剖宫产瘢痕部位妊娠患者再次妊娠结局随访分析

发布时间：2018-03-11 20:00

本文选题：剖宫产瘢痕部位妊娠　切入点：生育能力　出处：《山西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨剖宫产瘢痕部位妊娠(CSP)患者再次妊娠结局。方法:从2006年4月到2016年4月,共327名CSP患者在我院接受B超引导下清宫术/负压吸引术(DC)、双侧子宫动脉栓塞术(UAE)、局部病灶清除等治疗。2016年6月至2016年9月期间对上述患者进行了电话随访,随访内容主要包括:再次妊娠与否、再次妊娠与CSP间隔时间、再次妊娠母胎结局、分娩方式等。结果:共有47名患者失访,我们对剩下的280例患者资料进行收集整理。74名患者希望再次生育,但其中一半患者(50%,37/74)因害怕复发性剖宫产瘢痕部位妊娠(rCSP)及胎盘植入、前置胎盘、子宫破裂等并发症而严格避孕,拒绝尝试再次妊娠;另一半患者(50%,37/74)则积极备孕,并有21名(56.7%,21/37)患者成功分娩21名足月健康活婴(顺产4名,剖宫产娩出17名)。总共有54名患者再次妊娠(计划内或计划外)。9名(16.7%,9/54)患者再次发生CSP。结论:大部分CSP患者可以再次妊娠,其生殖结局包括:正常宫内妊娠、流产、复发性CSP、不孕等。胎盘植入为再次妊娠可能要面临的一个严重并发症,并且在产前检查中有可能被漏诊。CSP患者子宫下段可能会形成憩室或缺陷,对子宫下段的缺陷进行修补既不能保证治愈下段的瘢痕,也不能保证有良好的妊娠结局。对有生育需求及意愿的有CSP史的患者需要进行适当的宣教。一旦她们受孕,则需要尽早转诊至三甲医院并严密门诊随诊。最终我们仅收集到280名CSP患者的数据,我们的结果虽不能代表真正的复发率,但可以在此类患者再次妊娠的风险评估及不同诊疗方案对后续生育影响的可能性等方面提供一些证据。
[Abstract]:Objective: to investigate the repregnancy outcome of patients with cesarean scar (CSP). Methods: from April 2006 to April 2016, A total of 327 patients with CSP were treated with B-ultrasound guided hysteroscopy / negative pressure aspiration, bilateral uterine artery embolization and local focus clearance. The patients were followed up by telephone from June 2016 to September 2016. The main contents of follow-up included: re pregnancy or not, interval between re pregnancy and CSP, maternal and fetal outcome of re pregnancy, delivery mode, etc. Results: 47 patients were not visited. We collected and sorted out the data of the remaining 280 patients. 74 patients wanted to have a baby again, but half of them were 50 percent 37 / 74) afraid of recurrent cesarean scar pregnancy rCSP), placenta previa, placenta accreta, placenta previa. Complications such as uterine rupture were strictly contraceptive and refused to try to get pregnant again. The other half of the patients were actively preparing for pregnancy, and 21 patients with complications such as rupture of the uterus and 21 out of 37 patients gave birth to 21 healthy full-term live babies (4 live births). A total of 54 patients (planned or unplanned) had a second pregnancy (planned or unplanned). Conclusion: most CSP patients can be pregnant again, and their reproductive outcomes include: normal intrauterine pregnancy, miscarriage. Recurrent CSP, infertility, etc. Placenta accreta may be a serious complication of a second pregnancy, and may be missed in antenatal examination. The lower segment of the uterus in patients with CSP may develop diverticulum or defect. Repairing the defects in the lower segment of the uterus does not guarantee the healing of the scar in the lower segment, nor does it guarantee a good pregnancy outcome. Patients with a history of CSP who have the need and desire to have children need to be properly educated. Once they conceive, Then we need to be referred to the third Class Hospital as soon as possible and follow up closely. In the end, we collected only 280 patients with CSP, and our results do not represent the true recurrence rate. However, some evidence can be provided on the risk assessment of re-pregnancy and the possibility of the effect of different diagnosis and treatment programs on subsequent fertility in such patients.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.22

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