复发性流产患者成功妊娠后妊娠结局研究

Effect of Recurrent Spontaneous Abortion on Pregnancy Outcomes in Sequent Successful Pregnancy Patients

【目的】比较分析既往有复发性流产（RSA）病史产妇在成功妊娠后与初孕初产妇的孕期情况和妊娠结局的区别。【方法】将2010年1月至2014年9月在广州中医药大学第一附属医院产科住院分娩的98例既往有RSA病史的产妇作为病例组,按1∶1的比例随机选取同期住院分娩的98例初孕初产妇作为对照组进行病例对照研究。通过病历回顾的方法收集产妇的一般情况、孕产史、既往病史及本次妊娠结局等信息。病例组的最终有效信息采集表共91份,对照组共94份。录入数据,采用SPSS 16.0软件进行数据统计分析。【结果】单因素分析结果显示,孕产妇年龄、婚姻状况、ABO血型分布、不孕症病史、孕期是否出现先兆流产症状、安胎治疗情况、服用滋肾育胎丸安胎治疗、分娩孕周、不良妊娠结局,以及新生儿性别在两组间的差异均有统计学意义（P〈0.05）。经过Logistic回归分析,有5项因素进入回归模型,年龄（OR=1.466;95%CI=1.267~1.698）、孕期使用滋肾育胎丸安胎治疗（OR=4.484;95%CI=1.073~18.519）以及不良妊娠结局（OR=8.850;95%CI=2.994~26.316）是复发性流产的危险因素。其中,2组患者的不良妊娠结局的主要差别来源于妊娠期糖尿病的发生率。设置O型血型为参考分类,A型血型（OR=0.259;95%CI=0.088~0.765）是保护因素;新生儿性别（OR=0.336;95%CI=0.139~0.813）也是保护因素。【结论】年龄较大者以及ABO血型为O型者较A型者更容易发生RSA;有RSA史孕妇较初孕初产妇在孕期更倾向于发生先兆流产并接受滋肾育胎丸安胎治疗;孕育男性胎儿更倾向于发生RSA和先兆流产,发生不良妊娠结局的风险也明显升高,主要是妊娠期糖尿病的发病几率明显升高。

Objective To compare the difference of pregnancy outcomes between women who had a history of recurrent spontaneous abortion（ RSA） and women who were primigravida. Methods A case-control study was carried out. A total of 98 cases with a history of RSA and giving birth in the First Affiliated Hospital of Guangzhou University of Chinese Medicine from January of 2010 to September of 2014 served as the case group,while 98 primigravida giving birth at the same period in the same hospital were randomly selected as controls.The information collection form was designed following literature review before the research. All of the available data, including maternal demographic, reproductive information, medical history and present pregnancy outcomes, were collected from in-patient medical records. The number of valid information forms in case group was 91 and was 94 in control group after excluding the forms with incomplete data. The data was analyzed with SPSS 16.0 software. Results Univariate analysis results showed that maternal age, marital status, distribution of ABO blood groups, the history of infertility, clinical manifestation of threaten abortion, miscarriage treatment during pregnancy, medication of Zishen Yutai Pills for preventing miscarriage, time of delivery, adverse pregnancy outcome, and newborn sex were statistically significant different between the two groups（P〈0.05）.Logistic regression analysis results showed that there were significant differences in 5 factors between the two groups. Maternal age（ OR =1.466, 95% CI =1.267-1.698）, medication of Zishen Yutai Pills for preventing miscarriage（ OR =4.484, 95% CI =1.073-18.519）, and adverse pregnancy outcome（ OR =8.850, 95% CI =2.994-26.316） were the risk factors of RSA. Set blood type O as the classification reference, blood type A was a protective factor（OR=0.259, 95%CI =0.088-0.765）. And newborn sex was another protective factor of RSA（ OR=0.336, 95%CI =0.139-0.813）. Conclusion Older women or women with blood type O are more likely to suffer from RSA than women with blood type A. Comparing with primigravida, women who had a history of RSA are more willing to accept medication of Zishen Yutai Pills for miscarriage, and women giving birth of a boy are more likely to have RSA and thereatened abortion, having high risk of adverse pregnancy outcomes particularly for the increase of gestational diabetes incidence.