当科における１５年間の常位胎盤早期剥離症例の分析

• 華 凱

  兵庫医科大学産婦人科学教室

• 平 省三

  兵庫医科大学分娩新生児部

• 伊田 昌功

  兵庫医科大学産婦人科学教室

• 中川 昌子

  兵庫医科大学産婦人科学教室

• 村中 純子

  兵庫医科大学産婦人科学教室

• 別所 健史

  兵庫医科大学産婦人科学教室

• 礒島 晋三

  兵庫医科大学産婦人科学教室

書誌事項

タイトル別名

• Retrospective analysis of abruptio placentae over fifteen years.

抄録

A retrospective analysis of abruptio placentae in the Hospital of Hyogo College of Medicine was performed. There were 45 cases of abruprio placentae in 7141 deliveries, an incidence of 0.63 % over the past 15 years from January 1, 1974 through April 31, 1989. The average age of the patients was 31.2±9.6 years (21 to 41 years). In 25 of these patients (55.6 %) abruptio placentae occurred at 33 to 38 week of gestation. Risk factors were recognized in 28 cases (62.2 %) : hypertension of pregnancy (20 cases), uterus bicornis (5 cases), polyhydramnios (2 cases) and external trauma (1 case). The most common clinical symptom was abdominal pain, which was present in 43 (95.6 %) of the patients. Vaginal bleeding was noted in 31 (68.9 %), fetal distress in 23 (51.1 %), tonic uterine contraction in 22 (48.9 %) and intrauterine fetal death in 14 (31.1 %) at the time of admission. Bloody amniotic fluid was noted in 22 (48.9 %) of the 45 patients and bloody ascitic fluid in 18 (60 %) of the 30 patients who were delivered by caesarean section. The diagnosis of abruptio placentae was made antenatally in 28 (62.2 %) of the 45 patients and confirmed at delivery in the other 17 of the 30 (66.7 %) delivered by caesarean section : the diagnosis was abruptio placentae in 27 and fetal distress in three. The other 15 patients were delivered vaginally.<BR>The perinatal mortality of abruptio placentae was 55.6 % (25/45) which represents 15 % of the 168 perinatal deaths during the period. There were 14 intrauterine fetal deaths before admission, eight stillbirths after admission, and three neonatal deaths.<BR>The risk factors responsible for perinatal mortality due to abruptio placentae were analyzed. Perinatal death was significantly associated with tonic uterine contraction, bloody amniotic fluid, bloody ascitic fluid, more than 1000 ml of external hemorrhage, retroplacental echo-free space in real-time sonography, abruption of more than 50 % of placenta confirmed after delivery, posible ABO incompatibility and prenatal care in another hospital before the occurrence of abruptio placentae.<BR>Maternal complications appeared in 35 (77.8 %) of the 45 patients : anemia in 35, uteroplacental apoplexy in 16, DIC in 13, shock in five, thrombophlebitis in there, acute renal falure in two and endomyometritis in one. One patient who had severe hypertension during pregnancy before abruptio placentae and who was admitted to our hospital with the diagnosis of abruptio placentae complicated by DIC died of cerewbral hemorrhage. Early treatment for hypertension in pregnancy is very important to prevent maternal death due to abruptio placentae.

収録刊行物

• 産婦人科の進歩

  産婦人科の進歩 42 (1), 41-47, 1990

  近畿産科婦人科学会

キーワード

• abruptio placentae
• perinatal mortality
• maternal complications

詳細情報

• CRID: 1390282679922695296
• NII論文ID: 130004188031
• DOI: 10.11437/sanpunosinpo1949.42.41
• ISSN: 13476742
• ISSN: 03708446
• 本文言語コード: ja
• データソース種別:
  • JaLC
  • CiNii Articles
• 抄録ライセンスフラグ: 使用不可