Vaginal delivery after placental abruption with intrauterine fetal death: A 20-year single-center experience
Vaginal delivery after placental abruption with intrauterine fetal death: A 20-year single-center experience
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DOI：
10.1111/jog.13285
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发表时间：
2017-04-01
影响因子：
1.6
通讯作者：
Konishi, Ikuo
中科院分区：
文献类型：
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作者：
Inoue, Ayami;Kondoh, Eiji;Konishi, Ikuo
目的探讨胎盘早剥导致胎儿死亡时阴道分娩的可行性和安全性。方法回顾性分析1995 - 2015年京都大学医院收治的胎盘早剥合并宫内死胎的产妇。结果研究期间共发现16例。尝试VD 15例，成功14例（93.3%）。中位胎龄为36（24-39）周，有8例初产妇。毕晓普在入学时的平均得分为2.5分（1-9分）。8例妊娠合并妊高征。中位分娩时间分别为5 h和18 min (30 min-12 h - 43 min)，中位出血量为2503 (445-6808)mL。分别给予新鲜冷冻血浆（20 U）和红细胞浓缩物（10 U） 10例（71%）和9例（64%）。2例因产后出血需要子宫动脉栓塞，无产妇死亡或子宫切除术。Bishop评分bbbb3的患者（n = 6）分娩时间较Bishop评分3的患者短（P = 0.020），出血量明显大于Bishop评分3的患者（P = 0.020）。产程与出血量呈负相关（R-2 = -0.56, P = 0.039）。结论胎盘早剥合并宫内死胎后，无论胎龄、胎次、宫颈成熟度、产程长短，在医疗资源充足的情况下，VD是可行且安全的。
AimThe aim of this study was to elucidate the feasibility and safety of vaginal delivery (VD) when placental abruption causes fetal demise.MethodsWe conducted a retrospective study of women who were managed for placental abruption with intrauterine fetal death at Kyoto University Hospital during the period from 1995 to 2015.ResultsSixteen cases were identified during the study period. VD was attempted in 15 cases and was accomplished in 14 (93.3%) cases. The median gestational age was 36 (24-39) weeks, and there were eight primiparas. The median Bishop score on admission was 2.5 (1-9). Eight pregnancies were complicated with pregnancy-induced hypertension. The median duration of labor was 5 h and 18 min (30 min-12 h 43 min), and the median amount of hemorrhage was 2503 (445-6808) mL. Fresh frozen plasma ( 20 U) and red cell concentrate ( 10 U) were administered in 10 (71%) and 9 (64%) cases, respectively. Two cases required uterine artery embolization for post-partum hemorrhage, while there was no case of maternal death or hysterectomy. Patients with Bishop score > 3 (n = 6) experienced shorter-duration deliveries (P = 0.020) and had significantly larger blood loss volume (P = 0.020) compared to patients with Bishop score3. The duration of labor was negatively correlated with the amount of blood loss (R-2 = -0.56, P = 0.039).ConclusionAfter placental abruption with intrauterine fetal death, VD is feasible and safe regardless of gestational age, parity, cervical maturity, and duration of labor when intensive medical resources are available.