前置胎盘合并胎盘植入12例临床分析

目的：探讨前置胎盘合并胎盘植入的高危因素、诊断及治疗方法。方法对82例前置胎盘（前置胎盘组）和前置胎盘合并胎盘植入12例（胎盘植入组）孕产妇的临床资料进行回顾性分析。结果孕妇的年龄、孕次、前置胎盘类型及子宫手术史是发生胎盘植入的高危因素；胎盘植入组早产、新生儿窒息和产后出血的发生率均高于前置胎盘组（ P＜0.05）；产前彩色多普勒超声诊断前置胎盘合并胎盘植入的正确率为83.3％（10/12），胎盘增厚、胎盘后方子宫壁肌层低回声带变薄（≤1 mm）或消失、胎盘实质内血流丰富、胎盘内腔隙是诊断前置胎盘合并胎盘植入的特征性声像图；治疗方法主要是积极的期待疗法及适时终止妊娠。结论孕妇年龄≥30岁、孕次≥3次、中央型前置胎盘及子宫手术史是前置胎盘合并胎盘植入的高危因素，彩色多普勒超声产前诊断胎盘植入是目前最简便可行的方法，采取个体化处理措施可改善母婴结局。

Clinical analysis of 12 cases placenta previa combined with placenta accreta

Objective To investigate the high risk factors,diagnosis and management of placenta previa combined with placenta accreta .Methods The clinical data of 12 cases of placenta previa combined with placenta accrete （ placenta accreta group ） and 82 cases of placenta previa （ placenta previa group ） were analyzed retrospective-ly.Results The age, gravidity, the types of placenta previa and uterine operation history were high risk factors of placenta accreta;The incidences of premature delivery , neonatal asphyxia and postpartum hemorrhage of placenta ac-creta group were higher than those of placenta previa group （ all P〈0.05 ）;The accuracy rate of prenatal color doppler ultrasound in the diagnosis of placenta previa with accreta was 83.3%（10/12）.Placenta thickening, the hypoecho of uterine wall muscle layer at the rear of placenta band of being thinning （≤1 mm） or disappeaing , placental parenchy-ma′s rich blood flow , placental cavity gap were characteristic sonogram of placenta previa combined with placenta ac -creta;Expectant treatment and timely termination of pregnancy were the main treatment methods .Conclusion Over 30 years of age ,pregnancy over three times , central type of placenta previa and uterine operation history are high risk factors.Color Doppler ultrasound is currently the most convenient method in diagnosis of placenta accreta .The indi-vidual treatment can improve maternal and neonatal outcomes .