宫腔粘连分离术后活产情况及影响因素分析

Live birth situation after intrauterine adhesion separation operation and influencing factors analysis

目的分析不同宫腔粘连(IUA)类型患者行宫腔粘连分离术后活产情况及影响因素。方法回顾性分析2010年1月至2022年1月在首都医科大学附属北京妇产医院行宫腔镜下IUA电切分离术并在术后2年内妊娠的188例患者的病历资料,收集患者的基本资料及妊娠结局,应用单因素分析及多因素logistic回归分析探讨影响患者术后活产的主要因素。结果188例IUA患者术后有163例活产,活产率为86.7%。不同程度IUA患者受孕方式、分娩方式构成情况比较差异无统计学意义(P>0.05),产后出血量比较差异有统计学意义(P<0.05)。不同程度IUA患者在胎盘植入及行钳夹、清宫术构成情况比较差异有统计学意义(P<0.05)。单因素分析结果显示,人工流产、孕早期清宫(P=0.008)和孕中期引产(P<0.001)是术后活产的影响因素;多因素分析结果显示,孕中期引产(95%CI:0.02~0.35,P=0.001)是术后活产的影响因素。结论IUA术后易发生胎盘类相关疾病、产后出血,增加分娩时宫腔操作,对于既往多次人工流产史及中期引产患者应警惕不良妊娠结局发生。

Objective To analyze the live birth situation after intrauterine adhesions separation operation in the patients with different types of intrauterine adhesions(IUA)and its influencing factors.Methods The medical records data in 188 patients with hysteroscopic electrotomy separation for IUA and pregnancy within postoperative two years in the Affiliated Beijing Obstetrics and Gynecology Hospital of Capital Medical University from January 2010 to January 2022 were analyzed retrospectively.The basic data and pregnancy outcomes of the patients were collected.The main influencing factors of postoperative live birth were analyzed by univariate analysis and multivariate logistics regression.Results Among 188 cases of IUA,there were 163 cases of live births with a live birth rate of 86.7%.There was no statistical difference in the composition situation of conception methods and delivery methods among the patients with different degrees of IUA(P>0.05),and there was statistical difference in postpartum bleeding volume(P<0.05).There were significant differences in the composition of placenta implantation,conducting clamp and uterine clearance among the patients with different degrees of IUA(P<0.05).The univariate analysis results showed that artificial abortion,early pregnant curettage(P=0.008)and labor induction in second trimester(P<0.001)were the influencing factors of postoperative live birth;the multivariate analysis results showed that induction of labor in the second trimester(95%CI:0.02-0.35,P=0.001)was the influencing factor of postoperative live birth.Conclusion Placenta-related diseases and postpartum hemorrhage are prone to occur after IUA operation,and the uterine operation during delivery is increased.The patients with history of previous multiple induced abortions and mid-term induced labor should be vigilant against the occurrence of adverse pregnancy outcomes.