Clinical Analysis Of Placental Abruption In 51 Cases

Objective: To explore the causes, clinical manifestation, perinatal outcome, maternal complications of patients with placental abruption disease,to improve the early diagnostic rate and to reduce the maternal and fetal complications,improve the maternal and fetal prognosis.Methods: A retrospective analysis was made on clinical data of patients of the placental abruption during June 2012 to October 2014.Statistically analysis the situation of attack time,clinical manifestation and maternal and fetal outcomes between the light placental abruption and the severe placental abruption.Results: The incidence of placental abruption is 0.68% in our hospital(the childbirth in the corresponding period is 7536 cases).32 cases had clear cause disease(62.75%), with hypertensive disorder complicating pregnancy, premature rupture of membranes, mainly external force factors. During the period, we found 6 cases(11.76%) patients used magnesium sulfate to prevent miscarriages had labor symptoms or fetal distress in the process of termination had placental abruption. We also found 19 cases(37.25%) patients had no clear cause.The clinical manifestations of placental abruption were: waist abdominal distension, abdominal pain or vaginal bleeding, bloody amniotic fluid, fetal heart rate changes. There were 22 cases patients both had two or more than two of the clinical manifestations,yet there were 5 cases patients had no clinical manifestations.According to the diagnosis of placental abruption,among the 51 cases patients, Light placental abruption were 24 cases(47.06%), severe placental abruption were 27 cases(52.94%),in the comparision of clinical manifestations between light and severe placental abruption,abdominal pain, bloody amniotic fluid,fetal heart rate disappear and more than two clinical manifestations,the difference was statistically significant(P<0.05),however the vaginal bleeding,stressed uterus and fetal heart rate changes,the difference was not statistically significant. Ultrasound detectable rate of the pathogenic bacteria was 52.08%. Among the 48 cases patients who take the ultrasonography before termination,there were 25 cases had typical manifestation,23 cases were missed.The missed cases including 18 cases of light group and 5 cases of heavey group. Early onset of symptoms to the doctor and the processing time of the heavy group were longer than the light group(P < 0.01).Utero placental apoplexy 14 cases, of which the light of placental abruption in 1, 13 cases of severe placental abruption diffuse intravascular coagulation(DIC) l. Cesarean section 47 cases(92%), vaginal delivery in 4 cases(8%) and no cases of hysterectomy. Stillbirth 8 cases, turn to the neonatal intensive care unit 29 cases(20 cases of premature infants), premature deaths in 3 patients(all are less than 30 weeks gestational age, including 1 case of merger malformation fetus left ear is absent). The observation group’s rate of postpartum hemorrhage, utero plancental apoplexy, neonatal outcome difference compared with the control group, the difference was statistically significant(P<0.05).Conclusion: 1.The main cause of placental abruption were hypertensive disorder complicating pregnancy, premature rupture of membranes, external force factors, the use of magnesium sulfate has not ruled out as one of the triggers,remain to approve by further research later. 2.The clinical manifestation of placental abruption is varied,even small number cases have no typical manifestation. 3.Light placental abruption is easily to be misdiagnosis,B ultrasonography always has no typical manifestation, we should combine with incentives, clinical symptoms, using the results of B ultrasonic dynamic observation and cardiac monitoring make a diagnosis as soon as possible. 4.The length of time of diagnosis to treatment of placental abruption is one of the important factor which affect the severity of placental abruption. Early diagnosis and appropriate treatment could improve maternal and infant prognosis effectively,specially to severe placental abruption,the treatment time is shorter,the result is better.