33例不典型胎盘早剥临床误诊研究.doc

33例不典型胎盘早剥临床误诊研究[摘要] 目的:探讨不典型胎盘早剥临床特点,提高早期诊断率。方法: 2006年1月~2008年6月我院收治胎盘早剥病例共89例,对其中漏诊误诊的33例(37.1%)不典型胎盘早剥患者的临床资料进行回顾性分析。结果:误诊为先兆早产18例,足月先兆临产、临产9例,前置胎盘4例,胎盘边缘血窦破裂2例;胎盘位于后壁26例,前壁2例,偏低4例,侧壁1例;合并子痫前期中、重度者19例,有性交或外伤史6例,二者均有1例,无明显原因7例;产前死胎10例,胎儿宫内窘迫16例,围生儿死亡18例。结论:胎盘着床于后壁的早剥患者临床表现不典型易误诊先兆早产或先兆临产,合并子痫前期或有外伤史者易发生早剥,原因不明的死胎或较早期发生胎儿宫内窘迫可能是胎盘早剥的警示信号。 [关键词] 不典型胎盘早剥;特点;误诊分析 [中图分类号]R714.2 [文献标识码]B[文章编号]1673-7210(2009)08(a)-165-02 Misdiagnosis analysis of 33 cases of atypical placental abruption GUO Junliu, XIE Zengxia (Obstetrics and gynecology, the Chang’an Hospital of Dongguan City,Dongguan 523800, China) [Abstract] Objective: To investigate the clinical characteristics of atypical placental abruption and improve the early diagnosis. Methods: There were 89 cases placental abruption in the hospital from January 2006 to June 2008, included 33 cases(37.1%) atypical placental abruption. A retrospective analysis about the 33 cases was conducted. Results: In the misdiagnosed cases, 18 cases were threatened premature, 9 cases were labor or the precursor of full-term pregnancy, 4 cases were placenta previa, 2 cases were the breakdown of marginal placenta blood vessels. About the placenta, 26 cases were on the posterior wall, 2 cases were on the anterior wall, 1 was on the left wall. 19 cases were combined pre-eclampsia, 6 cases had the history of traumatic or sexual intercourse, 1 case had the history of traumatic and sexual intrecourse, 7 cases had no significant incentive. 10 cases were stillbirth, 16 cases were fetal distress, and perinatal death in 18 cases. Conclusion: Placental on the posterior wall may misdiagnose threatened premature labor or precursor labor, combined pre-eclampsia or trauma are prone to occur as early as the history of stripping, unexplained stillbirth or fetal distress may be a warning signal of placental abruption. [Key words] Atypical placental abruption; Characteristics; Misdiagnosis analysis 胎盘早剥是妊娠晚期严重并发症之一,典型病例具有起病急、发展快、病情重等特点,若处