胎盘植入严重不良妊娠结局相关危险因素分析

Analysis of related factors of severe adverse maternal outcomes in placenta accreta

目的探讨胎盘植入孕产妇发生严重不良妊娠结局的相关危险因素。方法回顾性分析广州医科大学附属第三医院2009年1月至2015年6月651例胎盘植入患者的临床资料。结果胎盘植入孕产妇严重不良妊娠结局的发生率为39.6%（258/651）。单因素分析显示,年龄、孕次、产次、流产次数、剖宫产次数、产前阴道出血次数、终止妊娠孕周、胎盘植入类型、未规律产前检查、合并内科疾病和合并前置胎盘是胎盘植入孕产妇发生严重不良妊娠结局的相关危险因素（P〈0.05）;多因素logistic回归分析显示,剖宫产次数（OR=2.248,95%CI：1.590~3.177,P=0.000）、合并内科疾病（OR=1.604,95%CI：1.080~2.384,P=0.019）和合并前置胎盘（OR=1.877,95%CI：1.204~2.925,P=0.005）是胎盘植入孕产妇发生严重不良妊娠结局的独立危险因素。结论胎盘植入孕产妇发生严重不良妊娠结局的独立危险因素为剖宫产次数、合并内科疾病及前置胎盘。

Objective To investigate the risk factors of serious adverse maternal outcomes in pregnant women with placenta accrete. Methods Retrospectively study data of 651 patients with placenta accreta in the third Affiliated Hospital of Guangzhou Medical University from January 2009 to June 2015. Result The occurrence rate of serious maternal adverse outcome was 39.63% （258/651） for women with placenta accreta. Univariate analysis showed that age, gravidity, parity, abortion, number of cesarean section, prenatal vaginal bleeding times, gestational age of termination of pregnancy, type of placenta accreta, irregular prenatal examination, complicated with medical diseases and placenta previa were related risk factors to serious maternal adverse outcome （P 〈 0.05）. Multivariate logistic regression analysis showed that number of cesarean section （OR= 2.248,95% CI：1,590-3.177 p=0.000）, complicated with medical disease （OR=1.604,95% CI：1.080-2.384/x=0.019） and placenta previa （OR= 1.877,95% CI： 1.204-2.925 ,P=0.005） were independent risk factors for serious maternal adverse outcome （P 〈 0.05）. Conclusion The independent risk factors of serious adverse maternal outcome of placenta accreta in pregnant women is the number of cesarean section, complicated with medical disease and placenta placenta.