摘要
目的:探讨妊娠中晚期完全性前置胎盘或胎盘前置状态患者的引产结局及其影响因素。方法:回顾分析2010年1月至2018年6月于南京鼓楼医院因死胎、胎儿严重发育异常等要求阴道分娩终止妊娠的44例完全性前置胎盘患者的临床资料,分析其阴道试产的可能性及其影响因素。结果:44例阴道试产的完全性前置胎盘状态孕妇中,36例成功获得阴道分娩,引产成功率81.8%。8例在引产过程中发生大出血行紧急剖宫取胎术。阴道试产成功组中产后24h失血量、异体输血率、严重近期并发症发生率及住院费用等均显著低于失败组。孕期有反复阴道出血患者的引产成功率为100%,死(减)胎患者的引产成功率为88.2%,胎盘边缘越过宫颈内口的距离≥40mm者减胎后引产成功率100%;3例伴有胎盘粘连/植入的患者仅1例经减胎后引产成功,余2例均引产失败,该组患者的严重近期并发症发生率高达100%。结论:孕中晚期要求引产的完全性前置胎盘或胎盘前置状态患者,在尽量排除胎盘植入的情况下,尤其患者孕期有反复阴道出血或胎儿死亡状态时,可在不增加临床不良结局的前提下,获得较高的阴道试产成功率。
Objective:To investigate the outcomes and influential factors of induced labor for women with complete placenta previa(CPP) during the second and third trimester.Methods:From Jan.2010 to Jun.2018,the clinical data of 44 patients with CPP who requested termination due to stillbirth,fetal malformation,and other reasons in Drum Tower hospital,were retrospectively analyzed.The feasibility and influences of vaginal trial production of CPP were researched.Results:In 44 pregnant women with CPP,36 women were successful in vaginal delivery,and the success rate of labor induction was 81.8%.An emergency operation was performed for 8 women who underwent massive vaginal bleeding during the induction of labor.The incidence of severe recent complications,total blood loss,allogeneic blood transfusion rate and the hospitalization expenses in the successful group of vaginal trial production were significantly lower than those in the failure group(P<0.05).In patients with recurrent vaginal bleeding during pregnancy,prenatal stillbirth or with a placental extension of ≥40 mm after feticide,the success rate of labor induction was 100%,88.2% and 100% respectively.In 3 patients with placental accreta,only 1 case was successfully induced by performing a feticide,and the incidence of severe recent complications was up to 100%.Conclusion:In the absence of placental accreta,the successful rate of labor induction of the pregnant women with CPP in the second and third trimester,may be improved without increasing the clinical adverse outcome,especially when the patients have recurrent vaginal bleeding or fetal death during pregnancy.
作者
苏宇
戴毅敏
郑明明
顾宁
王志群
Su Yu;Dai Yimin;Zheng Mingming(Department of Obstetrics and Gynecology,Drum Tower Hospital,Medical School of Nanjing University,Nanjing 210008)
出处
《现代妇产科进展》
CSCD
北大核心
2019年第6期420-423,共4页
Progress in Obstetrics and Gynecology
关键词
完全性前置胎盘状态
终止妊娠
引产
胎盘植入
剖宫取胎术
Complete placenta previa(CPP)
Termination of pregnancy
Induced labor
Placenta accreta
Hysterotomy
