本文關鍵詞：胎盤前置狀態(tài)和低置狀態(tài)對于妊娠結局的影響　出處：《大連醫(yī)科大學》2017年碩士論文　論文類型：學位論文

  更多相關文章： 胎盤前置狀態(tài) 危險因素 轉(zhuǎn)歸 分娩方式 母兒妊娠結局

【摘要】：目的:分析胎盤前置狀態(tài)和低置狀態(tài)的轉(zhuǎn)歸及妊娠結局,探討妊娠中期胎盤前置狀態(tài)和低置狀態(tài)的臨床意義。方法:采用回顧性研究方法,選取自2014~2016年于大連婦產(chǎn)醫(yī)院分娩住院的28周前胎盤前置狀態(tài)和低置狀態(tài)孕婦50例作為觀察組,選取同期于我院住院分娩的28周前胎盤位置正常的孕婦40例作為對照組。將觀察組的50例患者分為中央性胎盤前置狀態(tài)、部分性胎盤前置狀態(tài)、邊緣性胎盤前置狀態(tài)、胎盤低置狀態(tài)4組類型。收集90例孕婦的年齡、孕產(chǎn)次、宮腔操作史(刮宮、流產(chǎn)、子宮內(nèi)膜手術)、子宮手術史(剖宮產(chǎn)、子宮肌瘤核除術)、體外受精-胚胎移植史(IVF-ET)、妊娠期糖尿病(GDM)、胎兒性別、妊娠早期體重指數(shù)(BMI)、產(chǎn)前貧血、妊娠晚期胎盤的位置、分娩方式、胎盤粘連/植入、產(chǎn)后出血發(fā)病情況、新生兒窒息的發(fā)生率、新生兒出生體重和新生兒出生后1min、5min Apgar評分。分別進行比較,探討晚期胎盤轉(zhuǎn)歸及妊娠結局。結果:1、兩組患者基本情況的比較:年齡、宮腔操作史、產(chǎn)次、妊娠早期BMI、IVF-ET史及子宮手術史差異有統(tǒng)計學意義(P0.05)。孕次、GDM及胎兒性別無統(tǒng)計學意義(P0.05)。2、兩組孕婦妊娠結局比較:(1)觀察組和對照組陰道分娩率分別為30%和55%,前者陰道分娩率低于后者,差異有統(tǒng)計學意義(P0.05)。(2)觀察組和對照組產(chǎn)前貧血發(fā)生率分別為32%和12.5%(P0.05),差異有統(tǒng)計學意義。(3)兩組患者發(fā)生胎盤粘連/植入的幾率分別為12%和7.5%,其差異無統(tǒng)計學意義(P0.05)。(4)兩組患者發(fā)生產(chǎn)后出血的幾率分別為22%和2.5%(P0.05),其差異有統(tǒng)計學意義。3、兩組新生兒情況比較:觀察組和對照組早產(chǎn)、新生兒出生體重2500g、出生后1分鐘阿氏評分和出生后5分鐘Apgar評分、入新生兒科治療比較,其中早產(chǎn)、入新生兒科治療、新生兒出生體重2500g差異有統(tǒng)計學意義(P0.05)。出生后1分鐘和5分鐘Apgar評分的比較差異無統(tǒng)計學意義(P0.05)。4、中央性胎盤前置狀態(tài)、部分性胎盤前置狀態(tài)、邊緣性胎盤前置狀態(tài)及胎盤低置狀態(tài)4種不同類型母兒不良結局的比較,其中產(chǎn)前貧血和產(chǎn)后出血的差異均有統(tǒng)計學意義(P0.05),4組組間比較,早產(chǎn)率和剖宮產(chǎn)率差異均無統(tǒng)計學意義(P0.05)。5、中央性胎盤前置狀態(tài)、部分性胎盤前置狀態(tài)、邊緣性胎盤前置狀態(tài)及胎盤低置狀態(tài)4組的胎盤轉(zhuǎn)歸情況:轉(zhuǎn)歸率分別為33.33%、70%、72.22%和70%。中央性胎盤前置狀態(tài)組轉(zhuǎn)歸率明顯低于其余三組,差異有統(tǒng)計學意義,其余三組組間比較無統(tǒng)計學意義。6、妊娠中期不同附著部位的胎盤轉(zhuǎn)歸情況的比較:16例前壁胎盤前置狀態(tài)中11例分娩時胎盤位置正常,轉(zhuǎn)歸率69%,34例后壁胎盤前置狀態(tài)中18例分娩時胎盤位置正常,轉(zhuǎn)歸率53%。結論:1、年齡、宮腔操作史、產(chǎn)次、妊娠早期BMI、IVF-ET史、子宮手術史是胎盤前置狀態(tài)和低置狀態(tài)的高危因素;2、觀察組剖宮產(chǎn)率高于對照組;3、觀察組不良母兒妊娠結局發(fā)生率高于對照組;4、四種類型胎盤前置狀態(tài)的產(chǎn)婦產(chǎn)前貧血和產(chǎn)后出血比較,產(chǎn)前貧血發(fā)生率:完全性胎盤前置狀態(tài)部分性邊緣性低置狀態(tài),產(chǎn)后出血發(fā)生率:完全性胎盤前置狀態(tài)部分性低置狀態(tài)邊緣性胎盤前置狀態(tài);5、四種類型胎盤前置狀態(tài)轉(zhuǎn)歸的比較,其中中央性胎盤前置狀態(tài)轉(zhuǎn)歸率最小,預后最差,應該引起重視;6、妊娠中期胎盤不同附著部位轉(zhuǎn)歸的比較,前壁胎盤轉(zhuǎn)歸率高于后壁胎盤。
[Abstract]:Objective: to analyze the prognosis and outcome of pregnancy with placenta previa and lower status, to investigate the clinical significance of placenta previa and mid lower state of pregnancy. Methods: a retrospective study, selected from 2014~2016 years in Dalian maternity hospital inpatient delivery before 28 weeks before the placenta state and 50 cases of pregnant women as a state of low the observation group, pregnant women were selected in our hospital 28 weeks before the placenta in normal position in 40 cases as control group. 50 cases of the observation group were divided into the central placenta previa, partial placenta previa, marginal placenta pre state, placenta lower status of the 4 types of collected 90 cases of pregnant women. Age, pregnancy, intrauterine operation history (curettage, abortion, uterine surgery), uterine surgery (caesarean myomectomy), in vitro fertilization and embryo transfer (IVF-ET), a history of gestational diabetes (GDM), fetal sex, pregnancy Early pregnancy body mass index (BMI), prenatal anemia in late pregnancy, placental location, mode of delivery, placenta accreta / implant, the incidence of postpartum hemorrhage, the incidence of neonatal asphyxia, neonatal birth weight and neonatal Apgar score 1min, 5min respectively. Compared to the human placental outcomes and pregnancy outcome. Results: 1, compare the basic situation of the two groups were: age, history of uterine cavity operation, production time, BMI in early pregnancy, there were statistically significant differences in IVF-ET history and history of uterine surgery (P0.05). GDM times of pregnancy, and fetal sex was statistically significant (P0.05.2), compared two groups of pregnant women and pregnancy outcome: (1) the observation group and the control group vaginal delivery rate were 30% and 55%, the vaginal delivery rate was lower than the latter, the difference was statistically significant (P0.05). (2) the observation group and the control group prenatal anemia incidence rates were 32% and 12.5% (P0.05), the difference was statistically significant. (3) two groups of patients Born in placenta accreta / implantation probability were 12% and 7.5%, the difference was not statistically significant (P0.05). (4) two groups of patients with postpartum hemorrhage rates were 22% and 2.5% (P0.05), the difference was statistically significant.3, compared two groups of neonates: observation group and control group, premature birth, neonatal the birth weight of 2500g, 1 minutes after birth a's birth and score 5 minutes after the Apgar score comparison, in neonatal treatment the preterm birth, neonatal birth weight in the treatment of neonatal 2500g, difference was statistically significant (P0.05). No significant difference was born after 1 minutes and 5 minutes Apgar score (P0.05).4, central placenta previa, partial placenta previa placenta previa, comparison and marginal placenta lower status of 4 different types of maternal and fetal adverse outcomes, including differences in prenatal anemia and postpartum hemorrhage were statistically significant (P0.05, 4) Comparison between group, the preterm birth rate and cesarean section rate showed no significant difference (P0.05).5, central placenta previa, partial placenta previa placenta and placenta previa, marginal low home state 4 group outcomes: placenta outcome rates were 33.33%, 70%, 72.22% and 70%. central placenta previa group turnover rates were lower than the other three groups, the difference was statistically significant, the remaining three groups had no statistically significant.6, different parts of the second trimester placenta attached comparison outcome: 16 cases of anterior wall in 11 cases of placenta previa placenta childbirth normal location, the recovery rate of 69%, 34 cases of posterior wall of placenta previa in 18 cases of placenta childbirth normal location, the recovery rate of 53%. conclusion: 1, age, history of uterine cavity operation, production time, early pregnancy BMI, IVF-ET history, history of uterine surgery is placenta previa and lower state risk factors; 2, the observation group of cesarean section The yield is higher than the control group; 3, the observation group of adverse pregnancy outcomes was higher than control group; 4, four types of placenta previa maternal prenatal anemia and postpartum hemorrhage, the incidence of prenatal anemia: complete placenta previa part of lower marginal status, postpartum hemorrhage rate: complete placenta previa part of the state of the state of low marginal placenta previa; 5, compare the outcome of four types of placenta previa, including central placenta previa. The lowest rate, the worst prognosis, should pay attention to; 6, mid pregnancy outcomes were compared with different placenta attachment site, anterior placenta outcome rate is higher than the posterior wall placenta.

【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R714.2

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