胎盘早期剥离31例临床分析

目的：探讨胎盘早期剥离(早剥)的发病因素、临床表现及治疗。方法：回顾性分析31例胎盘早剥的临床资料、治疗及预后。结果：胎盘早剥的发生率为0．8％，机械性因素17例(54．8％)，妊娠高血压综合征引起的13例(41．9％)，以中重度为主。临床症状主要以腹痛、阴道流血为多见，分别为64．5％、54．8％，但有部分病例仅表现胎动消失或胎死子宫内，术前确诊较困难。临床类型轻重比例相近，病理类型以隐性和混合性多见，分别为45．2％、51．6％。分娩方式以剖宫产为主(83．9％)，围生儿死亡率54．8％。结论：胎盘早剥的发病因素以机械性因素和中重度妊娠高血压综合征为多见，临床表现以腹痛、阴道流血多见，围生儿病死率高，应做好孕期保健工作，积极推行孕期健康教育。     

人胎盘组织和滋养层细胞膜联素V的检测

目的检测膜联素V(AnnexinV)在人胎盘组织的表达及其分布,探讨乙肝病毒(HepatitisBVirus,HBV)感染胎盘细胞的可能方式.方法收集血清学HBsAg阳性孕妇足月胎盘组织39例、血清学HBsAg阴性孕妇足月胎盘组织4例,将培养的滋养层细胞制成细胞爬片,用免疫组化方法检测胎盘组织和滋养层细胞中的Annexin V.随机选取7例胎盘组织采用免疫荧光标记方法结合激光共聚焦技术对Annexin V进行重测.结果Annexin V存在于人类胎盘组织中,位于滋养层细胞、间质细胞及绒毛毛细血管内皮细胞的胞浆中.结论胎盘中含有丰富的AnnexinV,推测其可能是乙肝病毒进入滋养层细胞并感染胎儿的潜在受体.     

Hématome rétroplacentaire. Diagnostic,prise en charge et pronostic maternofœtal : étude rétrospective de 100 cas

ObjectivesTo update knowledge on placental abruption because there are few recent series published although the perinatal care has progressed.Patients and methodsA retrospective observational study has been conducted on 100 consecutive cases of abruptio placentae, occurring from January 2008 to June 2011, in the two maternity units of the University Hospital of Strasbourg (France).ResultsOne hundred and five births among which five twin pregnancies were included. Clinical context was evident in 91% of cases, but the classic clinical triad was present in only 4% of cases. Clots were found at immediate placenta examination in 77% of cases. Pathological diagnosis was directly in accordance with clinical diagnosis in half the cases. Mean date of childbirth was 33 weeks of amenorrhea and 6 days. Sixty-seven patients gave birth prematurely. Among them, 50 patients delivered before 34 weeks. Sixty caesareans were performed in emergency before labor, including 47 with general anesthesia. Twelve patients had post-partum haemorrhage and ten coagulation disorders. There was no maternal death. Perinatal mortality was 19% with 13 fetal deaths in utero (12.4%), four children born in an apparent death state with resuscitation failure (3.8%) and three neonatal deaths (2.8%).Discussion and conclusionPlacental abruption is a serious and unpredictable situation. Joint medical care of obstetricians and intensivists is often required. Perinatal mortality mainly occurs in utero.     

胎盘早剥的声像图表现及妊娠结局分析

目的 探讨胎盘早剥声像图特征及妊娠结局。方法 收集132例经产后诊断为胎盘早剥孕妇的产前超声检查资料,分析其声像图表现及妊娠并发症。结果 超声检出胎盘早剥48例,检出率36.36%（48/132）,漏诊率63.64%（84/132）。胎盘早剥声像图表现为胎盘增厚29例、胎盘实质回声异常16例、胎盘后方回声异常9例、胎盘边缘回声异常6例、胎盘胎儿面回声异常4例、宫壁与胎膜间回声异常2例以及羊水池内回声异常7例;主要并发症为剖宫产、子宫胎盘卒中、弥漫性血管内凝血、产后出血、早产、新生儿重度窒息及围生儿死亡,经超声检出胎盘早剥者以上并发症发生率均高于超声未检出者（P均<0.05）。结论 胎盘早剥产前超声检出率低;超声检出胎盘早剥者妊娠结局较差。     

胎盘早剥21例临床分析

目的 研究多囊卵巢综合症（PCOS）纤溶酶原激活物抑制因子-1（PAI-1）基因启动子区4G5G多态性的分布,探讨其与PCOS发病关系.方法 96例PCOS患者和50例对照组,用PCR方法测定PAI-1基因启动子区4G5G基因多态性;ELISA法检测血浆PAI-1水平.结果 PCOS组4G/4G基因型明显高于对照组,而5G/5G基因型显著少于对照组.PCOS组的PAI-1水平较对照组明显升高（29.32±2.37ng/mL与22.42±0.65ng/mL,P〈0.05）.结论 PCOS患者PAI-1基因启动子区4G/4G基因型频率增高,致血浆PAI-1水平升高,其与PCOS的发病有关.     

Abruptio placentae: Perinatal outcome in normotensive and hypertensive patients

OBJECTIVE: The objective of this study was to compare perinatal outcomes of hypertensive and normotensive women experiencing abruptio placentae. Our hypothesis is that hypertensive women have a less favorable perinatal outcome than do normotensive women. STUDY DESIGN: Women with the diagnosis of abruptio placentae delivered between July 1, 1988, and May 31, 1992, composed the study group (n = 226) in this case-control study. The incidence of abruptio placentae was 0.7% during this time. Those women with either multifetal gestations (n = 4) or delivery before 20 weeks' gestation (n = 2) were excluded from data analysis. The remaining 220 patients were divided according to their hypertensive (n = 29) or normotensive (n = 191) status. Maternal and neonatal medical records were reviewed and abstracted for demographic variables, antepartum complications, delivery route, abruptio placentae grade, neonatal gender, birth weight, Apgar score, cord pH, and perinatal mortality. These perinatal outcome variables were compared between the hypertensive and normotensive patient groups. RESULTS: Black women with abruptio placentae were significantly more likely to be hypertensive (p = 0.0078). Hypertensive women with abruptio placentae had the antepartum complication diabetes mellitus significantly more often than did normotensive women (p = 0.032). However, they were similar to normotensive women with regard to the frequency of positive urine drug screen and trauma. Hypertensive women were no more likely to be delivered before 32 or 37 weeks' gestation, have neonates weighing <1500 or 2500 gm, or to be delivered by cesarean section. Abruptio placentae grades 2 and 3 occurred more often in hypertensive women (p = 0.053), as did significantly lower umbilical cord artery (p = 0.005) and venous (p = 0.003) pH values. Neonates from hypertensive women were no more likely to have low 5-minute Apgar scores or to die than those from normotensive women. CONCLUSION: Although hypertensive women experiencing abruptio placentae are more likely to have higher-grade abruptio placentae and lower umbilical cord pH values, the overall perinatal outcome was not significantly different from that of normotensive women experiencing abruptio placentae. (AM J Obstet Gynecol 1994;170:1595-9.)     

Cesarean versus vaginal delivery in abruptio placentae associated with live fetuses

In order to test the relative effectiveness of cesarean section and vaginal delivery in mild abruptio placentae associated with live fetuses, 23 consecutive patients were delivered vaginally and 18 by cesarean section over an 18-month period at the University of Ife Hospital in Nigeria. The perinatal mortality of the vaginal delivery group (52.2%) was significantly greater than that of those delivered by cesarean section (16.7%) (P greater than 0.02; less than 0.05; chi 2 test). The 1-min Apgar score test was also significantly greater than that of those delivered by cesarean section (P greater than 0.001). These differences have been attributed to the admission-to-delivery interval, which was significantly longer in the vaginal delivery group (12 h vs. 2 h). It is concluded that cesarean section is clearly superior to vaginal delivery in the management of abruptio placentae associated with live fetuses.     

33例胎盘早剥的B超诊断

目的对产前B超检查产后证实为胎盘早剥的病例进行分析，以提高B超对胎盘早剥的确诊率。方法对我院1988年1月至2003年4月间33例胎盘早剥的声像图表现及临床资料进行回顾性分析。结果产前B超诊断胎盘早剥符合率为84．8％(28例)，其中前壁胎盘及重度胎盘早剥符合率高(93．7％，100％)，而后壁胎盘及轻度早剥无临床症状符合率低(72．77％；0)。胎盘早剥的超声图像特征为胎盘与子宫壁间为暗区、低回声，中等回声或混合回声15例，胎盘局部增厚6例，胎盘边缘或绒毛膜板下突出肿块8例(误为绒毛膜血管瘤1例)。彩色多普勤血流显像显示胎盘剥离区无血流信号。结论产前B超捡查对诊断胎盘早剥具有很重要的临床价值，为临床处理及分娩方式的选择提供了依据。     

Disseminated intravascular coagulopathy in pregnancy: thorough comprehension of etiology and management reduces obstetricians’ stress

In pregnancy and puerperium disseminated intravascular coagulopathy may accompany abruptio placenta, intrauterine fetal demise with retained dead fetus, amniotic fluid embolism, endotoxin sepsis, preecalampsia with HELLP and massive transfusion. Clinical signs and symptoms of DIC can include oozing from venupuncture sites and/or mucous membranes, red cell lysis from activation of the complement system, hemorrhage from coagulopathy and possible uterine atony, hypotension from hemorrhage and/or bradykinin release, and oliguria from end-organ insult and hypovolemia/hypotension. Treatment of DIC consists of replacement of volume, blood products, and coagulation components and cardiovascular and respiratory support with elimination of underlying triggering mechanism. Received: August 1998 / Accepted: 10 May 1999     

Apallisches Syndrom nach Abruptio bei Sichelzellanämie

Zusammenfassung Eine 20 Jahre alt gewordene, klinisch unauffällige Patientin aus Togo unterzog sich einer Abruptio in der 6. Schwangerschaftswoche unter Allgemeinanästhesie. Während der Narkoseausleitung kam es zum Herzstillstand und in der Folgezeit zur Entwicklung eines apallischen Syndroms mit Todeseintritt nach 1 Jahr und 9 Monaten. Erst nach dem Eingriff wurde eine Sichelzellanämie (HbS/S) diagnostiziert. Nach Vorstellung der Obduktionsbefunde werden ausgewählte gutachterliche Fragen sowie der Stellenwert von Leitlinien bei Behandlungsfehlergutachten diskutiert.

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