胎盘植入性疾病分型及危险因素和妊娠结局分析

Placenta accreta spectrum disorders:Typing,risk factors,and pregnancy outcome

目的分析胎盘植入性疾病的分型、危险因素和妊娠结局。方法选取2020年2月—2024年2月本院胎盘植入性疾病病人120例为病例组,并按1∶1比例选取同期产科检查资料齐全的健康产妇120例为对照组。回顾性分析两组孕产妇临床资料,采用二元Logistic回归法评估胎盘植入性疾病危险因素,并比较两组妊娠结局。结果120例胎盘植入性疾病病例中粘连型胎盘70例(58.33%),植入型胎盘32例(26.67%),穿透型胎盘18例(15.00%)。有剖宫产史、孕次(≥3次)、产次(经产妇)、前置胎盘、甲胎蛋白(AFP)水平增高均是胎盘植入性疾病的危险因素(OR=1.553~1518.151,95%CI=(1.261~13.575)^(1.862~169782.964),P均<0.05)。病例组早产、产后出血、产妇入住ICU、产褥期感染、低出生体质量儿发生率均高于对照组(P<0.05),新生儿Apgar评分低于对照组(χ^(2)=9.231,P<0.05)。结论胎盘植入性疾病以粘连型胎盘最为常见,其发生与剖宫产史、孕次、产次、前置胎盘、AFP水平相关。胎盘植入可引发不良妊娠结局,应引起足够重视。

Objective To investigate the typing,risk factors,and pregnancy outcomes of placenta accreta spectrum disorders.Methods A total of 120 patients with placenta accreta spectrum disorders in our hospital from February 2020 to February 2024 were enrolled as case group,and 120 healthy pregnant women with complete obstetric examination data were selected as control group.A retrospective analysis was performed for the clinical data of the pregnant women in both groups,and the binary Logistic regression method was used to identify the risk factors for placenta accreta spectrum disorders,while pregnancy outcome was compared between the two groups.Results Among the 120 patients with placenta accreta spectrum disorders,70(58.33%)had adherent placenta,32(26.67%)had implanted placenta,and 18(15.00%)had penetrating placenta.History of cesarean section,times of pregnancy(≥3),parity(multipara),placenta previa,and an increase in alpha-fetoprotein(AFP)were risk factors for placenta accreta spectrum disorders(OR=1.553-1518.151,95%CI=1.261-13.575 to 1.862-169782.964,P<0.05).Compared with the control group,the case group had significantly higher incidence rates of premature delivery,postpartum hemorrhage,maternal ICU admission,puerperal infection,and low-birth-weight infants(P<0.05)and a significantly lower Apgar score(χ^(2)=9.231,P<0.05).Conclusion Adherent placenta is the most common type of placenta accreta spectrum disorders,which is associated with the history of cesarean section,times of pregnancy,parity,placenta previa,and AFP level.Placenta accreta can lead to adverse pregnancy outcomes and should be taken seriously.