246例前置胎盘临床特征及子宫切除危险因素分析

Clinical characteristics of 246 cases of placenta previa and analysis on risk factors of hysterectomy

目的探讨前置胎盘(PP)的临床特点及子宫切除的危险因素。方法回顾性分析该院2020年1-12月收治的246例PP孕妇,包括凶险性前置胎盘(PPP)66例(PPP组)和普通PP 180例(普通PP组),并根据是否子宫切除分为子宫切除组(n=18)与保留子宫组(n=228)。分别对比患者的一般情况及妊娠结局,并采用多因素logistic回归分析探讨PP孕妇子宫切除的危险因素。结果PPP组妊娠次数、人工流产次数、剖宫产次数、手术持续时间、术中出血量、24 h出血量、住院时间及出血量≥2000 mL、输血、术后入重症监护室(ICU)、新生儿窒息孕妇占比均高于普通PP组,终止妊娠孕周早于普通PP组,新生儿体重低于普通PP组,差异有统计学意义(P<0.05);两组年龄无明显差异(P>0.05)。子宫切除组妊娠次数、剖宫产次数、手术持续时间、术中出血量、24 h出血量、住院时间及出血量≥2000 mL、术后入ICU、胎盘植入孕妇占比均高于子宫保留组,差异有统计学意义(P<0.05);两组年龄、人工流产次数、终止妊娠孕周、新生儿体重及输血、新生儿窒息孕妇占比均无明显差异(P>0.05)。多因素logistic回归分析结果显示,手术持续时间是子宫切除的独立危险因素[OR=1.037,95%CI(1.011,1.065),P=0.006]。结论多次妊娠、多次人工流产及既往剖宫产次数与PPP发生有关,手术持续时间是子宫切除的独立危险因素。

Objective To investigate the clinical characteristics of placenta previa(PP)and the risk factors of hysterectomy.Methods A total of 246 pregnant women with PP admitted and treated in this hospital from January to December 2020 were retrospectively analyzed,including 66 cases of pernicious placenta previa(PPP group)and 180 cases of common placenta previa(PP group).According to whether conducting hysterectomy,they were divided into the hysterectomy group(n=18)and uterus preservation group(n=228).The general conditions and pregnancy outcomes were compared among the patients,and the multivariate logistic regression analysis was used to explore the risk factors of hysterectomy in pregnant women with PP.Results The number of pregnancy times,abortion times,cesarean section delivery times,duration of surgery,intraoperative blood loss amount,24 h blood loss amount,duration of hospitalization,and proportions of pregnant women with bleeding amount≥2000 mL,blood transfusion,transfer to ICU after operation and newborn asphyxia in the PPP group were higher than those in the PP group,the gestational weeks of pregnancy termination was earlier than that in the PP group,and newborn body weight was lower than those in the PP group,and the differences were statistically significant(P<0.05).There was no statistical difference in the age between the two groups(P>0.05).The pregnancy times,cesarean section times,operation duration,intraoperative blood loss amount,24 h blood loss amount,duration of hospitalization,proportions of pregnant women with blood loss amount≥2000 mL,transferred to ICU after surgery,and incidence rate of placenta accreta in the hysterectomy group were higher than those in the uterus preservation group,and the differences were statistically significant(P<0.05).There was no significant difference in the age,induced abortion times,gestational week of termination,neonatal weight,proportion of blood transfusion and pregnant women with neonatal asphyxia between the two groups(P>0.05).The multivariate logistic regression analysis results showed that the operation duration was an independent risk factor for hysterectomy[OR=1.037,95%CI(1.011,1.065),P=0.006].Conclusion The multiple pregnancies,multiple induced abortions and previous cesarean sections times are related to the occurrence of PPP,and the operation duration is an independent risk factor for hysterectomy.