瘢痕子宫二次妊娠剖宫产术后并发症发生情况研究

Study on the incidence of complications after cesarean section in two cases of scarred uterus

目的:观察瘢痕子宫二次妊娠剖宫产术后并发症发生情况,分析发生并发症的影响因素,为提高瘢痕子宫二次妊娠患者临床治疗提供参考,降低生产时的并发症率,提高此类孕妇生育安全。方法:回顾性分析2014年2月至2016年2月我院手术的82例瘢痕子宫二次妊娠剖宫产产妇的临床资料,统计患者出现并发症的情况,按照是否出现并发症将患者分为并发症组(50例)和非并发症组(32例),比较两组患者个体指标及医疗相关指标,分析影响瘢痕子宫二次妊娠剖宫产并发症发生的相关因素和危险因素,探讨预防对策。结果:82例瘢痕子宫二次妊娠剖宫产患者共50例术后出现并发症,并发症率60.98%,并发症以出血为主共22例,其次为盆腹腔粘连15例、子宫破裂8例、前置胎盘5例。经影响因素单因素分析,产前出血量、首次剖宫产指征、再次妊娠距离首次剖宫产时间、首次剖宫产切口方式、本次剖宫产原因(先兆子宫破裂、胎儿宫内窘迫、产程停滞、宫缩乏力、患者自行选择)为瘢痕子宫二次妊娠剖宫产术后并发症的相关因素。经Logistic多因素分析,首次剖宫产指征、再次妊娠距离首次剖宫产时间<24个月、产前出血量>240mL、首次剖宫产横切口、本次因先兆子宫破裂为危险因素。结论:瘢痕子宫二次妊娠剖宫产并发症率高,并发症对母婴安全不利,合理选择首次妊娠处理方式、二次妊娠后适当运动、合理饮食提高自然产率,提高母婴安全。

Objectives： To observe the incidence of complications after cesarean section in patients with scarred uterus,and analyze the influencing factors of complications,so as to improve the uterine scar pregnancy clinical treatment of patients with scarred uterusscarred uterus,reduce the incidence rate of complications and improve the safety of pregnant women. Methods： A retrospective analysis on 82 patients with uterine scar pregnancy in our hospital from February 2014 to February 2016 was done. According to the complication incidence,the patients were divided into complication group（ 50 cases） and non-complication group（ 32 cases）. The individual and medical indicators of two groups were compared and related factors of cesarean section complications were analyzed.Results： Among the 82 patients,there were 50 cases with postoperative complications,and the complications incidence was 60. 98%. The main complications included 22 cases of hemorrhage,15 cases of pelvic cavity adhesion,8 cases of uterine rupture and 5 cases of placenta. By the single factor analysis of influencing factors,prenatal bleeding,the indication offirsttime of cesarean section,time betweenthe two timesof cesarean section,the incision type of the first time cesarean section and the reasons for cesarean section（ threatened rupture of uterus,fetal distress,birth process stagnation,uterine atony,patient self-selection） are related factors ofthe incidence of complications after cesarean section in patients with scarred uterus. By the Logistic analysis,the indication of first time of cesarean section,the time interval between two times of cesarean section（ T 〈24 months）,the amount of antenatal bleeding（〉 240 mL）,the transverse incision at the first time cesarean section and impending of rupture of uterus were risk factors. Conclusion： The uterine scar pregnancy has high postoperative complications rate,which impacts the safety of maternal and child. Reasonable selection of the first pregnancy treatment,exercise during second timegestation and natural diet can improve maternal and child safety.