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目的探讨瘢痕子宫伴前置胎盘(凶险性前置胎盘)再次剖宫产患者术中大出血的发生原因以及预防措施。方法收集分析2009年9月～2011年11月某院行单胎再次剖宫产155例患者的临床资料,其中伴前置胎盘者12例(观察组),瘢痕子宫不伴前置胎盘143例(对照组)。瘢痕子宫伴前置胎盘者12例术中出血原因进行归纳总结分析。结果瘢痕子宫伴前置胎盘组合并中央性前置胎盘,胎盘植入、先兆子宫破裂均高于瘢痕子宫不伴前置胎盘组。5例瘢痕子宫伴前置胎盘剖宫产术中大出血均为胎盘植入,且5例均为中央性前置胎盘,4例是前壁胎盘合并先兆子宫破裂。结论前壁中央性前置胎盘合并胎盘植入是瘢痕子宫伴前置胎盘剖宫产术中大出血主要原因。术前做好相应预防措施,必要时做好子宫动脉栓塞准备,尽可能保留子宫,对妊娠结局非常重要。
Objective To investigate the causes and preventive measures of intraoperative bleeding during cesarean section with placenta previa (precancerous placenta). Methods The clinical data of 155 patients with single cesarean section from September 2009 to November 2011 in a hospital were collected and analyzed. Among them, 12 cases with placenta previa (observation group), 143 cases with scar placenta without placenta previa (Control group). Scar uterine with placenta previa 12 cases of intraoperative bleeding were summarized and analyzed. Results The uterus with scarring had a combination of placenta accreta and central placenta previa, placenta accreta and uterus rupture were higher than the uterus without placenta previa. Five cases of cesarean scar with placenta previa bleeding in cesarean section were placenta accreta, and 5 cases were central placenta previa, 4 cases of anterior placenta combined with threatened uterine rupture. Conclusion Anterior central placenta previa combined with placenta accreta is the main cause of massive bleeding during cesarean section with scar uterus and placenta previa. Proper precautions, uterine artery embolization prepared when necessary, as much as possible to retain the uterus, pregnancy outcome is very important.