Matsubara Shigeki, Ohkuchi Akihide, Kikkawa Masashi, Izumi Akio, Kuwata Tomoyuki, Usui Rie, Watanabe Takashi, Suzuki Mitsuaki
Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan.
J Perinat Med. 2008;36(6):507-12. doi: 10.1515/JPM.2008.089.
To reconfirm that a low-lying placenta, with placental edge-internal os distance of 0-4 cm, is a risk factor for blood loss during delivery, and to determine whether blood loss differs between edge-os distance of < or =2 cm vs. >2 cm.
We compared total blood loss between 73 singleton pregnant women with edge-os distance of 0-4.0 cm vs. controls. We also compared total blood loss between pregnant women with distance of 0-2.0 cm (lower) vs. 2.1-4.0 cm (higher).
Total blood loss was significantly greater in women with placental edge-os distance of < or =4 cm than controls in both delivery modes. The lower group showed a significantly higher incidence of excessive hemorrhage during vaginal delivery (60 vs. 19%, P=0.046) and bled more (median 1240 vs. 860 mL, P=0.059) than the higher group. Although this did not reach statistical significance, the lower group more frequently bled antepartum, required emergent cesarean section, and delivered abdominally. Regression analysis showed no association between the amount of blood loss and the edge-os distance in both delivery modes.
Pregnant women with edge-os distance of 2.1-4.0 cm are of highest level of concern as are women with 0-2.0 cm distance.
再次确认胎盘下缘距宫颈内口距离为0 - 4 cm的低置胎盘是分娩时失血的一个危险因素，并确定胎盘下缘距宫颈内口距离≤2 cm与＞2 cm的产妇之间失血量是否存在差异。
我们比较了73名单胎妊娠且胎盘下缘距宫颈内口距离为0 - 4.0 cm的孕妇与对照组之间的总失血量。我们还比较了胎盘下缘距宫颈内口距离为0 - 2.0 cm（较低）与2.1 - 4.0 cm（较高）的孕妇之间的总失血量。
在两种分娩方式中，胎盘下缘距宫颈内口距离≤4 cm的产妇总失血量均显著高于对照组。较低组阴道分娩时大出血的发生率显著更高（60%对19%，P = 0.046），且失血量更多（中位数1240对860 mL，P = 0.059）。尽管这未达到统计学显著性，但较低组产前出血更频繁，需要紧急剖宫产，且更多经腹分娩。回归分析显示，在两种分娩方式中，失血量与胎盘下缘距宫颈内口距离之间均无关联。
胎盘下缘距宫颈内口距离为2.1 - 4.0 cm的孕妇与距离为0 - 2.0 cm的孕妇一样，都是最值得关注的。
