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目的探讨凶险性前置胎盘的诊断、治疗及孕妇年龄、距前次剖宫产时间、产前出血次数与术中出血的关系。方法 2013年12月-2014年12月深圳市妇幼保健院凶险性前置胎盘患者51例,按术中出血情况分为A组(11例,出血量≤1000m L)和B组(40例,出血量>1000 m L),回顾性分析51例凶险性前置胎盘的影像学特点及治疗情况,分析两组之间孕妇年龄、距前次剖宫产时间、产前出血次数的差异。结果 1超声检查对前置胎盘诊断的准确率为100%,此次统计中超声检查对胎盘植入诊断率为38.1%,MRI诊断率80.9%。251例凶险性前置胎盘均采用手术治疗,其中2例因不可控制的术中出血行子宫切除,其余49例术中采取有效止血方式预后良好。3孕妇年龄>35岁的比率B组高于A组,差异有统计学意义(P<0.05),而距前次剖宫产时间、产前出血次数两组比较,差异无统计学意义(P>0.05)。结论凶险性前置胎盘术前应通过超声及MRI充分评估其风险性,制定手术方案;高龄孕妇在凶险性前置胎盘手术中出血的风险性增加。
Objective To investigate the diagnosis and treatment of dangerous placenta previa, the age of pregnant women, the time of previous cesarean section, the number of prenatal bleeding and the intraoperative bleeding. Methods From December 2013 to December 2014, 51 cases of dangerous placenta previa in Shenzhen MCH center were divided into group A (n = 11, bleeding ≤1000 m L) and group B (n = 40) according to the intraoperative bleeding. Bleeding> 1000 m L). The imaging features and treatment of 51 cases of dangerous placenta previa were retrospectively analyzed. The differences of pregnant women ’s age, the time of previous cesarean section and the number of prenatal bleeding between the two groups were analyzed. Results 1 The accuracy of ultrasonography in diagnosing placenta previa was 100%. The diagnostic rate of placenta accreta was 38.1% and the rate of MRI diagnosis was 80.9%. 251 cases of malignant placenta previa were treated surgically, of which 2 cases due to uncontrolled intraoperative hemorrhage hysterectomy, the remaining 49 cases of surgery to take effective hemostasis in a good prognosis. 3 The ratio of pregnant women> 35 years old in group B was higher than that in group A, the difference was statistically significant (P <0.05), while there was no significant difference between the two groups in the time of pre-cesarean section and prenatal bleeding (P > 0.05). Conclusions The risk of preoperative placenta previa should be fully assessed by ultrasound and MRI, and the surgical plan should be established. The risk of bleeding in advanced placenta previa is increased in pregnant women with advanced placenta previa.