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凶险性前置胎盘的妊娠结局及其与产后出血的高危因素分析
李明;杜菲;滕银成;黄亚绢;陶敏芳;顾京红;周月娣;徐钦洋;戴钟英;蒋荣珍
0
(上海交通大学附属第六人民医院上海市产科重症监护中心妇产科研究所)
摘要:
目的:探讨凶险性前置胎盘(PPP)的母婴结局及其与产后出血的高危因素。方法:回顾性分析2011年1月至2015年12月上海市第六人民医院住院分娩的前置胎盘患者181例,PPP患者72例(PPP组,其中发生产后出血34例,非产后出血38例),无剖宫产史妊娠的前置胎盘患者109例(非PPP组)。比较PPP组和非PPP组孕妇的年龄、孕周、孕次、产后出血率、输血率、胎盘植入率、子宫切除率、早产率、新生儿窒息率之间的差异;采用单因素与二项分类Logistic回归分析PPP组发生产后出血的高危因素。结果:PPP妊娠总占比0.44%;PPP组孕妇年龄、孕次、产次、前壁胎盘率、中央型前置胎盘率、胎盘粘连率、胎盘植入率、产后出血量、产后出血发生率、子宫切除率、输血率、早产率均明显高于非PPP组(P<0.05),PPP组分娩孕周与新生儿体质量明显低于非PPP组(P<0.05)。单因素分析显示:PPP患者产后出血组胎盘粘连率、胎盘植入率、中央型前置胎盘率、二级及以下医院剖宫产史占比、非产程中剖宫产史占比、前置胎盘史占比明显高于无产后出血组(P<0.05);Logistic回归分析显示:胎盘粘连与中央型前置胎盘是PPP患者产后出血的独立危险因素(P<0.05)。结论:产后出血与早产是PPP主要的不良妊娠结局;对于前次剖宫产史此次妊娠合并中央型前置胎盘或胎盘粘连患者,应警惕产后出血发生;降低剖宫产率是防止PPP发生与减少产后出血的关键因素。
关键词:  凶险性前置胎盘  妊娠结局  高危因素
DOI:
基金项目:国家科技部“十二五”支撑计划项目(编号:2014BAI05B05)
The Pregnancy Outcome and the High Risk Factor of Postpartum Hemorrhage in PPP Patients
LI Ming;DU Fei;TENG Yincheng
(Obstetric Intensive Care Center,The Institute of Obstetrics and Gynecology,Affiliated Sixth People’s Hospital,Shanghai Jiaotong University)
Abstract:
Objective: To explore the pregnancy outcome and the high risk factor of postpartum hemorrhage in pernicious placenta previa( PPP) patients.Methods: The clinical data of 181 cases of placenta previa in Shanghai Jiaotong University Affiliated Sixth People’s Hospital from Jan.2011 to Dec.2015 were retrospectively analyzed.Among which,72 placenta previa patients were with PCS( PPP group: including with postpartum hemorrhage 34 cases and without postpartum hemorrhage 38 cases) and 109 placenta previa patients were without PCS( nonPPP) Age,delivery gestational weeks,gravidity,placenta previa centralis rate,rate of placenta previa implanted mainly in the anterior wall,placenta conglutination rate,placenta implantation rate,postpartum hemorrhage rate,transfusion rate,hysterectomy rate,preterm birth rate and neonatal asphyxia rate were compared between PPP group and non-PPP group.The high risk factors of postpartum hemorrhage in PPP group were analyzed with Logistic regression analysis.Results: The rate of PPP in all pregnancy was 0. 44%. The age,times of gestation and delivery,placenta previa centralis rate,rate of placenta previa implanted mainly in the anterior wall,placenta conglutination rate,placenta implantation rate,amount and rate of postpartum hemorrhage,transfusion rate,hysterectomy and preterm birth rate of PPP patients in PPP group were higher than those of non-PPP group( P<0. 05).Gestational weeks and neonatal weight in PPP group were lower than those of non-PPP group( P<0. 05). For the patients of PPP with the postpartum hemorrhage,the rate of placenta previa centralis,placenta conglutination rate,placenta implantation rate,the rate of patient with PCS in second-level hospitals,the rate of patient with PCS before labor stage were obviously higher than those of the patients of PPP without postpartum hemorrhage( P <0. 05). Placenta previa centralis and placenta conglutination were independent high risk factor of postpartum hemorrhage in PPP group( P <0. 05). Conclusions: The rate of adverse pregnancy outcomes of PPP patients are postpartum hemorrhage,and preterm birth.We should alert the postpartum hemorrhage in patient who had precious caesarean section accompany with placenta previa centralis or placenta conglutination.Reducing the rate of caesarean section could be the key factor of decreasing the occur of PPP and postpartum hemorrhage.
Key words:  Perniciousplacentaprevia  Pregnancyoutcome  Highriskfactors

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