剖宫产瘢痕部位妊娠发病的危险因素

Clinical risk factors of cesarean scar pregnancies

目的探讨剖宫产瘢痕部位妊娠(CSP)发病的危险因素。方法纳入北京大学第三医院妇产科自2016年7月至2021年6月收治的CSP患者596例作为观察组,应用分层抽样法、以既往剖宫产自然年分层纳入瘢痕子宫(剖宫产史)再妊娠为正常宫内妊娠(IUP)者1192例作为对照组,收集患者一般情况、孕产史、宫腔手术史及既往剖宫产情况,采用多因素logistic回归模型分析CSP发病的相关因素。结果596例CSP患者此次妊娠年龄为(34.6±4.4)岁,1192例IUP患者此次妊娠年龄为(35.6±3.6)岁(P<0.001)。多因素分析结果提示,此次妊娠年龄<35岁、药物流产史、妊娠间隔<2年、妊娠间隔≥8年、剖宫产术前宫腔手术史、剖宫产术后宫腔手术史、剖宫产次≥2次及未临产剖宫产是瘢痕子宫再妊娠发生CSP的相关因素,OR值(95%CI)分别为2.306(1.774~2.998)、1.629(1.102~2.407)、2.147(1.237~3.726)、1.474(1.110~1.957)、2.558(1.809~3.615)、8.020(5.966~10.781)、14.051(9.699~20.356)、2.683(1.930~3.731),均P<0.05。结论CSP发病与年龄、药物流产史、妊娠间隔、宫腔手术史、剖宫产次及剖宫产时机有关,其中剖宫产次≥2次及剖宫产术后宫腔手术史是CSP强相关的危险因素。

Objective To explore the risk factors related to cesarean scar pregnancies(CSP).Methods Among the patients during July 2016 to June 2021 in Peking University Third Hospital,596 cases of CSP patients were included as study group,and 1192 cases of intrauterine pregnancy(IUP)women with history of cesarean section(s)were chosen as control group through stratified sampling according to the civil year of previous cesarean section matched with CSP group.The correlation between the general situation of patients,the history of gravidity and parity,the history of surgeries in uterine cavity and the previous cesarean section and the occurrence of CSP was explored through multivariate logistic regression analysis.Results The current age of 596 CSP patients was(34.6±4.4)years,and that of 1192 IUP patients was(35.6±3.6)years(P<0.001).Multivariate logistic regression analysis showed that the following factors may increase the risk of CSP:age<35 years old(OR=2.306,95%CI:1.774-2.998),history of medical abortion(OR=1.629,95%CI 1.102-2.407),pregnancy interval<2 years from the last cesarean section(OR=2.147,95%CI:1.237-3.726),pregnancy interval≥8 years from the last cesarean section(OR=1.474,95%CI:1.110-1.957),history of surgeries in uterine cavity before the last cesarean section(OR=2.558,95%CI:1.809-3.615),history of surgeries in uterine cavity after the last cesarean section(OR=8.020,95%CI:5.966-10.781),previous cesarean delivery≥2 times(OR=14.051,95%CI:9.699-20.356)and history of previous cesarean sections before labor(OR=2.683,95%CI:1.930-3.731)(all P<0.05).Conclusions The occurrence of CSP is related to the age of patients,the history of medical abortion,pregnancy interval,the history of surgeries in uterine cavity and the previous cesarean section,among which previous cesarean delivery≥2 times and history of surgeries in uterine cavity after the last cesarean section are the strongly associated risk factors.