128例胎盘早剥患者临床特点分析

目的 分析胎盘早剥患者的发病特点及临床结局.方法 回顾性分析本院2014-2016年人院治疗的胎盘早剥患者临床资料,比较院内、院外发病患者的临床特征.结果 纳入128例胎盘早剥患者,其中院内发病者73例,院外发病者55例.胎盘早剥患者中已临产46例(35.9％),未临产82例(64.1％);分娩孕周≥37周62例(48.4％),＜34周37例(28.9％),未分娩3例(2.3％);剖宫产分娩79例(61.7％),顺产转剖宫产19例(14.8％),顺产23例(17.9％),产钳助产3例(2.3％).院外发病的患者具有典型临床症状的占96.4％,最易出现的症状为阴道流血(P＜0.01).院内发病患者主要症状表现为胎心率异常(P＜0.05).院外发病患者常因起病急、病情重,紧急剖宫产的比例更高(P＜0.01);但在不同发病地点,其发生母儿不良结局(包括胎盘剥离面积、产后出血、死胎等)的风险差异无统计学意义.结论 胎盘早剥部分病例起病隐匿,大多数无特异性表现;院外发病者起病急、病情凶险,及时转诊并进行积极处理后可有效地降低母儿不良结局的发生.

Analysis of clinical characteristics of 128 patients with placental abruption

Objective To analyze the clinical characteristics and outcomes of placental abruption.Methods A retrospective analysis of the clinical data was conducted among patients with placental abruption treated in Southwest Hospital between January 2014 and December 2016.The clinical characteristics were compared between the patients with in-hospital occurrence of placental abruption and those with occurrence before admission.Results Among the 128 cases of placental abruption treated in our hospital,placental abruption occurred during hospitalization in 73 cases and before admission in 55 cases.Placental abruption occurred during labor in 46 (35.9％) and before labor in 82 (64.1％) of the patients.Upon delivery,62 (48.4％) patients were at a gestational age of ≥ 37 weeks and 37 (28.9％) had a gestational age of ＜ 34 weeks;3 (2.3％) patients received further expectant treatment without immediate delivery.Seventy-nine (61.7％) of the patients had cesarean delivery,19 (14.8％) had conversion from vaginal delivery to cesarean section,23 (17.9％) had vaginal delivery,and 3 (2.3％) underwent assisted delivery.Typical clinical symptoms were observed in 96.4％ patients with placental abruption before admission,and the most frequent symptom was vaginal bleeding (P ＜ 0.01).In patients with occurrence of placental abruption during hospitalization,fetal heart rate abnormality was the most frequent presentation (P ＜ 0.05).The patients with placental abruption before admission often had acute onset,critical conditions,and a high likeliness of emergency cesarean section,but they had comparable risks for unfavorable maternal or neonatal outcomes (including extensive placental lesion,postpartum hemorrhage,stillbirth,etc.) with the patients with in hospital occurrence of placental abruption.Conclusion In some eases placental abruption occurs without specific manifestations,and nearly half of the patients with placental abruption before admission have acute onset and are in critical condition,who required timely referral and active treatments to lower the risk of unfavorable maternal or neonatal outcomes.