瘢痕子宫再次妊娠并发前置胎盘73例母婴结局分析

Analysis on maternal and fetal outcomes in 73 cases re-pregnant women with cesarean scar uterus complicating placenta previa

目的探讨前次剖宫产后瘢痕子宫再次妊娠并发前置胎盘的母婴围生期结局及其影响因素。方法回顾性分析2014年1月至2015年12月于重庆医科大学附属第一医院住院分娩的瘢痕子宫(前次剖宫产术后)并发前置胎盘的孕妇73例,对母体一般情况、术中情况及母婴结局等进行比较,根据是否并发凶险性前置胎盘及前次是否为择期剖宫产将73例孕妇进行分组。结果 (1)前次择期剖宫产再次妊娠时并发凶险性前置胎盘概率[40.00%(18/45)]高于阴道试产失败后剖宫产再次妊娠[28.57%(8/28)],差异有统计学意义(P<0.01)。(2)并发凶险性前置胎盘的孕妇胎盘植入、产后出血、子宫切除、弥散性血管内凝血、输血及新生儿不良结局发生率显著高于非凶险性前置胎盘孕妇,差异均有统计学意义(P<0.05)。结论瘢痕子宫再次妊娠易并发前置胎盘;前次择期剖宫产的孕妇再次妊娠时并发凶险性前置胎盘及母婴不良结局的发生率升高;严格掌握首次剖宫产指征是降低再次妊娠时母婴不良结局的关键。

Objective To explore the maternal and fetal perioperative outcomes of re-pregnant women with cesarean scar uterus complicating placenta previa and its influential factors. Methods Seventy-three cases of cesarean scar uterus complicating placenta previa delivered in the First Affiliated Hospital of Chongqing Medical University from January 2014 to December2015 were retrospectively analyzed. The maternal general condition,intraoperative situation as well as maternal and fetal outcome were compared. Seventy-three pregnant women were grouped according to whether complicating dangerous placenta previa occur-rence and whether previous pregnancy being elective cesarean section. Results（1）The probability of complicating dangerous placenta previa in re-pregnancy women with previous elective cesarean section was higher than that in re-preganat women with cesarean section after vaginal trial labor failure,the difference was statistically significant[40.00%（18/45） vs. 28.57%（8/28）,P〈0.01].（2）The occurrence rates of placenta implantation,postpartum hemorrhage,hysterectomy,DIC,blood transfusion and poor neonatal outcomes in the pregnant women with complicating dangerous placenta previa were significantly higher than those in the preg-nant women with non-dangerous placenta previa,the difference was statistically significant（P〈0.05）. Conclusion Re-pregnant women with cesarean scar uterus are easier to develop placenta previa;re-pregnancy women with previous elective cesarean section have the high occurrence rates of complicating dangerous placenta previa and poor maternal and neonatal outcomes;strictly mastering the indication of first cesarean section is the key to reduce the poor maternal and neonatal outcomes of re-pregnancy.