剖宫产瘢痕部位妊娠影响因素分析
发布时间：2018-04-29 06:17
本文选题：瘢痕妊娠 + 剖宫产术 ； 参考：《郑州大学》2014年硕士论文
【摘要】：剖宫产瘢痕部位妊娠（caesarean scar pregnancy，CSP），是指有剖宫产史孕妇，胚胎着床于子宫下段剖宫产切口瘢痕处[1]，国内多数文献称子宫下段剖宫产切口处妊娠，是一种特殊类型的异位妊娠，患者常因合并胎盘植入、子宫破裂、大出血行子宫切除术而失去生育能力，甚至失去生命。近年来随着剖宫产率的逐年上升和阴道超声技术的临床应用，CSP的发病率和检出率也随之增加，，严重威胁着育龄期妇女的生殖健康及生命安全。本文旨在探讨CSP发病的影响因素，为减少和预防CSP发生提供理论依据。 目的 通过回顾性分析CSP患者的既往剖宫产子宫切口缝合方式、孕产史、既往剖宫产术前术中异常情况等临床资料，探讨CSP发病的影响因素，为减少和预防CSP的发生提供理论依据。 材料与方法 1.选取2003年1月至2013年7月在郑州大学第三附属医院就诊的53例瘢痕妊娠患者为CSP组，选取同期疤痕子宫合并宫内妊娠患者95例作为对照组；CSP组和对照组患者的既往剖宫产术均在本院进行，且手术方式均为子宫下段剖宫产术。 2.回顾性分析53例CSP患者的临床资料，对CSP患者的年龄、孕产史孕次、人工流产次数、剖宫产次数㖞、既往剖宫产子宫切口缝合方式连续浆肌全层单层缝合和连续缝合肌层、浆膜层包埋双层缝合㖞、既往剖宫产术前术中异常情况胎膜早破、胎盘早剥、人工胎盘剥离术、臀位剖宫产㖞及距前次剖宫产时间等因素与CSP发病的关系进行整理分析。 3.采用SPSS17.0软件包，将临床整理所得数据录入建立数据库并进行统计分析，定性资料，采用2检验，以α＝0.05为检验水准。 结果 1CSP组与对照组不同年龄的比较 CSP患者集中于31～40岁，但与对照组相比，两组在年龄分布上无统计学差异P＞0.05㖞。 2CSP组与对照组孕产史情况的比较 53例CSP患者在孕次方面差异无统计学意义P＞0.05㖞；人工流产≥2次38例（71.7%），剖宫产≥2次30例（56.6%），均高于对照组，两组之间差异均有统计学意义（P＜0.05）。 3CSP组与对照组既往剖宫产子宫切口缝合方式的比较 53例CSP患者单层缝合方式30例（56.6%），高于对照组，两组之间差异具有统计学意义（P＜0.05）。 4CSP组与对照组既往剖宫产术前术中异常情况的比较 53例CSP患者胎膜早破25例（47.2%），臀位剖宫产20例（37.7%），均高于对照组，差异有统计学意义（P＜0.05)；胎盘早剥7例（13.2%），低于对照组，但差异无统计学意义P＞0.05)；人工胎盘剥离术8例（15.1%），低于对照组，差异有统计学意义（P＜0.05)。其中CSP组胎膜早破合并胎盘早剥4例，胎膜早破合并臀位剖宫产2例，人工胎盘剥离合并臀位剖宫产1例。 5CSP组与对照组距前次剖宫产时间的比较 CSP组和对照组在距前次剖宫产时间分布上有统计学差异（P＜0.05)，其中距前次剖宫产时间≤5年37例（69.8%），高于对照组，2＝4.646，P＝0.031；≥16年2例（3.8%），比率低于对照组，2＝4.241，P＝0.039，两组之间差异均有统计学意义（P＜0.05)。 结论 1.既往剖宫产子宫切口缝合方式是CSP发病的影响因素。 2.多次人工流产史、多次剖宫产史、胎膜早破、臀位剖宫产及距前次剖宫产时间是CSP发病的影响因素。
[Abstract]:In recent years , with the increasing of cesarean section rate and clinical application of vaginal ultrasound , the incidence and detection rate of CSP is increasing , which seriously threatens the reproductive health and life safety of women in childbearing age . In recent years , with the increase of cesarean section rate and the clinical application of vaginal ultrasound technique , the incidence and the life safety of women in childbearing age are seriously threatened . In recent years , this paper aims to explore the influential factors of CSP pathogenesis , and provide theoretical basis for reducing and preventing CSP .
Purpose
In order to reduce and prevent the occurrence of CSP in CSP patients , the clinical data of the prior cesarean section , the history of pregnancy and the abnormalities of previous cesarean section were analyzed retrospectively .
Materials and Methods
1 . In the third Affiliated Hospital of Zhengzhou University from January 2003 to July 2013 , 53 patients with scar pregnancy were selected as CSP group , and 95 patients with scar uterus and intrauterine pregnancy were selected as control group .
Prior cesarean section was performed in both the CSP group and the control group , and the procedure was performed in the lower section of the uterus .
2 . The clinical data of 53 patients with CSP were analyzed retrospectively , including the age , the history of pregnancy , the number of abortions , the number of times of cesarean section , the number of cesarean sections , the previous cesarean section , the continuous suture and the continuous suture muscle layer , the serosa - embedding double - layer suture , the abnormalities of the previous cesarean section , the premature rupture of the fetal membranes , the placental abruption , the manual placenta stripping , the breech section cesarean section and the relationship between the factors such as the time before the previous cesarean section and the pathogenesis of CSP .
3 . Using SPSS 17.0 software package , the data entered into the database was entered into the database and the statistical analysis and qualitative data were analyzed . The qualitative data were analyzed by 2 tests , with 伪 = 0.05 as the test level .
Results
Comparison of age between 1CSP group and control group
Compared with the control group , there was no statistical difference between the two groups in the age distribution compared with the control group ( P > 0.05 ) .
Comparison between 2CSP group and control group ' s history of pregnancy
There was no statistical difference in the pregnant time between 53 patients with CSP ? P > 0.05 ?
There were 38 cases ( 71.7 % ) induced by artificial abortion , 30 cases ( 56.6 % ) in cesarean section and 30 cases ( 56 . 6 % ) respectively , which were significantly higher than those in control group ( P < 0.05 ) .
Comparison between 3CSP group and control group prior cesarean section suture method
In 53 patients with CSP , 30 cases ( 56.6 % ) were single - layer suture , which was higher than that of the control group ( P < 0.05 ) .
Comparison of abnormal cases in 4CSP group and control group before cesarean section
In 53 patients with CSP , 25 cases ( 47.2 % ) had PROM and 20 cases ( 37.7 % ) were higher than those in the control group ( P < 0.05 ) .
The placental abruption in 7 cases ( 13.2 % ) was lower than that of the control group , but the difference was not statistically significant ( P > 0.05 ) .
In 8 cases ( 15.1 % ) of artificial placenta , the difference was statistically significant ( P < 0.05 ) . Among them , there were 4 cases of PROM , 4 cases of PROM , 2 cases of PROM , 2 cases of cesarean section , 1 case of artificial placenta and 1 case of cesarean section .
Comparison of the time of cesarean section between 5CSP group and control group
There was statistical difference ( P < 0.05 ) between CSP group and control group ( P < 0.05 ) in the previous cesarean section time 鈮
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