凶险型中央性前置胎盘45例临床分析

摘要

Objective To investigate the high risk factors and treatment outcome of pernicious central placenta previa. Methods A total of 45 cases of pernicious central placenta previa in our hospital from October 2011 to February 2014 were se-lected. Then the retrospective analysis was performed on the age,gestational week,abortion times,cesarean delivery times,com-plicating placenta increta rate,intraoperative and postoperative bleeding volume and treatment outcome. Results The incidence rate of pernicious central placenta previa complicating placenta increta was 26.67%(12/45);the predilection high risk factors of pernicious central placenta previa complicating placenta increta included abortion times greater than or equal to twice ,cesarean section times greater than or equal to twice ,and placenta adhesion and bleeding history found in previous operation;the occur-rence rate of above factors,and intraoperative and postoperative bleeding volume with 1 000-3 000 mL and more than 3 000 mL in pernicious central placenta previa complicating placenta increta were significantly higher than those without complicating pla-centa increta,the difference was statistically significant(P<0.05);45 cases all adopted the operation treatment,in which the uterine resection rate was 26.67%(12/45),but the uterine resection rate in the patients with complicating placenta increta was 66.67%(8/12). Conclusion The scarred uterus is a main high risk factor for placenta increta occurrence,which is easy to form the perni-cious central placenta previa and has great harm to the parturient and neonate. Taking timely and effective prevention measures and timely implementing hysterectomy can effectively reduce the postpartum hemorrhage rate and avoid parturient death.%目的：探讨凶险型中央性前置胎盘的高危因素及治疗结局。方法选取2011年10月至2014年2月徐州市妇幼保健院产科收治的凶险型中央性前置胎盘患者45例，对其年龄、流产次数、剖宫产次数、合并胎盘植入发生率、术中术后出血量及治疗结局进行回顾性分析。结果凶险型中央性前置胎盘合并胎盘植入发生率为26.67%（12/45），其好发高危因素为流产次数大于或等于2次，剖宫产次数大于或等于2次，前次术中发现有胎盘粘连史；凶险型中央性前置胎盘合并胎盘植入患者中具有以上因素者及术中术后出血量为1000～3000、>3000 mL的发生率明显高于未植入者，差异均有统计学意义（P<0.05）；45例患者均采用手术治疗，其中子宫切除率达26.67%（12/45），并发胎盘植入者的子宫切除率为66.67%（8/12）。结论瘢痕子宫是发生胎盘植入的主要高危因素，容易形成凶险型中央性前置胎盘，对母婴危害极大，及时采取有效的预防措施及适时实施子宫切除术能有效减少产后出血率，避免产妇死亡。