妊娠合并子宫腺肌病孕妇的围产结局分析

Perinatal outcome of pregnant women with adenomyosis

目的分析妊娠合并子宫腺肌病对围产结局的影响。方法选择2014年4月至2019年4月北京大学第三医院单胎妊娠合并子宫腺肌病分娩孕妇257例(子宫腺肌病组),另选择同期单胎妊娠非子宫腺肌病分娩孕妇257例作为对照组,回顾性对比分析两组孕妇的一般情况及围产期母儿结局。结果子宫腺肌病组孕妇的年龄与对照组比较无显著差异,中位数分别为35、34岁(P>0.05);体质指数明显高于对照组,中位数分别为23.9、21.8 kg/m^2(P<0.01);辅助生殖技术受孕的比例明显明显高于对照组[分别为25.3%(64/253)、3.1%(8/257),P<0.01]。子宫腺肌病组的分娩孕周明显早于对照组,中位数分别为38.0、39.2周(P<0.01);早产发生率[分别为17.1%(44/257)、4.7%(12/257),P<0.01]、子痫前期发生率[分别为13.7%(35/255)、5.8%(15/257),P=0.003]分别比较均有差异。子宫腺肌病组产后出血多,尤其是严重产后出血发生率明显高于对照组[分别为5.8%(14/241)、1.2%(3/257),P=0.004]。子宫腺肌病组剖宫产率明显高于对照组[分别为57.0%(146/256)、31.5%(81/257),P<0.01]。子宫腺肌病组新生儿出生体重明显低于对照组,中位数分别为3140、3440 g(P<0.01);小于胎龄儿(SGA)发生率明显高于对照组[分别为21.5%(55/256)、4.7%(12/257),P<0.01]。子宫腺肌病组与对照组相比,新生儿脐动脉血pH值和1分钟Apgar评分均无显著差异(P均>0.05)。结论妊娠合并子宫腺肌病患者生育力低,多需借助辅助生殖技术受孕。妊娠合并子宫腺肌病孕妇早产、子痫前期、产后出血、剖宫产率高,新生儿出生体重低,SGA发生率高。妊娠合并子宫腺肌病可明显增加母儿不良围产结局的发生。

Objective To analyze the effect of pregnancy with adenomyosis on perinatal outcome.Methods From April 2014 to April 2019,singleton pregnant women complicated with adenomyosis in Peking University Third Hospital was selected and the perinatal outcomes were analyzed retrospectively.Results The age of patients in the pregnancy with adenomyosis group(study group)was not different from that of the control group(median:35 vs 34 years old,P>0.05);the body mass index was higher than that of the control group(median:23.9 vs 21.8 kg/m^2,P<0.01);the rate of assisted reproductive technology was significantly higher than that of the control group[25.3%(64/253)vs 3.1%(8/257),P<0.01].Compared with the control group,the gestational age at delivery was significantly lower in the study group(median:38.0 vs 39.2 weeks,P<0.01);the rates of preterm birth[17.1%(44/257)vs 4.7%(12/257),P<0.01]and preeclampsia[13.7%(35/255)vs 5.8%(15/257),P=0.003]were significantly higher in the study group.The incidence of severe postpartum hemorrhage in the study group was significantly higher than that in the control group[5.8%(14/241)vs 1.2%(3/257),P=0.004].The incidence of cesarean section was higher in the study group[(57.0%(146/256)vs 31.5%(81/257),P<0.01].Neonatal weight was lower in the study group than that in the control group(median:3140 vs 3440 g,P<0.01);the incidence of small for gestational age(SGA)was higher in the study group[21.5%(55/256)vs 4.7%(12/257),P<0.01].There were no significant differences in umbilical artery pH and 1-minute Apgar score between the study group and the control group(all P>0.05).Conclusions Pregnant women complicated with adenomyosis has low fertility,and most of them need assisted reproductive technology to conceive.The pregnant women with adenomyosis has the poor perinatal outcome,including an increased incedence of preterm birth,preeclampsia,postpartum hemorrhage,cesarean section and SGA,and low newborn weight.