影响瘢痕子宫意外妊娠药物流产结局的相关因素分析

Analysis of Related Factors Affecting the Outcome of Drug Abortion in Pregnant Women with Scar Uterus

目的分析影响瘢痕子宫意外妊娠药物流产结局的相关因素。方法选取2017年1月至2018年12月因意外妊娠在我院行药物流产的118例剖宫产患者,根据流产结局分成流产不全组(观察组)与流产完全组(对照组),其中观察组46例,对照组72例,比较两组年龄、孕次、产次、停经时间、孕囊大小、孕囊与瘢痕距离、本孕距离剖宫产后的时间、剖宫产后至本孕间的妊娠次数等指标的差异,分析影响药物流产结局的相关因素。结果观察组年龄(34.17±5.47)岁、停经时间(44.37±5.99)d、孕囊大小(0.92±0.30)cm与对照组[(34.56±5.61)岁;(44.96±6.47)d;(1.04±0.39)cm]比较无差异(P>0.05),观察组多次妊娠率(56.52%)、多次分娩率(19.57%)显著高于对照组(22.22%;18.06%)(P<0.05);观察组孕囊与瘢痕距离(16.57±4.74)mm显著低于对照组(19.44±4.44)mm(P<0.05),虽然观察组本孕距离剖宫产后的时间(23.13±8.22)个月低于对照组(24.92±9.08)个月,但无统计学差异(P>0.05),观察组剖宫产后至本孕间的平均妊娠次数(0.72±0.74)次显著高于对照组(0.33±0.99)次(P<0.05)。相关分析表明,多次妊娠率、多次分娩率、孕囊与瘢痕距离、剖宫产后至本孕间的妊娠次数与药物流产结局密切相关(r1=-0.199,P1=0.030;r2=-0.205,P2=0.026;r3=0.304,P4=0.001;r4=-0.255,P4=0.005),年龄、停经时间、孕囊大小、本孕距离剖宫产后的时间与流产结局无关(r5=0.035,P5=0.707;r6=0.046,P6=0.621;r7=0.165,P7=0.075;r8=0.099,P8=0.286)。结论剖宫产后的瘢痕子宫妇女应该尽量避免意外妊娠,加强安全性知识、在完成生育意愿的要求后切实落实长效避孕节育措施,或采取有效的安全避孕措施以及紧急避孕方式等等,尽量减少剖宫产后再次发生妊娠的次数,以尽最大限度减少意外妊娠所带来的不必要的二次伤害。

Objective To analyze the factors related to the outcome of drug abortion in pregnancy with scar uterus.Methods 118 cases of cesarean section who underwent drug abortion due to accidental pregnancy in our hospital from January 2017 to December 2018 were selected.According to the outcome of abortion,they were divided into two groups:incomplete abortion group(observation group)and complete abortion group(control group).There were 46 cases in observation group and 72 cases in control group.The differences of age,pregnancy times,parity,menopause time,gestational sac size,gestational sac and scar distance,the duration of pregnancy after cesarean section and the number of pregnancies between cesarean section and this pregnancy between the two groups were compared.The related factors that affect the outcome of drug abortion was analyzed.Results There was no difference in age,menopause time and gestational sac size between the observation group and the control group(P>0.05),but the multiple pregnancy rate(56.52%)and multiple delivery rate(19.57%)in observation group were signifi cantly higher than those in control group(22.22%;18.06%)(P<0.05),and the distance between the gestational sac and scar(16.57±4.74)mm was significantly lower in the observation group than in the control group(19.44±4.44)mm(P<0.05).Although the time between cesarean section and pregnancy in the observation group(23.13±8.22)months was lower than that in the control group(24.92±9.08)months,but there was no statistical difference(P>0.05).The average number of pregnancies between cesarean section and pregnancy in the observation group(0.72±0.74)time was signifi cantly higher than that in the control group(0.33±0.99)time(P<0.05).Relevant analysis showed that multiple pregnancy rate,multiple delivery rate,distance between gestational sac and scar,number of pregnancies between cesarean section and this pregnancy were closely related to the outcome of drug abortion(r1=-0.199,P1=0.030;r2=-0.205,P2=0.026;r3=0.304,P4=0.001;r4=-0.255,P4=0.005),but the age,duration of menopause,size of gestational sac,distance of pregnancy from cesarean section were not related to the outcome of abortion(r5=0.035,P5=0.707;r6=0.046,P6=0.621;r7=0.165,P7=0.075;r8=0.099,P8=0.286).Conclusion Women with scarred uterus after cesarean section should avoid accidental pregnancy as far as possible,strengthen safety knowledge,implement long-term contraceptive measures after fulfilling the requirement of fertility will,or take effective safe contraceptive measures and emergency contraceptive methods,etc.,so as to minimize the number of pregnancies occurring again after cesarean section,so as to maximize the number of pregnancies and tolimit the unnecessary secondary injury caused by unexpected pregnancy.