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目的探讨55例植入性胎盘患者的产前诊断及与其预后的关系。方法选择2005年1月～2010年1月在山东省聊城市第二人民医院分娩,经过术后病理证实的植入性胎盘患者55例,采用回顾性病例统计分析方法进行研究。结果患者的产后出血量,是否行围产期全宫切除术以及是否合并不同类型的前置胎盘均与患者既往流产次数无关(P>0.05)。产前超声明确诊断的植入性胎盘患者为14.55%,产前超声能否明确植入性胎盘的诊断与患者是否合并前置胎盘、植入性胎盘为前壁附着有关(P<0.05),相关分析表明产前超声诊断与产后出血量及胎盘植入面积明显相关(P=0.000)。患者是否行围产期全宫切除术与患者的产前出血量明显相关(P=0.000),与是否合并中央性前置胎盘有关(P<0.01)。结论植入性胎盘仅55.38%能够通过超声获得明确的产前诊断,但当植入性胎盘合并产前出血的前置胎盘时超声诊断则相对容易,而且这部分患者尤其是合并产前出血的中央性前置胎盘患者的预后较差,应做围产期全子宫切除术的准备。如产前应用核磁共振检测胎盘植入面积大小对产后出血的预测有重要的指导意义。
Objective To investigate the relationship between prenatal diagnosis and prognosis in 55 cases of implanted placenta. Methods From January 2005 to January 2010, 55 patients with implanted placenta confirmed by postoperative pathology in the Second People’s Hospital of Liaocheng City, Shandong Province were selected and retrospectively analyzed. Results The amount of postpartum hemorrhage, whether or not the perineal hysterectomy was combined with different types of placenta previa had no correlation with the number of previous abortion (P> 0.05). The diagnosis of placenta accreta was 14.55%. The diagnosis of placenta accreta was related to the presence of placenta previa and placenta accreta (P <0.05) Correlation analysis showed that prenatal ultrasound diagnosis was significantly associated with postpartum hemorrhage and placenta accreta (P = 0.000). Whether patients underwent perineal hysterectomy and the patient’s prenatal bleeding was significantly correlated (P = 0.000), and whether the merger of the central placenta previa (P <0.01). Conclusions Only 55.38% of placenta accreta placenta can get definite prenatal diagnosis by ultrasound, but it is relatively easy to diagnose when the placenta accreta placenta previa combined with placenta previa, and this part of patients especially with prenatal hemorrhage Central placenta previa patients with poor prognosis, should be done during perinatal hysterectomy. Such as prenatal application of MRI to detect the size of placenta accreta after the prediction of postpartum hemorrhage has important guiding significance.