剖宫产后再次妊娠前置胎盘附着位置对母婴结局的影响

目的 探讨剖宫产后再次妊娠合并前置胎盘中，不同胎盘主体附着位置对母婴结局的影响。方法 选择皖南医学院附属黄山市人民医院2013年4月至2017年6月收治的剖宫产后再次妊娠合并前置胎盘并接受剖宫产治疗的患者41例，根据胎盘主体附着位置分为子宫前壁组（21例）与子宫后壁组（20例），比较两组患者临床资料及母婴结局。结果 子宫前壁组患者胎盘植入率、产时出血量高于子宫后壁组，差异有统计学意义（P<0.05）；两组产褥感染率、新生儿的早产率、出生体质量基本一致；子宫前壁组急诊剖宫产率及新生儿窒息发生率高于子宫后壁组，但差异无统计学意义（P>0.05）。结论 剖宫产后再次妊娠合并前置胎盘中，胎盘主体附着于子宫前壁更易出现胎盘植入及产时出血量增加，在围生期应提高警惕。

Maternal and neonatal outcomes according to placental location in placenta previa of re-pregnant women with previous cesarean section

Objective To investigate whether the location of placenta in placenta previa is important in the development of maternal and neonatal complications among re-pregnant women with previous cesarean section.Methods Forty-one re-pregnant women with placenta previa after cesarean section were included.The patients were admitted to the People''s Hospital of Huangshan Affiliated Wannan Medical College from April 2013 to June 2017. According to placental location in uterus, the patients were divided into anterior group (21 cases) and posterior group (20 cases). The baseline information, maternal and neonatal outcomes were compared between the two groups.Results Compared with the posterior group, the rate of placenta increta and the intrapartum hemorrhage in the anterior group increased (P<0.05). There was no difference in the incidence of puerperal infection and premature birth as well as birth weight between the two groups (P>0.05). The rate of emergency cesarean section and asphyxia neonatorum was higher in anterior group than in the posterior group, without statistical significance (P>0.05).Conclusion The re-pregnant women with history of cesarean section, with anterior placenta in placenta previa, are at more risk of placenta accrete and the increased volume of intrapartum hemorrhage, which should be treated with caution in perinatal period.