胎盘早剥并发子宫胎盘卒中危险因素及母婴结局分析

目的：探讨并分析胎盘早剥并发子宫胎盘卒中的危险因素以及母婴结局。方法回顾性分析2011年6月至2015年6月沭阳县中医院收治的50例胎盘早剥孕产妇，依据术中检查其有无并发子宫胎盘卒中将之划分为观察组（并发有子宫胎盘卒中）21例和对照组（未并发子宫胎盘卒中）29例，对两组的临床资料及母婴结局进行比较，分析引起子宫胎盘卒中的危险因素。结果经统计学分析，两组患者的临床资料（年龄、孕周、孕产次及早产率）相比差异无显著性意义，在外伤、脐带原因及羊水过量上两组间也无显著性意义（χ2值分别为0．07、0．05、0．00，均P＞0．05），但观察组子痫前期者要显著多于对照组，差异有显著性意义（χ2＝4．47，P＜0．05）；两组胎盘早剥所致母婴结局相比，观察组孕产妇宫腔积血、子宫压痛和DIC的发病率显著高于对照组（χ2值分别为18．64、22．58、3．74，均P＜0．01或＜0．05）；对照组胎儿Apgar评分显著高于对照组，死亡率低于对照组，差异具有显著性意义（χ2值分别为8．64、6．90，均P＜0．01）；两组的胎盘附着部及剥离面积差异也有显著性意义（χ2值分别为9．43、19．29，均P＜0．01）。结论子痫前期是预测胎盘早剥的重要因素，子宫胎盘卒中更易并发于胎盘附着于子宫底／角部者，其并发会导致母婴结局不良。

Risk factors and maternal and neonatal outcomes of placental abruption associated with uteroplacental apoplexy

Objective To investigate and analyze the risk factors and maternal and neonatal outcomes of placental abruption complicated with uteroplacental apoplexy .Methods A retrospective analysis was done on the data of 50 lying in women with placental abruption during the period of June 2011 and June 2015 years in Shuyang Hospital of Traditional Chinese Medicine , and they were divided into observation group associated with uteroplacental apoplexy (21 cases) and control group without uteroplacental apoplexy (29 cases).Two groups were compared in clinical data and maternal and neonatal outcomes to analyze the risk factors of uteroplacental apoplexy .Results The clinical data of two groups (age, gestational age, pregnancy and preterm birth rate) was not significantly different.In trauma, umbilical cord and excessive amniotic fluid, there were no significant differences between two groups (χ2 value was 0.07, 0.05 and 0.00, respectively, all P>0.05), but the cases of preeclampsia in the observation group were more than in the control group with significant difference (χ2 =4. 47, P<0.05).In the observation group the incidences of maternal uterine bleeding , uterine tenderness and DIC were remarkably higher than in the control group (χ2 value was 18.64, 22.58 and 3.74, respectively, P<0.01 or P<0.05), but the Apgar scores of fetus was significantly lower (5.74 ±1.46 vs 8.72 ±1.28) and mortality was higher than in the control group (χ2 value was 8.64 and 6.90, respectively, both P<0.01).Two groups were significantly different in attachment and stripping area (χ2 value was 9.43 and 19.29, respectively, both P<0.01).Conclusion Preeclampsia is an important factor in the prediction of placental abruption , and uteroplacental apoplexy is more likely to occur in cases with placenta at fundus of uterus or uterine horn .Complicating of two will lead to adverse maternal and neonatal outcomes .