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目的探讨胎盘早剥的发病诱因、临床表现、胎心监护和超声检查对胎盘早剥的诊断意义。方法对2000年1月至2010年12月收治的56例胎盘早剥患者资料进行回顾性分析。结果胎盘早剥发病率0.55%。胎膜早破、臀位、机械性外伤、脐带因素、妊娠高血压为重要诱因。主要临床表现为阴道流血、持续性下腹痛、血性羊水、胎心率异常或消失。胎盘早剥产前诊断率57.1%,B超检出率92.0%,产后出血率32.1%,凝血功能障碍8.9%,新生儿窒息率21.4%,围生儿死亡率21.4%,剖宫产中证实子宫胎盘卒中13例(占剖宫产者54.2%)。Ⅱ度胎盘早剥患者的临床表现、产前诊断率、母婴并发症发病率均高于Ⅰ度。结论应重视胎盘早剥的高危因素,根据病史、临床症状和体征,结合B超及电子胎心监护,综合分析判断,尽早做出正确诊断和处理,减少母婴的发病率和病死率。
Objective To investigate the causes of placental abruption, clinical manifestations, fetal heart rate monitoring and ultrasound diagnosis of placental abruption. Methods The data of 56 cases of placental abruption admitted from January 2000 to December 2010 were analyzed retrospectively. Results The incidence of placental abruption 0.55%. Premature rupture of membranes, breech, mechanical trauma, umbilical cord factors, pregnancy-induced hypertension as an important incentive. The main clinical manifestations of vaginal bleeding, persistent lower abdominal pain, bloody amniotic fluid, fetal heart rate abnormalities or disappearance. The prenatal diagnosis rate of placental abruption was 57.1%, the detection rate of B-ultrasound was 92.0%, the rate of postpartum hemorrhage was 32.1%, the coagulation dysfunction was 8.9%, the neonatal asphyxia rate was 21.4% and the perinatal mortality rate was 21.4% 13 cases of uterine placental stroke (accounting for 54.2% of cesarean section). Ⅱ degree placental abruption in patients with clinical manifestations, prenatal diagnosis rate, the incidence of maternal and infant complications were higher than Ⅰ degree. Conclusion The high risk factors of placental abruption should be emphasized. According to the history, clinical symptoms and signs, combined with B ultrasound and electronic fetal heart monitoring, comprehensive analysis and judgment, make the correct diagnosis and treatment as soon as possible to reduce the morbidity and mortality of mother and infant.