摘要
目的探讨前置胎盘附着于剖宫产子宫瘢痕部位伴或不伴胎盘植入性疾病(PAS)对妊娠结局的影响。方法回顾性收集北京大学第一医院2015年1月1日至2020年12月31日分娩的有剖宫产史伴前置胎盘、且临床资料完整的孕妇共225例。根据孕妇是否伴胎盘植入分为植入组(172例,占76.4%)和非植入组(53例,占23.6%),比较两组孕妇的妊娠结局包括子宫切除率、产后出血率及输血率等。再根据胎盘植入程度将孕妇分为侵入组(包括植入性PAS及穿透性PAS,共153例,占68.0%)和非侵入组(包括粘连性PAS及非PAS,共72例,占32.0%),比较两组孕妇的妊娠结局。进一步行多因素回归分析,明确与不良妊娠结局发生相关的因素。结果(1)非植入组与植入组孕妇比较,子宫切除率低[分别为0(0/53)、12.2%(21/172);P=0.005],产后出血率低[分别为5.7%(3/53)、60.5%(104/172);P<0.01],输血率低[分别为7.5%(4/53)、66.9%(115/172);P<0.01],分别比较,差异均有统计学意义。(2)非侵入组孕妇无一例切除子宫,与侵入组比较,产后出血率低[分别为6.9%(5/72)、66.7%(102/153);χ^(2)=70.873,P<0.01],输血率低[分别为6.9%(5/72)、74.5%(114/153);χ^(2)=90.869,P<0.01],分别比较,差异均有统计学意义。(3)多因素回归分析显示,胎盘植入程度与产后出血(OR=27.622,95%CI为9.873~77.280,P<0.01)及输血(OR=36.912,95%CI为13.239~102.922,P<0.01)均呈显著正相关;随着胎盘植入程度加重,产后出血及术中输血的风险均显著增加。其他高危因素,包括前置胎盘类型和剖宫产术次数等与不良妊娠结局无显著相关性(P均>0.01)。结论前置胎盘附着于剖宫产子宫瘢痕处不伴PAS或仅为粘连性PAS不能作为临床上不良妊娠结局的预测因素,伴侵入性PAS将增加不良妊娠结局风险。
Objective To investigate the effect of placenta previa attached to cesarean scar for adverse pregnant outcomes in patients with or without placenta accreta spectrum disorders(PAS).Methods The clinical information of patients with cesarean section history and placenta previa during the perioperative period at Peking University First Hospital from January 1st,2015 to December 31st,2020 were collected retrospectively.There were 53 cases without PAS and 172 cases with PAS,153 cases with abnormally invasive placenta(containing placenta increta and placenta percreta)and 72 cases without PAS or with placenta accreta.The pregnant outcomes including rate of postpartum hemorrhage,transfusion,hysterectomy between the above groups were compared.Multivariate analysis was performed to study the factors significantly associated with PAS.Results Pregnant women with PAS were at higher risk of adverse pregnant outcomes than those without PAS.Patients with PAS had higher incidences of hysterectomy[12.2%(21/172)vs 0(0/53);P=0.005],postpartum hemorrhage[60.5%(104/172)vs 5.7%(3/53);P<0.01]and blood transfusion[66.9%(115/172)vs 7.5%(4/53);P<0.01].In the subgroup analysis stratified by the type of PAS,patients with abnormally invasive placenta were at higher risk of hysterectomy[13.7%(21/153)vs 0(0/72);P<0.01],postpartum hemorrhage[66.7%(102/153)vs 6.9%(5/72);χ^(2)=70.873,P<0.01]and blood transfusion[74.5%(114/153)vs 6.9%(5/72);χ^(2)=90.869,P<0.01].After multiple logistic regression,the type of creta had the positive relation with postpartum hemorrhage(OR=27.622,95%CI:9.873~77.280;P<0.01)and blood transfusion(OR=36.912,95%CI:13.239~102.922;P<0.01).There were no significant correlations between adverse pregnant outcomes and the type of placenta previa or the times of cesarean section(all P>0.01).Conclusions Placenta previa attached to cesarean scar without PAS or with placenta accreta could not act as the factor of predicting adverse pregnant outcomes in clinic.Placenta previa attached to cesarean scar with placenta increta or placenta
作者
郑蔚然
杨馨蕊
孙瑾
牟元
闫婕
杨慧霞
Weiran Zheng;Xinrui Yang;Jin Sun;Yuan Mu;Jie Yan;Huixia Yang(Department of Obstetrics and Gynecology,Peking University First Hospital,Beijing 100034,China)
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2021年第12期861-867,共7页
Chinese Journal of Obstetrics and Gynecology
关键词
前置胎盘
侵入性胎盘
妊娠结局
剖宫产术
Placenta previa
Placenta accreta
Pregnancy outcome
Cesarean section
