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  • 陈铮,陈澜,何晓英.胎盘附着部位对前置胎盘状态妊娠中期引产结局的影响[J].同济大学学报(医学版),2020,41(5):625-629.    [点击复制]
  • CHEN Zheng,CHEN Lan,HE Xiao-ying.Impact of placenta attachment position on maternal outcomes in patients with placenta praevia undergoing pregnancy termination in the second trimester[J].同济大学学报(医学版),2020,41(5):625-629.   [点击复制]
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胎盘附着部位对前置胎盘状态妊娠中期引产结局的影响
陈铮,陈澜,何晓英
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(上海交通大学医学院附属国际和平妇幼保健院妇产科,上海市胚胎源性疾病重点实验室,上海市临床重点专科(建设项目)—“强主体”妇产科,上海200030)
摘要:
目的探讨不同胎盘附着部位对前置胎盘状态妊娠中期引产结局的影响。方法回顾性分析2003年12月—2019年12月上海交通大学医学院附属国际和平妇幼保健院收治的103例胎盘前置状态中期妊娠引产孕妇的临床资料,孕周为16~26周。根据胎盘不同附着部位分为A组(前壁胎盘组,47例)和B组(后壁胎盘组,56例),比较两组患者的一般情况和引产结果。根据有无剖宫产史,进一步将A组分为A1组(无剖宫产史,30例)和A2组(有剖宫产史,17例),比较两组患者的一般情况和引产结果。所有患者均采用利凡诺尔羊膜腔注射联合米非司酮引产。计量资料采用t检验,计数资料采用χ2检验。结果A组和B组、A1组和A2组之间患者年龄、孕周、孕次、产次、流产次数、有无剖宫产史、胎盘类型比较,差异均无统计学意义(P>0.05)。A组患者引产出血量、输血率显著高于B组,A组患者住院时间显著延长,差异均有统计学意义(P<0.05)。与A2组相比,A1组患者引产成功率显著下降,引产出血量、输血率、PAS发生率显著增加,住院时间显著延长,差异均有统计学意义(P<0.05)。结论前置胎盘状态妊娠中期引产孕妇中,胎盘附着部位与引产不良结局存在相关性,尤其是凶险性前置胎盘状态患者并发症显著增高,因此引产前需确定胎盘附着部位,根据危险因素制订有效的干预措施,尽可能减少并发症。
关键词:  胎盘附着部位  胎盘前置状态  前壁胎盘  后壁胎盘  妊娠中期
DOI:10.16118/j.1008-0392.2020.05.014
投稿时间:2020-02-10
基金项目:国家自然科学基金青年项目(81702546);上海交通大学中国医学科学院创新单元(2019RU056);中国医学科学院医学与健康科技创新工程项目(2019-I2M-5-064)
Impact of placenta attachment position on maternal outcomes in patients with placenta praevia undergoing pregnancy termination in the second trimester
CHEN Zheng,CHEN Lan,HE Xiao-ying
(Dept. of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital,Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Embryo Original Diseases,Shanghai Municipal Key Clinical Specialty, Shanghai 200030, China)
Abstract:
ObjectiveTo explore the effect of placenta attachment position on maternal outcomes in patients with placenta praevia undergoing pregnancy termination in the second trimester. MethodsThe labor induction by intraamniotic injection of ethacridine lactate was performed in 103 patients with placenta praevia at 16 to 26 weeks of gestation in the International Peace Maternity and Child Health Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from December 2003 to December 2019. There were 47 patients whose placenta attached to the anterior wall of the uterus(group A) and 56 patients whose placenta attached to the posterior wall of the uterus(group B). Group A was further divided into group A1(n=30 without cesarean section history) and group A2(n=17 had cesarean section history). The general characteristics and maternal outcomes of these two groups were analyzed using t test or Chi-square test. ResultsThere were no significant differences in the age, gestational weeks, gravidity and parity, times of abortion, cesarean section history, the type of placenta previa between group A and group B(P>0.05), and between group A1 and group A2(P<0.05). Group A had higher incidence of hemorrhage, blood transfusion rate and longer length of hospital stay than group B(P>0.05). For patients who had the history of cesarean section, pernicious placenta previa is very important to predict adverse maternal outcomes, such as placenta adherence, hemorrhage and so on. ConclusionFor the pregnant women with placenta praevia who underwent pregnancy termination in the second trimester, the placenta attachment position has a correlation with adverse outcome. Therefore, effective intervention measures should be made according to risk factors to reduce complications.
Key words:  placenta attachment position  placenta previa  anterior placenta  posterior placenta  the second trimester

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