则无显著差异(P0.05)。孕妇高龄、有剖宫产史、孕产次和流产次数增多与深层侵入的发生显著相关。与浅层侵入组比较,深层侵入组中孕妇行输血治疗、合并产后出血或前置胎盘、术后入住ICU治疗、新生儿出生体重2500g和入住NICU治疗等不良妊娠结局发生风险显著升高;在行剖宫产术终止妊娠、合并先露异常或胎膜早破等方面,深层侵入组与浅层侵入组无显著差异(P0.05)。结论:胎盘植入,尤其植入性胎盘和穿透性胎盘使母儿不良妊娠结局发生风险增高,与其相关的并发症与合并症亦可威胁母儿生命。

The impact of placenta accreta and implantation depth on gravida and fetus.

Objective：To investigate the clinical characteristics and the impact of placenta accreta and implantation depth on gravida and fetus. Methods：A retrospective review was conducted to 266 singlet pregnancies with placenta accreta （ case group） and 266 non-placenta accreta singlet pregnancies （control group） from Jan. 2008 to Dec. 2010 in our hospital. The case group was divided into deep invasion group and superficial invasion group by the implantation depth. Deep invasion group consisted of two parts：placenta increta and placenta percreta. And placenta accreta was included in superficial group. Results：Compared the case group with the control group, there were significant differences on the aspects of treatment of blood transfusion, postpartum haemorrhage, premature delivery, neonatal asphyxia, needing treatment in NICU, fetal death, etc （P〈0.05）. But the two groups had no statistical differences in previous cesarean section history, using cesarean operation to terminate pregnancy, fetal gender, and so on （P〉0.05）. There was a significant relationship between the risk of deep invasion and advanced maternal age, previous cesarean section history, increased number of pregnancy, parity or abortion. Compared with superficial invasion group, deep invasion group had a high risk of adverse pregnancy outcomes which contained treatment of blood transfusion, postpartum haemorrhage, complicated with placenta previa, needing treatment in ICU, neonatal birth weight 〈 2500g, needing treatment in NICU. And had no statistical differences in using cesarean operation to terminate pregnancy, complicated with malpresentation or premature rupture of merebrane, and so on （ P 〉 0. 05 ）. Conclusions： Placenta accreta, especially placenta increta and placenta percreta, make the risk of adverse pregnancy outcomes increased. Complications, which are related with them, also may be a serious threat to maternal and fetal life safety.