胎盘早剥86 例的临床表征与病因分析

目的:分析胎盘早剥漏诊、误诊原因,提高早期确诊率,降低母儿并发症。方法:回顾性分析我院10年内胎盘早剥患者的临床资料,分析比较胎盘早剥漏诊与误诊原因。结果:过去十年内我院共检测出胎盘早剥86例,发生率为0.46%,该类孕妇临床表现主要为腰腹胀或腹痛、阴道流血、血性羊水。其中,急诊入院患者占(61.6%),有明确诱因39例,占45.3%,且以妊娠期高血压疾病、胎膜早破、外伤性因素为主。B超检出率62.8%。轻型胎盘早剥45例(52.3%),重型胎盘早剥41例(47.7%),出现症状到就诊及处理时间重型胎盘早剥均长于轻型胎盘组P<0.01。剖宫产分娩60例(69.8%),阴道分娩26例(30.2%)。结论:临床发病到临床处理时间是影响胎盘早剥轻重程度的重要因素;胎盘早剥临床表现易与早产、先兆临产或胎儿窘迫等混淆;后壁胎盘发生胎盘早剥时,超声容易漏诊。

Clinical Manifestation and Cause Analysis on 86 Cases of Placental Abruption

Objective: To analyze the cause for missed diagnosis and misdiagnosis on placental abruption and to enhance the accu-racy of early diagnosis and decrease the complication of mother and fetus.Methods: The clinical data of 86 placental abruption cases from October 2001 to September 2011 in our hospital were retrospectively reviewed.Compare and analyze the missed diagnosis and mis-diagnosis on placental abruption.Results: During October 2001 and September 2011,the incidence of placental abruption was 0.46%,in which emergence patients accounted for 61.6%,and 39 cases had the predisposing factors(45.3%),mainly including hypertensive dis-orders complicating pregnancy,premature rupture of fetal membranes,and traumatic factors.The main clinical manifestations included lower abdormen pain,vaginal hemorrhage,bloody amniotic fluid.The detection rate of ultrasonography was 62.8%.45 cases had mild placental abruption(52.3%),and 41 cases had severe placental abruption(47.7%).The interval from the onset of the initial clinical sign to treatment for patients with severe placental abruption was longer than those with mild placental abruption(P<0.01).60 cases had cesarean section(69.8%),and 26 cases were vaginal delivery(30.2%).Conclusions: The interval from the onset of the initial clinical sign to treat-ment is closely associated with the severity of placental abruption.The clinical manifestations of placental abruption are easily confused with premature delivery,threatened labor or fetal distress.Missed diagosis by ultrasonography in placental abruption would occur when the placenta is located on posterior.