The Clinical Analysis And Intervention Strategies Study On246Cases Of Placental Abruption

ObjectiveTo explore the onset time, diagnosis methods, etiopathogenisis andincentive, obstetrical management and perinatal outcome of placental abruptionby the clinical analysis of pregnancy complicated by placental abruption inLinqing and adjacent6cities. We also summarized the similarities andcharacteristics of placental abruption caused by different factors, and theinsufficient during diagnosis and therapy. Our study might further summarizethe diagnosis, prevention and therapy of pregnancy complicated by placentalabruption. Our study might explore effective treatment and preventivemeasurement, and provide the basis for improving maternal and fetal outcome.MethodsWe collect264pregnant women with placental abruption from the SecondPeople’s Hospital in LiaoCheng during Jan2007to Dec2012, and the age, parity,career, antenatal examination frequency, residence address, etiology, gestationalweeks with placental abruption, symptoms and syndromes, treatment, pregnancycomplications, perinatal outcome were recorded. The data was analyzedretrospectively. The SPSS software package (version17.0) was used for allstatistical analysis. T-test and Chi-squared test were used to analyze the data.Results1.264of21264pregnant women (1.24%) were complicated with placentalabruption. Although the incidence was different, there was no statisticalsignificance (P>0.05).2. The incidence of pregnant women with placentalabruption was higher in countryside (1.42%) than that in city (0.99%)(P<0.05).The constituent ratio was significant different between farmer, worker, office worker and the rest (P<0.05). The incidence of placental abruption in multipara(1.66%) was higher than that in unipara (0.96%)(P<0.05). Farmer and multiparawere the high risk group with placental abruption.3. The constituent ratio wasdifferent in every age group, and the age group (25~30) was highest (P<0.05).The high occurrence age was25~30in this area.4. The incidence of incompletepregnancy with placental abruption (68.56%,181/264) was higher than that inpregnancy (31.44%)(P<0.05). The high occurrence gestational weeks was≥32in this area, including32-37weeks.5. The time of pre-natal examinations was<5in207pregnant women with placental abruption (78.41%).46cases had5~9times (17.42%).11cases had>10times (4.17%). The difference was significant(P<0.05). The incidence of placental abruption was inversely proportional to thetime of pre-natal examinations.6. The first etiology of placental abruption wasgestational hypertension, and the second was premature rupture of membranes.The incentive was overstrain, emotional, smoking and drug abuse.7. Theclinical situation was different because of etiology, including abdominal pain,vaginal bleeding, board-like rigidity of the abdomen complicated withabdominal pain, bloody amniotic fluid, fetal distress, dead fetus in uterus andspontaneous abortion. However, the specificity was not significant comparedwith other obstetrical diseases.264cases of placental abruption of prenatalultrasound diagnosis of was86cases, and diagnosis rate was32.58%.8. Theaverage time of light placental abruption from symptoms to end was4.36±3.82h,and the severe placental abruption was7.52±3.59h (P<0.05). The incidence ofcomplication with placental abruption, such as postpartum hemorrhage,hemorrhagic shock, uteroplacental apoplexy, DIC and acute renal failure, washigher in patients with severe placental abruption than that in patients with lightplacental abruption (P<0.05). The state of illness was more complex in severeplacental abruption, and the probability of complication was higher. Moreover,the intraoperative uterine artery ligation of the ascendant branch was higher insevere placental abruption than that in light placental abruption. Hysterectomywas found in severe placental abruption, and there was no death.9. Theincidence rate of perinatal asphyxia and the mortality rate were higher in severeplacental abruption than that in light placental abruption (P<0.05). Theprobability of premature infant (Apgar score≥8) and term infant in lightplacental abruption was higher than severe placental abruption (P<0.05).10. The main treatment was caesarean section in patients with severe and lightplacental abruption. The incident of caesarean section was lower in lightplacental abruption (83.95%) than that in severe placental abruption (96.08%)(P<0.05). The rate of vaginal delivery was higher in light placental abruption(11.73%) than that in severe placental abruption (3.92%)(P<0.05).7preventingmiscarriages were observed in light placental abruption, and no case was foundin severe placental abruption. However, there was no statistically significant(P>0.05).ConclusionsThe major etiology of placental abruption is gestational hypertension, andthe second is premature rupture of membranes. The clinical manifestation ofplacental abruption is not obvious specificity.The incidence of complications,theincidence rate of perinatal asphyxia and the mortality rate in patients withsevere placental abruption is significantly higher than that in patients with lightof placental abruption.The main treatment was caesarean section in patients withsevere and light placental abruption. Spuc treatment approach is limited to theindividual patients with light placental abruption.The prenatal health educationof pregnant woman should be strengthened, and the prenatal care should be paidmore attention.Rural maternal and multipara are in high risk of placentalabruption. So we should reinforce the work of prenatal care in countryside, andimprove the quality of prenatal care.Placental abruption might be reduced andprevented when we take measurement to remove all kinds of incentives, andprevent gestational hypertension. Therefore, maternal and fetal outcome mightbe improved.