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产前或产时合并冠状病毒感染的前置胎盘患者发生产科出血的风险。

The Risk of Obstetrical Hemorrhage in Placenta Praevia Associated with Coronavirus Infection Antepartum or Intrapartum.

机构信息

Department of Obstetrics and Gynecology-"Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania.

"St. Pantelimon" Emergency Clinical Hospital, 021623 Bucharest, Romania.

出版信息

Medicina (Kaunas). 2022 Jul 27;58(8):1004. doi: 10.3390/medicina58081004.

Abstract

: The aim was to evaluate the severity of obstetrical bleeding in the third trimester associated with COVID infection in placenta previa and accreta. : A retrospective study was conducted to compare the risk of obstetrical bleeding in the case of placenta previa with or without associated SARS-CoV-2 infection. Patients presenting with placenta previa before labor were classified into three groups: group A (control) as no infection throughout their pregnancy, group B as confirmed infection during the 1st trimester, and group C as confirmed infection at the time of delivery. Infected patients were stratified according to the severity of signs and symptoms. The severity of obstetrical hemorrhage at birth was assessed quantitatively and qualitatively. All placentas were analyzed histologically to identify similarities. : Prematurity and pregnancy-induced hypertension appear significantly related to SARS-CoV-2 infection during the 3rd trimester. Placenta accreta risk increases significantly with infection during the 1st trimester. No statistically significant differences in the severity of hemorrhage associated with childbirth in cases with placenta previa between groups A and C but increased obstetrical bleeding mainly due to emergency hemostatic hysterectomy in group B driven by placenta accrete were detected. Obstetrical hemorrhage at birth in the case of coexistence of the infection was found not to correlate with the severity of the viral disease. Meanwhile, the number of days of hospitalization after birth is related to the specific treatment of COVID infection and not related to complications related to birth. : The study finds an increased incidence of placenta accreta associated with placenta previa in cases where the viral infection occurred in the first trimester of pregnancy, associated with an increased incidence of hemostasis hysterectomies in these patients. Placental histological changes related to viral infection are multiple and more important in patients who had COVID infection in the first trimester.

摘要

目的是评估与 COVID 感染相关的前置胎盘和胎盘植入症的第三孕期产科出血的严重程度。

进行了一项回顾性研究,以比较有无 SARS-CoV-2 感染的前置胎盘患者的产科出血风险。在分娩前出现前置胎盘的患者被分为三组:A 组(对照组)为整个孕期无感染,B 组为孕早期确诊感染,C 组为分娩时确诊感染。根据症状和体征的严重程度对感染患者进行分层。评估出生时产科出血的严重程度进行定量和定性分析。所有胎盘均进行组织学分析以确定相似之处。

早产和妊娠高血压似乎与第三孕期的 SARS-CoV-2 感染显著相关。胎盘植入的风险随着孕早期的感染显著增加。A 组和 C 组之间,在胎盘前置的情况下,与分娩相关的出血严重程度没有统计学差异,但在 B 组中,由于胎盘植入症导致的紧急止血性子宫切除术导致产科出血增加。在感染并存的情况下,发现出生时的产科出血与病毒疾病的严重程度无关。同时,产后住院天数与 COVID 感染的具体治疗有关,与分娩相关的并发症无关。

研究发现,与病毒感染发生在妊娠早期的前置胎盘相关的胎盘植入症发病率增加,与这些患者中止血性子宫切除术的发病率增加相关。与病毒感染相关的胎盘组织学变化是多方面的,在孕早期有 COVID 感染的患者中更为重要。

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本文引用的文献

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COVID-19, thrombosis and pregnancy.新型冠状病毒肺炎、血栓形成与妊娠
Thromb Update. 2021 Dec;5:100077. doi: 10.1016/j.tru.2021.100077. Epub 2021 Oct 5.
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The Effects of COVID-19 on the Placenta During Pregnancy.COVID-19 对妊娠期胎盘的影响。
Front Immunol. 2021 Sep 15;12:743022. doi: 10.3389/fimmu.2021.743022. eCollection 2021.
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Management of massive hemorrhage in pregnant women with placenta previa.前置胎盘孕妇大出血的管理
Anesth Pain Med (Seoul). 2020 Oct 30;15(4):409-416. doi: 10.17085/apm.20076.

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