重型胎盘早剥58例临床分析

目的：探讨重型胎盘早剥的临床特点。寻找胎盘早剥的最好防治措施。方法：回顾性分析1992年-2005年5月1日我院18300例分娩产妇中发生重型胎盘早剥58例的临床资料。结果 失血性休克18例、凝血功能障碍8例、急性肾功能衰竭5例、羊水栓塞0例、子宫卒中26例、围产儿死亡33例、无孕产妇死亡、剖宫产术49例、其中子宫卒中26例中双侧子宫动脉上行支结扎术15例，宫腔填塞碘仿纱条9例，子宫次全切除术2例。阴道分娩9例，吸引产5例，臀牵引产2例，自然分娩2例。结论：重型胎盘早剥早诊断，不能短时间分娩者，立即行剖宫产，尽早应用冷沉淀及输血，子宫卒中可先采用双侧子宫动脉上行支结扎术或碘仿纱条填塞子宫，而不能完全成为子宫切除指征。

Clinical Analysis of 58 Cases of Severe Placental Abruption

Objective:To explore the clinical characteristic of severe placental abruption and find the best way to prevent and treat it.Methods:From 1992 to 2005,the clinical data of 58 cases of severe placental abruption from 18300 pregnant women of our hospital were retrospectively analyzed.Results: Hemorrhagic shock was in 18 cases,reduced coagulation in 8 cases,acute renal failure in 5 cases,none amniotic fluid embolism,uteroplacental apoplexy in 26 cases,perinatal death in 33 cases,none pregnant woman dead,cesarean section in 49 cases,15 cases were performed bilateral ligation of the ascendant branch of uterine arteries from 26 cases of uteroplacental apoplexy,9 cases were packed the womb with iodoform gauze strip,subtotal hysterectomy in 2 cases,vaginal delivery in 9 cases,application of vacuum extractor in 5 cases,breech extraction in 2 cases,nature birth in 2 cases.Conclusion:The patients with severe placental abruption should be diagnosed early,with which can't deliver soon should apply cesarean section immediately and use cryo and blood transfusion as soon as possible.Uteroplacental apoplexy can't be seen totally as the indication of hysterectomy,but should apply bilateral ligation of the ascendant branch of uterine arteries or pack the womb with iodoform gauze strip first.