初次妊娠患者发生前置胎盘的影响因素分析

Analysis of factors associated with placenta previa in primigravidas

目的探讨初次妊娠患者发生前置胎盘的影响因素及其对妊娠结局的影响。方法收集2016年1月至2019年1月于我院行剖宫产手术的6475例初次妊娠患者的临床资料,其中,373例前置胎盘患者为病例组,6102例非前置胎盘患者为对照组。采用t检验或χ2检验比较2组年龄、采用辅助生殖技术、子宫肌瘤、子宫内膜异位症、胎盘位置(前壁或后壁)、职业(有或无)、卵巢肿瘤和孕前体质量指数(BMI)等指标差异,并进一步对有统计学意义指标采用多因素logistic回归分析。采用χ2检验或t检验比较2组止血处理措施(宫腔球囊压迫、子宫动脉上行支结扎、B-Lynch缝合止血)、子宫切除、胎盘植入、术中失血量、输血、住院时间等指标差异。结果与对照组比较,病例组辅助生殖技术、子宫肌瘤和子宫内膜异位症发生率显著增高(P<0.05)。进一步多因素logistic回归分析显示,辅助生殖技术[OR=2.94,95%CI:(2.00~4.35),P<0.01]、子宫肌瘤[OR=2.70,95%CI:(1.89~3.85),P<0.01]和子宫内膜异位症[OR=2.56,95%CI:(1.64~4.00),P<0.01]是初次妊娠妇女发生前置胎盘的独立危险因素。病例组术中采用非常规止血措施(子宫球囊压迫、子宫动脉上行支结扎)和子宫切除术比例显著超过对照组(均P<0.001);病例组术中失血量、术中输血和住院时间均显著高于对照组(均P<0.05)。结论辅助生殖技术、子宫肌瘤和子宫内膜异位症是初次妊娠患者发生前置胎盘的独立危险因素。前置胎盘患者剖宫产术中需采用更多的非常规止血措施。

Objective To investigate factors associated with placenta previa in primigravidas and their impact on pregnancy outcomes.Methods A total of 6475 primigravidas who underwent cesarean section in Shengjing hospital from January 2016 to January 2019 were retrospectively evaluated,including 373 patients with placenta previa as the experimental group and 6102 patients without placenta previa as the control group.t test or chi-square test was used to compare the age difference,assisted reproductive technologies,uterine myoma,endometriosis,placental position(anterior or posterior),occupation(professional or non-professional),ovarian tumor,and pre-pregnancy body mass index(BMI)between the two groups.Logistic regression analysis was used to analyze the statistically significant indexes.Chisquare test or t test was used to compare the hemostatic measures(uterine balloon tamponade,uterine artery branch ligation,B-Lynch sutures),hysterectomy,placenta accreta,blood loss,blood transfusion,length of hospital stay,and other indicators between the two groups.Results Compared to the control group,the incidence of assisted reproductive technologies,uterine myoma,and endometriosis in the placenta previa group were significantly higher(P<0.05).Logistic regression analysis showed that assisted reproductive technologies(OR=2.94,95%CI:2.00-4.35,P<0.01),uterine myoma(OR=2.70,95%CI:1.89-3.85,P<0.01)and endometriosis(OR=2.56,95%CI:1.64-4.00,P<0.01)were independent risk factors for placenta previa in primigravidas.The application of hemostasis methods(uterine balloon tamponade and uterine artery branch ligation),hysterectomy in the placenta previa group were significantly greater than that in the control group(P<0.001).The volume of blood loss,the number of blood transfusions,and the length of hospital stay in the placenta previa group were significantly higher than that in the control group(P<0.05).Conclusion Assisted reproductive technologies,uterine myoma,and endometriosis were independent risk factors of placenta previa in primigravidas.In addition,more unconventional hemostasis measures should be applied to patients with placenta previa.