剖宫产史次数对中期妊娠胎盘前置状态伴植入经阴道引产结局的影响

Effects of cesarean sections numbers on the outcome of vaginal induction in patients of second trimester with placenta previa implantation

目的 探讨剖宫产史次数对中期妊娠胎盘前置状态伴植入经阴道引产结局的影响。方法 回顾性分析上海交通大学医学院附属国际和平妇幼保健院2008年6月—2020年10月具有剖宫产史的中期妊娠胎盘前置状态伴植入经阴道引产的49例患者临床资料,根据剖宫产史次数分为2组:1次剖宫产史患者,共33例;≥2次剖宫产史患者,共16例。探讨比较2组患者的引产结局。结果 剖宫产史≥2次的患者较1次剖宫产史的患者住院时间长、住院费用高、引产出血量多,且失血性休克、弥散性血管内凝血(disseminated intravascular coagulation, DIC)、感染和子宫切除发生率均较高(P<0.05)。4例经阴道引产失败后子宫切除者均为具有2次剖宫产史的中央性胎盘前置状态植入型或穿透型患者。结论 剖宫产后中期妊娠胎盘前置状态伴植入经阴道引产的结局与剖宫产次数有关。剖宫产史≥2次的患者较1次剖宫产史的患者更容易发生产后大出血、DIC、感染或子宫切除等不良结局。

Objective To investigate the effect of the number of caesarean sections on the outcome of vaginal induction in patients of second trimester with placenta previa implantation. Methods Forty-nine pregnant women with placenta previa implantation who had a history of cesarean section and received vaginal induction in the second trimester from June 2008 to October 2020 were included in the study. There were 33 cases with a history of 1 cesarean section and 16 cases patients with a history of ≥2 cesarean sections. The outcomes of the induction of labor for these two groups of patients were compared. Results Patients with a history of cesarean section ≥2 times had a longer hospital stay, higher hospitalization costs, and more bleeding than those with a history of 1 cesarean section. Meanwhile, the incidence of hemorrhagic shock, disseminated intravascular coagulation(DIC), infection and hysterectomy were also higher(P<0.05). Four cases underwent hysterectomy after failed vaginal labor induction, all of whom were patients with a history of 2 cesarean sections and with implanted or penetrating central placenta previa. Conclusion The outcome of vaginal induction in the second trimester in patients with placenta previa implantation is closely related to the number of cesarean sections. Patients with a history of cesarean sections ≥2 are more likely to have postpartum hemorrhage, DIC, infection, or hysterectomy than those with history of 1 cesarean section.