二次剖宫产术后并发症发生情况及影响因素分析

The complications of cesarean delivery again of pregnant woman with scar uterus and its influent factors

目的:分析瘢痕子宫产妇二次妊娠行剖宫产后并发症发生的影响因素。方法:回顾性分析本院2015年2月—2018年2月收治的瘢痕子宫二次妊娠行剖宫产产妇286例临床资料,统计产妇并发症发生情况,并根据是否出现并发症进行分组,将出现并发症产妇纳入观察组,未出现并发症产妇纳入对照组,比较两组产妇一般资料,采用logistic多因素回归分析产妇术后并发症的危险因素。结果:286例产妇再次行剖宫产术后并发症发生率为62.2%(178例),其中合并盆腹腔黏连88例(49.4%),产后出血56例(31.5%),子宫破裂或先兆子宫破裂13例(7.3%),前置胎盘12例(6.7%),子宫切除9例(5.1%)。单因素分析发现,首次剖宫产切口方式、确诊瘢痕子宫病程、有无盆腔炎病史和产前出血量与剖宫产术后并发症的发生有关(P<0.05);剖宫产切口方式为横切口、本次剖宫产原因为先兆子宫破裂、确诊瘢痕子宫病程<2年、有盆腔炎病史和产前出血量≥240ml为瘢痕子宫二次妊娠剖宫产术后并发症的危险因素。结论:瘢痕子宫二次妊娠剖宫产术后并发症发生率高,首次妊娠鼓励孕妇进行阴道试产、产妇首次剖宫产尽量避免采用横切口术式、积极预防产前出血,对降低二次妊娠术后并发症发生具有积极意义。

Objective： To investigate influent factors on complications of pregnant woman with scar uterus after cesarean section again. Methods： A retrospectively study was conducted for analyze data of 286 women who had experienced cesarean section again in Deqing county maternal and child health care and family planning service center of Zhejiang province from February 2015 to February 2018. 286 women were divided into observation group （178 women with postoperative complications） and control group （108 women without postoperative complications） according to whether had postoperative complications. The demographic data were compared between the two groups. And Logistic multiva- riate regression was used to analyze the risk factors of postpartum complications. Results： The incidence of postoperative complications after cesarean section again was 62.20/oo in 286 women, which included 88 cases （49.4%） with intra - abdominal adhesions, 56 cases （31.5 % ） with postpartum hemorrhage, and 13 cases （7.3%） with ruptured uterus or precursory uterine rupture, 12 cases （6.7 %） with placenta previa, and 9 cases （5.10%） with hysterectomy. Univariate analysis found that the first cesarean section incision method, time of scar uterine, history of pelvic inflammatory disease, and prenatal hemorrhage were related to postpartum complications of cesarean section again（P〈0.05）. Multivariate analysis found that the cesarean section with transverse incision, time of scar uterine less than 2 years, a history of pelvic inflammatory disease, and prenatal hemorrhage ≥240 mL were the risk factors of complications after cesarean section again. Conclusion.. The incidence of complications after cesarean section again is high. In order to reduce the incidence of postoperative complications, the first pregnant women should be encouraged to perform vaginal trials, uterus transversal incisions should be avoided when the first cesarean section, and antepartum hemorrhage should be prevented actively.