前置胎盘孕妇紧急剖宫产的预测因子分析

Analysis on predictive factors of emergency cesarean section in pregnant women with placenta previa

目的初步确定前置胎盘孕妇紧急剖宫产的预测因子,为产前护理和分娩择期提供临床依据。方法回顾性分析2007年4月-2017年3月医院收治的214例前置胎盘孕妇的临床资料,其中择期剖宫产121例,紧急剖宫产93例。单变量和多变量回归分析紧急剖宫产预测因子。结果医源性早产43例,单因素分析剖宫产史(OR 3.4;95%CI 1.64~7.1)、早产<37周(OR 3.4;95%CI 1.3~9.2)、胎龄<32周产前出血(OR 18;95%CI 6.5~50)、胎龄>32周产前出血(OR 9.7;95%CI 3.4~27)、产前出血次数(OR 14;95%CI 5.4~37)、产前出血住院(1~7 d OR 6.5;95%CI 2.3~18,>7 d OR 27;95%CI 9.8~77)、产前出血补剂(铁剂OR 2.4;95%CI 1.4~4.2,输血OR 12;95%CI 3.6~43)。多因素分析剖宫产史(OR 4.6;95%CI 1.8~11)、产前出血1次(OR 7.5;95%CI 2.5~23)、产前出血2次(OR 14;95%CI 4.3~47)、产前出血≥3次(OR 27;95%CI 8.3~90)及产前输血(OR 6.6;95%CI 1.8~24)。结论剖宫产史、产前出血次数及产前输血为前置胎盘紧急剖宫产预测因子,此类前置胎盘孕妇需个性化产前保健,适时实行保守治疗,减少医源性早产。

Objective To initially identify the predictive factors of emergency cesarean section in pregnant women with placenta previa,provide a clinical basis for prenatal nursing and selection of delivery opportunity. Methods The clinical data of 214 pregnant women with placenta previa treated in Hainan Maternal and Child Health Care Hospital from April 2007 to March 2017 was analyzed,including 121 cases undergoing elective cesarean section and 93 cases undergoing emergency cesarean section. Univariate and multivariate regression models were used to analyze the predictive factors of emergency cesarean section. Results A total of 43 cases were diagnosed as iatrogenic proterm labor. Univariate analysis showed that history of cesarean section（OR： 3. 4; 95% CI： 1. 64-7. 1）,prematurity 37 weeks（OR： 3. 4; 95%CI： 1. 3-9. 2）,antepartum hemorrhage during gestational age32 weeks（OR： 18; 95% CI： 6. 5-50）,antepartum hemorrhage during gestational age32 weeks（OR： 9. 7; 95% CI： 3. 4-27）,number of antenatal hemorrhage（OR： 14; 95% CI： 5. 4-37）,hospitalization due to antenatal hemorrhage（1-7 d,OR： 6. 5; 95% CI： 2. 3-18, 7 d,OR： 27; 95% CI： 9. 8-77）,therapy of antenatal hemorrhage（iron OR： 2. 4; 95% CI： 1. 4-4. 2,blood transfusion OR： 12; 95% CI： 3. 6-43） were predictive factors of emergency cesarean section. Multivariate analysis showed that history of cesarean section（OR： 4. 6; 95% CI： 1. 8-11）,antenatal hemorrhage for one time（OR： 7. 5; 95%CI： 2. 5-23）,antenatal hemorrhage for two times（OR： 14; 95% CI： 4. 3-47）,antenatal hemorrhage≥3 times（OR： 27; 95% CI： 8. 3-90）,and antenatal blood transfusion（OR： 6. 6; 95% CI： 1. 8-24） were predictive factors of emergency cesarean section.Conclusion History of cesarean section,number of antenatal hemorrhage,and antenatal blood transfusion are predictive factors of emergency cesarean section in pregnant women with placenta previa,individualized antenatal care is needed,conservative therapy should be provided appropriately to reduce iatrogenic proterm labor.