胎盘后血肿和绒毛膜下血肿的临床特征及妊娠结局比较

doi:10.3760/cma.j.issn.1007-1245.2024.01.026

摘要/Abstract

摘要：

目的　探讨胎盘后血肿和绒毛膜下血肿的临床特征，并对其妊娠结局进行对比，加强临床对此类血肿的认识。方法　回顾性分析2021年4月至2022年9月在山东大学齐鲁医院分娩且在妊娠中期发现的160例宫腔内血肿患者的临床资料，年龄20～40岁，妊娠周数12～25⁺²周。根据其血肿类型分为胎盘后血肿组及绒毛膜下血肿组，各80例，综合对比分析两组临床特征及妊娠结局。采用t检验、χ²检验进行统计比较。结果　胎盘后血肿组胎儿窘迫发生率为13.75%（11/80），绒毛膜下血肿组为2.50%（2/80），两组比较差异有统计学意义（χ²=6.782，P=0.009）；胎盘后血肿组足月妊娠发生率为56.25%（45/80），绒毛膜下血肿组为87.50%（70/80），两组比较差异有统计学意义（χ²=19.324，P<0.001）；胎盘后血肿组早产发生率为27.50%（22/80），绒毛膜下血肿组为5.00%（4/80），两组比较差异有统计学意义（χ²=14.879，P<0.001）；胎盘后血肿组胎膜早破、胎盘异常及胎盘残留发生率分别为40.00%（32/80）、37.50%（30/80）及31.25%（25/80），绒毛膜下血肿组分别为12.50%（10/80）、12.50%（10/80）及7.50%（6/80），两组比较差异均有统计学意义（χ²=15.626、13.333、14.444，均P<0.001）；胎盘后血肿组分娩孕周（36.12±3.02）周，早于绒毛膜下血肿组（38.12±2.89）周（t=4.280，P<0.001）；胎盘后血肿组新生儿体质量为（3 025.25±562.02）g，低于绒毛膜下血肿组的（3 323.21±578.25）g（t=3.096，P=0.002）；胎盘后血肿组新生儿疾病（新生儿肺炎、新生儿肺透明膜病、新生儿溶血）发生率为17.91%（12/67），高于绒毛膜下血肿组的2.70%（2/74），两组比较差异有统计学意义（χ²=9.093，P=0.003）。结论　胎盘后血肿和绒毛膜下血肿在血肿体积、分娩孕周及妊娠结局上存在差异，前者更易引发不良的妊娠结局，临床需要提高警惕，及时采取有效干预措施，减少不良妊娠结局的发生率。

关键词:

妊娠结局, 胎盘后血肿, 绒毛膜下血肿, 临床特征

Abstract:

Objective　To explore the clinical characteristics of women with retroplacental hematoma and subchorionic hematoma, and to compare their pregnancy outcomes to enhance the clinical understanding of such hematomas. Methods　The clinical data of 160 women with intrauterine hematoma who delivered at Qilu Hospital of Shandong University from April 2021 to September 2022 and were found in the second trimester of pregnancy were collected and analyzed retrospectively. They were 20-40 years old. The gestational weeks were 12-25⁺² weeks. According to the types of hematoma, they were divided into a retroplacental hematoma group and a subchorionic hematoma group, with 80 cases in each group. The clinical characteristics and pregnancy outcomes of the two groups were comprehensively compared and analyzed. t test and χ² test were used for the statistical analysis. Results　The incidence of fetal distress in the retroplacental hematoma group was higher than that in subchorionic hematoma group [13.75% (11/80) vs. 2.50% (2/80)], with a statistical difference (χ²=6.782,P=0.009). The incidence of full-term pregnancy in the retroplacental hematoma group was lower than that in the subchorionic hematoma group [56.25% (45/80) vs. 87.50% (70/80)], with a statistical difference (χ²=19.324, P<0.001). The incidence of premature delivery in the retroplacental hematoma group was higher than that in the subchorionic hematoma group [27.50% (22/80) vs. 5.00% (4/80)], with a statistical difference (χ²=14.879, P<0.001). The incidences of premature rupture of membranes, abnormal placenta, and residual placenta in the postplacental hematoma group were higher than those in the subchorionic hematoma group [40.00% (32/80) vs. 12.50% (10/80), 37.50% (30/80) vs. 12.50% (10/80), and 31.25% (25/80) vs. 7.50% (6/80)], with statistical differences (χ²=15.626, 13.333, and 14.444; all P<0.001). The gestational weeks of delivery in the postpartum hematoma group was shorter than that in the subchorionic hematoma group [(36.12±3.02) weeks vs. (38.12±2.89) weeks], with a statistical difference (t=4.280, P<0.001). The newborns' body weight in the postpartum hematoma group was lower than that in the subchorionic hematoma group [(3 025.25±562.02) g vs. (3 323.21±578.25) g], with a statistical difference (t=3.096, P=0.002). The incidence of neonatal diseases (neonatal pneumonia, neonatal hyaline membrane disease, and neonatal hemolysis) in the retroplacental hematoma group was higher than that in the subchorionic hematoma group [17.91% (12/67) vs. 2.70% (2/74)], with a statistical difference (χ²=9.093, P=0.003). Conclusions　There are significant differences between women with retroplacental hematoma and subchorionic hematoma in hematoma volume, delivery gestational weeks, and pregnancy outcomes; the former is more likely to cause adverse pregnancy outcomes, so it is necessary to be vigilant and take effective intervention measures in time to reduce the incidence of adverse pregnancy outcomes.

Key words:

Pregnancy outcomes, Retroplacental hematoma, Subchorionic hematoma, Clinical characteristics

张云涛陈丽君.

胎盘后血肿和绒毛膜下血肿的临床特征及妊娠结局比较 [J]. 国际医药卫生导报, 2024, 30(1): 125-129.

Zhang Yuntao, Chen Lijun.

Clinical characteristics and pregnancy outcomes of women with postplacental hematoma versus subchorionic hematoma [J]. International Medicine and Health Guidance News, 2024, 30(1): 125-129.

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