(1)胎盤異常並びに諸因子の多変量解析に基づく分娩時出血多量の予知に関する研究(<特集>第61回学術講演会シンポジウム1「産科出血と胎盤異常」)

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Objectives: To establish prediction method for massive haemorrhage at deliverly by analyzing the relationship between amounts of bleeding and placental abnormalities (placenta previa, low placenta, placenta abruption) as well as other obstetrical factors. Methods: 1. We reviewed 56 singleton pregnancies with placenta abruption, 49 singleton pregnancies with low placenta in 2002-2008 and 129 singleton pregnancies with placenta previa in 2000-2008. We analyzed the relationship between amounts of bleeding at deliverly and factors (delivery mode, DIC, IUFD, onset time) in placenta abruption, the distance of edge of placenta to the internal OS (pi-l) in low placenta with the trial labor. In placenta previa, we investigated the followings: 1) diagnostic accuracy of echo findings (a: placenta lacnae, b: lack of clear zone, c: presence of sponge like findings, d: presence of a sinus venosus) for adherence of placenta previa. 2) multivariate analyses for massive bleeding (>2,500mL) with factors (age≥35y/o, para, previous C/S, placenta on anterior wall, DL: distance of edge of placenta to internal OS≥2cm, Cx≤25mm and echo findings (a,b,c,d)). 2. We reviewed 3,682 singleton pregnancies with or without placental abnormalities and multivariate analyses were done for the relation between amounts of bleeding (TV>1,000mL, CS>2,500mL) and obstetric various factors including maternal history, incidents in pregnant, incidents in delivery, abnormalities of placenta, cord and fetus and delivery mode. Results: 1. In placenta abruption, the multivariate analysis revealed that only DIC (odds ratio (OR): 18.2; 95% confidence interval (CI): 1.3-264.5) was associated with massive bleeding at delivery. In low placenta, pi-l correlated inversely with amount of bleeding. In placenta previa, 1) Sensitivity, specificity and positive predict value of echo findings for adherence of placenta previa were a: 60%, 85.9%, 13.0%; b:60%, 96.2%, 37.5%; c:40%, 78.9%, 7.4%; d:0%, 82.0%, 0% respectively. The multivariate analysis revealed that only lack of clear zone (OR: 51.4; CI: 1.7-1534.0) was associated with adherence of placenta previa. 2) The multivariate analysis revealed that Cx≤25mm (OR: 11.0; CI: 3.5-10.9), presence of sponge like findings (OR: 3.5; CI: 1.1-10.9), age≥35y/o (OR: 3.4; CI: 1.1-10.5) were associated with massive bleeding. 2. It was analysis revealed that polyhydramnion (OR: 51.9; CI: 13.1-205.0), placenta previa (OR: 7.4; CI: 3.0-17.9), age≥35y/o (OR: 2.3; CI: 1.1-4.6) were associated with massive bleeding in singleton CS cases; and low placenta (OR: 6.3; CI: 1.7-22.8), baby weight≥3,500g (OR: 3.1; CI: 2.0-4.9), BMI>25 (OR: 2.8; CI1.6-5.0), IVF-ET (OR: 2.9; CI1.4-6.2) were associated with massive bleeding in singleton TV cases. Conclusion: The effective predictive factors for massive bleeding at delivery were DIC in placenta abruption, shorter pi-l in low placenta with the trial labor, Cx≤25mm and presence of sponge like findings in non adherence cases of placenta previa. Low placenta was the most effective factor for massive PPH in singleton vaginal delivery and placenta previa was that in singleton C/S. The lack of clear zone was a predictive factor for placental adherence in placenta previa but not so effective. In cases without placental abnormalities, baby weight≥3,500g, BMI>25 and IVF-ET were effective predictive factors for massive bleeding in singleton vaginal delivery. These results were useful to prepare for massive bleeding at delivery in cases with or without placental abnormalities.
2009-09-01

(1)胎盤異常並びに諸因子の多変量解析に基づく分娩時出血多量の予知に関する研究(<特集>第61回学術講演会シンポジウム1「産科出血と胎盤異常」)

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