| 摘要: |
| 目的:根据中央性前置胎盘磁共振成像(MRI)检查结果进行新分型,探讨分型处理后的妊娠结局及其不同分型所采用的剖宫产手术切口方式。方法:选择2013年1月至2017年3月在四川省妇幼保健院住院分娩的中央性前置胎盘患者247例,根据中央性前置胎盘MRI检查结果将其分为Ⅰ型(137例)、Ⅱa型(56例)、Ⅱb型(31例)、Ⅲ型(23例),分析不同型别患者的妊娠结局及剖宫产手术不同切口方式及其手术情况。结果:(1)4型患者年龄、孕次、孕周差异无统计学意义(P>0.05)。而Ⅲ型患者的瘢痕子宫患者比例最高,与其他3型相比差异有统计学意义(P<0.05)。Ⅲ型患者的产次最多,与Ⅰ型、Ⅱa型相比差异有统计学意义(P<0.05)。(2)4型患者术前出血率、术前出血量、术前血红蛋白、急诊手术率差异均无统计学意义(P>0.05)。Ⅰ型患者全部采用经腹子宫下段横切口避开胎盘,Ⅱa型患者全部采用经腹子宫下段横切口胎盘打洞,Ⅱb型患者全部采用经腹子宫体部横切口,Ⅲ型患者子宫下段横切口9例,子宫下段横切口胎盘打洞4例,子宫体部横切口10例。(3)Ⅲ型患者术中、术后出血量最多,手术时间最长,术后血红蛋白最低,胎盘植入率最高,输血量和输血率以及子宫切除率最高,术后住院天数最长、住院费用最高,与其他3型比较,差异均有统计学意义(P<0.05)。Ⅱb型、Ⅱa型、Ⅰ型患者除在手术时间及输血率方面有差异,其他方面两两比较差异均无统计学意义(P>0.05)。结论:中央性前置胎盘新分型可以进一步筛选出高危病例,对不同的分型可采用不同的剖宫产方式,以期获得良好的妊娠结局。 |
| 关键词: 中央性前置胎盘 剖宫产 子宫切口 产后出血 分型 子宫切除 |
| DOI： |
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| 基金项目: |
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| Discussion on the Feasibility of the New Classification and Management of Central Placenta Previa |
| JIANG Qingyuan;DU Xiaohong;ZHANG Qin;XIONG Qing |
| (Sichuan Provincial Hospital for Women and Children) |
| Abstract: |
| Objective:According to the results of magnetic resonance imaging examination,the central placenta previa was classified into new types,and to explore the outcomes of the pregnancy after different management according to the new types and different type of cesarean section incision.Methods:In department of obstetrics in Sichuan provincial hospital for women and children between January 2013 and March 2017,247 cases of central placenta previa were selected to be divided into typeⅠ(137 cases),type Ⅱ a(56 cases),type Ⅱ b(31 cases),type Ⅲ(23 cases) according to the results of magnetic resonance imaging examination of the placenta.The pregnancy outcomes of the patients,the different type of cesarean section incision and the results of the operation were analyzed.Results:(1) There was no difference in age,gravidity and gestational weeks among the four types(P>0.05).But compared with the other three types,the proportion of scar uterus was highest in type Ⅲ,and the difference was statistically significant(P<0.05).The time of parity in type Ⅲ was significantly higher than that in typeⅠ,typeⅡa,the difference was statistically significant(P<0.05).(2)There was no difference in rate of preoperative bleeding,preoperative blood loss,preoperative hemoglobin and emergency operation rate among the 4 types(P>0.05).The incision of the uterine of TypeⅠ was transverse incision of lower uterine segment;the incision of the uterine of typeⅡa was transverse incision of lower uterine segment and holing the placenta at the same time.The incision of the uterine of typeⅡb was transverse incision of uterine body to avoid the placenta.In typeⅢ:9 cases were transverse incision of lower uterine segment,4 cases were transverse incision of lower uterine segment and holing the placenta,10 cases were transverse incision of uterine body to avoid the placenta.(3)Type Ⅲ had the most of the blood loss,the lowest of postoperative hemoglobin,the longest operating time,the highest rate of placenta increta,blood transfusion,and hysterectomy,the longest hospitalization time and the most hospitalization expenses,compared with the other three types,the differences were all statistically significant(P < 0.05).There were significant differences on the operation time and blood transfusion rate among typeⅡb,type Ⅱa and typeⅠ,there was no statistical difference on the other indexes among type Ⅱ b,typeⅡ a and type Ⅰ(P > 0.05).Conclusions:The new classification of central placenta previa can screen the higher risk cases,different types of central placenta previa can use different cesarean section incision to obtain a better pregnancy outcome. |
| Key words: Centralplacentaprevia Cesareansection Incisionoftheuterine Postpartumhemorrhage Newclassification Hysterectomy |
