12例凶险性前置胎盘术中出血情况的临床分析

目的探讨瘢痕子宫伴前置胎盘(凶险性前置胎盘)再次剖宫产患者术中大出血的发生原因以及预防措施。方法收集分析2009年9月～2011年11月某院行单胎再次剖宫产155例患者的临床资料,其中伴前置胎盘者12例(观察组),瘢痕子宫不伴前置胎盘143例(对照组)。瘢痕子宫伴前置胎盘者12例术中出血原因进行归纳总结分析。结果瘢痕子宫伴前置胎盘组合并中央性前置胎盘,胎盘植入、先兆子宫破裂均高于瘢痕子宫不伴前置胎盘组。5例瘢痕子宫伴前置胎盘剖宫产术中大出血均为胎盘植入,且5例均为中央性前置胎盘,4例是前壁胎盘合并先兆子宫破裂。结论前壁中央性前置胎盘合并胎盘植入是瘢痕子宫伴前置胎盘剖宫产术中大出血主要原因。术前做好相应预防措施,必要时做好子宫动脉栓塞准备,尽可能保留子宫,对妊娠结局非常重要。

Clinical analysis on intraoperative hemorrhage status of pernicious placenta previa patients

OBJECTIVE To investigate the reason and precautionary measures of massive haemorrhage during repeated cesarean section in pregnancy patients with scar uterous and placenta previa.METHODS The clinical data of 155 parturients patients who undergoing cesarean section again from 2009 to 2011 were analyzed retrospectively,12 cases of all patients were with placenta previa,143 cases were without.RESULTS The rate of massive haemorrhage,placenta accreta and threatened uterine rupture in group re-cesarean section(who with cicatricial uterus and placenta previa)were higher respectively than those whitout placenta previa.Intraoperative massive hemorrhage occured in 5 cases who with the central type placenta praevia,and 4 cases were placenta previa and threatened uterine rupture.CONCLUSION Antetheca central placenta praevia plus placenta implantation is a chief factor of massive hemorrhage of intraoperative cesarean section.Making good preoperative preparations,such as uterine artery embolization(UAE),is significant for the outcome of pregnancy.