胎盘植入深度与胎儿结局关系探讨

Depth of invasion inplacenta accreta spectrum disorders and fetal outcome

目的探讨前置胎盘伴胎盘植入谱系疾病中,胎盘植入深度与新生儿结局及胎儿出生缺陷的关系。方法对2003年1月1日至2018年12月31日于北京大学第三医院分娩的前置胎盘伴胎盘植入的478例单胎妊娠患者的病例资料进行回顾性分析,根据植入程度分为粘连性胎盘植入组及侵袭性胎盘植入组,分别采用χ^(2)检验及log-binomial回归的方法对两组新生儿结局及胎儿出生缺陷的发生率进行单因素和多因素分析。结果在新生儿结局方面,小于胎龄儿的发生率在侵袭性胎盘植入组(3.4%)高于粘连性胎盘植入组(0.9%),但差异无统计学意义(P=0.074)。单因素分析显示侵袭性胎盘植入的新生儿期并发症,包括新生儿肺炎(3.0%比0)、新生儿呼吸窘迫综合征(8.1%比0.4%)、脑室内出血(3.4%比0)和转儿科的比例(49.6%比17.2%)显著高于粘连性胎盘植入组(P<0.05)。但多因素分析排除孕产妇年龄、分娩孕周、母体并发症因素影响后,差异无统计学意义。出生缺陷检出结果显示,共26例(5.4%)胎儿及新生儿存在出生缺陷,其中11例(42.3%)为心血管系统畸形,7例为(26.9%)颜面部畸形。与粘连性胎盘植入相比,单因素及多因素分析均显示侵袭性胎盘植入出生缺陷的发生率(8.5%)高于粘连性胎盘植入(1.8%,RR=3.96,95%CI=1.25~12.53),差异有统计学意义(P<0.05)。结论胎盘植入深度与胎儿出生缺陷的发生风险相关,随着植入程度的加重,胎儿出生缺陷的发生风险增加。

Objective To explore the relationship between depth of invasion in placenta previa with placental accreta spectrum disorder and fetal and neonatal outcomes.Methods 478 cases of singleton pregnancy with placenta previa and placental accreta spectrum disorder who were delivered in Peking University Third Hospital from January 1,2003 to December 31,2018 were analyzed retrospectively.According to the depth of invasion,the patients were divided into two groups:superficial placenta accreta and deep or invasive placenta accreta.The differences in birth defects and neonatal outcomes between the two groups were analyzed by Pearson's chi-square test and log-binomial regression analysis.Results The incidence of small for gestational age infants in deep invasion group was higher than that in superficial invasion group(3.4%vs 0.9%),but there was no statistically significant difference(P=0.074).Univariate analysis showed that the proportion of neonatal pneumonia(3.0%vs 0.0%),neonatal respiratory distress syndrome(8.1%vs 0.4%),intraventricular hemorrhage(3.4%vs 0.0%),and admission to neonatology department(49.6%vs 17.2%)were significantly higher in the deep invasion group.However,the differences became statistically insignificant in multivariable analyses after adjustments for maternal age,gestational age,and maternal complications.There were a total of 26 cases(5.4%)with birth defects,including 11 cases(42.3%)with cardiovascular system malformation and 7 cases(26.9%)with facial malformation.Compared with the superficial invasion group,the incidence of birth defects in deep invasion group was higher(8.5%vs 1.8%,P=0.001;RR=3.96,95%CI 1.25-12.53,P=0.019)in both univariate and multivariate analysis.Conclusion The depth of placenta invasion is associated with increased risk of fetal birth defects.The deeper the placenta invaded,the higher the risk of birth defects.