| Background and purpose:Placental Abruption(PA)has the clinical characteristics of unpredictable,occult disease,rapid onset,and rapid development.If it cannot be discriminated and interfered in time,it will pose a great threat to the safety of mother and child,and it is a serious complication in late pregnancy.The incidence of placental abruption in China is 0.31%-2.1%[1,3,4],the foreign incidence rate ranges from 0.4%-3.8%[2],and the perinatal mortality rate is 20%-35%,15 times as much as non-placental abruption[3].Domestically,according to the placental stripping area and clinical manifestations,it is divided into mild placental abruption and severe placental abruption.Severe placental abruption is more critical,and symptoms are also different,and rapid progress is one of the important causes of adverse outcomes in perinatal period,which seriously threatens the safety of maternal life.In the face of patients with different complaints,clinical manifestations,early identification,timely diagnosis and treatment of severe placental abruption is still one of the problems faced by obstetricians.This article retrospectively analyzed the data of 162 cases of severe placental abruption from January 2008 to September 2018 in the First Hospital of Bethune Jilin University,and summarized the age,gestational age,risk factors of placental abruption,the clinical symptoms and the characteristics of maternal and child outcomes to provide evidence-based evidence for early identification,timely diagnosis and treatment of severe placental abruption.Research data and methods:By retrospective analysis of the age of disease,week of pregnancy,number of pregnancies,high-risk factors,clinical symptoms and signs,auxiliary examinations,mode of delivery and maternal and child outcomes of 162 patients with severe placental abruption,we contrast and analyze:1.Age distribution of mild and severe placental abruption;2.Distribution of preterm and term patients with mild and severe placental abruption;3.Distribution of patients who are in no initial pregnancy with mild and severe placental abruption;4.distribution of high risk factors for mild and severe placental abruption(gestational hypertension,abnormal umbilical cord,scar uterus,premature rupture of fetal membrane,placental abnormality,thyroid disease,gestational diabetes,uterine fibroids,multiple placenta,assisted reproduction,uterine malformation,trauma,and too little water in sheep);5.distribution of clinical symptoms and signs of mild and severe placental abruption(varying degrees of vaginal bleeding,paroxysmal lower abdominal pain,abnormal color doppler ultrasound,abnormal fetal heart,uterine tenderness or placental stiffness,disappearance of fetal heart,persistent abdominal pain,abnormal fetal movement,bloody amniotic fluid,shock,no specific manifestations);6.distribution of the mode of delivery and maternal and child outcomes(postpartum hemorrhage,uterine placental stroke,DIC,acute kidney injury,hysterectomy and normal newborn,mild neonatal asphyxia,severe neonatal asphyxia,stillbirth or stillbirth)of mild and severe placental abruption;7.the relationship between the treatment time from the first symptom of severe placental abruption to the termination of pregnancy and the each maternal and fetal outcome.SPSS 22.0 software was used for statistical analysis of the data,and the measurement data were tested for normality.The non-normal distribution measurement data were expressed by the median(P25-P75),and the mann-Whitney test was used for comparison between groups.Measurement data of normal distribution were expressed as mean standard deviation,and t test was used for comparison between groups.Frequency and rate were used to represent grade and classification data,and chi-square test and mann-whitney test were used for comparison between groups.P<0.05 was considered statistically significant.Result:1.The average age of severe placental abruption was 29.5 years.Patients aged 25 to 34 years old had the highest proportion of severe placental abruption(56.20%).Pregnant women with severe placental abruption had higher age of disease(P<0.05).There was no statistically significant difference between the proportion of elderly pregnant women with severe placental abruption and that with mild placental abruption(P>0.05).2.The proportion of severe placental abruption was highest(49.4%)between 32 weeks and 36+6 weeks.The pregnant women with severe placental abruption had a smaller gestational age.Proportion of preterm pregnant women in severe placental abruption was higher than that in light placental abruption(P<0.05)3.In severe placental abruption,the proportion of patients with first pregnancy was lower than those with pregnancy history.Compared with mild placental abruption,there was no statistical difference(P>0.05).4.Hypertension during pregnancy was the most common risk factor for severe placental abruption(50.0%).Compared with mild placental abruption,the proportion of patients with gestational hypertension,preeclampsia without severe manifestations and preeclampsia with severe manifestations in severe placental abruption was higher in severe placental abruption,while the proportion of patients with chronic hypertension was lower.5.The first clinical symptom of severe placental abruption was the highest rate of vaginal bleeding(101cases,62.3%).The second was paroxysmal lower abdominal pain in 100 cases(61.7%)and fetal heart abnormality in 74 cases(45.7/%).The distribution proportion of severe placental abruption in severe placental abruption was higher than that in light placental abruption in different degrees of vaginal bleeding,abnormal placental heart,uterine tenderness or placental stiffness,placental heart disappearance,and persistent abdominal pain(all P<0.05).The proportion of severe placental abruption in patients without specific manifestations was lower than that in the light group(P<0.05).6.In this study,the positive ultrasound detection rate of severe placental abruption was 64.1%,and the positive ultrasound images were mainly manifested as:abnormal echo observed behind the placenta,abnormal echo at the placenta edge,local thickening of the placenta,and fetal death in utero.7.In this study can be queried to complete cardiac monitoring results in 125 cases,contains various types of cardiac monitoring,the normal group(normal NST,CST/OCT Ⅰ type)proportion of the highest(68 cases,54.4%),followed by abnormal group(abnormal NST,CST/OCT Ⅲtype)(36 cases,28.8%),and atypical group(atypical NST,CST/OCTIItype)(21 cases,16.8%).8.In severe placental abruption,the levels of APTT and TT were higher than that of light weight,while the levels of FIB,PLT and HB were lower than that of light weight,and the difference was statistically significant(P<0.05).The PT level was higher than the mild level,and the difference was not statistically significant(P>0.05).9.In this study,cesarean delivery rate(79%)of patients with severe placental abruption was higher than that of patients with mild placental abruption(73.2%),and the difference was not statistically significant(P>0.05).10.The proportion of uterine placental stroke,postpartum hemorrhage,DIC and hysterectomy in severe placental abruption was higher than that in light placental abruption(all P<0.05),and there was no statistical difference in the occurrence of acute kidney injury(P>0.05).11.The rate of severe asphyxia,stillbirth or stillbirth in neonates with severe placental abruption was 57.4%.The proportion of severe asphyxia in neonates,stillbirth or stillbirth was higher than that of light placental abruption,while the proportion of normal neonates was lower than that of light placental abruption,and the difference was statistically significant(P<0.05).The proportion of newborns with mild asphyxia was lower than that of light placental abruption,and the difference was not statistically significant(P>0.05).12.The duration of severe placental abruption from first symptom to termination of pregnancy was 224 minutes(104 minutes,450 minutes).The longer the time from the first symptom to the termination of pregnancy,the more likely the serious maternal complications(postpartum hemorrhage,acute renal injury,DIC)and the more the number of maternal complications,and severe adverse fetal outcomes(severe asphyxia,stillbirth)were more likely.13.Among the twelve patients with DIC complicated by severe placental abruption,ten patients were directly performed cesarean section or hysterectomy,including nine cases of postpartum hemorrhage,two cases of acute renal injury,four cases of hysterectomy,eight cases of fetal stillbirth and one case of severe fetal asphyxia.Two cases were delivered via vagina,among which one case had postpartum eclampsia accompanied by postpartum hemorrhage and acute renal injury and hysterectomy,one case of fetal stillbirth and one case of severe asphyxia.Conclusion:1.Compared with mild placental abruption,patients with severe placental abruption are more likely to occur at the gestational age of not full term,and the age of illness is higher in pregnant women.2.The most common risk factor of severe placental abruption is gestational hypertension,in which patients with gestational hypertension and preeclampsia are more prone to severe placental abruption.3.The most common first symptoms and signs of severe placental abruption are varying degrees of vaginal bleeding,paroxysmal lower abdominal pain and fetal heart abnormality,and the specific symptom and sign is uterine tenderness or platy hardness.4.Compared with fetal heart rate monitoring,the positive rate of ultrasound in severe placental abruption is higher,but it has some limitations,so it is necessary to judge comprehensively according to the clinical manifestations and signs.5.Cesarean section is the main mode of delivery in the middle plate of severe fetus,but if the maternal state permits,the patients who can end the delivery in a short period of time can give birth through vagina under close monitoring.6.The time from the first symptom of severe placental abruption to termination of pregnancy is closely related to the outcome of pregnancy.The longer the time is,the more serious the condition is,the worse the prognosis is.Early identification and timely treatment can improve the outcome of gestation.7.The treatment of severe placental abruption complicated with DIC is to terminate pregnancy while actively replenishing blood volume and coagulation factors.If severe postpartum hemorrhage or DIC is not easy to correct,uterus should be resected in time. |
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