子宫畸形对妊娠结局影响的初步探讨

发布时间：2018-07-07 07:56

本文选题：子宫畸形 + 妊娠结局　；参考：《首都医科大学》2017年硕士论文

【摘要】：研究背景:子宫畸形是女性生殖系统发育异常中最常见的一种,主要包括中隔子宫、双子宫、双角子宫、弓形子宫、单角子宫等。子宫畸形在非孕期往往无临床症状,妊娠时由于宫腔形态失常及子宫内膜发育不良能够引起流产、早产、胎膜早破、胎位异常、胎儿生长受限等不良妊娠结局,剖宫产率也相应增加。不同类型子宫畸形形成原因不同,对妊娠结局的影响也不完全相同。在各种子宫畸形中,中隔子宫的发病率最高,文献报道其最容易引起复发性流产。单角子宫则更容易引起胎位异常,剖宫产率也相对较高。关于不同类型子宫畸形对妊娠的影响,由于样本量及统计学方法的不同,各研究结果并不一致,至今尚无统一的结论。子宫畸形患者妊娠时剖宫产率高达70%以上,胎位异常是主要原因。关于剖宫产术中是否行子宫畸形矫形术(主要涉及中隔子宫,单角+残角子宫),考虑到会增加出血的风险,目前尚无确切的结论。目的:1.探讨子宫畸形与妊娠结局的关系。2.研究不同类型子宫畸形分别对妊娠结局的影响。3.评估剖宫产术中行子宫畸形矫形术的安全性。方法:选取2011年至2015年在首都医科大学附属北京妇产医院建档并分娩的375例子宫畸形妊娠患者为研究对象,并随机选取同期375例正常子宫妊娠患者作为对照。入组标准:年龄18-34岁,单胎妊娠,初产妇,无合并子宫肌瘤、子宫腺肌症,无内外科合并症,既往无子宫肌瘤剔除术史及子宫畸形矫形术史。采集患者的一般资料信息:年龄,子宫畸形类型,诊断方法,孕次;产前情况:既往自然流产、稽留流产、人工流产、胎死宫内,胎膜早破,胎盘早剥,前置胎盘,胎儿窘迫,胎位异常;产时、产后情况:是否脐带绕颈,分娩方式(阴道分娩、剖宫产),剖宫产指征,早产,足月产,分娩孕周,产后出血,胎盘粘连/滞留;新生儿情况:出生体重,1分钟Apgar评分。采用SPSS17.0统计学软件对数据进行统计分析,计量资料采用均数±标准差来描述,分析比较采用t检验或方差分析;计数资料以构成比来表示,分析比较采用卡方检验、连续性矫正或Fisher确切概率法。P0.05为差异有统计学意义。结果:1.畸形组平均孕次高于对照组(1.64±0.91 VS 1.51±0.77,P=0.035);畸形组胎膜早破(29.9%VS 22.1%,P=0.016),产后出血(3.2%VS 1.1%,P=0.043),脐带绕颈(31.5%VS 17.1%,P=0.000),胎位异常(46.9%VS 5.3%,P=0.000),早产(16.0%VS 4.0%,P=0.000),剖宫产(72.5%VS 18.4%,P=0.000)等发生率均显著高于正常子宫组;而分娩孕周(37.78±1.96 VS 39.21±1.26,P=0.000),新生儿出生体重(3069.67±548.84 VS 3384.99±402.52,P=0.000),巨大儿发生率(1.3%VS 4.8%,P=0.006)均显著低于正常子宫组。2.畸形组中,胎位异常、新生儿体重等方面的发生率在不同类型子宫畸形之间有明显差异(P0.05)。单角子宫胎位异常的发生率最高(70.1%),双子宫新生儿出生体重最低。3.本研究中22例中隔子宫患者于剖宫产术中切除中隔,12例单角+残角子宫患者于术中行残角子宫切除术。结果1例中隔子宫患者发生产后出血(4.5%),1例单角+残角子宫患者发生产后出血(8.3%)。切除与未切除中隔的两组患者在产后出血发生率(4.5%VS 2.8%,P=0.534)及产后出血量(442.27±160.77 VS385.47±153.55,P=0.120)方面差异均无统计学意义;术中行残角子宫切除术患者的产后出血量(599.17±461.74 VS 365.77±149.17,P=0.003)明显高于术中未行残角子宫切除术的患者,而两者在产后出血发生率方面差异并无统计学意义(8.3%VS 3.8%,P=0.470)。结论:子宫畸形患者妊娠时,胎膜早破、胎位异常、产后出血、早产等不良妊娠结局的发生风险会增加,剖宫产率也相应提高;单角子宫患者妊娠时胎位异常的发生率最高;关于剖宫产术中中隔子宫以及残角子宫矫形术问题,建议在条件允许的情况下,对所有残角子宫患者行残角子宫+同侧输卵管切除术。临床中对于子宫畸形患者应该及早明确诊断,加强孕产期保健,个体化治疗,降低围产期并发症的发生。
[Abstract]:Background: uterine malformation is the most common type of abnormal development of female reproductive system, mainly including septum uterus, double uterus, double horned uterus, arched uterus, single angle uterus, etc.. Uterine malformation often has no clinical symptoms during non pregnancy. The incidence of cesarean section is also increased. The causes of different types of uterine malformation are different, and the influence on the pregnancy outcome is not exactly the same. Among the various uterine malformations, the incidence of the uterus is the highest, the literature is reported that it is the most likely to cause recurrent abortion. The single angle uterus is easier. The effect of different types of uterine malformation on pregnancy, due to the difference of sample size and statistical method, is not consistent, and there is no unified conclusion. The rate of cesarean section is up to 70%, and the abnormal fetal position is the main reason. In caesarean section Whether or not uterine malformation (mainly involving the septum, single angle, and residual angle uterus), there is no definitive conclusion in consideration of the risk of increasing bleeding. Objective: 1. to investigate the relationship between uterine malformation and pregnancy outcome (.2.) to study the effect of different types of uterine malformation on pregnancy outcome in.3. assessment of uterine malformation during cesarean section Methods: 375 cases of uterine malformed pregnancy were selected from 2011 to 2015 in Beijing Obstetrics and Gynecology Hospital of Capital Medical University, and 375 cases of normal uterine pregnancy were selected randomly as control. The standard of the group was 18-34 years old, single pregnancy, primipara, no uterine myoma and uterus. Adenomyosus, no internal surgery complication, history of myomectomy without uterine myomectomy and history of orthopedic surgery. Collect the general information of patients: age, type of uterus, diagnosis, pregnancy; prenatal abortion, abortion, abortion, fetal death, premature rupture of fetal membranes, placenta previa, fetal distress, fetal distress. Parturition: umbilical cord around the neck, delivery mode (vaginal delivery, cesarean section), cesarean section, premature delivery, term delivery, birth, pregnancy, pregnancy, postpartum hemorrhage, placental adhesion / retention; newborn conditions: birth weight, 1 minutes Apgar score. The data were statistically analyzed with SPSS17.0 software, and the measurement data were measured in mean number. T test or analysis of variance was used for analysis and comparison; count data were represented by composition ratio. Analysis compared with chi square test, continuous correction or Fisher exact probability.P0.05 was statistically significant. Results: the average pregnancy rate of 1. malformed groups was higher than that of the control group (1.64 + 0.91 VS 1.51 + 0.77, P=0.035), and the malformed group had premature rupture of membranes (29 .9%VS 22.1%, P=0.016), postpartum hemorrhage (3.2%VS 1.1%, P=0.043), umbilical cord around the neck (31.5%VS 17.1%, P=0.000), abnormal fetal position (46.9%VS 5.3%, P=0.000), premature birth (16.0%VS 4%, P=0.000), cesarean section (72.5%VS 18.4%, P=0.000), and so on were significantly higher than the normal uterus group; and birth pregnancy week (37.78 + 1.96 39.21 + 1.26,), newborn birth Weight (3069.67 + 548.84 VS 3384.99 + 402.52, P=0.000), the incidence of giant infants (1.3%VS 4.8%, P=0.006) was significantly lower than the normal uterine group.2. malformation group, abnormal fetal position, neonatal weight and other aspects of the incidence of different types of uterine abnormalities between different types of uterine abnormalities (P0.05). The incidence of single angle uterus fetal abnormalities (70.1%), Gemini In the study of the lowest birth weight of the uterus.3., 22 septate septum patients were excised during cesarean section and 12 cases of single angle + remnant angle hysterectomy were performed during the operation. Results 1 cases of septum uteri were treated with post production bleeding (4.5%), 1 cases of single angle + remnant uterus were produced after production (8.3%). Excision and unexcised septum were removed. There was no significant difference between the two groups in the incidence of postpartum hemorrhage (4.5%VS 2.8%, P=0.534) and postpartum hemorrhage (442.27 + 160.77 VS385.47 + 153.55, P=0.120), and the amount of postpartum hemorrhage (599.17 + 461.74 VS 365.77 + 149.17, P=0.003) in the surgical resection of the remnant angle hysterectomy was significantly higher than that of the non residual angle hysterectomy in the operation. There is no significant difference in the incidence of postpartum hemorrhage (8.3%VS 3.8%, P=0.470). Conclusion: the risk of premature rupture of membranes, abnormal fetal position, postpartum hemorrhage, preterm birth and other adverse pregnancy outcomes will increase, and the rate of cesarean section increases accordingly; the incidence of abnormality of fetal position during pregnancy in single horned uterus patients. With regard to the problem of the septum and the residual angle of the uterus during cesarean section, it is suggested that the hysterectomy of the remnant uterus and the ipsilateral salpingectomy for all patients with residual angle uterus should be performed under conditions permitted. Happen.
【学位授予单位】：首都医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.2

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