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目的探讨胎盘早剥病例的临床特点,提高诊断率,改善母儿预后。方法回顾性分析初诊时误、漏诊的80例(A组)和初诊时确诊的28例(B组)临床资料。结果胎盘早剥发生率为0.58%,误(漏)诊率为74.07%;妊高征、胎膜早破及催产素应用不当是胎盘早剥的主要发病诱因,妊高征与机械因素B组多于A组,两组差异均有统计学意义(P<0.01);阴道流血、腰背胀痛、腹胀痛和血性羊水,B组明显多于A组,差异有统计学意义(P<0.01)。新生儿窒息、婴儿死亡,B组明显多于A组,差异有统计学意义(P<0.01)。结论胎盘早剥误(漏)诊的主要因素是:病情隐匿,诱因不明,症状不典型,B超检出率低。因此,产科医务人员需高度重视主诉,详细询问患者病史,细仔检查盆腔体征,尤其要严密观察产程进展中的每个变化,并采用B超或彩超动态监测变化,力求尽早明确诊断,及时处理以降低母儿并发症和病死率。
Objective To explore the clinical features of cases of placental abruption, improve the diagnostic rate and improve the prognosis of maternal and child. Methods The clinical data of 80 cases (group A) who had misdiagnosis and missed diagnosis at first visit and 28 patients (group B) who were diagnosed at first visit were retrospectively analyzed. Results The incidence of placental abruption was 0.58% and the rate of misdiagnosis was 74.07%. PIH, premature rupture of membranes and inappropriate oxytocin were the main inducing factors of placental abruption. PIH and mechanical factor B (P <0.01); vaginal bleeding, back pain, abdominal pain and bloody amniotic fluid were significantly more in group B than in group A (P <0.01), the difference was statistically significant ). Neonatal asphyxia and infant mortality were significantly more in group B than in group A, with significant differences (P <0.01). Conclusions The main causes of placental abruption (missed) diagnosis are: the condition is hidden, the cause is unknown, the symptoms are not typical, and the detection rate of B-ultrasound is low. Therefore, the obstetric medical staff should pay close attention to the main complaint, ask the patient’s medical history in detail, carefully examine the pelvic signs, in particular, to closely observe every change in the progress of labor, and use B ultrasound or color Doppler ultrasound to dynamically monitor the changes and strive to make a clear diagnosis as soon as possible and timely treatment To reduce maternal complications and mortality.