目的 探讨影响胎盘早剥妊娠结局的相关因素,提高早期识别和及时处理胎盘早剥的能力。方法 回顾性分析2010-01至2016-01陆军总医院产科收治的72例胎盘早剥临床资料,探讨其诱因及临床诊断,同时分析妊娠期高血压疾病及是否规范产检等因素对妊娠结局的影响。结果 妊娠期高血压疾病、有无规范产检及首发征象至临床处理时间是决定胎盘早剥程度的3个重要影响因素,重型胎盘早剥的临床处理时间(1~120 h)明显大于轻型胎盘早剥(1~51.5h),差异有统计学意义(P<0.05);妊娠期高血压疾病组和不规范产检组产后出血(38.5%,40.7%)、急性肾损伤(11.5%,11.1%)、低体重胎儿(59.3%,68.9%)及早产率(70.4%,72.4%)均高于对照组,差异有统计学意义(P<0.05)。有4例严重胎盘早剥患者,围产儿均死亡。结论 重视胎盘早剥的诱因、规范产检、早期识别、缩短首发征象至临床处理的时间是改善妊娠结局的重要因素。

Objective To explore the factors that influence the outcomes of pregnancy in placental abruption so as to improve the ability of early diagnosis and treatment of placental abruption.Methods The clinical data on seventy-two cases of placental abruption treated at Army General Hospital between January 2010 and January 2016 were retrospectively reviewed. The causes of placental abruption and the influence of hypertensive disorders and standard checkups on pregnancy outcomes were analyzed.Results The severity of placental abruption depended on three important factors: hypertensive disorders in pregnancy, standard checkups and the interval between the onset of the first initial clinical sign and delivery. Severe cases of placental abruption(1-120 h) took a longer time to treat than minor ones(1-51.5 h),and the difference was statistically significant(P<0.05).The incidence of postpartum hemorrhage(38.5%,40.7%), acute kidney injury(11.5%,11.1%), premature birth (70.4%,72.4%)and low birth weight baby (59.3%,68.9%)in cases with gestational hypertension group and non-standard checkup group was significantly higher than in control group (P<0.05).There were four cases of severe placental abruption and all the perinatal infants died.Conclusions We can improve the pregnancy outcome of placental abruption by identifying the causes, standardizing checkups during pregnancy and ensuring early diagnosis and treatment.