再生育孕妇合并凶险性前置胎盘的妊娠结局分析

目的:探讨再生育孕妇合并凶险性前置胎盘的妊娠结局。方法:回顾性收集2012年8月至2014年8月在浙江大学医学院附属妇产科医院产科住院且分娩的470例前置胎盘孕妇资料,按有无剖宫产史以及胎盘是否附着在子宫瘢痕处将其分为凶险性前置胎盘组和非凶险性前置胎盘组,比较两组的年龄、孕周、孕次、宫腔手术次数、胎盘植入率、子宫切除率以及并发症等。结果:凶险性前置胎盘孕妇的年龄[(32.5±4.1)岁]、孕次[(3.4±1.2)次]、宫腔多次手术史的比例(28.7%)均大于非凶险性前置胎盘孕妇[(30.7±4.5)岁、(2.1±1.4)次、13.6%,均P<0.05];而凶险性前置胎盘孕妇终止妊娠的孕周[(35.6±2.7)周]小于非凶险性前置胎盘孕妇[(36.7±2.7)周,P<0.001];凶险性前置胎盘孕妇产后大出血发生率、输血率、胎盘植入率、子宫切除率(29.7%、35.6%、27.7%、11.9%)均高于非凶险性前置胎盘孕妇(8.1%、10.8%、5.7%、0.8%,均P<0.05)。多元回归分析结果,胎盘植入与凶险性前置胎盘发生大出血明显相关(P<0.05)。结论:瘢痕子宫再生育妇女要充分评估发生凶险性前置胎盘的风险,加强孕前咨询和孕期监测,减少不良妊娠结局发生。
Abstract: Objective: To analyze the maternal outcomes of pregnant women with pernicious placenta previa(PPP). Methods: Clinical data of 470 patients with placenta previa admitted in Women's Hospital Zhejiang University School of Medicine from August 2012 to August 2014 were collected and retrospectively analyzed. The patients were divided into pernicious group(n=101) and non-pernicious group(n=369) according to the history of cesarean section and location of placenta attached to the uterine. The general profiles, maternal outcomes of two groups were compared. Results: The age, gravidity and rate of recurrent cavity surgery of pernicious group [(32.5±4.1) y, 3.4±1.2, 28.7%] were higher than those of non-pernicious group[(30.7±4.5) y, 2.1±1.4,13.6%](P<0.05). The gestational age of pernicious group was (35.6±2.7) weeks, less than that of non-pernicious group [(36.7±2.7) weeks, P<0.001]. Rate of postpartum massive hemorrhage, rate of blood transfusion, rate of placental implantation and hysterectomy in pernicious and non-pernicious group were 29.7%, 35.6%, 27.7%, 11.9% and 8.1%, 10.8%, 5.7%, 0.8%, respectively(P<0.05). Multiple regression analysis showed that placenta accrete was significantly associated with postpartum massive hemorrhage in pernicious group(P<0.05). Conclusion: The awareness of the danger of pregnant women with PPP before operation and paying more attention to antenatal care are key measures to decrease the adverse maternal outcomes of pregnant women with placenta previa. Key words: Cesarean section/adverse effects Placenta accreta Placenta previa Cicatrix Uterine diseases Treatment outcome Postpartum hemorrhage/etiology Retrospective studies