中期妊娠胎盘前置状态引产剖宫产分娩影响因素分析

An analysis of the influencing factors of cesarean section among the women with induced labor in placenta previa state during the second trimester pregnancy

目的探讨中期妊娠胎盘前置状态引产分娩方式的相关影响因素。方法回顾性分析我院2012~2018年中期妊娠胎盘前置状态合并死胎或胎儿畸形的引产病例共51例,按分娩方式将其分为阴道分娩组和剖宫产组,比较两组间年龄、剖宫产史、孕次、产次、分娩孕周、胎盘覆盖宫颈内口范围、伴发胎盘植入、羊水量的差异。将单因素分析中具有统计学意义的变量(既往剖宫产史、胎盘覆盖宫颈内口范围、伴发胎盘植入)为自变量,拟合多因素Logistic回归方程,探讨胎盘前置状态引产剖宫产分娩的相关危险因素。结果(1)阴道分娩组和剖宫产组比较,两组间既往剖宫产史、胎盘覆盖宫颈内口范围、伴发胎盘植入之间比较,差异均有统计学意义。(2)多因素Logistic回归分析显示,既往剖宫产史、伴发胎盘植入是剖宫产分娩的危险因素。与未植入比较,胎盘植入者剖宫产的危险度是其13.333倍;既往有剖宫产史者本次剖宫产的危险度是无剖宫产史者的8.727倍。结论胎盘前置状态中期妊娠引产,合并既往剖宫产史及胎盘植入者,其剖宫产分娩的危险度增加。

Objective To explore the related influencing factors of delivery mode among the women with induced labor in placenta previa state during the second trimester pregnancy.Methods From 2012 to 2018,a total of 51 cases of induced labor in placenta previa state during the second trimester pregnancy complicated with fetal death or fetal malformation in our hospital were analyzed retrospectively.They were divided into the vaginal delivery group and the cesarean section group according to the delivery mode.The differences between the two groups were compared in terms of age,the history of cesarean section,gravidity,parity,delivery pregnancy week,placenta coverage area at the cervix internal ora,associated placenta increta and amniotic fluid volume.The variables with statistical significance in univariate analysis(previous history of cesarean section,placenta coverage area at the cervix internal ora and associated placenta increta)were taken as independent variables,and they were combined with multivariate logistic regression equation for a probe into the related risk factors of cesarean section among the women with induced labor in placenta previa state.Results(1)The differences between the vaginal delivery group and the cesarean section group in the previous history of cesarean section,placenta coverage area at the cervix internal ora and associated placenta increta were all statistically significant.(2)Multivariate logistic regression analysis suggested that the previous history of cesarean section and associated placenta increta were the risk factors of cesarean section.Compared with the case of no placenta increta,the risk of cesarean section in those with placenta increta was 13.333 times;the risk of the cesarean section among the patients with previous history of cesarean section was 8.727 times that among the patients without previous history of cesarean section.Conclusion The risk of cesarean section is increased in the case of induced labor during the second trimester of placenta previa combined with previous history of cesarean section and placenta increta.