复发性剖宫产瘢痕妊娠发病危险因素分析

Analysis of Risk Factors of Recurrent Cesarean Scar Pregnancy

目的:探讨复发性剖宫产瘢痕妊娠(RCSP)发病的危险因素。方法:选择2012年1月至2018年12月就诊于陆军军医大学第二附属医院的剖宫产瘢痕妊娠(CSP)患者病历资料,电话回访患者治疗后再次妊娠情况。根据再次妊娠结局分为正常宫内妊娠组(132例)和RCSP组(46例)。比较两组患者临床和超声影像学特点,分析复发性剖宫产瘢痕妊娠发病的危险因素。结果:两组患者在流产次数(P=0.011)、前次CSP妊娠孕龄(P=0.020)、前次CSP子宫下段剩余肌层厚度(P=0.018)、前次CSP孕囊周围血流分级(P=0.033)、前次CSP治疗方式(P=0.040)之间差异有统计学意义;Logistic回归分析显示:流产≥4次(相较于无流产者OR 13.884,P=0.020,95%CI 1.511~127.593),前次CSP妊娠孕龄>56天(相较于孕龄<42天者OR 5.482,P=0.005,95%CI 1.613~18.625)是RCSP发病的危险因素。结论:RCSP的发生受患者流产次数及前次CSP妊娠孕龄影响,流产次数多、前次CSP妊娠孕龄大的患者再次妊娠患RCSP的风险增加。CSP一经发现应尽早终止妊娠,对于有CSP史和多次流产史的女性,再次妊娠应警惕RCSP的发生。

Objective:To investigate the risk factors of recurrent cesarean scar pregnancy(RCSP).Methods:The clinical records were retrospectively reviewed from patients who were diagnosed with cesarean scar pregnancy(CSP)in the Second Affiliated Hospital of Army Medical University of China,between January 2012 and December 2018,and the following pregnant information after treatment was followed-up by telephone.The patients were divided into normal intrauterine pregnancy group(132 cases)and RCSP(46 cases)group according to the reproductive outcome.The clinical and ultrasonographiccharacteristics of the two groups were compared to analyze the risk factors of recurrent caesarean scar pregnancy.Results:There were statistically significant differences between the two groups in the number of abortions(P=0.011),gestational age of previous CSP(P=0.020),residual myometrial thickness in the lower segment of uterus(P=0.018),grading of color Doppler signal around the gestational sac(P=0.033),and treatment methods(P=0.040)in previous CSP.Logistic regression analysis showed that 4 or more times of abortions(compared to patients without abortion,OR=13.884,P=0.020,95% confidence interval 1.511-127.593)and gestational age of previous CSP more than 56 days(compared to gestational age less than 42 days,OR=5.482,P=0.005,95% confidence interval 1.613-18.625)were the risk factors for RCSP.Conclusions:The occurrence of RCSP is affected by the number of abortion and the gestational age of previous CSP.Patients with more times of abortions and older gestational age from previous CSP have an increased risk of RCSP.Therefore,CSP should be treated as soon as possible.Meanwhile,for women with a history of CSP and multiple abortions,the occurrence of RCSP should be on the alert.