疤痕子宫再次妊娠发生前置胎盘的临床结局

Clinical outcomes of placenta previa in scarred uterus

目的：探讨疤痕子宫再次妊娠发生前置胎盘对妊娠结局的影响.方法：收集2004年1月至2010年6月本院住院分娩的48例疤痕子宫再次妊娠发生前置胎盘的患者,分为前置胎盘附着在子宫剖宫产疤痕部位组（A组,n=20）、前置胎盘非附着在子宫剖宫产疤痕部位组（B组,n=28）,并设疤痕子宫胎盘位置正常组（C组,n=50）作为对照.分析比较3组患者孕期产检情况、产前出血、分娩方式、产后出血、胎盘植入、子宫切除、围产儿预后等情况.结果：3组患者行急诊剖宫产以及产前出血、产后出血、胎盘植入、早产及新生儿窒息发生的比率差异均有统计学意义（均P〈0.05）;而A、B组患者全部采用剖宫产的分娩方式（100%）,与C组（90%）差异有统计学意义;B、C组没有患者行子宫切除术（0%）,与A组20%（4例）的子宫切除率相比差异有统计学意义（20%）.结论：疤痕子宫再次妊娠发生前置胎盘对妊娠的结局有严重影响,做好孕期监护和及时有效的术中处理有利于改善疤痕子宫前置胎盘母儿的预后.

Objective： To investigate the pregnancy outcomes of women with placenta previa in scarred uterus with subsequent pregnancy. Methods： Between January 2004 and June 2010,48 cases of placenta previa in scarred uterus with subsequent pregnancy admitted in our hospital were divided into 2 groups-the scar-adhering placenta previa group （Group A,n = 20） and non scar-adhering placenta previa group （ Group B, n = 28 ）. A cohort of women with normal placenta in scarred uterus were enrolled in a contrgl group （Group C,n = 50）. We analyzed and compared the outcomes of prenatal examination, antepartum hemorrhage, pattern of delivery, postpartum hemorrhage, placenta implantation,hysterectomy and perinatal prognosis in the three groups. Results ： Statistical differences among the three groups were noted in the ratio of emergency cesarean section, antepartum hemorrhage, postpartum hemorrhage, placenta implantation, premature birth and neonatal asphyxia （ P 〈 0.05 ）. All patients in Groups A and B underwent cesarean section （ 100% ） ,compared with a rate of 90% in Group C at the level of statistical difference. No cases in Groups B and C underwent hysterectomy （0%）, which was statistically different with the case in Group A （20% ,n =4）. Conclusion： Placenta previa in scarred uterine with subsequent pregnancy may have a severe impact on pregnancy outcome. Good prenatal care, timely and effective intraoperative management may improve the maternal and fetal prognosis for those with placenta previa in scarred uterus.