目的探讨凶险性前置胎盘的诊断、治疗及孕妇年龄、距前次剖宫产时间、产前出血次数与术中出血的关系。方法 2013年12月-2014年12月深圳市妇幼保健院凶险性前置胎盘患者51例,按术中出血情况分为A组(11例,出血量≤1000m L)和B组(40例,出血量>1000 m L),回顾性分析51例凶险性前置胎盘的影像学特点及治疗情况,分析两组之间孕妇年龄、距前次剖宫产时间、产前出血次数的差异。结果 1超声检查对前置胎盘诊断的准确率为100%,此次统计中超声检查对胎盘植入诊断率为38.1%,MRI诊断率80.9%。251例凶险性前置胎盘均采用手术治疗,其中2例因不可控制的术中出血行子宫切除,其余49例术中采取有效止血方式预后良好。3孕妇年龄>35岁的比率B组高于A组,差异有统计学意义(P<0.05),而距前次剖宫产时间、产前出血次数两组比较,差异无统计学意义(P>0.05)。结论凶险性前置胎盘术前应通过超声及MRI充分评估其风险性,制定手术方案;高龄孕妇在凶险性前置胎盘手术中出血的风险性增加。

Objective To explore the relationship between hemorrhage during cesarean section and diagnosis of pernicious placenta previa,treatment of pernicious placenta previa,maternal age,the distance to previous cesarean section and the antepartum hemorrhage times. Methods Retrospectively analyzed was used in this study,51 cases of pernicious placenta previa who hospitalized in materal and child care hospital of Shenzhen were selected,and they were divided into A group( 11 cases,blood lossing≤1000 m L)and B group( 40 cases,blood lossing > 1000 m L) according to blood lossing during cesarean section. The different of maternal age,the distance to previous cesarean section and the antepartum hemorrhage times of the two groups was analyzed respectively. Results 1The accuracy of diagnosis to pernicious placenta previa by ultrasonic testing was 100%,the diagnosis rate of placenta implantation by ultrasound and MRI were 38. 1% and 80. 9% respectively. 2 Surgical treatments were carried out in all pemicious placenta previa patients,2 cases received cesarean hysterectomy because of uncontrollable hemorrhage,another 49 cases were used conservative operation and the outcomes were well. 3The incidence of more than 35 years old of group B was higher than that of group A( P <0. 05),there was no statistics significance in the distance to previous cesarean section and the antepartum hemorrhage times between the two groups. Conclusions Pernicious placenta previa patients should be fully accessed by ultrasound and MRI,so as to formulate corresponding operation plan; High age pregnant women had higher risk in hemorrhage of cesarean section with pernicious placenta previa.