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目的分析胎盘植入引起产后出血的危险因素和临床处理。方法回顾性分析孕晚期确诊胎盘植入72例孕妇的临床资料。其中,26例产后24h出血量≥1500ml(A组),46例<1500ml(B组),比较两组的一般资料和临床结局。结果流产史、产次、剖宫产史和合并前置胎盘是产后出血的危险因素(P<0.05)。A组中18例行保守治疗,如宫腔填塞纱条、子宫捆绑术、子宫动脉栓塞术止血成功,8例行子宫切除术。结论前置胎盘、瘢痕子宫并发胎盘植入极度凶险。对高度怀疑可能切除子宫的病例,可在术前行子宫动脉置管。
Objective To analyze the risk factors and clinical management of postpartum hemorrhage caused by placenta accreta. Methods The clinical data of 72 pregnant women with placenta accreta in the third trimester of pregnancy were retrospectively analyzed. Among them, 26 cases of postpartum hemorrhage ≥ 1500ml (A group), 46 cases <1500ml (B group), the general information and clinical outcomes of the two groups were compared. Results The history of abortion, parity, history of cesarean section and combined placenta previa were the risk factors of postpartum hemorrhage (P <0.05). A group of 18 cases of conservative treatment, such as intrauterine packing gauze, uterine bundling, uterine artery embolization to stop bleeding, hysterectomy in 8 cases. Conclusions The placenta previa, scar uterus and placenta accreta are extremely dangerous. For highly suspected cases of possible removal of the uterus, uterine artery catheterization can be performed preoperatively.