胎盘早剥经阴道分娩的相关影响因素分析

Analysis of related factors influencing vaginal delivery of placental abruption

目的探讨胎盘早剥经阴道分娩的相关影响因素。方法回顾性分析2020年1月—12月本院产科收治的232例胎盘早剥患者的临床资料,其中149例阴道分娩患者、83例剖宫产患者,收集患者临床资料(年龄、孕龄、有无剖宫产史、是否初产、流产史、有无胎膜早破、有无妊娠期糖尿病、有无妊娠期高血压疾病、是否羊水过少、是否羊水过多、是否双胎妊娠、有无脐带因素、有无子宫肌瘤),采用单因素及多因素Logistic回归分析胎盘早剥经阴道分娩的相关影响因素。结果阴道分娩患者与剖宫产患者年龄、有无剖宫产史、是否初产、流产史、有无胎膜早破、有无妊娠期糖尿病、是否羊水过少、是否羊水过多、是否双胎妊娠、有无脐带因素、有无子宫肌瘤占比比较差异无统计学意义;阴道分娩患者孕龄<28周占比为13.42%,高于剖宫产患者的0.00%,伴有妊娠期高血压疾病占比为13.42%,低于剖宫产患者的54.22%,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,孕周<28周是胎盘早剥经阴道分娩的保护因素(OR<1,P<0.05),伴有妊娠期高血压疾病是胎盘早剥经阴道分娩的危险因素(OR>1,P<0.05)。结论胎盘早剥发生在孕周<28周的孕产妇中可在严密监测下进行阴道分娩,而胎盘早剥发生在伴有妊娠期高血压疾病的孕产妇中则以剖宫产为宜,临床可据此选取适宜的分娩方式,以减少母婴风险的发生。

Objective To investigate the related factors influencing vaginal delivery of placental abruption.Methods The clinical data of 232 patients with placental abruption admitted to the department of obstetrics in our hospital from January 2020 to December 2020 were retrospectively analyzed,including 149 patients with vaginal delivery and 83 patients with cesarean section.The clinical data of patients in the two groups were compared,including age,gestational age,cesarean section history,first labor,abortion history,whether there was premature rupture of membranes,whether there was gestational diabetes,whether there was gestational hypertension,whether there was oligomniotic fluid,whether there was excessive amniotic fluid,whether there was non-twin pregnancy,whether there was umbilical cord factor,whether there was uterine fibroids,etc.Multiple Logistic regression analysis was used to analyze the related factors of vaginal delivery of placental abruption.Results There were no significant differences in age,gestational age,cesarean section history,first labor,abortion history,whether there was premature rupture of membranes,whether there was gestational diabetes,whether there was oligomniotic fluid,whether there was excessive amniotic fluid,whether there was non-twin pregnancy,whether there was umbilical cord factor,whether there was uterine fibroids between the vaginal delivery patients and cesarean section patients.The gestational age of<28 weeks in vaginal delivery patients was 13.42%,which was higher than 0.00%in cesarean section patients,and the proportion of hypertensive disorder complicating pregnancy was 13.42%,which was lower than 54.22%in cesarean section patients,the difference was statistically significant(P<0.05).Multivariate Logistic regression analysis showed that gestational age<28 weeks was a protective factor(OR<1,P<0.05),and hypertensive disorder complicating pregnancy was a risk factor(OR>1,P<0.05).Conclusion Placental abruption occurs in women whose gestational age was<28 weeks and could be delivered vaginally under close monitoring,while caesarean section was appropriate if placental abruption occurs in pregnant women with hypertension during pregnancy,clinically appropriate delivery methods could be selected accordingly to reduce the occurrence of maternal and infant risks.