65　Placental Implantation Cases Analysis And The Review Of Literature

Objective:To explore the risk factors,early diagnosis,treatment and prognosis for placental implantation.Methods:A 9-year retrospective case-control study was conducted from January 1,2002 to December 31,2010 at the second hospital, ShanXi medical university. In the same period,65 cases of placenta implantation were identified. Then randomly selecting 100 pregnancy cases without placenta implatation as matched group, the general control clinical characteristics, infant and maternal prognosis were analysed useing SPSS 13.0 package program, and made a review of early diagnosis and treatment.Result:(1) From January 1,2002 to December 31,2010,65 placenta implantation cases were diagonosed in our hospital, and the constitutent ratio was 0.86%; (2) the average gestational age of the termination of pregnancy of placenta implantation patients excluding 4 induced labor cases was 38.16 weeks at childbirth; there were 45 placenta accrete cases,20 placenta increta cases; (3) the pencentage of advanced maternal age was 36.92%(24 patients), compared with the matched group, the trend chi-square P<0.01, the risk of 30～34 years pregnant women complicted placenta increta was 1.39 times than those younger than 30 years old, and 2.97 times than older than 34 years; the previous abortion history of cases percentage was 63.08%(41 cases), and average abortion were 1.12 times. Compared with matched group, trends chi-square P<0.01, indicated with the increasing of miscarriage times, the risk of placenta implantation increased, when abortion 1 time the risk of placenta implantation was 1.24 times, when abortion 2 times the risk was 3.39 times than cases without previous abortion history; 29 patients (44.62%) had a history of delivery, trend chi-square P=0.05 compared with matched group, but a history of delivery increased the risk of placenta implantation; Pregnant women cultural degree rising, compared with control group, chi-square and trend chi-square all P>0.05; 19 Placenta implantation cases (31.15%) were combinated by placenta previa, and compared with matched group, chi-square P<0.01, multivariate logistic regression analyse, (OR 13.14,95% CI 3.54～48.85).12 patients (18.46%) of 65 cases were complicated by hypertension disease, compared with matched group, chi-square P＜0.01, multivariate logistic regression analyse, (OR 4.55,95% CI 1.38～13.00).3 cases of 65 cases combined myoma,2 cases combined with gestational diabetes,3 cases combined with thyroid disease,5 cases combined with blood disease, 1 case combined with twin pregnancy and there were all no statistically significant differences compared with matched group; the sex ratio of neonatal was 1.03, compared with matched group, the difference was not statistically significant; (4) 32 cases of 65 implantable placenta cases happened postpartum hemorrhage, including 18 placenta increta cases (56.25%), and 14 placenta accrete cases (43.75%). The incidence of placenta accrete and increta happening postpartum hemorrhage had statistic difference, X2=20.69>X20.01,1, P＜0.01; (5)the difference of conservative success rate of placenta accrete and placenta increta had statistic significance, X2=10.91>X20.01,1,P<0.01; (6) no pregnant women and babies dead.10 cases (16.95%) came up premature rupture of membrane.18 cases (29.51%) was preterm labor; neonatal asphyxia rate was 10.17%(6/59).Conclusion:(1)Advanced age, history of abortion, previous pregnancy history, placenta previa and pregnangcy complicated with hypertention disease were risk factors for placenta implantation, of which the two latter were independent risks; (2) more attentions should pay to the patients with multiple placenta implantation risk factors, even if antenatal examination of pregnant women not indicated, but did not exclude the placenta increta, rescuing preparation and enough blood resource should be arranged before delivery; (3) when placenta implantation was found in the labor,doctors should strive for conservative treatment, which should be based on the placenta increta types and the volume of bleeding, but for conservative treatment failure remedying by hysterectomy; (4)the postpartum hemorrhage ratio and the conservative success rate of placenta increta and accreta were statistically significant, and attached importence to and strengthen the placenta increta follow-up after conservative therapy; (5)the incidence of neonatal asphyxia, premature birth was higher coinciding with placenta implantation, so medical workers should strengthen the monitoring.