周 密, 陈 锰, 张 力, 等.前置胎盘合并瘢痕子宫孕妇的严重不良围产结局分析.四川大学学报(医学版),2017,48(5):783-787
前置胎盘合并瘢痕子宫孕妇的严重不良围产结局分析
Severe Adverse Pregnancy Outcomes in Placenta Previa and Prior Cesarean Delivery
  
中文关键词:  前置胎盘 瘢痕子宫 妊娠结局
英文关键词:Placenta previa Cesarean section Pregnancy outcome
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中文摘要:
      目的 分析前置胎盘合并瘢痕子宫孕妇的不良围产结局,并研究其相关危险因素。方法 采用回顾性病例对照研究,纳入2005年1月至2015年6月在四川大学华西第二医院再次剖宫分娩的前置胎盘合并瘢痕子宫孕妇,分析严重不良结局的发生情况。严重不良结局定义为(以下任何一项):输红细胞≥10单位,术后转入ICU,膀胱、肠管或输尿管损伤需要外科修补,二次手术,子宫切除,或孕产妇死亡。并采用单因素及多因素logistic回归分析严重不良结局的危险因素。结果 近10+年共有478例前置胎盘合并瘢痕子宫孕妇在四川大学华西第二医院行再次剖宫产终止妊娠。本组孕妇平均年龄(32.5±4.8)岁,多数孕妇年龄大于30岁;平均孕4次产1次;其中131例(27.4%)孕妇发生严重不良结局。输红细胞≥10单位者有75例 (15.7%,75/478);术后转入ICU 44例(9.2%,44/478);发生膀胱损伤而需修补者共有11例,无输尿管或肠管损伤发生;有4例二次手术,其均是由于保守治疗后内出血而行急诊剖宫产子宫切除。子宫切除(107例,22.4%)是最常见的严重不良结局;最后经过剖宫产术和/或术后病理检查证实的311例胎盘异常附着者,只有172例(55.3%)术前超声或者磁共振检查怀疑有胎盘异常附着。多因素分析显示,凶险性前置胎盘(即胎盘附着于前次剖宫产切口瘢痕上)、产前怀疑胎盘异常附着(粘连、植入或穿透)和产前血红蛋白水平<100 g/L是严重不良结局的独立危险因素,其比值比和95%可信区间(95%CI)分别为2.4(1.5~3.8)、3.6(2.3~5.6)和2.5(1.6~3.9)。结论 在前置胎盘合并瘢痕子宫的孕妇中,凶险性前置胎盘、产前怀疑胎盘异常附着和产前血红蛋白水平<100 g/L会显著增加严重不良结局的风险。
英文摘要:
      【Abstract】 Objective To investigate the severe adverse pregnancy outcomes in pregnancies with placenta previa and prior cesarean delivery and its risk factors. Methods This retrospective casecontrol study reviewed all pregnancies with placenta previa and prior cesarean delivery delivered by repeat cesarean section in our institution between January 2005 and June 2015, and investigated the incidence of severe adverse pregnancy outcome. A composite of severe adverse pregnancy outcomes (including transfusion of 10 units or more red blood cells, maternal ICU admission, unanticipated injuries, repeat operation, hysterectomy, and maternal death) and other maternal and neonatal outcomes were described. Univariate and multivariable logistic regression analysis were used to quantify the effects of risk factors on severe adverse pregnancy outcomes. Results There were 478 women with placenta previa and prior cesarean delivery in our hospital over the last decade. The average age of them was 32.5±4.8 years old, most women were beyond 30 years old, the average gravidity and parity were 4 and 1, 131 cases (27.4%) had severe adverse pregnancy outcomes. Transfusion of 10 units or more red blood cells happened in 75 cases (15.7%, 75/478); 44 cases (9.2%, 44/478) necessitated maternal ICU admission; unanticipated bladder injury occurred in 11 cases, but non ureter or bowel injury happened; All 4 repeat operations were due to delayed hemorrhage after conservative management during cesarean delivery, and an emergent hysterectomy was performed for all of the 4 cases. Hysterectomy (107 cases, 22.4%) was the most common severe adverse pregnancy outcome. Among all 311 morbidly adherent placenta cases finally confirmed by pathological or surgical findings or both, only 172 (55.3%) were suspected before delivery. Multivariable logistic regression analysis showed that the risk of severe adverse
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