剖宫产术后经期延长危险因素分析

Risk Factors of Prolonged Menstrual Period after Cesarean Section

目的:探讨剖宫产术后女性出现经期延长的危险因素。方法:随机抽取2012年1月至2016年1月于安徽医科大学第一附属医院进行子宫下段剖宫产手术女性,共纳入814例,对其剖宫产后月经情况进行回访,按照是否出现经期延长分为对照组(无经期延长)618例,病例组(有经期延长)196例,分析比较两组人口统计学特征、手术情况等相关信息。结果:对照组有113例(18.3%)出现子宫瘢痕憩室,病例组有150例(76.5%)出现子宫瘢痕憩室,经单因素分析后,将差异有统计学意义的因素进行多因素Logistic回归检验,发现两组间多次剖宫产率(11.3%vs 25.0%)、羊水胎粪污染Ⅲ度率(4.5%vs 11.7%)、发生宫口扩张比例(15.7%vs 24.0%)、妊娠期合并症及并发症比例(20.4%vs 29.1%)明显更高,差异有统计学意义(P<0.05),对照组既往流产次数低于病例组(0.59±0.41次vs 0.83±0.37次),而孕前体质量指数高于病例组(22.02±2.69 kg/m^(2) vs 21.58±2.65 kg/m^(2)),差异有统计学意义(P<0.05)。结论:剖宫产术后女性出现经期延长受到多种因素的影响,主要与剖宫产术后子宫瘢痕憩室的形成和产后慢性子宫内膜炎相关。术前对产妇进行全面评估,严格把控剖宫产手术指征,减少感染的发生,能够更好地减少剖宫产术后经期延长的发生。

Objective:To investigate the risk factors of prolonged menstrual period after cesarean section.Methods:Patients underwent cesarean section in First Affiliated Hospital of Anhui Medical University from January 2012 to January 2016 were selected randomlyand divided into control group(618 cases without prolonged menstruation)and case group(196 cases with prolonged menstruation).The demographic characteristics,operation and other related information between the two groups were analyzed and compared.Results:113(18.3%)individuals in control group and 150(76.5%)individuals in case group were diagnosed with uterine diverticulum.After univariate analysis,the meaningful factors were tested by multivariate Logistic regression.Multivariate Logistic regression suggested that history of multiple cesarean sections(11.3%vs.25.0%),meconium-stained amniotic fluid(4.5%vs.11.7%),cervical dilatation(15.7%vs.24.0%),pregnancy complications(20.4%vs.29.1%,respectively)were significantly higher in case group(P<0.05).The number of previous abortions of control group(0.59±0.41 vs.0.83±0.37)was significantly lower,while the pre-pregnancy body mass index(22.02±2.69 kg/m^(2) vs.21.58±2.65 kg/m^(2))was significantly higher than case group(P<0.05).Conclusions:Prolonged menstrual period after cesarean section is mainly associated with uterine diverticulum and chronic endometritis.Therefore,reducing the rate of cesarean section strictly following surgical indications is needed to reduce the occurrence of prolonged menstrual period after cesarean section.