凶险性前置胎盘及胎盘植入的妊娠结局分析

目的:分析凶险性前置胎盘及胎盘植入的妊娠结局。方法:2016年3月—2018年6月在本院住院行剖宫产分娩,诊断凶险性前置胎盘及胎盘植入者92例,统计其临床数据并进行分层分析。结果:出血量300~11000ml,子宫切除15例(16.3%),围产期并发症21例(22.8%);分娩活产儿90例(97.8%),41例(45.5%)转入NICU。术前超声提示植入、术后诊断植入、术时采取胎盘打洞方式的患者出血量均较对照组增多(P<0.05);出血量与剖宫产次数相关(r=0.291),孕次4~9次患者子宫切除的发生率较孕次1~3次患者增高(P<0.05);术前超声提示植入、术后诊断植入的患者子宫切除和围产期并发症的发生率较对照组更高(P<0.05);进行综合管理后患者的子宫切除率降低(P<0.05)。上述各组活产儿转入NICU的发生率均无差异(P>0.05);结论:孕次>3次、既往有剖宫产史、术前超声及术后诊断植入的病例妊娠结局更差,综合管理后子宫切除率降低。

Clinical analysis of pregnancy outcomes of women with pernicious placenta previa and placenta accreta

Objective:To analyze pregnancy outcomes of women with pernicious placenta previa and placenta accrete.Methods:The clinical data of 92 women with pernicious placenta previa and placenta accreta were analyzed and were stratified analyzed.Results:The average blood loss of these women was 300-11000 ml,15(16.3%)women had received hysterectom,and 21(22.8%)women had perinatal complications.There were 90(97.8%)live births,and 41(45.5%)newborns had been transferred to NICU.Blood loss of women with placenta accreta diagnosed by ultrasonography,women with placenta accreta diagnosed after cesarean,or women with placenta hole punching during cesarean had increased significantly(P<0.05).The incidence of hysterectomy of women with 4-9 times of pregnancy was significant higher than that of women with 1-3 times of pregnancy(P<0.05).The incidences of hysterectomy and perinatal complicationsan of women with placenta accreta diagnosed by ultrasonography and women with placenta accreta diagnosed after cesarean had increased significantly(P<0.05),but those of women received comprehensive management during pregnancy had decreased significantly(P<0.05).There was no statistically significant different in the incidence of newborns transferred to NICU among women with different situation(P>0.05).Conclusion:The women with pregnancy over 3 times,with cesarean history,with placenta accreta diagnosed by ultrasound,or with postoperative diagnosis of placenta accreta have worse pregnancy outcomes.The women accepting comprehensive management during pregnancy have lower hysterectomy.