延期妊娠引产失败的相关因素分析

Analysis of factors associated with failure to induce labor in delayed pregnancy

目的探讨延期妊娠引产失败的相关因素。方法收集2017年1月至2021年1月在西北妇女儿童医院产科住院的延期妊娠产妇病历资料171例;依据引产结果将其分为引产成功组84例,引产失败组87例;按产后胎盘病检结果分为亚临床期绒毛膜羊膜炎组59例,非绒毛膜羊膜炎组112例;对各组产妇的基本指标、外周血炎性指标、胎盘病检结果进行比较,并进行统计学分析。结果引产成功组与引产失败组产妇的年龄、人工流产次数、孕前体重、分娩前体重、孕前体质量指数(BMI)、分娩前BMI、新生儿出生体重比较差异均有统计学意义(t值分别为-3.414、-1.220、-2.373、-2.461、-3.470、-3.764、-5.616,P<0.05);引产成功组与引产失败组产妇的身高比较差异有统计学意义(Z=2.158,P<0.05)。引产成功组与引产失败组的产前外周血白细胞计数(WBC)、中性粒细胞百分比(NEUT)、C反应蛋白(CRP)、降钙素原(PCT)水平比较差异均有统计学意义(t值分别为-2.348、-2.158、-2.614、-2.176,P<0.05)。亚临床期绒毛膜羊膜炎组与非绒毛膜羊膜炎组外周血WBC、NEUT、CRP和PCT水平比较差异均有统计学意义(t值分别为2.589、2.603、2.615、2.144,P<0.05)。引产成功组与引产失败组产妇产后胎盘出现亚临床期绒毛膜羊膜炎的发生率比较差异有统计学意义(χ2=75.385,P<0.001);引产成功组与引产失败组产妇产后发热的发生率比较差异也有统计学意义(Fisher确切概率法,P=0.001)。多因素Logistic回归分析结果显示,产妇的年龄(OR=1.203,95%CI:1.019~1.419)、身高(OR=1.151,95%CI:1.021~2.060)、人工流产次数(OR=2.021,95%CI:1.571~4.216)、分娩前BMI(OR=3.403,95%CI:2.581~5.348)、WBC(OR=1.021,95%CI:1.001~1.046),以及新生儿出生体重(OR=1.003,95%CI:1.001~1.004)均是引产失败的危险因素(P<0.05)。ROC曲线分析显示,WBC、NEUT、CRP、PCT诊断亚临床期绒毛膜羊膜炎的截断值分别为7.85×109/L、76.00%、14.00μg/mL、0.04ng/mL。WBC+NEUT+CRP+PCT联合诊断亚临床期绒毛膜羊膜炎的AUC为0.683,灵敏度为85.40%,特异度为77.90%,四项指标联合诊断亚临床期绒毛膜羊膜炎有较高的AUC、灵敏度、特异度,优于单项指标的诊断。结论产妇的年龄、身高、人工流产次数、分娩前BMI、WBC,以及新生儿出生体重均是引产失败的危险因素,亚临床期绒毛膜羊膜炎是导致引产失败高危因素之一。

Objective To explore the factors associated with the induced labor failure in delayed pregnancy.Methods From January 2017 to January 2021,medical records of 171 postponed pregnant women who hospitalized in the Department of Obstetrics of Northwest Women's and Children's Hospital were collected.According to the results of induction of labor,they were divided into 84 cases in the group of successful induced abortion and 87 cases in the group of failed induced abortion.According to the pathological examination results of postpartum placenta,they were divided into 59 cases in subclinical chorioamnionitis group and 112 cases in non-chorioamnionitis group.The basic indicators,peripheral blood inflammatory indicators,placental pathological examination results of each group were compared,and statistical analysis was carried out.Results There were statistically significant differences in age,number of previous induced abortions,pre-pregnancy weight,pre-delivery weight,pre-pregnancy body mass index(BMI),pre-delivery BMI and neonatal birth weight between the successful and failed labor induction groups(t=-3.414,-1.220,-2.373,-2.461,-3.470,-3.764 and-5.616,respectively,P<0.05).There was a significant difference in the height between the successful and failed induced labor groups(Z=2.158,P<0.05).There were statistically significant differences in prenatal peripheral blood white blood cell(WBC),neutrophil percentage(NEUT),C-reactive protein(CRP)and procalcitonin(PCT)levels between the successful and failed labor induction groups(t=-2.348,-2.158,-2.614 and-2.176,respectively,P<0.05).There were statistically significant differences in the levels of WBC,NEUT,CRP and PCT in peripheral blood between subclinical chorioamnionitis group and the non-chorioamnionitis group(t=2.589,2.603,2.615 and 2.144,respectively,P<0.05).There was statistically significant difference in the incidence of subclinical chorioamniotitis in postpartum placenta between the successful and failed labor induction groups(χ2=75.385,P<0.001).There was also a statistically significant difference in the incidence of postpartum fever between the successful and failed labor induction groups(Fisher's exact test,P=0.001).Multivariate Logistic regression analysis showed that maternal age(OR=1.203,95%CI:1.019-1.419),height(OR=1.151,95%CI:1.021-2.060),number of induced abortions(OR=2.021,95%CI:1.571-4.216),pre-delivery BMI(OR=3.403,95%CI:2.581-5.348),WBC(OR=1.021,95%CI:1.001-1.046),and newborn birth weight(OR=1.003,95%CI:1.001-1.004)were all risk factors for induced labor failure(P<0.05).The ROC curve analysis showed that the cut-off values of WBC,NEUT,CRP and PCT in the diagnosis of subclinical chorioamnionitis were 7.85×109/L,76.00%,14.00μg/mL and 0.04ng/mL,respectively.The AUC of WBC+NEUT+CRP+PCT in the joint diagnosis of subclinical chorioamnitis was 0.683,and the sensitivity was 85.40%,and the specificity was 77.90%.The combination of the four indexes in the diagnosis of subclinical chorioamnitis had higher AUC,sensitivity and specificity,which was superior to the diagnosis of single indexes.Conclusion Maternal age,height,number of induced abortions,pre-delivery BMI,WBC and neonatal birth weight are all risk factors for induced labor failure.Subclinical chorioamnionitis is one of the high-risk factors for induced labor failure.