影响瘢痕子宫再妊娠并发凶险性前置胎盘的因素及妊娠结局分析

Analysis of risk factors and pregnancy outcomes of perinicious placenta previa in scarred uterus repregnancy patients

摘要:

目的 分析影响瘢痕子宫再妊娠并发凶险性前置胎盘的因素及妊娠结局。方法 回顾性分析2019年10月—2020年10月重庆医科大学附属第一医院、重庆医科大学附属妇女儿童医院、重庆医科大学附属大学城医院住院分娩并发前置胎盘的200例二次剖宫产单胎妊娠产妇的分娩数据，按是否并发凶险性前置胎盘将产妇分为非凶险性前置胎盘组（122例）与凶险性前置胎盘组（78例），对两组产妇本次及前次的剖宫产基本情况、术中和术后情况、新生儿结局进行比较，并通过构建多因素逐步Logistic回归模型分析瘢痕子宫再妊娠并发凶险性前置胎盘的危险因素。结果 非凶险性前置胎盘组产妇前次剖宫产时发生的急诊剖宫产占比高于凶险性前置胎盘组产妇（P <0.05）；非凶险性前置胎盘组产妇本次剖宫产时的妊娠次数、宫腔操作次数、宫腔操作≥3次、产前出血、24 h出血量、输血、产后出血、胎盘植入、弥散性血管内凝血、子宫切除、早产、新生儿重症监护病房入住，新生儿窒息均低于凶险性前置胎盘组产妇（P <0.05），新生儿出生体重大于凶险性前置胎盘组（P <0.05）。阴道试产失败行剖宫产产妇再妊娠并发凶险性前置胎盘的比例低于前次择期剖宫产产妇（P <0.05）。多因素逐步Logistic回归分析结果显示，宫腔操作次数多［O^R =1.446（95% CI：1.132，1.851）］、前次择期剖宫产［O^R =4.481（95% CI：1.758，11.412）］是瘢痕子宫再妊娠并发凶险性前置胎盘的危险因素（P <0.05）。结论 既往宫腔操作次多以及前次择期剖宫产是瘢痕子宫再妊娠并发凶险性前置胎盘的危险因素。

Abstract:

Objective To study the maternal and infant outcomes and related risk factors associated with perinicious placenta previa.Methods By using retrospective cohort method, the information of 200 scarred uterus pregnant women with placenta previa from October 2019 to October 2020 in the Department of Gynecology and Obstetrics of the University-Town Hospital of Chongqing Medical University, the First Affiliated Hospital of Chongqing Medical University, the Women and Children's Hospital of Chongqing Medical University were collected. The maternal baseline characteristics, postoperative and perinatal outcomes were compared. The risk factors of pernicious placenta previa in scar uterus repregnancy were analyzed by binary logistic regression.Results In the analyse of the previous pregnancy, the proportion of emergency cesarean section in the non-pernicious placenta previa group was much higher than that in the pernicious placenta previa group (P <0.05). While no significant differences were found in age of delivery, gestational week of delivery, intrauterine operations, 24 hour blood loss, blood transfusion, postpartum hemorrhage, premature delivery, neonatal intensive care unit (NICU) admission, neonatal asphyxia rate and neonatal weight between two groups (P <0.05). In present pregnancy, the delivery pregnancy week of pernicious placenta previa group was significantly shorter than the non-pernicious placenta previa group (P <0.05). In addition, the number of pregnancies and intrauterine operations as well as the incidence of prenatal bleeding, 24-hour blood loss, blood transfusion, postpartum bleeding, placenta implantation, disseminated intravascular coagulation (DIC), hysterectomy, NICU occupancy were all significantly higher than the non-pernicious placenta previa group (P <0.05). Multiple logistic regression analysis showed that increased number of intrauterine operations [O^R = 1.446 (95% CI: 1.132, 1.851)] and the previous elective cesarean section [O^R = 4.481 (95% CI: 1.758, 11.412)] are risk factors for developing pernicious placenta previa.Conclusion The increased number of previous intrauterine procedures and direct elective cesarean section are the risk factors for the pernicious placenta previa.