瘢痕子宫再次妊娠并发前置胎盘的临床特点及预后分析

Clinical Features and Prognosis of Scar Uterus Re-pregnancy Complicated with Placenta Previa

【目的】分析瘢痕子宫再次妊娠并发前置胎盘的临床特点及母婴结局，探讨其干预措施。【方法】以本院2015年3月至2017年3月收治的174例前置胎盘产妇为研究对象，对其临床资料进行回顾性分析。按照产妇是否存在瘢痕子宫，将其分别纳入瘢痕子宫组（观察组，n=81）及非瘢痕子宫组（对照组，n=93），比较两组产妇临床特点及母婴结局，分析瘢痕子宫再次妊娠并发前置胎盘对母婴预后的影响。【结果】两组产妇年龄、入院孕周、前置胎盘类型、前置胎盘位置等一般临床资料比较，差异无统计学意义（P〉0．05），观察组孕次高于对照组，差异有统计学意义（P〈0．05）；两组产妇术前无痛性阴道出血发生率、平均产前阴道出血量比较，差异无统计学意义（P〉0．05）。两组产妇均经剖宫产终止妊娠。观察组手术时间、产后出血量高于对照组，其术中输血率、宫腔填塞纱布率、胎盘附着面缝扎率、胎盘植入率、背包缝合率及子宫切除率亦高于对照组，差异有统计学意义（P〈0．05）；观察组新生儿早产率、窒息率、死亡率略高于对照组，但组间比较差异无统计学意义（P〉0．05）。【结论】瘢痕子宫再次妊娠并发前置胎盘的临床特点与单纯前置胎盘类似，但对产妇结局的影响较单纯前置胎盘更为严重，应注重积极主动地对其干预，确保母婴安全。

[Objective]To analyze the clinical features, mother and infant outcomes of scar uterus re-pregnancy complicated with placenta previa, and to explore the intervention measures. [Methods] A total of 174 cases with placenta previa treated in our hospital from March 2015 to March 2017 were analyzed retrospectively. According to the existence of maternal uterine scar, the patients were included in the uterine scar group （study group, n = 81） and non scar uterus group （control group, n ：93）. The clinical characteristics and maternal outcome, the impact of uterine scar pregnancy complicated with placenta previa on maternal and neonatal outcomes in each group were analyzed. [Results] There was no significant difference between the two groups in the general clinical data such as the age of the pregnant women, the gestational age of admission, the type of placenta previa and the location of placenta previa （ P〈0.05）. The pregnancy rate of observation group was higher than that of control group, the difference was statistically significant （ P〈0.05）. The incidence of painless vaginal bleeding and the average a- mount of vaginal bleeding before operation in two groups were not statistically significant （ P〈0.05）. Two groups of pregnant women were terminated by caesarean section. The operation time and the amount of postpartum hem- orrhage in the observation group were higher than those in the control group. The rate of intraoperative blood transfusion, the rate of intrauterine gauze filling, the rate of placental attachment, the rate of placenta accreta, the rate of suture and the rate of hysterectomy were also higher than those of the control group, the difference was statistically significant （ P〈0.05） ; Premature birth rate of newborn, asphyxia rate and mortality rate of the observation group were slightly higher than that of the control group, but there was no significant difference between the two groups （ P〈0.05）.[Conclusion]The clinical features of scarred uterus secondary to placenta previa are similar to those of simple placenta previa, but its effect on the outcome of the maternal is more severe than that of the simple placenta previa. Therefore, attention should be payed to active intervention to ensure the safety of mother and baby.