黄　萍，黄新梅，盛　伟

(1.安徽省蚌埠市第一人民医院妇产科，安徽 蚌埠 233000；2.江西省九江市庐山区人民医院妇产科，江西 九江 332900；3.复旦大学附属儿科医院，上海 201102)



不典型胎盘早剥诊治的回顾性分析

黄萍1，黄新梅2，盛伟3

(1.安徽省蚌埠市第一人民医院妇产科，安徽 蚌埠 233000；2.江西省九江市庐山区人民医院妇产科，江西 九江 332900；3.复旦大学附属儿科医院，上海 201102)

目的分析不典型胎盘早剥的临床特点、早期诊断、分娩方式及处理方法。方法回顾性分析了安徽省蚌埠市第一人民医院2012年1月至2014年12月收治的分娩孕产妇7 468例，其中胎盘早剥37例，按产前是否明确诊断包括不典型胎盘早剥23例，对其临床表现、诊断和处理方法进行分析。结果在23例不典型胎盘早剥患者中，胎盘早剥合并妊娠期高血压疾病患者9例(占39.13%)、胎膜早破7例(占30.43%)、子宫压痛3例(13.04%)、腹痛伴阴道流血5例(占21.74%)、无腹痛性阴道流血4例(占17.39%)、外伤2例(占8.70%)、无明显临床症状的2例(占8.70%)。在37例胎盘早剥患者中，B超诊断准确率为27.03%，误诊率为18.92%，漏诊率为54.05%。37例患者顺产9例(占24.32%)，剖宫产28例(占75.68%)，其中死胎、死产、新生儿轻度窒息和重度窒息各3例(占8.11%)。结论不典型胎盘早剥误诊及漏诊率较高，B超阴性是漏诊的主要原因；B超异常以及阴道流血是最为有用的诊断手段。

不典型胎盘早剥；回顾性分析；早期诊断；分娩方式；处理方法

[Abstract]Objective To analyze the clinical features, early diagnosis, mode of delivery and processing method of atypical placental abruption. Methods Clinical data of 7 468 cases of pregnant women giving birth in Bengbu First People’s Hospital in Anhui Province during the period of January , 2010 to December, 2014 were retrospectively analyzed, and 37 of them were diagnosed with placental abruption, in whom 23 were cases of atypical placental abruption. The clinical manifestations, diagnosis and treatment of cases of atypical placental abruption were analyzed. Results In 23 cases with atypical placental abruption, 9 cases were complicated with pregnancy induced hypertension (39.13%), 7 cases with premature rupture of fetal membranes (30.43%), 3 cases with uterine tenderness (13.04%), 5 cases with abdominal pain and vaginal bleeding (21.74%)，4 cases with vaginal bleeding but no abdominal pain (17.39%), 2 cases with trauma (8.70%), and 2 cases without obvious clinical symptoms (8.70%). In 37 cases of placental abruption, the accuracy of B-ultrasound was 27.03%, misdiagnosis rate was 18.92%, and the rate of missed diagnosis was 54.05%. Moreover, 9 cases underwent natural labors (24.32%) and caesarean section were performed in 28 cases (75.68%), including 3 cases of dead fetus, 3 cases of dead birth, 3 cases of mild asphyxia and 3 cases of severe asphyxia (8.11%). Conclusion Misdiagnosis rate and missed diagnosis rate of atypical placental abruption are high, and B-ultrasound negative is the main cause of missed diagnosis. B-ultrasound abnormality and abnormal vaginal bleeding are useful diagnostic methods.

[Key words]atypical placental; retrospective analysis; early diagnosis; delivery mode; treatment method

胎盘早剥是指孕妇在妊娠20周后或分娩期，正常位置的胎盘在胎儿分娩前部分或全部从子宫壁剥离，国内发病率为0.46%～2.10%[1]。典型胎盘早剥往往起病急、进展快，是严重威胁孕产妇和胎儿生命的妊娠并发症，也是造成妊娠后期阴道出血、孕妇及胎儿围产期死亡的主要原因[2]。……