剖宫产后瘢痕子宫患者再次妊娠并发前置胎盘对围生期母儿结局的影响研究

Study on the effect of placenta previa among the patients with cesarean scar pregnancy on maternal and infantile outcomes during perinatal period

目的通过病例对照研究,分析剖宫产后瘢痕子宫患者再次妊娠并发前置胎盘对围生期母儿结局的影响。方法以2014年6月-2016年6月住院分娩的剖宫产后瘢痕子宫并发前置胎盘的131例孕妇为研究对象,根据前次剖宫产原因将孕妇分为两组:前次为择期剖宫产的102例孕妇为A组,并依据前置胎盘程度,将本组凶险型前置胎盘设为A组凶险亚组,将本组非凶险型前置胎盘设为A组非凶险亚组;前次为阴道试产失败转剖宫产的29例孕妇设为B组,将本组凶险型前置胎盘设为B组凶险亚组,将本组非凶险型前置胎盘设为B组非凶险亚组。比较各组孕妇的一般情况、术中及术后并发症发生率、母儿结局。结果 A组发生凶险型前置胎盘46例,发生非凶险型前置胎盘56例;B组发生凶险型前置胎盘5例,发生非凶险型前置胎盘24例。两组凶险型前置胎盘发生率比较,差异有统计学意义(P<0.05)。两组孕妇的年龄、平均孕次、妊娠天数、高龄比例、产前出血发生率、宫腔手术≥3次比例比较,差异均无统计学意义(均P>0.05)。A组凶险亚组孕妇的妊娠天数显著低于A组非凶险亚组,而年龄、平均孕次、产前出血发生率、宫腔手术≥3次比例显著高于A组非凶险亚组,差异均有统计学意义(P<0.05)。B组两亚组上述指标比较差异均无统计学意义(P>0.05)。结论前次择期剖宫产后再次妊娠并发凶险型前置胎盘的风险显著高于前次阴道试产失败的剖宫产孕妇,而且母儿不良结局发生率较高。

Objective To analyze the effect of placenta previa among the patients with cesarean scar pregnancy on maternal and infantile outcomes during perinatal period based on a case-control study.Methods A total of 131 hospitalized pregnant women with cesarean scar pregnancy complicated with placenta previa from June 2014 to June 2016 were selected as study objects,then they were divided into group A（including 102 pregnant women with selective cesarean section history） and group B（including 29 pregnant women with previous cesarean section history due to failure of vaginal trial production） according to the causes of previous cesarean section.The pregnant women in group A were divided into pernicious placenta previa subgroup A and non-pernicious placenta previa subgroup A;the pregnant women in group B were divided into pernicious placenta previa subgroup B and non-pernicious placenta previa subgroup B.The general situation,the incidence rates of intraoperative and postoperative complications,maternal and infantile outcomes in different groups were compared.Results In group A,46 pregnant women were diagnosed as pernicious placenta previa;in group B,5 pregnant women were diagnosed as pernicious placenta previa.There was statistically significant difference in the incidence rate of pernicious placenta previa between the two groups（P 0.05）.There was no statistically significant difference in age,mean gravidity,days of pregnancy,the proportion of advanced age pregnant woman,the incidence rate of postpartum hemorrhage,the times of intrauterine operation≥3 between the two groups（all P〈 0.05）.The days of pregnancy in pernicious placenta previa subgroup A was statistically significantly lower than that in non-pernicious placenta previa subgroup A（P〈 0.05）;age,mean gravidity,the incidence rate of postpartum hemorrhage,the times of intrauterine operation≥3 in pernicious placenta previa subgroup A were statistically significantly higher than those in non-pernicious placenta previa subgroup A（P〈 0.05）.There was no statistically significant difference in the above-mentioned indexes between pernicious placenta previa subgroup B and non-pernicious placenta previa subgroup B（P〈 0.05）.Conclusion The risk of placenta previa among the patients with cesarean scar pregnancy is significantly higher than that among the patients with previous cesarean section history due to failure of vaginal trial production,the incidence rates of maternal and infantile adverse reactions are relatively high.