前置胎盘合并瘢痕子宫孕妇的严重不良围产结局分析

发布时间：2018-03-16 10:47

本文选题：前置胎盘　切入点：瘢痕子宫　出处：《四川大学学报(医学版)》2017年05期 　论文类型：期刊论文

【摘要】：目的分析前置胎盘合并瘢痕子宫孕妇的不良围产结局,并研究其相关危险因素。方法采用回顾性病例-对照研究,纳入2005年1月至2015年6月在四川大学华西第二医院再次剖宫分娩的前置胎盘合并瘢痕子宫孕妇,分析严重不良结局的发生情况。严重不良结局定义为(以下任何一项):输红细胞≥10单位,术后转入ICU,膀胱、肠管或输尿管损伤需要外科修补,二次手术,子宫切除,或孕产妇死亡。并采用单因素及多因素logistic回归分析严重不良结局的危险因素。结果近10+年共有478例前置胎盘合并瘢痕子宫孕妇在四川大学华西第二医院行再次剖宫产终止妊娠。本组孕妇平均年龄(32.5±4.8)岁,多数孕妇年龄大于30岁;平均孕4次产1次;其中131例(27.4%)孕妇发生严重不良结局。输红细胞≥10单位者有75例(15.7%,75/478);术后转入ICU 44例(9.2%,44/478);发生膀胱损伤而需修补者共有11例,无输尿管或肠管损伤发生;有4例二次手术,其均是由于保守治疗后内出血而行急诊剖宫产子宫切除。子宫切除(107例,22.4%)是最常见的严重不良结局;最后经过剖宫产术和/或术后病理检查证实的311例胎盘异常附着者,只有172例(55.3%)术前超声或者磁共振检查怀疑有胎盘异常附着。多因素分析显示,凶险性前置胎盘(即胎盘附着于前次剖宫产切口瘢痕上)、产前怀疑胎盘异常附着(粘连、植入或穿透)和产前血红蛋白水平100g/L是严重不良结局的独立危险因素,其比值比和95%可信区间(95%CI)分别为2.4(1.5~3.8)、3.6(2.3~5.6)和2.5(1.6~3.9)。结论在前置胎盘合并瘢痕子宫的孕妇中,凶险性前置胎盘、产前怀疑胎盘异常附着和产前血红蛋白水平100g/L会显著增加严重不良结局的风险。
[Abstract]:Objective to analyze the placenta previa complicated with uterine scar pregnant women with adverse perinatal outcome, and to study the related risk factors. Methods a retrospective case - control study, in the January 2005 to June 2015 at the Sichuan University Huaxi Second Hospital of placenta previa cesarean section again with uterine scar pregnancy, occurrence of serious adverse outcomes. Serious adverse outcome is defined as (any one of the following): red blood cell transfusion more than 10 units, after transferred to ICU, bladder, bowel or ureter injury need surgical repair, two surgery, hysterectomy, or maternal death. And regression analysis of risk factors of serious adverse outcomes using univariate and multivariate logistic. Results a total of 478 years of nearly 10+ cases of placenta previa complicated with uterine scar pregnancy in West China Second Hospital of Sichuan University underwent cesarean section termination of pregnancy. The average age of the women (32.5 + 4.8) years old, the majority of pregnant women The average gestational age more than 30 years; 4 1 times; 131 cases (27.4%) pregnant women have serious adverse outcomes. Red blood cell transfusion more than 10 units in 75 cases (15.7%, 75/478); transferred to ICU after operation in 44 cases (9.2%, 44/478); bladder injury. There were a total of 11 cases of repair no, ureter or bowel injury; 4 cases of two operations, which are due and emergency cesarean hysterectomy after conservative treatment of internal bleeding. Hysterectomy (107 cases, 22.4%) is the most common serious adverse outcomes; finally after 311 cases of cesarean section for placenta and / or postoperative pathological examination confirmed the abnormal attachment, only 172 cases (55.3%) preoperative ultrasound or magnetic resonance examination of suspected abnormal placenta attachment. Multivariate analysis showed that placenta previa (i.e. placenta attached to the previous cesarean section scar on), prenatal attachment (suspected abnormal placenta adhesion, implantation or penetration) and prenatal hemoglobin level 100 G/L is an independent risk factor for severe adverse outcomes, the odds ratios and 95% confidence intervals (95%CI) were 2.4 (1.5~3.8), 3.6 (2.3~5.6) and 2.5 (1.6~3.9). Conclusion in placenta previa complicated with uterine scar pregnancy, placenta previa, prenatal risk suspected abnormal placenta attachment and prenatal hemoglobin level 100g/L significant increase in serious adverse outcomes.

【作者单位】：四川大学华西第二医院产科;出生缺陷与相关妇儿疾病教育部重点实验室(四川大学);
【基金】：国家十三·五重大项目基金(No.2016YFC1000400) 四川省科技厅科技支撑计划项目(No.2015SZ0136)资助
【分类号】：R714.2

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