胎盘早剥124例分析及其早期识别诊断

目的：分析胎盘早剥病例的临床特点，为早期识别诊断提供循证依据。方法回顾性分析2008年1月至2014年3月胎盘早剥病例的病因、临床表现及妊娠结局差异。结果Ⅰ、Ⅱ及Ⅲ度各有58、45、21例。Ⅰ度早剥患者中妊娠高血压疾病发生率显著低于Ⅱ度早剥患者，规范产检比例显著高于Ⅲ度早剥患者，而胎膜早破发生率显著高于Ⅱ度、Ⅲ度早剥患者（P＜0．05）。Ⅰ度早剥患者以阴道流血为主要症状，Ⅱ度、Ⅲ度早剥患者以腹痛伴阴道流血或腹痛为主要表现。Ⅰ度早剥患者剖宫产率显著低于Ⅲ度患者，不良妊娠结局发生率显著低于Ⅱ度、Ⅲ度早剥患者（P＜0．05）。结论规范产检，注重病史或高危因素，加强腹部查体，警惕腹痛、阴道流血等临床表现，提高胎心监护异常图形的识别能力，结合超声检查细心分析等措施有助于早期诊断，并有效改善胎盘早剥患者的预后。

Analysis of 124 cases of placental abruption and its early diagnosis

Objective To analyze the clinical manifestations of placental abruption ,and try to provide evidence‐based data for early diagnosis .Methods Retrospective cases of placental abruption from January 2008 to March 2014 were analyzed ,the clinical characteristics ,etiological factor and outcomes were compared .Results There were 58 cases in Ⅰ degree ,45 cases in Ⅱ degree and 21 cases in Ⅲ degree .The incidence of PIH in Ⅰ degree group was significantly lower than that in Ⅱ degree group ,the incidence of PROM in Ⅰ degree group was significantly higher than that in Ⅱ and Ⅲ degree groups(P< 0 .05) .The main symptoms of Ⅰ degree group were vaginal bleeding .The main performances of Ⅱ and Ⅲ degree group were abdominal pain with or without vaginal bleed‐ing .The cesarean section rate of Ⅰ degree group was significantly lower than that of Ⅲ degree group ,and the rate of maternal‐fetal adverse outcomes was statistically lower than Ⅱ and Ⅲ degree groups (P< 0 .05) .Conclusion It is helpful for early diagnosis of placental abruption and improving prognosis by regular prenatal care ,analyzing and combining with history or risk factors ,ultra‐sound ,physical examination ,and paying attention to clinical performance like abdominal pain and vaginal bleeding ,as well as impro‐ving the ability to identify the abnormal FHR .