本文選題：胎盤前置狀態(tài)　切入點(diǎn)：孕中期　出處：《河北醫(yī)科大學(xué)》2014年碩士論文

【摘要】：妊娠28周之前，胎盤附著在子宮下部，其下緣達(dá)到或覆蓋子宮內(nèi)口稱為胎盤前置狀態(tài)[1]。子宮峽部從妊娠12周后逐漸拉長而形成子宮體腔的下部，至妊娠晚期，進(jìn)一步拉伸形成子宮下段。胎盤前置狀態(tài)在妊娠期子宮峽部拉伸擴(kuò)張逐步形成子宮下段的過程中可由于胎盤生長與子宮峽部擴(kuò)張不同步，發(fā)生局部剝離引起反復(fù)性無痛性出血，并引起先兆流產(chǎn)、流產(chǎn)等。部分胎盤前置狀態(tài)孕婦，，由于反復(fù)出血、難免流產(chǎn)、胎兒畸形的需要終止妊娠，選擇適當(dāng)?shù)姆绞娇梢杂行p少病人創(chuàng)傷、減輕經(jīng)濟(jì)負(fù)擔(dān)。 目的：探討不同情況下孕中期前置胎盤狀態(tài)終止妊娠的最適宜方式。 方法：采用回顧分析方法，收集2007年4月至2013年3月六年間河北醫(yī)科大學(xué)第二醫(yī)院住院分娩的胎盤前置狀態(tài)孕中期終止妊娠的病例47例，并回顧分析其中3個(gè)特殊病例。 結(jié)果：47名患者中初始決定的分娩方式，24例陰道分娩，23例剖宮取胎。11例自然臨產(chǎn)成功陰道分娩。13例病例行藥物引產(chǎn)，成功12例。一例羊膜腔注藥引產(chǎn)，胎盤娩出后出血洶涌，剖腹探查術(shù)，術(shù)中大量出血，行子宮全切術(shù)。23例行剖宮取胎術(shù)，其中7例因出后出血多改行子宮切除術(shù)，16例剖宮取胎術(shù)并保留子宮�？傮w患者年齡28.19±5.00歲(18～40歲)，結(jié)束妊娠孕周23.29±3.49周(14.43～27.71周)，出血量1021.49±1654.23mL(90～6500mL)，輸入血液成分平均1010.64±1580.31mL(0～5600mL)。陰道分娩成功病例，出血平均值448.26±419.84mL(90～1500mL)。剖宮取胎成功病例，術(shù)中出血平均值218.25±208.87mL(100～1000mL)。子宮切除8例，經(jīng)手術(shù)及病理證實(shí)均為胎盤植入，全部為中央性前置胎盤，均有剖宮產(chǎn)史�；颊吣挲g28.19±1.92歲(27～33歲)，結(jié)束妊娠的孕周22.4464±4.05周(14.43～26.57周)，術(shù)中出血量4150.00±1953.75mL(800～6500mL),輸入血液成分3950.00±1419.00mL(0～5600mL)。 案例1患者為孕24+6周，經(jīng)產(chǎn)婦，無剖宮產(chǎn)史，以陣發(fā)性腹痛為主要原因入院，入院前無陰道出血，5天前產(chǎn)科彩超示：胎盤前置狀態(tài)。宮頸軟，宮口開6cm行人工破膜術(shù)后，陰道出血洶涌1000mL，伴血壓下降，及時(shí)建立雙液路，補(bǔ)充血容量，及靜脈輸入紅細(xì)胞，為縮短產(chǎn)程行碎胎術(shù)，術(shù)后子宮收縮良好，陰道出血不多生命體征平穩(wěn)。 個(gè)案2：患者孕23+2周第一孕，中央性前置胎盤，經(jīng)陰道分娩，胎盤先娩出，其后胎兒娩出，產(chǎn)前及產(chǎn)中出血共約300mL。 個(gè)案3患者孕24+2周第三孕，兇險(xiǎn)性前置胎盤、胎盤粘連，剖宮取胎術(shù)中胎盤取出后子宮下段出血多，依次給予卡前列素氨丁三醇促進(jìn)宮縮、止血帶捆綁子宮峽部、8字縫合宮壁止血、雙側(cè)子宮動(dòng)脈結(jié)扎術(shù)及子宮下段宮腔填塞，縫合子宮，查無出血后關(guān)腹，術(shù)中出血約900Ml,術(shù)中輸入懸浮紅細(xì)胞2單位及血漿300mL，術(shù)后1+小時(shí)，再次陰道出血并逐漸增多、出血性休克、DIC，復(fù)行開腹探查術(shù)，切除子宮。 結(jié)論： 1不同處理方式需參考胎盤位置、剖宮產(chǎn)史、流產(chǎn)史等行綜合評估，并與病人進(jìn)行良好溝通后決定。 2若邊緣性胎盤前置狀態(tài)、部分性胎盤前置狀態(tài)及完全性胎盤前置狀態(tài)中無剖宮產(chǎn)史，孕產(chǎn)婦基礎(chǔ)狀況較好時(shí)，提前建立液路、合血并做好搶救準(zhǔn)備情況下，陰道分娩具備一定安全性，雖有時(shí)出血量較多，但產(chǎn)后恢復(fù)時(shí)間短，對孕婦損傷較小。 3對既往有剖宮產(chǎn)史同時(shí)存在前置胎盤狀態(tài)孕產(chǎn)婦明確診斷、謹(jǐn)慎處理，嚴(yán)格區(qū)分是否存在胎盤植入。如影像學(xué)提示可能存在胎盤植入，應(yīng)放棄陰道試產(chǎn)，行剖宮取胎術(shù)終止妊娠，以方便產(chǎn)后出血的處理。同時(shí)應(yīng)密切觀察產(chǎn)后出血情況，及時(shí)發(fā)現(xiàn)及處理各種分娩并發(fā)癥。
[Abstract]:Before 28 weeks of pregnancy, the placenta attached to the bottom of the lower edge of the uterus or cover is called placenta previa uterine isthmus from [1]. after 12 weeks of pregnancy and uterine cavity formed gradually stretched to the lower part of late trimester of pregnancy, further stretching formation of lower uterine segment. Placenta previa state in the period of uterine isthmus pregnancy stretch expansion gradually formed in the lower uterine segment due to placental growth and expansion of uterine isthmus is not synchronized, the occurrence of local peeling caused by repeated painless bleeding, and caused by threatened abortion, abortion. Partial placenta previa pregnant women, due to repeated bleeding, abortion, fetal malformation need to terminate pregnancy, select the appropriate method can effectively reduce the trauma patients and to reduce the economic burden.
Objective: To explore the best way to terminate pregnancy in different cases of placenta previa under different conditions.
Methods: a retrospective analysis method was used to collect 47 cases of placenta previa in the second hospital of Hebei Medical University from April 2007 to March 2013, and 47 cases were terminated in the second trimester. 3 cases were retrospectively analyzed.
Results: the mode of delivery in 47 patients the initial decision, 24 cases of vaginal delivery, 23 cases of caesarean section in.11 cases of natural labor successful vaginal delivery.13 patients received drug abortion, 12 cases were successful. One case of amniotic cavity injection induced abortion, placenta bleeding after surging, laparotomy, with large amount of bleeding total hysterectomy was performed,.23 underwent caesarean operation, including 7 cases with bleeding after diverted hysterectomy, 16 cases of caesarean operation and preservation of the uterus. The average age of patients with 28.19 + 5 years (18~40 years), the end of the gestational weeks of 23.29 + 3.49 weeks (14.43 ~ 27.71 weeks) the amount of bleeding, 1021.49 + 1654.23mL (90 ~ 6500mL), the input of blood components was 1010.64 + 1580.31mL (0 ~ 5600mL). Successful vaginal delivery cases, bleeding average 448.26 + 419.84mL (90 ~ 1500mL). The success of caesarean bleeding cases, average 218.25 + 208.87mL (100 ~ 1000mL) of uterus. After surgical resection in 8 cases. And the pathological results were placenta implantation, all central placenta previa, had a history of cesarean section patients. Age 28.19 + 1.92 years old (27~33 years old), the end of pregnancy gestational age 22.4464 + 4.05 weeks (14.43 ~ 26.57 weeks), the amount of intraoperative bleeding was 4150 + 1953.75mL (800 ~ 6500mL), the input of blood components 3950 + 1419.00mL (0 ~ 5600mL).
1 cases of patients with gestational age of 24+6 weeks, multipara, no history of cesarean section, with paroxysmal abdominal pain as the main reason for admission, no vaginal bleeding before admission, 5 days before the obstetric ultrasound showed: placenta previa. Cervical soft, cervix 6cm for artificial rupture of membranes, vaginal bleeding surging 1000mL, with a decrease of blood pressure, the timely establishment of double liquid, supplement the blood volume and infusion of red blood cells, to shorten the production process for embryotomy, postoperative uterine contraction, vaginal bleeding more stable vital signs.
Case 2: Patients with 23+2 weeks pregnant the first pregnancy, placenta praevia, vaginal delivery, the placenta before childbirth, after fetal childbirth, prenatal bleeding and produced a total of about 300mL.
3 cases of patients with pregnancy 24+2 weeks gestation third, placenta previa, placenta accreta, caesarean section after remove the placenta fetal lower segment uterine bleeding, in order to give carboprost ammonia butyl alcohol three to promote uterine contraction, the tourniquet tied the uterine isthmus, 8 uterine wall suture hemostasis, bilateral uterine artery ligation and uterus uterine tamponade, uterine suture, no abdominal hemorrhage, bleeding is about 900Ml, the input of suspended red blood cells and plasma 300mL 2 units in operation, 1+ hours after the surgery, vaginal bleeding again and gradually increased, hemorrhagic shock, DIC, complex laparotomy, removal of the uterus.
Conclusion:
1 the different methods of treatment should refer to the placental position, the history of cesarean section, the history of abortion and so on, and make a good communication with the patients.
2 if the marginal placenta previa, no history of cesarean section of placenta previa and complete placenta previa in pregnant women, based in good condition, advance the establishment of fluid, blood and ready for rescue cases, vaginal delivery has certain safety, although sometimes more blood, but postpartum recovery time is shorter. Less damage to pregnant women.
3 with a history of cesarean section and maternal placenta previa diagnosis, careful treatment, strictly distinguish the existence of placenta implantation. Such as imaging suggests the presence of placenta implantation, should give up for vaginal delivery, caesarean operation termination of pregnancy, with convenient treatment of postpartum hemorrhage. At the same time should closely observe the situation of postpartum hemorrhage, discover and deal with all kinds of complications of childbirth.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R719.3

【引證文獻(xiàn)】

相關(guān)期刊論文 前1條

1 王文建;;前置胎盤剖宮產(chǎn)產(chǎn)后出血65例臨床分析[J];中外醫(yī)療;2015年04期

本文編號(hào)：1706362