目的:更新有关胎盘早剥的知识,因为尽管围产期护理取得了进展,但最近发表的系列报道很少。
方法:对100例胎盘早剥患者进行了回顾性观察研究,发生在2008年1月至2011年6月,在斯特拉斯堡大学医院(法国)的两个产科。
结果:一百零五胎,其中包括五胎双胎。临床背景在91%的病例中很明显,但只有4%的病例存在经典的临床三合会。在77%的病例中,立即进行胎盘检查时发现了凝块。一半病例的病理诊断与临床诊断直接一致。平均分娩日期为闭经33周和6天。67名患者早产。其中,50例患者分娩前34周。分娩前进行了60次剖腹产手术,包括47例全身麻醉.12例患者产后出血和10例凝血障碍。没有产妇死亡。围产期死亡率为19%,子宫内死亡13例(12.4%),4名出生在复苏失败的明显死亡状态的儿童(3.8%)和3名新生儿死亡(2.8%)。
结论:胎盘早剥是一种严重且不可预测的情况。通常需要产科医生和重症医师的联合医疗护理。围产期死亡主要发生在子宫内。
OBJECTIVE: To update knowledge on placental abruption because there are few recent series published although the perinatal care has progressed.
METHODS: A retrospective observational
study has been conducted on 100 consecutive cases of abruptio placentae, occurring from January 2008 to June 2011, in the two maternity units of the University Hospital of Strasbourg (France).
RESULTS: One hundred and five births among which five twin pregnancies were included. Clinical context was evident in 91% of cases, but the classic clinical triad was present in only 4% of cases. Clots were found at immediate placenta examination in 77% of cases. Pathological diagnosis was directly in accordance with clinical diagnosis in half the cases. Mean date of childbirth was 33 weeks of amenorrhea and 6 days. Sixty-seven patients gave birth prematurely. Among them, 50 patients delivered before 34 weeks. Sixty caesareans were performed in emergency before labor, including 47 with general anesthesia. Twelve patients had post-partum haemorrhage and ten coagulation disorders. There was no maternal death. Perinatal mortality was 19% with 13 fetal deaths in utero (12.4%), four children born in an apparent death state with resuscitation failure (3.8%) and three neonatal deaths (2.8%).
CONCLUSIONS: Placental abruption is a serious and unpredictable situation. Joint medical care of obstetricians and intensivists is often required. Perinatal mortality mainly occurs in utero.