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目的了解不同类型的凶险性前置胎盘伴胎盘植入患者的围术期临床特点。方法将2010年1月—2014年12月该院收治的231例孕晚期凶险性前置胎盘伴胎盘植入患者作为研究对象,按照胎盘植入的程度将其分为三组:粘连性胎盘组134例、植入性胎盘组61例、穿透性胎盘组36例,探讨其围术期的临床特点。结果 (1)三组患者进行比较显示年龄、孕次和既往剖宫产次数无明显差异(P>0.05)。(2)穿透性胎盘位于子宫前壁的概率高于另外二组,差异均具有统计学意义(P<0.05)。(3)胎盘植入程度越深,其术中失血量越多,差异均有统计学意义(P<0.05);穿透性和植入性胎盘组的产后出血及DIC的发生率明显高于粘连性胎盘组,差异有统计学意义;粘连性胎盘组中的患者,均无子宫切除、产褥感染、失血性休克者,而穿透性胎盘组中以上并发症发生率均高于植入性胎盘组;植入性胎盘组和穿透性胎盘组新生儿轻度窒息发生率高于粘连性胎盘组,差异有统计学意义。结论 (1)胎盘植入的程度与孕妇年龄、孕次和既往剖宫产次数无关。(2)穿透性胎盘植入的患者其胎盘多位于子宫前壁。(3)胎盘植入的深度对孕产妇的结局具有一定的影响。
Objective To understand the perioperative clinical features of different types of aggressive placenta accreta with placenta accreta. Methods A total of 231 placenta accreta placenta patients with placenta accreta in the third trimester of pregnancy admitted to our hospital from January 2010 to December 2014 were divided into three groups according to the extent of placenta accreta: 134 cases, implanted placenta group 61 cases, penetrating placenta group 36 cases, to explore the clinical features of its perioperative period. Results (1) Comparison of three groups of patients showed no significant difference in age, gestational times and previous cesarean section (P> 0.05). (2) The probability of penetrating placenta located in the anterior wall of the uterus is higher than the other two groups, the differences were statistically significant (P <0.05). (3) The deeper the degree of placenta accreta was, the more intraoperative blood loss was, the difference was statistically significant (P <0.05). The incidence of postpartum hemorrhage and DIC in penetrating and implantable placenta group was significantly higher than Adhesion placenta group, the difference was statistically significant; Adhesion placenta patients in the group, no hysterectomy, puerperal infection, hemorrhagic shock, and penetrating placenta in the complication rate were higher than implanted placenta Group. The incidence of mild asphyxia in implanted placenta group and penetrating placenta group was higher than that in adhesion placenta group, the difference was statistically significant. Conclusion (1) The degree of placenta accreta has nothing to do with the age of pregnant women, gestational times and the number of previous cesarean section. (2) In patients with penetrating placenta, the placenta is mostly located in the anterior wall of the uterus. (3) The depth of placenta accreta has a certain impact on the outcome of maternal.