Cheng Wei-Wei, Lin Sui-Qing
Department of Obstetrics, Affiliated International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University Medical College, Shanghai 200030, China.
Zhonghua Fu Chan Ke Za Zhi. 2008 Aug;43(8):593-6.
To study the clinical characteristics, the outcome of pregnancy and the risk factors of uteroplacental apoplexy complicating severe placental abruption.
A retrospectively study of the 52 cases of placental abruption who had delivered in our hospital from Jan. 2002 to Dec. 2006 was conducted. These cases were divided into 2 groups: 17 cases of uteroplacental apoplexy complicating placental abruption as observation group, the others with no uteroplacental apoplexy as control group. The risk factors of disease, clinical characteristics and the outcome of pregnancy between the two groups were compared.
(1) The incidence of placental abruption was 0.15% (52/35 049) among the total deliveries patients with uteroplacental apoplexy complicating placental abruption took up 0.05% (17/35 049) of all deliveries and 33% (17/52) of all abruption cases. (2) General information and delivery: There were no significant differences (P > 0.05) regarding their mean age and BMI in two groups. All women in observation group had C-section delivery, which were 21 in control group. 14 women had vaginal delivery. The incidence of premature labour was 88% (15/17) in observation group, and 49% (17/35) women in control group delivered after 37 weeks. Significant differences were observed regarding delivery methods and gestational weeks (P < 0.01). (3) RISK FACTORS: the incidence of preeclampsia, 71% (12/17), and the duration of disease, 6.4 hours, in observation group were more than those in control group, 20% (7/35) and 4.2 hours (P < 0.01). There were no significant differences between two groups in premature rupture, polyhydroamnions (P > 0.05). (4) Clinical characteristics in two groups: bloody amniotic fluid, fetal distress, hematometra and postpartum hemorrhage occurred in 82% (14/17) vs 26% (9/35), 65% (11/17) vs 29% (10/35), 35% (6/17) vs 6% (2/35), and 59% (10/17) vs 11% (4/35), with a significant difference (P < 0.01), but no statistical difference existed between indices such as abdominal pain, vaginal bleeding and abdominal tension (P > 0.05). (5) Placenta sites and abruption areas: placenta sites were distributed from anterior or posterior of uterine body 5/17 vs 24/35, the fundus or cornu of uterus 12/17 vs 11/35 (P < 0.01). All cases in observation group presented abruption areas > 1/3, and 9 cases >or= 2/3, 27 cases abruption areas < 1/3 and 8 cases abruption areas 1/3 - 2/3 in control group (P < 0.01). (6) Other complications and outcome: Hemorrhagic shock 3 vs 0, DIC 3 vs 0, hysterectomy 1 vs 0, intrauterine fetal death 3 vs 2, neonatal asphyxia 8 vs 5 and neonatal death 1 vs 0. There were significant differences (P < 0.01) between the two groups.
Preeclampsia, long duration of disease and fundal or cornual placenta a risk factors for uteroplacental apoplexy complicating placental abruption, which may lead to a poor maternal-fetal prognosis.
探讨胎盘早剥并发子宫胎盘卒中的临床特点、妊娠结局及危险因素。
回顾性分析2002年1月至2006年12月在我院分娩的52例胎盘早剥患者。将这些病例分为2组：17例胎盘早剥并发子宫胎盘卒中者为观察组，其余无子宫胎盘卒中者为对照组。比较两组疾病的危险因素、临床特点及妊娠结局。
（1）胎盘早剥在全部分娩患者中的发生率为0.15%（52/35049），胎盘早剥并发子宫胎盘卒中占全部分娩的0.05%（17/35049），占全部胎盘早剥病例的33%（17/52）。（2）一般资料及分娩情况：两组平均年龄及BMI比较差异无统计学意义（P>0.05）。观察组均行剖宫产，对照组21例行剖宫产，14例行阴道分娩。观察组早产发生率为88%（15/17），对照组49%（17/35）的患者在37周后分娩。两组分娩方式及孕周比较差异有统计学意义（P<0.01）。（3）危险因素：观察组子痫前期发生率71%（12/17）、病程6.4小时，高于对照组的20%（7/35）及4.2小时（P<0.01）。两组胎膜早破、羊水过多发生率比较差异无统计学意义（P>0.05）。（4）两组临床特点：血性羊水、胎儿窘迫、宫腔积血及产后出血发生率观察组为82%（14/17）、65%（11/17）、35%（6/17）、59%（10/17），对照组为26%（9/35）、29%（10/35）、6%（2/35）、11%（4/35），差异有统计学意义（P<0.01），但腹痛、阴道流血及腹部压痛等指标比较差异无统计学意义（P>0.05）。（5）胎盘位置及早剥面积：胎盘位于子宫体前壁或后壁观察组5/17、对照组24/35，位于子宫底部或宫角处观察组12/17、对照组11/35（P<0.01）。观察组所有病例早剥面积>1/3，其中9例≥2/3，对照组27例早剥面积<1/3，8例早剥面积1/3~2/3（P<0.01）。（6）其他并发症及结局：失血性休克观察组3例、对照组0例，弥散性血管内凝血观察组3例、对照组0例，子宫切除观察组1例、对照组0例，胎儿宫内死亡观察组3例、对照组2例，新生儿窒息观察组8例、对照组5例，新生儿死亡观察组1例、对照组0例。两组比较差异有统计学意义（P<0.01）。
子痫前期、病程长及胎盘位于子宫底部或宫角处是胎盘早剥并发子宫胎盘卒中的危险因素，可导致母婴预后不良。
