胎盘早剥相关因素及其诊断和结局分析

目的分析胎盘早剥的发病原因，以及不同分级胎盘早剥患者的临床表现、诊断和结局。方法收集房山区中医医院2001年1月至2014年3月92例胎盘早剥患者的临床资料并进行统计分析。结果在12082例产妇中共有92例胎盘早剥患者，胎盘早剥发生率为0．8％。妊娠期高血压疾病、胎膜早破、外伤因素是主要的发病诱因，分别占38．0％、20．7％、12．0％。临床表现主要为阴道出血、不规则腹痛、血性羊水。3级患者的板状腹、胎心异常、胎心率消失及休克发生率比较差异均有统计学意义（x2值分别为19．20、9．77、6．83、8．42，均P〈0．05）。产前诊断为胎盘早剥者59例，产前诊断率为64．1％，Ⅰ度、Ⅱ度、Ⅲ度胎盘早剥患者的产前诊断率分别为36．7％、64．0％、86．5％，差异有统计学意义（x2=17．88，P〈0．05）。剖宫产75例（81．5％），阴道分娩17例（18．5％），子宫次全切除1例；并发子宫胎盘卒中4例，弥散性血管内凝血1例，均为Ⅲ度胎盘早剥患者。围产儿死亡13例，死亡率为13．8％，死胎10例，新生儿窒息21例，转新生儿重症监护室（NICU）23例，新生儿死亡3例。Ⅲ度胎盘早剥出现死胎、新生儿窒息及转NICU的比例显著高于Ⅰ度和Ⅱ度患者，差异均有统计学意义（x2值分别为6．17、6．10、18．67，均P〈0．05）。结论积极预防胎盘早剥诱因，及时诊断胎盘早剥并积极治疗，有助于减少胎盘早剥的发生，改善母婴顸后。

Related factors,diagnosis and outcomes of placental abruption

Objective To explore the causes of placental abruption and clinical manifestations, diagnosis and outcomes of placental abruption with various severity. Methods Statistical analysis was conducted on the clinical data of the 92 cases with placental abruption admitted in Traditional Chinese Medicine Hospital of Fangshan District during the period of January 2001 to March 2014. Results Totally 92 cases were found with placental abruption of the 12 082 maternal, and the incidence was 0. 8%. The major predisposing factors included hypertensive disorders complicating pregnancy （38.0%）, premature rupture of fetal membranes （20.7%）, and traumatic factors （12.0%）. The main clinical manifestations included vaginal hemorrhage, irregular abdomen pain and bloody amniotic fluid. The incidence of abdominal plate, abnormal fetal heart rate, disappearance of fetal heart rate and shock among patients with various severity were significantly different （X2 value was 19.20, 9.77, 6.83 and 8.42, respectively, all P 〈 0.05 ）. There were 59 cases diagnosed before birth, and the prenatal diagnosis rate was 64.1%. The prenatal diagnosis rate of Ⅰ degree, Ⅱ degree and Ⅲ degree of placental abruption was 36.7% , 64.0% and 86.5% , respectively with significant difference （X2 = 17.88, P 〈 0.05 ）. Cesarean section was performed in 75 cases （81.5%） and vaginal delivery was accepted by 17 eases （18.5%）. Subtotal hysterectomy was performed in one ease, uterine apoplexy occurred in 4 cases, and disseminated intravascular coagulation was found in one case. These 6 cases were the patients with III degree of placental abrnption. There were 13 perinatal death cases, and the mortality was 13.8%. There were 10 stillbirths, 21 cases of neonatal asphyxia, 23 cases transferred to neonatal intensive care unit （NICU） and 3 cases of neonatal death. The proportions of stillbirth, neonatal asphyxia and transferring to NICU in patients with Ⅲ degree of placental abruption were significantly higher than those in the pat