胎盘附着部位对凶险性前置胎盘妊娠结局的影响及高危因素分析

目的研究不同胎盘附着部位对凶险性前置母婴结局的影响,并分析其发生的高危因素。方法回顾性分析剖宫产后再次妊娠合并前置胎盘105例患者的临床资料,其中胎盘附着于子宫疤痕处46例(研究组),胎盘附着位置未跨越子宫疤痕处59例(对照组)。比较两组患者的一般情况、妊娠特点、妊娠结局及新生儿情况,分析讨论两组发生的相关因素。结果研究组胎盘粘连或植入、产后出血、输血、子宫切除及新生儿窒息发生率的发生率均高于对照组,平均出血量也高于对照组(P0.05)。回归分析显示妊娠距末次流产时间小于半年者,前次剖宫产术在二级及以下医院开展者,研究组发生率明显高于对照组,差异有统计学意义。结论凶险性前置胎盘,胎盘附着于子宫疤痕处者导致胎盘粘连或胎盘植入、产后出血、输血、子宫切除及新生儿窒息的风险显著增高,是实际意义上的凶险性前置胎盘。前次剖宫产术于二级及以下医院开展,流产后半年内再次妊娠为其发生的高危因素。应提高剖宫产缝合技术,降低剖宫产率,减少流产,降低凶险性前置胎盘的发生。

Maternal outcomes of placental position and analysis of high risk factor in pernicious placenta previa patients

Objective To discuss the effects of placental position in placenta previa patients with scar uterine on maternal outcomes and to analyze high risk factors of pernicious placenta previa patients. Methods A retrospective study was conducted in 105 re-pregnant women with placenta previa after cesarean section. They were divided to study group（ A）included 46 patients who got planted on the cesarean scars. The control group included 59 patients who were planted beyond scars. The general characteristics,maternal outcomes,and neonatal outcomes of these two groups were analyzed to get high risk factor. Results There had no significant differences of age,gestational weeks,bleeding during pregnancy and antepartum hemorrhage between two groups（ P ﹥0. 05）. More incidence of postpartum hemorrhage,placenta adherence,placenta accrete, hysterectomy,blood transfusion and neonatal asphyxia were found in the group A（ P ﹤0. 05）. There were no significant differences on premature delivery,low birth weight in two groups（ P ﹥0. 05）. A regression analysis prompt that those patients who got pregnant below 6 month after last miscarriages and those who take cesarean sections in second-class hospitals took a higher proportion in group A. Conclusion The placental position of pernicious placenta previa patients in which its location beneath the uterine incision is very important to predict bad maternal outcomes,such as placenta adherence,postpartum hemorrhage,neonatal asphyxia and so on. A lazy cesarean section operation and short period between two pregnancy were higher risk of pernicious placenta previa. In these cases,close attention should be paid for massive hemorrhage.