52例前置胎盘的临床分析

目的 探讨不同类型前置胎盘与母婴预后的关系.方法 选取2009年7月至2013年7月成都市第五人民医院妇产科收治的2 565例孕妇中的52例前置胎盘患者为研究对象,并按照前置胎盘类型,将其分为中央性前置胎盘组（n=20）、部分性前置胎盘组（n=15）和边缘性前置胎盘组（n=17）.本研究遵循的程序符合成都市第五人民医院人体试验委员会所制定的伦理学标准,得到该委员会批准,分组征得受试对象本人的知情同意,并与之签署临床研究知情同意书.结果 本研究前置胎盘发生率为2.03％（52/2 565）.中央性前置胎盘组患者首次出血孕龄、诊断孕龄、分娩孕龄均显著早于部分性前置胎盘组和边缘性前置胎盘组,差异有统计学意义（t=8.53,7.78,6.79,6.51,5.36,4.79;P＜0.05）,而其产后平均出血量及剖宫产率亦明显高于后二者,且差异有统计学意义（t=12.93,15.35,7.56,6.78;P＜0.05）.中央性前置胎盘组新生儿出生体质量显著低于部分性前置胎盘组和边缘性前置胎盘组,前者分别与后二者比较,差异有统计学意义（t=10.35,11.01;P＜0.05）.结论 中央性前置胎盘患者母婴预后较部分性和边缘性前置胎盘差.早期诊断前置胎盘,密切监视胎儿宫内情况,积极组织配合熟练的手术、麻醉、护理、重症监护及新生儿科等多学科协作团队,采取主动干预策略,是保证前置胎盘患者母婴良好预后的关键.

Clinical Analysis of 52 Gravidas with Placenta Praevia

Objective To investigate the relationship between different degrees of placenta praevia and clinical outcomes.Methods From July 2009 to July 2013,a total of 52 patients with placenta praevia were included in the study.They were divided into total placenta praevia group（n=20）,partial placenta praevia group（n=15） and marginal placenta praevia group（n=17）.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Fifth People＇s Hospital of Chengdu.Informed consent was obtained from each patients.Results The incidence rate of placenta praevia was 2.03％ （52/2 565）.Statistical differences were found among three groups in the gestational weeks at first bleeding,diagnosis and delivery（t=8.53,7.78,6.79,6.51,5.36,4.79; P＜0.05）.The blood loss and cesarean section rate were obviously higher in total placenta praevia group than those of partial placenta praevia group and marginal placenta praevia group（t =12.93,15.35,7.56,6.78; P＜0.05）.There also had significant differences in birth weight among three groups （t =10.35,11.01;P＜0.05）.Conclusions Compared with partial and marginal placenta praevia,clinical outcomes of patients with total placenta praevia are much worse.The diagnosis of placenta praevia as early as possible could help us to evaluate the patients＇ condition and provide guidance of clinical management,and finally obtain good clinical outcomes.