剖宫产瘢痕妊娠相关危险因素分析

Study on related risk factors of cesarean scar pregnancy

目的探讨剖宫产瘢痕妊娠(CSP)发病的可能危险因素,为预防和减少剖宫产瘢痕妊娠的发生提供理论依据。方法选取该院2012年5月-2018年10月确诊的CSP 93例为观察组,选取同期在院诊断瘢痕子宫合并宫内早孕90例为对照组。采用回顾性病例对照研究方法,分析两组患者的年龄、人工流产史、剖宫产术后人工流产史、剖宫产时机、剖宫产切口缝合方式、胎盘粘连及产后出血等情况,采用多因素非条件Logistic回归分析CSP发生的可能危险因素。结果两组患者年龄、人工流产史、剖宫产术后人工流产史、剖宫产时机、剖宫产切口缝合方式及胎盘粘连比较差异有统计学意义(P<0.05);产后出血两组患者比较差异无统计学意义(P>0.05)。多因素非条件Logistic回归分析结果显示,年龄(OR=3.083,95%CI=1.407~6.756)、剖宫产术后人工流产史(OR=1.586,95%CI=1.093~2.302)、剖宫产时机(OR=3.649,95%CI=1.800~7.396)、剖宫产切口缝合方式(OR=4.461,95%CI=2.164~9.195)及胎盘粘连(OR=3.117,95%CI=1.133~8.577)与CSP的发生有相关性。结论年龄、剖宫产术后人工流产史、剖宫产时机、剖宫产切口缝合方式及胎盘粘连是CSP发生的可能危险因素。

Objective To explore the possible risk factors of cesarean scar pregnancy and provide theoretical basis for the prevention and decrease of cesarean scar pregnancy.Methods 93 cases of cesarean scar pregnancy diagnosed from May 2012 to October 2018 were selected as the study group, and 90 cases of scar uterus combined with early pregnancy diagnosed in our hospital during the same period were selected as the control group.A retrospective case-control study was conducted to analyze the age, history of artificial abortion, history of artificial abortion after cesarean section, timing of cesarean section, suture method of cesarean section incision, placental adhesion and postpartum hemorrhage of the two groups, multivariate unconditional Logistic regression analysis was used to analyze the possible risk factors for cesarean scar pregnancy.Results There were significant differences in age, history of artificial abortion, history of artificial abortion after cesarean section, timing of cesarean section, suture method of cesarean section incision and placental adhesion between the two groups(P<0.05).There was no significant difference in two groups that postpartum hemorrhage(P>0.05).Multivariate unconditional Logistic regression analysis showed that age(OR=3.083,95%CI=1.407-6.756),history of artificial abortion after cesarean section(OR=1.586,95%CI=1.093-2.302),timing of cesarean section(OR=3.649,95%CI=1.800-7.396),suture method of cesarean section incision(OR=4.461,95%CI=2.164-9.195),placental adhesion(OR=3.117,95%CI=1.133-8.577) were correlated with the occurrence of cesarean scar pregnancy.Conclusion Age, history of artificial abortion after cesarean section, timing of cesarean section, suture method of cesarean section incision, placental adhesion were the possible risk factors for the occurrence of cesarean scar pregnancy.