發(fā)布時(shí)間：2018-06-09 20:26

  本文選題：兇險(xiǎn)性前置胎盤 + 前次擇期剖宮產(chǎn)　； 參考：《重慶醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的:通過對(duì)瘢痕子宮再次妊娠并發(fā)前置胎盤(PP)孕婦的臨床資料進(jìn)行回顧性分析,探討瘢痕子宮再次妊娠并發(fā)PP對(duì)孕婦和圍產(chǎn)兒的影響及前次不同剖宮產(chǎn)原因所致瘢痕子宮合并PP對(duì)母兒的影響。方法:對(duì)重慶醫(yī)科大學(xué)附屬第一醫(yī)院、重慶市婦幼保健院、重慶市急救中心等3家醫(yī)院產(chǎn)科于2014年1月~2015年6月收入住院分娩,并屬于剖宮產(chǎn)后瘢痕子宮合并PP的197例孕婦進(jìn)行系統(tǒng)性回顧性分析,對(duì)孕婦一般情況、術(shù)中情況、母兒結(jié)局等方面進(jìn)行系統(tǒng)性分析比較。根據(jù)患者疾病的兇險(xiǎn)程度分為:兇險(xiǎn)性前置胎盤(PPP)和非兇險(xiǎn)性前置胎盤(NPPP);根據(jù)前次剖宮產(chǎn)原因分為:社會(huì)因素(擇期剖宮產(chǎn))和陰道試產(chǎn)失敗中轉(zhuǎn)剖宮產(chǎn)。結(jié)果:瘢痕子宮再次妊娠并發(fā)PPP的孕婦孕次(4.82±1.503)、早產(chǎn)兒比例(42.1%)、宮腔多次手術(shù)史比例(98.7%)、產(chǎn)前出血比例(73.7%)均顯著高于瘢痕子宮再生育并發(fā)NPPP孕婦[(3.97±1.231)次、15.7%、88.4%、29.8%,P0.05];瘢痕子宮再次妊娠并發(fā)PPP的孕婦產(chǎn)后出血發(fā)生率、胎盤植入率、彌漫性血管內(nèi)凝血(DIC)的發(fā)生率、子宮切除率及新生兒重癥監(jiān)護(hù)病房(NICU)的入住率均顯著高于瘢痕子宮再生育并發(fā)NPPP組的孕婦(34.2%vs 3%、67.1%vs 24.8%、9.2%vs 0.8%、23.1%vs 0%、28.9%vs 5.8%,P0.05)。前次擇期剖宮產(chǎn)較陰道試產(chǎn)失敗后所致疤痕子宮的孕婦再生育時(shí)更易并發(fā)PPP(P0.05)。前次擇期剖宮產(chǎn)后所致疤痕子宮的孕婦再次妊娠并發(fā)PPP,胎盤植入的發(fā)生率、產(chǎn)后出血率、出血量(1000ml/24h)、子宮破裂的發(fā)生率、子宮切除率、DIC的發(fā)生率、輸血、新生兒窒息的發(fā)生率以及入住NICU與圍產(chǎn)兒死亡的比例顯著高于并發(fā)NPPP的孕婦(P0.05)。結(jié)論:前次擇期剖宮產(chǎn)所致疤痕子宮的婦女再生育并發(fā)PPP風(fēng)險(xiǎn)顯著高于前次陰道試產(chǎn)失敗中轉(zhuǎn)剖宮產(chǎn)孕婦,且前次擇期剖宮產(chǎn)孕婦再生育合并PP的母兒發(fā)生不良結(jié)局機(jī)率顯著較前次陰道試產(chǎn)失敗的剖宮產(chǎn)孕婦高;因此,在臨床上嚴(yán)格把握孕產(chǎn)婦首次剖宮產(chǎn)的指征是改善孕婦再次妊娠對(duì)母兒不良結(jié)局的關(guān)鍵。
[Abstract]:Objective: to retrospectively analyze the clinical data of pregnant women with hypertrophic pregnancy complicated with placenta previa PPV. To investigate the effect of scar uterus with PP on pregnant women and perinatal infants and the effects of scar uterus combined with PP on mothers and infants. Methods: the obstetrics and obstetrics of the first affiliated Hospital of Chongqing Medical University, Chongqing Maternal and Child Health Hospital and Chongqing Emergency Center were admitted to give birth in hospital from January 2014 to June 2015. And 197 pregnant women with scar uterus combined with PP after cesarean section were systematically analyzed and compared in general condition, intraoperative condition and maternal and fetal outcome. According to the dangerous degree of the patient's disease, it can be divided into: dangerous placenta previa (PPPP) and non-dangerous placenta previa (NPPPN), according to the causes of previous cesarean section: social factors (elective cesarean section) and vaginal trial delivery failure to cesarean section. Results: the proportion of pregnant women with PPP (4.82 鹵1.503g), preterm infants (42.1%), history of multiple operations in uterine cavity (98.775%) and antepartum hemorrhage (73.7%) were significantly higher than those in pregnant women with NPPP (3.97 鹵1.231 times 15.788.4%); The incidence of postpartum hemorrhage in pregnant women complicated with PPP, The rate of placenta implantation, the incidence of diffuse intravascular coagulation (DIC), the rate of hysterectomy and the occupancy rate of NICU were significantly higher than those of pregnant women with cicatricial uterus reproducing and NPPP. The rate of implantation was significantly higher than that of pregnant women with cicatricial uterus reproducing complicated with NPPP (34.2 vs 24.87.2vs 0.823.1vs 0.28.9 vs 5.8P0.05). The previous elective cesarean section was more likely to be complicated with PPP P0.05 than that of the pregnant women with scar uterus caused by the failure of vaginal trial delivery. Pregnant women with scar uterus caused by cesarean section of the last time were complicated with PPP, placenta accreta, postpartum hemorrhage rate, bleeding volume of 1000ml / 24 h, rate of uterine rupture, rate of hysterectomy and DIC, blood transfusion. The incidence of neonatal asphyxia and the proportion of neonatal death in NICU and perinatal infants were significantly higher than those in pregnant women complicated with NPPP (P 0.05). Conclusion: the risk of PPP in women with scar uterus due to previous elective cesarean section is significantly higher than that in women undergoing cesarean section during previous vaginal trial delivery failure. In addition, the probability of adverse outcome of pregnancy with PP during the previous elective cesarean section was significantly higher than that of the previous vaginal trial delivery failure. Strictly grasping the indication of the first cesarean section is the key to improve the bad outcome of pregnant women.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R714.2

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