妊娠合并子宫肌瘤对妊娠期并发症及剖宫产相关指标的影响

Effects of Uterine Fibroids on Pregnancy Complications and Cesarean Section

目的:分析妊娠合并子宫肌瘤的不同临床特征对妊娠期并发症及剖宫产指标的影响。方法:选取2016年1月-2018年10月我院产科住院分娩的妊娠合并子宫肌瘤孕妇277例为子宫肌瘤组,无子宫肌瘤孕妇200例作为对照组,回顾性分析孕期并发症的发生情况、子宫肌瘤的临床特征、剖宫产手术方式、剖宫产相关指标。结果:子宫肌瘤组孕妇胎位异常、先兆早产或早产的发生率明显高于对照组(P<0.05),两组胎膜早破、胎盘异常及产后出血的发生率无统计学差异(P>0.05);子宫肌瘤直径<5cm胎位异常、胎膜早破、先兆早产或早产发生率明显低于直径≥5cm(P<0.05),单个子宫肌瘤胎位异常、先兆早产或早产、产后出血发生率明显低于多个子宫肌瘤(P<0.05),肌壁间肌瘤胎位异常发生率明显高于浆膜下肌瘤、阔韧带肌瘤、黏膜下肌瘤、混合型肌瘤(P<0.05);剖宫产+子宫肌瘤剔除术组手术时间及术后缩宫素用量明显高于子宫肌瘤单纯剖宫产及对照组剖宫产(P<0.05),三组间术中出血量无统计学差异(P>0.05);子宫肌瘤直径<5cm、单个子宫肌瘤术中出血量及术后缩宫素使用量明显小于直径≥5cm、多个子宫肌瘤(P<0.05),肌壁间肌瘤术后缩宫素使用量明显大于浆膜下肌瘤、阔韧带肌瘤、黏膜下肌瘤及混合型肌瘤(P<0.05),子宫肌瘤不同临床特征间手术时间无统计学差异(P>0.05)。结论:妊娠合并子宫肌瘤的不同临床特征对妊娠期并发症及剖宫产相关指征的影响略有不同,应根据肌瘤的特征进行评估和选择分娩方式。

Objective:To analyze the influence of different clinical characteristics of uterine fibroids on pregnancy complications and cesarean section indexes.Methods:277 pregnant women with uterine fibroids were selected as the uterine fibroids group and 200 pregnant women without uterine fibroids as the control group from January 2016 to October 2018.The incidence of pregnancy complications,clinical characteristics of uterine fibroids,operation mode of cesarean section and related indicators of cesarean section were retrospectively analyzed.Results:The incidence of abnormal fetal position,preterm labor or preterm labor in the uterine fibroid group was significantly higher than that in the control group(P<0.05).There was no statistical difference in the incidence of premature rupture of membranes,placental abnormalities and postpartum hemorrhage between the two groups(P>0.05).The incidence of abnormal fetal position,premature rupture of membranes,preterm labor or preterm labor in the uterine fibroids<5cm was significantly lower than that of uterine fibroid≥5cm group(P<0.05).The incidence of abnormal fetal position preterm labor or preterm labor,postpartum hemorrhage in the single uterine fibroids was significantly lower than that of multiple uterine fibroids(P<0.05).The incidence of abnormal fetal position in the intramuscular fibroids was significantly higher than that of subserous fibroids,broad ligament fibroids,submucosal fibroids,mixed fibroids(P<0.05).The operation time and postoperative oxytocin dosage in the cesarean section+myomectomy group were significantly higher than those in the hysteromyoma group and the control group(P<0.05),and there was no statistical difference in intraoperative blood loss among the three groups(P>0.05).The intraoperative blood loss and postoperative usage of oxytocin in pregnant women with uterine fibroids<5cm in diameter and single uterine fibroids were significantly smaller than that in uterine fibroids diameter≥5cm and multiple uterine fibroids(P<0.05),and the postoperative usage of oxytocin in intramural fibroids was significantly larger than that in subserous fibroids,broad ligament fibroids,submucosal fibroids and mixed fibroids(P<0.05),but there were no statistically significant differences in operative time between different clinical features of uterine fibroids(P>0.05).Conclusion:The different clinical features of pregnancy with uterine fibroids have slightly different effects on pregnancy complications and cesarean section,and we should evaluate and choose delivery mode according to the characteristics of uterine fibroids.