【摘要】 目的:探讨胎盘早剥患者保守治疗的临床价值,以改善母儿妊娠结局。方法:回顾性分析安徽省立医院近十年来诊治一般情况良好、无急性胎盘早剥征象且胎盘剥离面积<1/2的胎盘早剥患者60例的临床资料,其中行保守治疗32例(保守治疗组)和立即终止妊娠28例(未行保守治疗组),比较两组孕妇及新生儿情况以及胎盘剥离面积<1/3和介于1/3～1/2的两组孕妇的分娩方式及母婴结局。结果:①保守治疗组中仅1例患者出现胎死宫内(入院24小时),行剖宫产终止妊娠;其余孕龄平均延长3.1±0.6周。②保守治疗组孕妇剖宫产率、新生儿死亡率、新生儿Apgar评分≤3分、Apgar评分4～7分的比例均低于非保守治疗组(P<0.05);而保守治疗组阴道分娩率和Apgar评分≥8分的比例均高于非保守治疗组(P<0.05)。③两组在胎盘剥离面积<1/3和介于1/3～1/2时,新生儿Apgar评分和新生儿死亡率比较,差异均有统计学意义(P<0.05);胎盘剥离面积介于1/3～1/2时,两组分娩方式比较,差异也有统计学意义(P<0.05)。结论:对胎盘早剥症状较轻,胎盘剥离面积<1/2胎盘面积者,可行保守治疗,能延长孕周,减少早产儿并发症,提高早产儿存活率。对于胎盘剥离面积介于1/3～1/2的患者,保守治疗后孕妇和新生儿仍有较好的妊娠结局。更多还原

【Abstract】 Objective:To evaluate the clinical value of conservative treatment of placental abruption to improve the pregnancy outcome.Methods:The clinical data of 60 cases with mild abruptio placenta from our hospital in recent ten years were retrospectively analyzed which had a good general conditions,no acute placental abruption symptom and with placental abruption aera not exceeding 1/2.Among whom,32 patients were treated in conservative way and the other 28 cases were dealed in nonconservative way.The delivery mode and outcome of mother and fetus were compared between these 2 groups(placental abruption aera<1/3;1/3～1/2).Results:①Only 1 fetus died in intrauterine in conservative group (within 24h after admission,then were bring out by cesarean delivery),all the other pregnant woman’s gestational weeks were extended averagely 31±06 w.②The cesarean section rate,proportion of Apgar≤3,proportion of 4≤Apgar≤7 in conservative group were all lower than that in nonconservative group(P<005).But the proportion of Apgar≥8 in conservative group was higher than that in nonconservative group(P<005).③In placental abruption aera <1/3 and in 1/3～1/2 conditions,there were significant difference in the Apgar scoring of neonate,and perinatal mortality between these 2 groups.When the placental abruption aera was among 1/3～1/2,there was significant difference in the delivery way between these 2 groups(P<005).Conclusions:Placental abruption patients with untypical symptom and stripping area<1/2 could be treated in conservative way.The conservative treatment method have a positive effect in extending the gestational weeks,reducing the complication of premature and improving the survival rate of premature infant.For the patients whose placental abruption aera was in 1/3～1/2,conservative treatment can still result in good pregnancy outcome.更多还原