剖宫产瘢痕妊娠相关因素分析

发布时间：2018-08-04 18:43

【摘要】：目的:本研究分析了CSP(Caesarean scar pregnancy,剖宫产瘢痕妊娠)患者的发病年龄、全身因素、剖宫产情况、子宫切口缝合方式以及术后恢复情况等临床资料,探讨了CSP发病的影响因素,为降低和预防CSP的发生提供理论依据。方法:本研究选取2008年1月-2016年10月在就诊的51例CSP患者作为实验组(CSP组);选取同期59例剖宫产术后妊娠位置正常者为对照组。分别对两组对象的临床资料进行回顾性分析,包括年龄、全身情况(体重指数、贫血情况、慢性病史、盆腹腔手术史等)、子宫位置、剖宫产情况(剖宫产原因,术前阴道试产过程等)、孕产史(总孕产次、人工流产次数、剖宫产次数等)、切口缝合方式及距前次剖宫产时间、剖宫产术后恢复情况等。结果:1、CSP组与对照组年龄的比较CSP组中患者的剖宫产年龄及发病年龄较为集中,与对照组相比,两组在年龄分布上不存在统计学差异(P0.05);2、CSP组与对照组全身情况的比较CSP的发病与剖宫产术前非孕期体重指数、CSP发病时体重指数、剖宫产术后、CSP发病时贫血情况、慢性病史、妊娠期合并症、盆腹腔手术无相关性。两组数据差异不显著(P0.05);3、CSP组与对照组子宫位置的比较CSP组后倾子宫10例(19.6%),与对照组相比,两组数据的差异显著(P0.05);4、CSP组与对照组临床症状的比较CSP组在停经早期出现腹部疼痛和(或)流血症状的有39例(76.5%),高于对照组高,两组数据的差异显著(P0.05);5、CSP组与对照组孕产次的比较CSP组总孕次≥ 3次45例(88.24%),CSP组剖宫产术≥2次12例(25.49%),人工流产数≥ 2次26例(50.98%),术后人工流产数≥ 2次11例(21.57%),均高于对照组,两组之间有显著性差异(P0.05);术前人工流产≥ 2次5例(9.8%),两组差异不显著(P0.05);6、CSP组与对照组距前次剖宫产间隔时间的比较CSP组距上次剖宫产时间多集中在24-96个月(2-8年),与对照组相比,差异无统计学意义(P0.05);7、CSP组与对照组剖宫产情况比较CSP组术前有胎膜早破者10例(19.6%),与对照组相比,差异不显著(P0.05);因阴道试产失败后行剖宫产者5例(9.8%),其中4例(7.8%)因产程异常行剖宫产术,均低于对照组,差别显著(P0.05);因臀位行剖宫产的有13例(25.49%)高于对照组,差异有统计学意义(P0.05);因羊水过少、巨大儿、无指征剖宫产、妊娠期高血压等行剖宫产术者与对照组相比,差别不显著(P0.05);8、CSP组与对照组在术后发热情况的比较CSP组有2例(3.92%)出现剖宫产术后发热,与对照组相比,差别不显著(P0.05);结论:1、多数CSP患者在孕早期可出现腹痛和(或)阴道流血等临床症状。2、子宫后倾是CSP发病的相关因素。3、多次剖宫产、人工流产,尤其是剖宫产术后再人流术是CSP发病的相关因素。4、臀位、无阴道试产过程的剖宫产是CSP发病的相关因素。
[Abstract]:Objective: to analyze the age of onset, systemic factors, cesarean section, uterine incision suture and postoperative recovery in CSP (Caesarean scar pregnancy, patients with cesarean scar pregnancy, and to explore the influencing factors of CSP. To provide theoretical basis for reducing and preventing the occurrence of CSP. Methods: from January 2008 to October 2016, 51 patients with CSP were selected as experimental group (CSP group) and 59 cases with normal pregnancy position after cesarean section as control group. The clinical data of the two groups were analyzed retrospectively, including age, systemic condition (body mass index, anemia, history of chronic disease, history of pelvic and abdominal surgery, etc.), location of uterus and cesarean section (cause of cesarean section). The history of pregnancy (total pregnancy, induced abortion, cesarean section, etc.), the method of incision suture and the time from the previous cesarean section, the recovery of cesarean section, etc. Results compared with the control group, the age of cesarean section and the age of onset in the CSP group were higher than those in the control group, and compared with the control group, the age of cesarean section in the CSP group was higher than that in the control group. There was no significant difference in age distribution between the two groups (P0.05). There was no significant difference in the body mass index between the CSP group and the control group (P0.05). The body mass index (BMI) during the onset of CSP before and after cesarean section, the anemia during the onset of CSP after cesarean section, the history of chronic disease, and the body mass index (BMI) before and after cesarean section were not significantly different between the two groups. Complications during pregnancy, pelvic abdominal surgery has no correlation. There was no significant difference between the two groups (P0.05) the position of uterus in CSP group and control group was not significant; 10 cases (19.6%) of retroversion uterus in CSP group were compared with those in control group. The difference between the two groups was significant (P0.05) the clinical symptoms of the CSP group and the control group were significantly higher than that of the control group, and 39 cases (76.5%) of the CSP group had abdominal pain and / or bleeding at the early stage of menopause, which was higher than that in the control group. There was a significant difference between the two groups (P0.05) the total pregnancy times 鈮，

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