凶险性前置胎盘从孕28周到分娩前转归的高危因素及磁共振成像分析

The High Risk Factor of Pernicious Placenta Previa from the 28-week Pregnancy to Delivery: a Retrospective Nested Case-Control Study

目的:探讨孕产妇和新生儿因素对凶险性前置胎盘(PPP)从孕28周到分娩前转归的影响因素,以及MRI检查对PPP术中出血量的可预测性。方法:对成都市妇女儿童中心医院2019年1月至2021年12月孕28周超声检查提示PPP的孕妇进行回顾性巢式病例对照研究。采用多重线性回归分析检测磁共振成像(MRI)检查结果与术中出血量的相关性。采用二元逻辑回归分析孕产妇及胎儿因素对PPP转归的影响。结果:在孕28周超声检查提示PPP的孕妇中,合并妊娠期高血压(GHD)产妇在分娩前仍为PPP的风险增加了5.7倍(HR 5.723,95%CI 1.498~21.861,P=0.011);既往剖宫产次数每增加1次,增加8.2倍(HR 8.218,95%CI 2.751~24.554,P<0.001)的PPP风险。结论:孕28周超声检查提示为PPP的孕妇,43.9%在分娩时仍为PPP。且合并GHD、既往多次剖宫产的孕妇这一风险可能会更高。降低或严格把关第1次非医学指征的剖宫产手术是控制PPP发生的根本措施。

Objective:To determine the maternal and neonatal factors on the prognosis of pernicious placenta previa(PPP)from 28 weeks of gestation to delivery, and the predictability of MRI on the bleeding volume during PPP.Methods:From January 2019 to December 2021,retrospective nested case-control study was conducted on pregnant women who were diagnosed with PPP by ultrasound at 28 weeks of gestation in Chengdu Women′s and Children′s Central Hospital.Multiple linear regression analysis was used to detect the correlation between MRI results and intraoperative bleeding.Binary logistic regression was used to analyze the influence of maternal and fetal characteristics on PPP outcome.Results:Among the pregnant women with PPP diagnosedby ultrasonography at 28 weeks of gestation, the risk of PPP at delivery increased 5.7 times(OR 5.723,95% CI 1.498-21.861,P=0.011);The risk of PPP increased 8.2 times(OR 8.218,95% CI 2.751-24.554,P<0.001)for every increase in the number of previous cesarean sections.Conclusion:43.9% of the pregnant women who were diagnosed as PPP by ultrasound at 28 weeks of gestation were still PPP at the time of delivery.The risk may be higher for the pregnant women with multiple cesarean sections or GHD.Reducing or strictly controlling the first non-medical indication cesarean section is the fundamental measure to control the occurrence of PPP.