目的 探讨不同生育政策和不同手术方式在前置胎盘（placenta previa，PP）剖宫产术中的应用效果。方法 回顾性分析2003年1月1日至2022年12月31日在中山大学附属第一医院产科的因PP行剖宫产术的孕妇237例，根据生育政策改变的时间，分为两孩政策前79例（A组：2003年1月1日至2015年12月31日）、两孩政策后96例（B组：2016年1月1日至2019年12月31日）、三孩政策后62例（C组：2020年1月1日至2022年12月31日），期间对PP处理的主要手术方式为子宫切除术、术中行子宫动脉上行支结扎和放置宫腔止血球囊、子宫颈提拉缝合术，分析比较3个时间段内子宫切除率、住院时长、手术时长、术中出血量、围术期输血率、围术期感染率及围术期转重症监护病房（ICU）发生率。结果 3组相比，子宫切除率分别为31.6%、16.7%和11.3%；住院时长分别为12.72 d、8.80 d和10.11 d，差异均具有统计学意义（P<0.05）。3组的手术时长、术中出血量、围术期输血率、围术期感染率、围术期转ICU率差异无统计学意义。结论 随着生育政策变更，PP的综合治疗，特别是手术方式的改良，有助于降低子宫切除率和缩短产妇住院时长。

Objective To explore the application effects of different surgical techniques in cesarean section for placenta previa，with consideration of varying fertility policies. Methods To explore the application effects of different surgical methods in cesarean section for placenta previa，with consideration of changes in fertility policies. MethodsA retrospective analysis was conducted on 237 pregnant women with placenta previa who underwent cesarean section in the Obstetric Department of our hospital from January 1，2003 to December 31，2022. Based on the time of changes in fertility policies，they were divided into three groups： Group A （before the two-child policy， from January 1，2003 to December 31，2015），Group B （after the two-child policy， from January 1，2016 to December 31，2019），and Group C （after the three-child policy， from January 1，2020 to December 31，2022）. During this period，the main surgical approaches for managing placenta previa in our department included hysterectomy，ligation of the ascending uterine artery branches intraoperatively and placement of an intrauterine hemostatic balloon，and cervical suture ligation. We analyzed and compared the hysterectomy rates，length of hospital stay，surgical duration，intraoperative blood loss，perioperative transfusion rates，perioperative infection rates，and perioperative ICU transfer rates among the three time periods. Results Comparison among the three groups showed that the hysterectomy rates were 31.6%，16.7%，and 11.3%，respectively； the lengths of hospital stay were 12.72 days，8.80 days，and 10.11 days，respectively； there were statistically significant differences （all P<0.05）. There were no statistically significant differences in surgical duration，intraoperative blood loss，perioperative transfusion rates，perioperative infection rates，or perioperative ICU transfer rates among the three groups. Conclusion With changes in fertility policies，comprehensive treatment for placenta previa，especially improvements in surgical methods，has contributed to reducing hysterectomy rates and shortening the length of maternal hospital stay.