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目的:探讨胎盘早剥经阴道分娩的处理方法及观察指标,以期减少胎盘早剥对母体的损伤,为患者再次妊娠提供有利条件。方法:回顾性分析105例2007年7月～2010年3月在北京妇产医院产科经阴道分娩的胎盘早剥患者的临床资料。结果:新生儿轻度窒息5例,重度窒息6例,死胎15例(4例为双胎),死产3例(2例为放弃胎儿,1例孕27周);产后出血6例,DIC 2例,肺水肿1例,无孕产妇死亡。产程时间及孕产妇结局与胎盘早剥类型间无统计学相关性。胎盘早剥的不同类型与发病孕周间有统计学相关性,轻型早剥多发生于孕足月(≥37周),重型早剥以早产偏多(28～37周)。胎盘早剥发病孕周与围产儿预后间有统计学相关性。结论:胎盘早剥经阴道分娩,母婴预后与结束分娩的时间无关,而在于产程的严密监护。胎盘早剥患者选择阴道分娩时,应综合考虑孕龄、出血、凝血功能、胎儿宫内状况等。
OBJECTIVE: To explore the treatment and observation of vaginal delivery of placental abruption in order to reduce the damage of maternal placental abruption and provide favorable conditions for the second pregnancy. Methods: A retrospective analysis of 105 cases from July 2007 to March 2010 in Beijing Maternity Hospital obstetric vaginal delivery of placental abruption clinical data. Results: Neonatal mild asphyxia in 5 cases, severe asphyxia in 6 cases, stillbirth in 15 cases (4 cases of twins), stillbirth in 3 cases (2 cases to give up the fetus, 1 case of 27 weeks of pregnancy); postpartum hemorrhage in 6 cases, DIC 2 cases, 1 case of pulmonary edema, no maternal deaths. No correlation was found between labor time and maternal outcome and type of placental abruption. The different types of placental abruption have a statistically significant correlation with the incidence of gestational age. Most of the patients with mild to severe preeclampsia (≥37 weeks) and those with severe premature rupture (28-37 weeks) are more likely to develop. There was a significant correlation between placental abruption gestational age and perinatal outcome. Conclusion: The vaginal delivery of placental abruption, maternal and infant prognosis has nothing to do with the end of childbirth, but rather the strict monitoring of labor. Patients with placental abruption choose vaginal delivery, should be taken into account gestational age, bleeding, coagulation, intrauterine conditions.