植入性胎盘的产前诊断与预后的关系

目的探讨55例植入性胎盘患者的产前诊断及与其预后的关系。方法选择2005年1月～2010年1月在山东省聊城市第二人民医院分娩,经过术后病理证实的植入性胎盘患者55例,采用回顾性病例统计分析方法进行研究。结果患者的产后出血量,是否行围产期全宫切除术以及是否合并不同类型的前置胎盘均与患者既往流产次数无关（P〉0.05）。产前超声明确诊断的植入性胎盘患者为14.55%,产前超声能否明确植入性胎盘的诊断与患者是否合并前置胎盘、植入性胎盘为前壁附着有关（P〈0.05）,相关分析表明产前超声诊断与产后出血量及胎盘植入面积明显相关（P=0.000）。患者是否行围产期全宫切除术与患者的产前出血量明显相关（P=0.000）,与是否合并中央性前置胎盘有关（P〈0.01）。结论植入性胎盘仅55.38%能够通过超声获得明确的产前诊断,但当植入性胎盘合并产前出血的前置胎盘时超声诊断则相对容易,而且这部分患者尤其是合并产前出血的中央性前置胎盘患者的预后较差,应做围产期全子宫切除术的准备。如产前应用核磁共振检测胎盘植入面积大小对产后出血的预测有重要的指导意义。

The correration between the prenatal diagnosis and the prognosis in the patients with placenta accreta

Objective: To explore correlation the prenatal diagnosis with the prognosis in 65 cases of the placenta accrete.Methods: 65 cases had been collected in the 2008 First Affiliated Hospital of Sun Yat-sen University from January 1998 to January and all the cases confirmed placenta accrete via pathological diagnosis.Retrospective analyses methods had been used in this study.Results: There were no relationships between the number of abortions with the amount of postpartum hemorrhage,peripartum hysterectomy preformed and different types of placenta previa(P> 0.05).Only 55.38% cases got definitely prenatal ultrasound diagnosis,and the prenatal ultrasound diagnosis were had relationship with the merger of placenta previa and anterior attached placenta(P<0.05).Regression analysis shown the significant correlations between the positive prenatal ultrasound diagnosis and postpartum hemorrhage or the square of placenta accrete(P=0.000).The regression analysis also had shown the significant correlations between periparum hysterectomy and prenatal hemorrhage(P= 0.000).Periparum hysterectomy had relationship with the central placenta previa(P<0.01).Conclusion: Only 55.38% cases got definitely prenatal ultrasound diagnosis,and the prenatal diagnosis were easier in the prenatal hemorrhage with placenta previa-accreta,and the peripartum hysterectomy should be prepared for the poor prognosis of the central placenta previa-accreta.MRI might be more effective in the postpartum hemorrhage prognostic for their more accurate square detection of placenta accrete.