胎盘植入性疾病患者不同终止妊娠时机的母婴结局分析

Analysis of maternal and infant outcomes in patients with placenta accreta disease at different timing of pregnancy termination

目的探讨胎盘植入性疾病(PAS)患者不同终止妊娠时机的母婴结局。方法选取2022年2月至2023年10月在我院分娩的PAS患者54例,根据终止妊娠孕周分为34 w≤孕周<35 w(A组)21例、35 w≤孕周<36 w(B组)14例、36 w≤孕周≤37 w(C组)19例。对比3组术中、术后的相关指标;各组新生儿以及产妇预后情况;采用logistic多因素分析影响新生儿以及产妇不良结局的相关因素。结果术中出血量、术后住院时间、急诊手术率:A组<B组<C组,差异有统计学意义(P<0.05);三组产后出血率、子宫切除率、入住ICU率以及失血性休克率比较,差异无统计学意义(P>0.05);Logistic多因素分析显示,术中出血量、剖宫产次数、孕周、胎盘植入、侵入型胎盘植入、完全型胎盘植入是影响产妇不良结局的独立危险因素(P<0.05);三组均无新生儿死亡事件出现,新生儿窒息率、转入NICU率:A组<B组<C组,差异有统计学意义(P<0.05);孕周、出生时体重、胎盘植入、剖宫产次数、侵入型胎盘植入、完全型胎盘植入是影响新生儿不良结局的独立危险因素(P<0.05)。结论PAS患者在妊娠34-35w期间终止妊娠是最适宜的终止妊娠时间,可更好的平衡母婴之间的风险,且母婴结局相对更好。

Objective To investigate the maternal and infant outcomes of patients with placenta accreta spectrum disorders(PAS)at different timing of pregnancy termination.Methods Fifty-four PAS patients who delivered in our hospital from February 2022 to October 2023 were selected as research subjects.According to the gestational age of termination of pregnancy,the 54 women were divided into group A(35w>gestational age≥34w),group B(36w>gestational age≥35w),and group C(37w≥gestational age≥36w).The numbers of patients in the groups A,B and C were 21,14 and 19,respectively.The intraoperative and postoperative related indicators and the prognosis of neonates and mothers were compared among the three groups.Logistic multifactor analysis was used to analyze the related factors affecting neonatal and maternal adverse outcomes.Results For intraoperative blood loss,postoperative hospital stay and emergency surgery rate,the group A<the group B<the group C(P<0.05).There was no statistically significant difference in the postpartum hemorrhage rate,hysterectomy rate,ICU admission rate and hemorrhagic shock rate among the three groups(P>0.05).Logistic multifactor analysis showed that intraoperative blood loss,number of cesarean sections,gestational age,placenta accreta,invasive placenta accreta,and complete placenta accreta were independent risk factors for adverse maternal outcomes(P<0.05).There were no neonatal deaths in the three groups.For rate of neonatal asphyxia and transfer rate to NICU,the group A<the group B<the group C(P<0.05).Logistic multifactor analysis showed that gestational age,birth weight,placenta accreta,number of cesarean sections,invasive placenta accreta,and complete placenta accreta were independent risk factors for adverse neonatal outcomes(P<0.05).Conclusions For PAS patients,pregnancy termination during 34-35 weeks of pregnancy is the most appropriate time.It can better balance the risks between mother and baby.It can also achieve the best outcome for both mother and baby.