疤痕子宫孕妇妊娠早期孕囊位置及疤痕厚度与并发前置胎盘和胎盘植入的关系

Relationship between Gestational Sac Position and Scar Thickness in Early Pregnancy with Scarred Uterus and Con-current Placenta Previa and Placenta Accreta

目的:探讨疤痕子宫孕妇妊娠早期孕囊位置及疤痕厚度与并发前置胎盘和胎盘植入的关系。方法:选取2019年7月—2021年4月中山博爱医院收治的首次疤痕子宫再次妊娠孕妇300例为研究对象,其中并发前置胎盘、胎盘植入的46例纳入为研究组,其余254例纳入对照组。分析并发前置胎盘、胎盘植入的影响因素,对比两组孕妇母婴结局。结果:两组孕妇距离前次剖宫产时间、前次剖宫产手术医院、终止妊娠时间、妊娠期并发症、产前出血、痛经史、盆腔炎史对比,差异无统计学意义(χ^(2)=0.824、0.040、0.268、0.344、0.832、0.832、0.994、0.160,P>0.05)。研究组年龄大于对照组,人工流产次数多于对照组,孕囊位置位于宫腔下1/3、疤痕厚度≤5 mm者多于对照组,差异有统计学意义(t/χ^(2)=4.433、12.453、6.453、5.208,P<0.05)。孕囊位置在宫腔下1/3的疤痕子宫孕妇并发前置胎盘、胎盘植入的风险是位于宫腔上2/3孕妇的4.384倍,疤痕厚度>5 mm孕妇并发前置胎盘、胎盘植入的风险是≤5 mm的0.291倍,差异有统计学意义(χ^(2)=20.552、9.029,P<0.05)。研究组产后出血、产褥期感染、早产、低体重儿、新生儿窒息发生率高于对照组,差异有统计学意义(χ^(2)=9.931、4.883、26.172、6.508、9.505,P<0.05)。结论:疤痕子宫孕妇妊娠早期孕囊位置、疤痕厚度是发前置胎盘和胎盘植入的影响因素,临床可根据此识别胎盘异常发生风险,制定针对性预防措施,改善母婴结局。

Objective: To investigate the relationship between the position of gestational sac and the thickness of scar and placenta previa and placenta accreta. Methods: A total of 300 pregnant women with re-pregnancy in the first scarred uterus from July2019 to April 2021 were selected as the research objects, of which 46 cases with concurrent placenta previa and placenta accreta were included in the study group, and the remaining 254 cases were included in the control group. The influencing factors of concurrent placenta previa and placenta accreta were analyzed, and the maternal and infant outcomes of the two groups were compared. Results: There was no staistically significant difference between the two groups in the time from the previous cesarean section, the hospital for the previous cesarean section, the time of termination of pregnancy, complications during pregnancy, antepartum hemorrhage, history of dysmenorrhea, and history of pelvic inflammatory disease(χ^(2)=0.824, 0.040, 0.268, 0.344, 0.832, 0.832,0.994, 0.160, P>0.05). The study group was older than the control group, had more induced abortions, the gestational sac was located in the lower third of the uterine cavity, and the scar thickness was less than or equal to 5 mm, and the difference was statistically significant(t/χ^(2)=4.433, 12.453, 6.453, 5.208, P<0.05). The risk of placenta previa and placenta accreta in pregnant women with scarred uterus in the lower third of the uterine cavity was 4.384 times higher than that in the upper 2/3 of the uterine cavity,the risk of placenta previa and placenta accreta in pregnant women with scar thickness >5 mm was 0.291 times that of ≤5 mm,and the difference was statistically significant(χ^(2)=20.552, 9.029, P<0.05). The incidence rates of postpartum hemorrhage, puerperal infection, premature birth, low birth weight infants, and neonatal asphyxia in the study group were higher than those in the control group, and the differences were statistically significant(χ^(2)=9.931, 4.883, 26.172, 6.508, 9.505, P<0.05). Conclusion: The location of the gestational sac and the thickness of the scar in the early pregnancy of pregnant women with scarred uterus are the influencing factors of the concurrent placenta previa and placenta accreta. Based on this, the risk of placental abnormalities can be identified clinically, and targeted preventive measures can be formulated to improve maternal and infant outcomes.