孕妇年龄与剖宫产术后瘢痕子宫再次妊娠及妊娠结局的关系

The relationship between the age of pregnant women and the pregnancy outcome of the second pregnancy in the pregnant women with scar uterus due to cesarean section

目的探讨剖宫产术后瘢痕子宫孕妇再次妊娠时孕妇年龄与剖宫产发生妊娠并发症以及与妊娠结局的关系。方法通过对2015年12月1日至2018年10月31日分娩所有瘢痕子宫再次妊娠的剖宫产的孕妇作为研究对象,按照年龄将其划分为3组,即Ⅰ组:26~30岁组798例;Ⅱ组:31~35岁组958例;Ⅲ组:>35岁组669例。统计3组孕妇的妊娠合并症以及并发症的发生率和妊娠结局,分别以是否有研究因素为应变量(无=0,有=1),以年龄因素为自变量(26~30岁为1,31~35岁为2,>35岁为3),做Logistic回归分析孕妇年龄做为单一因素,其与瘢痕子宫再次妊娠时妊娠期的合并症、并发症以及妊娠结局等的相关性。结果剖宫产术后瘢痕子宫再次妊娠的剖宫孕妇中,其本次辅助生殖助孕妊娠、不良孕产史、妊娠合并子宫肌瘤、妊娠合并慢性高血压、妊娠合并贫血、妊娠合并糖尿病、妊娠期糖尿病、子痫前期、产后出血、分娩巨大新生儿、新生儿低体重儿、早产新生儿的发病率中年龄是其发病的高危因素;而在妊娠合并心脏病、妊娠合并甲状腺功能异常前置胎盘、胎盘植入、羊水过少、胎膜早破、足月小样儿以及死胎时年龄并非高危因素。结论对于剖宫产术后瘢痕子宫再次及妊娠至足月的孕妇要针对高龄育龄女性妊娠时加强围生期检查及保健工作,加强孕期监管,进行干预,预防并发症、治疗合并症,适时终止妊娠,根据个体情况选择最佳的分娩方式,保障母婴健康。

Objective To investgate the correlation between the age of pregnant women and the pregnancy outcome as well as pregnancy complications of the second pregnancy in the pregnant women with scar uterus due to cesarean section.Methods The pregnant women with scar uterus due to cesarean section who were treated from December 1,2015 to October 31,2018 were enrolled as research objects.The pregnant women were divided into three groups according to their age:groupⅠ(n=798)in 26~30 years;groupⅡ(n=958)in 31~35 years;groupⅢ(n=669)in 35 years.The p regnancy complications,the incidence rate of complications and pregnancy outcomes were observed and compared among the three groups.Logistic regression analysis was used to analyze the the correlation between the age of pregnant women and complications as well as pregnancy outcome.Results Among the pregnancy women with the second pregnancy with scar uterus due to cesarean section,the age of pregnant women was the high risk factor in incidence of assisted reproductive pregnancy,adverse pregnancy and delivery history,pregnancy with uterine fibroids,pregnancy with chronic hypertension,pregnancy with anemia,pregnancy with diabetes mellitus,gestational diabetes mellitus,preeclampsia,postpartum hemorrhage,gigantic neonates,low birth weight neonates and premature neonates,however,the age of pregnant women was not the high risk factor in incidence of gestation heart disease,pregnancy with thyroid dysfunction,placenta previa,placenta implantation,oligohydramnios,premature rupture of membranes,full-term infants and stillbirth age.Conclusion For pregnant women with scarred uterus after cesarean section and re-pregnancy to full term,it is necessary to strengthen perinatal examination and health care,strengthen supervision during pregnancy,intervene and prevent complications,treat complications,terminate pregnancy in time,select the best delivery mode according to individual conditions so as to ensure maternal and infant health.