胎盘植入62例临床分析

目的对北京协和医院胎盘植入病例的临床处理和结局进行分析。方法对2011年1月至2013年12月北京协和医院收治的胎盘植入病例62例进行回顾性病例分析。并对其中我院分娩的45例孕妇,根据超声或核磁共振结果,分为产前疑诊组和产前未疑诊组,比较两组患者一般情况及产科并发症发生情况。结果 62例胎盘植入病例中,24.2%合并剖宫产史,66.1%合并人工流产史。胎盘部分或全部残留占35.5%,合并产后出血51.6%,严重产后出血共7例。子宫切除共6例。产前疑诊胎盘植入病例合并剖宫产史者显著高于产前未疑诊病例(P=0.043);产前疑诊组合并前置胎盘、产后出血、胎盘穿透发生率均高于未疑诊组,但无统计学差异(P0.05)。6例子宫切除病例中有3例合并中央性前置胎盘,1例胎盘穿透,4例严重产后出血。结论剖宫产史和人工流产史是胎盘植入和胎盘穿透的高危因素,产前疑诊胎盘植入病例有助于制定分娩和抢救计划,以避免严重产科并发症的发生。

Clinical analysis of 62 pregnancy women with placenta increta and percreta

Objective：To analyze the management and outcomes of pregnant women with placenta increta and percreta.Methods：The data of 62 pregnant women diagnosed with placenta increta and percreta admitted in Peking Union Medical College Hospital from Jan 2011 to Dec 2013 were retrospectively analyzed.Among them,forty five women delivered in our hospital were divided to two groups according to the characteristics of ultrasound and magnetic resonance imaging antenatally,i.e.the suspected placenta increta group and the unsuspected group.Student＇s t test and x2 test were used to compare the characteristics,management and obstetric complications between the two groups.Results：Among 62 patients diagnosed placenta increta or percreta postpartum,24.2％ had at least one previous caesarean section,and 66.1 ％ had at least one artificial abortion.Partial or total placenta retention occurred in 35.5％ of patients.Postpartum hemorrhage occurred in 51.6％ of patients,among them 7 patients with severe postpartum hemorrhage.Postpartum hysterectomy was done in 6 patients.The patients with previous caesarean section in suspected placenta increta group were more than in the unsuspected group （P =0.043）.In addition,more obstetric complications including placenta previa,postpartum hemorrhage and placenta percreta were seen in women with suspected placenta increta,but no significant difference was found compared with women in the unsuspected group.Conclusions：Placenta increta or percreta were associated with high risk of obstetric complications including life-threatening maternal haemorrhage and peripartum hysterectomy.The antenatal diagnosis for the patients with suspected placenta increta would help to make detail birth plan and management measures to avoid severe obstetric maternal morbidity.