凶险型与非凶险型前置胎盘处理与妊娠结局的关系

目的：探讨凶险型与非凶险型前置胎盘孕妇的胎盘处理情况与妊娠结局的关系,以及对围生儿的影响。方法回顾性分析2012年1月至2014年12月在乐山市人民医院产科就诊的158例前置胎盘孕妇临床资料。根据有无剖宫产史及胎盘位置将入组孕妇分为凶险型组（54例）和非凶险型组（104例）,比较分析两组围手术期处理及新生儿结局差异。结果凶险型组的产后出血例数、出血量、输血量、胎盘植入、子宫切除明显多于非凶险型组,差异均有统计学意义（χ2或t值分别为7．090、20．393、16．570、36．900、14．308,P＜0．01）;凶险型组中早产儿占79．6％,明显高于非凶险型组的40．4％,差异有统计学意义（χ2＝25．022, P＜0．01）;凶险型组新生儿的平均体重为（1604．1±173．2）kg,显著低于非凶险型组（2380．3±215．4）kg,差异有统计学意义（t＝20．903,P＜0．01）;两组新生儿出生后1min、5min Apgar评分及死亡率差异无统计学意义（P＞0．05）。结论凶险型前置胎盘产后出血、胎盘植入、子宫切除、早产及低出生体重儿的风险显著高于非凶险型前置胎盘。应该根据孕妇是否为凶险型前置胎盘来制定个体化的治疗方案,以改善母婴结局。

Correlation of pernicious and non-pernicious placenta previa with pregnancy outcomes

Objective To explore the correlation of the treatment of pernicious and non-pernicious placenta previa with pregnancy outcomes as well as the influence on perinatal infants.Methods A retrospective analysis was conducted on clinical data of 158 puerperas with placenta previa in People’s Hospital of Leshan from January 2012 to December 2014.They were divided into pernicious placenta previa group (54 cases) and non-pernicious placenta previa group (104 cases) according to the history of cesarean section and placental location. The perioperative management and neonatal outcomes were analyzed.Results The number of cases of postpartum hemorrhage, blood loss volume, volume of blood transfusion, placenta implantation rate and hysterectomy rate in pernicious previa group were significantly higher than those in non-pernicious placenta previa group (χ2 or t value was 7.090, 20.393, 16.570, 36.900 and 14.308, respectively, all P<0.01).The proportion of neonatal premature was 79.6%in pernicious previa group, which was significantly higher than 40.4% in non-pernicious placenta previa group (χ2 =25.022, P<0.01).The average neonatal birth weight was 1 604.1 ±173.2kg in pernicious previa group, and it was obviously lower than that (2 380.3 ±215.4kg) in non-pernicious placenta previa group (t=20.903,P<0.01).There was no significant difference in Apgar scores after born for 1 min and 5 mins between two groups (P>0.05).Conclusion The risks of postpartum hemorrhage, placenta accreta, hysterectomy, premature delivery and low birth weight are significantly higher in pernicious placenta previa patients than in non-pernicious placenta previa patients.Individual treatment plans should be made according to the feature of placenta previa so as to improve maternal and neonatal outcomes.