前次剖宫产术对再次妊娠影响的临床评价

Clinical Evaluation of the Effect of Previous Cesarean Section on Re-Pregnancy

目的:探讨剖宫产术后再次妊娠时妊娠期并发症的发生及不良分娩结局的情况。方法:选择2012年3月至2015年10月在成都市妇女儿童中心医院诊治的剖宫产术后再次妊娠孕妇5960例为观察组,选择同期非瘢痕子宫再次妊娠分娩经产妇6656例为对照组,回顾性分析比较两组妊娠期并发症的发生情况及分娩后母儿情况。结果:观察组前置胎盘、胎盘植入、妊娠期高血压疾病、早产、胎膜早破、胎儿生长受限的发生率均高于对照组(P<0.05),观察组重型胎盘植入(穿透型、植入型)的发生率高于对照组(P<0.05)。观察组产后输血、子宫切除、产褥感染的发生率均明显高于对照组(P<0.05),两组产后出血率及新生儿窒息率差异无统计学意义(P>0.05)。结论:剖宫产术增加了再次妊娠时妊娠期并发症及不良分娩情况的发生率,并且可能是导致重型胎盘植入的主要原因之一。严格控制首次剖宫产有助于改善母婴结局。

Objective：To investigate the incidence of pregnancy complications and adverse labor outcomes in re-pregnancy cases after previous cesarean section.Methods：The total of 5960 patients who was pregnant again with the history of cesareans section from March 2012 to October 2015 in Chengdu Women and Chlildren Center Hospital were included in the study as the observation group,while 6656 patients with the history of vaginal delivery from same period as the control group.A retrospective analysis was carried out to compare the pregnancy complications and labor outcomes among the two groups.Results：The incidence of pregnancy complications in the observation group were higher than those in the control group（P0.05）,including the rates of placenta previa,placenta implantation,pregnancy induced hypertension,premature labour,premature rupture of fetal membranes and fetal growth restriction（P0.05）.The incidence of severe placenta implantation（penetrating type and implantation type） in the observation group was higher than that in the control group（P0.05）.The incidence of postpartum transfusion,hysterectomy and puerperal infection in the observation group was significantly higher than that in the control group（P0.05）.There was no significant difference in the rate of postpartum hemorrhage and the rate of neonatal asphyxia between the two groups（P 0.05）.Conclusions：Cesarean section increases the incidence of pregnancy complications and may be one of the major causes of severe placenta implantation.Strict control of the first cesarean section rate can help improve maternal and child outcomes.