20例孕晚期植入性凶险型前置胎盘的临床分析

目的探讨晚孕期植入性凶险型前置胎盘的临床特点、母婴结局和终止妊娠的治疗方案，以提高对植入性凶险型前置胎盘的认识。方法回顾性分析了福建医科大学省立临床医学院妇产科2010年1月至2012年12月确诊的20例植入性凶险型前置胎盘患者的临床资料，总结植入性凶险型前置胎盘的处理经验。结果20例患者经术前核磁共振、彩超及术中所见明确为植入性凶险型前置胎盘，均以剖宫产结束妊娠。20例均发生产后出血，术中出血量1000～5000mL，平均2600mL。子宫切除12例，膀胱破裂修补3例，3例行介入治疗。早产儿19例。新生儿窒息6例，其中5例轻度窒息，1例重度窒息。结论植入性凶险型前置胎盘对母儿危害大，应提高认识，及时识别，术前应做好充分准备，以减少母婴并发症，介入治疗值得借鉴。

Clinical analysis of 20 cases of implanted pernicious placenta previa at late pregnancy

Objective To investigate the clinical characteristics, maternal and infant outcomes, and treatment of pregnancy termination of patients with implanted pernicious placenta previa, aiming to improve cognition on implanted pernicious placenta previa. Methods Twenty cases of late pregnancy with implanted pernicious placenta previa were diagnosed in Fujian Provincial Hospital from January 2010 to December 2012, and their clinical data were analyzed to summarize treatment experience. Results Twenty patients were diagnosed with implanted pernicious placenta previa by MRI, color Doppler ultrasound and intraoperative findings, and their pregnancy terminated with cesarean section. All of them suffered PPH with intraoperative bleeding volume of 1 000-5 000mL （mean 2 600mL ）. Twelve cases underwent hysterectomy, 3 underwent bladder rupture repairing, and 3 received intervention therapy. There were 19 cases of preterm labor and 6 cases of neonatal asphysia, including 5 cases of mild asphydis and 1 severe case. Conclusion Implanted pernicious placenta previa is dangerous to mothers and infants, which should be highly considered. Timely recognizing and comprehensive preparation before surgery are necessary for reducing maternal and fetal complications. Intervention therapy is worthy of encouraging.