Локалізація плаценти у порожнині матки як фактор ризику розвитку післяпологової кровотечі

Abstract

Для визначення впливу розташування плаценти на величину післяпологової крововтрати проаналізовані історії пологів у 378 жінок з локалізацією плаценти: в області дна матки – 128 осіб, у тілі матки – 182 особи, у нижньому відділі матки – 68 жінок. Найчастіше фізіологічна крововтрата відмічається у жінок з розміщенням плаценти у дні матки. У пологах, ускладнених кровотечею, плацента у 3 рази частіше розміщувалась у нижніх відділах та у 1,4 рази частіше у дні матки. Локалізацію плаценти у дні та нижньому відділі матки необхідно розцінювати як фактор ризику розвитку післяпологової кровотечі. Для определения влияния расположения плаценты на величину послеродового кровотечения проанализированы истории родов у 378 женщин с локализацией плаценты в области дна матки – 128 человек, в теле матки – 182, в нижнем отделе – 68 женщин. Наиболее часто физиологическая кровопотеря отмечалась у женщин с размещением плаценты в теле матки. В родах, осложненных кровотечением, плацента в 3 раза чаще располагалась в нижних отделах и в 1,4 раза в дне матки. Локализацию плаценты в дне и теле матки следует расценивать как фактор риска развития послеродового кровотечения. Introduction. The recent years researches have stated that placentation localization in the uterine cavity is closely associated with gestation course and labor. However, the research data on the dependence of blood loss amount on placenta location in the uterine cavity are few and ambiguous. Therefore, this issue requires further study. The aim of the study was to determine the influence of placenta localization in the uterine cavity on the amount of postpartum blood loss. Object and research methods. Retrospective clinical and statistical analysis of the labor and delivery records and also prenatal records of 378 women with different placenta localization: in the uterine fundus area – 128 women (I group), in the uterine body – 182 women (II group), in the uterus lower part – 68 women (III group) was carried out. Localization of placenta was determined by ultrasound method using linear probe 3,5 mHz. The results and discussion of the study. It was determined that in women with placenta location in the uterine fundus, the first labor were observed in 2,9 times more frequent, in comparison with the cases of placenta location in the lower parts (р˂0,001). So, implantation of the ovum in the fundus area occurs more often in primiparas. However, such placenta location causes reduced motor function of the uterus, disorder of normal excitation wave irradiation and processes of myometrium retraction. Clinically it is manifested in long labor duration in women with placenta localization in the uterine fundus area, delayed labor, that were observed in 6,3±2,4% of this group and in women with placenta location in the uterus lower parts were not observed at all. According to obtained data, the labor duration in women with lower part placenta localization, on the contrary, was the shortest in comparison with I group women (488,5±29,5 minutes compared to 706,7±38,3 minutes, р˂0,001 ), in 2,7 times more frequent the premature birth were observed (11,8±3.3% compared to 4,7±2,1%, р˂0,05), in 4,2 times more frequent women give birth for the third time or more (13,3±3,5% compared to 3,2±1,7%, р˂0,01). The average blood loss during labor in women with placenta localization in the uterine fundus area amounted 501,7±26,4 ml, in the uterine body – 425,6±26,3 ml, and in the uterus lower part 567,4±23,7 ml (р˂ 0,05). It should be noted, that in labor, complicated by hemorrhage, placenta was 3 times more often localized in the lower parts (р˂ 0,01) and 1,4 times more often in the uterine fundus area (р˂ 0,05). Conclusions. Thus, physiological blood loss was observed in women with placenta localization in the uterine fundus area. Postpartum hemorrhage in most cases complicates labor with placenta localization in the uterine fundus area and lower part of the uterus. But the reasons, in our opinion, are different. Placenta localization in the uterine fundus causes contractile activity disorder, which complicates labor and leads to more frequent bleeding due to exclusion of large area of uterus muscles. When placenta is localized in the uterus lower part, bleeding is primarily caused by reproductive system inferiority, functional disability of the uterine muscular layer.