前置胎盘患者围生产期的妊娠结局及相关影响因素分析

Analysis on the factors affecting perinatal outcome in patients with placenta previa

目的:探讨前置胎盘患者围生产期的妊娠结局及相关影响因素。方法:选取2014年1月~2021年11月在芜湖市第二人民医院诊断为前置胎盘的产妇105例,分为胎盘植入组和非胎盘植入组,Logistic回归分析前置胎盘患者围生产期妊娠结局的影响因素。结果:多因素Logistic回归结果显示,流产次数(≥2次)(OR_(2)=1.309;OR_(≥3)=1.824)、剖宫产次数(≥1次)(OR=1.854)、胎盘位置(前壁)(OR=1.252)、伴胎盘植入(是)(OR=6.012)是产后出血的危险因素。年龄(≥35岁)(OR=2.321)、伴胎盘植入(是)(OR=3.352)是子宫切除的危险因素。流产次数(≥3次)(OR=1.318)、伴胎盘植入(是)(OR=3.930)是末次住院总天数的危险因素,而入院孕周(≥32周)(OR_(32~38^(+6))=0.234;OR_(39~41^(+6))=0.156)是患者末次住院天数的保护因素。结论:前置胎盘患者围生产期的主要不良结局有产后出血、子宫切除、末次总住院时间增加。既往流产次数、剖宫产次数、胎盘位置、伴胎盘植入均是前置胎盘患者产后出血的影响因素,高龄和伴胎盘植入则增加患者子宫切除的风险。

Objective:To investigate the factors affecting perinatal outcomes in patients with placenta previa.Methods:105 pregnant women confirmed as placenta previa in our hospital were included from January 2014 to November 2021,and divided into placental accreta group and non-placental accreta group.Logistic regression model was used to analyze the influencing factors associated with perinatal outcomes.Results:The multivariate logistic regression analysis showed that the number of abortions(≥2 times)(OR_(2)=1.309;OR_(≥3)=1.824)and cesarean sections(≥1 time)(OR=1.854),placental position(anterior wall)(OR=1.252),and concomitant presence of placenta implantation(OR=6.012)were risk factors for postpartum hemorrhage.The age(≥35 years old)(OR=2.321)and concomitant presence of placenta accreta(OR=3.352)were risks for hysterectomy,and the number of miscarriages(≥3 times)(OR=1.318)and concomitant presence of placenta accreta(OR=3.930)were factors affecting the total days of final hospital stay.However,the gestational week by admission(≥32 weeks)(OR_(32-38^(+6))=0.234;R_(39-41^(+6))=0.156)was protective factors for the days of last hospitalization.Conclusion:The main adverse perinatal outcomes of patients with placenta previa are associated with postpartum hemorrhage,hysterectomy,and increased total days of final hospital stay.The number of previous miscarriages and cesarean sections,location of the placenta and concomitant presence of placenta accreta are factors affecting postpartum hemorrhage in patients with placenta previa,and older age and placenta accreta may increase the risks of hysterectomy.