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目的探讨胎盘早剥胎死宫内的临床处理方案及分娩方式。方法回顾性分析2005年1月至2011年7月于南阳市第一人民医院妇产科治疗的胎盘早剥胎死宫内患者23例。其中阴道分娩11例(阴道分娩组),剖宫产12例(剖宫产组),比较两组年龄、分娩方式、出血量、产时及产后并发症,评价阴道分娩的安全性。结果 23例患者中,11例(47.8%)行阴道分娩,12例因阴道试产失败或因其他原因直接行剖宫产手术,其中16.7%(2/12)因术中出血多,保守治疗无效而行次全子宫切除术。两组均无孕产妇死亡病例发生;两组患者的年龄、孕周、妊娠次数、产前出血量、产前合并症比较,差异均无统计学意义(P>0.05);剖宫产组产后出血发生率(91.7%)、出血量(1986.4±1653.3)ml均高于阴道分娩组的54.5%和(928.0±737.8)ml,但差异均无统计学意义(P=0.069;P=0.076)。结论胎盘早剥胎死宫内的患者选择恰当的时机和分娩方式可减少对患者的进一步损伤,阴道试产是一个值得肯定的分娩方式,可以尝试在严密监测和纠正凝血功能的情况下经阴道分娩。
Objective To investigate the clinical treatment of placental abortion fetus intrauterine and delivery methods. Methods A retrospective analysis of 23 patients with intrauterine death from placental abruption in obstetrics and gynecology from January 2005 to July 2011 in Nanyang First People’s Hospital was performed. Including vaginal delivery in 11 cases (vaginal delivery group), cesarean section in 12 cases (cesarean section group), comparing two groups of age, mode of delivery, bleeding, birth and postpartum complications, evaluate the safety of vaginal delivery. Results Of the 23 patients, 11 (47.8%) had vaginal delivery, 12 had failed vaginal trial or had cesarean section because of other reasons, of which 16.7% (2/12) had conservative treatment because of intraoperative bleeding Invalid hysterectomy. There were no maternal deaths in both groups. There was no significant difference in age, gestational age, number of pregnancy, prenatal bleeding and prenatal complications between the two groups (P> 0.05) Bleeding rate (91.7%) and bleeding volume (1986.4 ± 1653.3) ml were higher than 54.5% and (928.0 ± 737.8) ml in vaginal delivery group, but the differences were not statistically significant (P = 0.069; P = 0.076). Conclusion placental abortion fetus intrauterine patients choose the right timing and mode of delivery can reduce the further damage to the patient, vaginal trial is a sure way of delivery, you can try to closely monitor and correct coagulation function of the vagina childbirth.