凶险型前置胎盘植入的影响因素及妊娠结局

Influence factors and pregnancy outcomes for pernicious placenta previa with placenta accreta

目的:探究凶险型前置胎盘(pernicious placenta previa,PPP)植入的影响因素和不同类型PPP的妊娠结局。方法:采用病例对照研究方法收集2013年12月至2018年2月长沙市某三级甲等综合医院收治的PPP患者410例,其中250例伴胎盘植入者为病例组,160例不伴胎盘植入者为对照组,分析两组临床资料与植入的关系,并根据前置胎盘的不同类型(中央、部分、边缘、低置)观察PPP的妊娠结局。结果:Logistic回归结果显示产次>2(OR=3.221)、剖宫产次≥2(OR=3.048)、中央性前置胎盘(OR=3.607)、胎盘位于前壁(OR=4.592)是PPP植入的独立危险因素(P<0.05);居住地为城市(OR=0.614)、孕期系统产检(OR=0.590)是其保护因素(P<0.05)。中央组产妇术中出血量、产后出血率、子宫切除率高于边缘组和低置组,转ICU率、并发症发生率高于边缘组,住院天数多于边缘组(均P’<0.008)。4组死胎率差异无统计学意义(P>0.05);中央组早产率高于边缘组和低置组,新生儿体重低于低置组,1 min Apgar评分低于其他3组,窒息率高于其他3组(P’<0.008)。结论:产次>2、剖宫产次≥2、中央性前置胎盘、胎盘位于前壁是PPP植入的独立危险因素;居住地为城市、孕期系统产检是其保护因素。中央性PPP更易导致产妇产后大出血、子宫切除,同时增加胎儿早产、低体重和窒息的风险,严重威胁母婴生命安全。

Objective:To explore the influence factors for pernicious placenta previa(PPP)with placenta accreta and pregnancy outcomes of different types of PPP.Methods:A case-control study was conducted to collect 410 PPP patients admitted to a general hospital in Changsha from December 2013 to February 2018.Two hundred and fifty cases of PPP with placenta accreta were treated as a case group,and 160 cases of PPP without placenta accreta were treated as a control group.The relationship between clinical data and placenta accreta was analyzed,and the pregnancy outcomes of PPP was observed according to different types of placenta previa.Results:Logistic regression showed that delivery times were more than 2(OR=3.221),cesarean section times were more than 2(OR=3.048),central placenta previa(OR=3.607),placental attachment site(anterior wall)(OR=4.592)were independent risk factors for PPP with placenta accrete(P<0.05).Living in cities(OR=0.614),systematic prenatal examination(OR=0.590)were protective factors(P<0.05).Average intraoperative blood loss,postpartum bleeding rate,hysterectomy rate in the central group were all higher than those in the marginal and low-set group.The incidence rates of ICU transfer,complications,and hospital stay were higher or longer than those in the marginal group(P’<0.008).There was no significant difference in stillbirth rate among the 4 groups(P>0.05).Preterm delivery rate was higher than that of the marginal and low-set group,and the birth weight was lower than that of the low-set group.Apgar score at 1 min and asphyxia rate were lower and higher than those of the other 3 groups,respectively(P’<0.008).Conclusion:Delivery times(>2),cesarean section times(≥2),central placenta previa,placenta attachment site(anterior wall)are independent risk factors for PPP with placenta accreta.Living in cities,systematic prenatal examination were protective factors.The central PPP is more likely to lead to postpartum hemorrhage,hysterectomy,and increases in the risk of preterm birth,low birth weight as well as asphyxia of fetus,which seriously threatens maternal and fetal life.