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[目的]结合临床实践经验,开展胎盘早剥患者妊娠结局的临床分析。[方法]选取2008年5月～2010年5月期间,某院胎盘早剥46例为研究对象,采取回顾性研究,将胎盘剥患者的临床治疗资料进行搜集整理,并与责任护士、经治医师共同探讨病例,总结胎盘早剥患者的妊娠结局,探讨相应的处理及预防措施,采用Microsoft Excel建立数据库,运用SPSS13.0统计软件进行统计分析。[结果]①妊娠结局:46例患者中,27例行剖宫产终止妊娠(孕28周前行小剖宫取胎术1例),阴道分娩9例,胎吸助产6例。4例发生子宫胎盘卒中、死胎及DIC行子宫次全切除术成功挽救生命。新生儿中6例轻度窒息,4例重度窒息,1例围生儿死亡。②阴道出血13例(28.26%);血性羊水5例(10.87%);腹痛或腰痛12例(26.09%),其中持续性剧烈腹痛6例(13.04%);板状腹8例(17.39%);宫底上升6例(13.04%);休克3例(6.52%);胎儿宫内窘迫6例(13.04%);胎动消失4例(8.70%);无症状者12例(26.09%),均为Ⅰ度胎盘早剥。③胎盘早剥原因主要有妊娠期高血压疾病40.43%(19/46),外力作用(创伤、过劳、性生活)占19.15%(9/46),引产(使用催产素、前列腺素)占15.22%(7/46),早破水占13.04%(6/46),原发性高血压、羊水过多、贫血等占10.87%(5/46)。[结论]为减少胎盘早剥、改善母婴妊娠结局,必须应加强产前宣教与检查,重视高危妊娠的监测,做好危险人群的预防工作。一旦出现胎盘早剥,在综合分析病情的基础上,及时正确诊断处理,缓解产妇病情,降低母婴死亡率。
[Objective] To analyze the clinical outcome of pregnancy with placental abruption in combination with clinical practice. [Methods] Forty-six cases of placental abruption in a hospital from May 2008 to May 2010 were studied retrospectively. The clinical treatment data of placental abruption patients were collected and sorted out, and were compared with the responsible nurses, The doctors discussed the cases together and summarized the pregnancy outcomes of patients with placental abruption. The corresponding treatment and preventive measures were discussed. The database was set up by using Microsoft Excel and the statistical analysis was carried out by SPSS13.0 statistical software. [Results] (1) Outcome of pregnancy: Of the 46 patients, 27 were terminated by cesarean section (one fetus was taken by cesarean section 28 weeks before pregnancy), 9 were vaginal delivery and 6 were fetus assisted by birth. 4 cases of uterine placental stroke, stillbirth and DIC subtotal hysterectomy successfully save lives. 6 cases of mild asphyxia in neonates, 4 cases of severe asphyxia and 1 case of perinatal death. ② vaginal bleeding in 13 cases (28.26%); bloody amniotic fluid in 5 cases (10.87%); abdominal or lumbago in 12 cases (26.09%), including persistent severe abdominal pain in 6 cases (13.04% 6 cases (13.04%) in end of fundus, 3 cases (6.52%) in shock, 6 cases (13.04%) in fetal distress, 4 cases (8.7%) disappeared in fetal movement, 12 cases I degree placental abruption. The main causes of placental abruption were 40.43% (19/46) of hypertensive disorder complicating pregnancy and 19.15% (9/46) of external force (trauma, overworked, sex life), and the proportion of induced labor (oxytocin and prostaglandin) 15.22% (7/46), premature rupture of water accounted for 13.04% (6/46), essential hypertension, polyhydramnios and anemia accounted for 10.87% (5/46). [Conclusion] In order to reduce the placental abruption and improve the maternal and fetal pregnancy outcome, we must strengthen prenatal mission and inspection, pay attention to the monitoring of high risk pregnancy, and do the prevention of dangerous population. In the event of placental abruption, based on a comprehensive analysis of the disease, timely and correct diagnosis and treatment to ease the maternal condition and reduce maternal and infant mortality.