前次剖宫产时机与再次妊娠发生胎囊异常种植关系研究  

The relationship research about timing of cesarean section and the next abnormal sac planation

作　　者：种轶文[1] 曾琳[2] 赵扬玉[1] CHONG Yi-wen;ZENG Lin;ZHAO Yang-yu(Peking University Third Hospital,Beifing 100191,China)

机构地区：[1]北京大学第三医院妇产科,北京100191 [2]北京大学第三医院流行病教研室,北京100191

出　　处：《中国实用妇科与产科杂志》2018年第12期1378-1381,共4页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：国家重点研发计划"生殖健康及重大出生缺陷防控研究"重点专项(2016YFC1000408);首都卫生发展科研专项(2016-1-4091)

摘　　要：目的探讨前次剖宫产时机与再次妊娠发生剖宫产瘢痕妊娠及胎盘植入是否有关。方法以2010年1月至2015年11月北京大学第三医院妇产科收治的剖宫产瘢痕妊娠患者及剖宫产术后胎盘植入患者263例为病例组,剖宫产术后再次分娩未发生胎盘植入及瘢痕妊娠的患者651例为对照组,收集两组患者的临床资料,比较剖宫产时机差异。结果病例组年龄(32.3±4.4)岁,产程中剖宫产33例(12.5%),1次剖宫产史者214例(81.4%),2次及以上剖宫产史者49例(18.6%);对照组年龄(32.0±4.3)岁,产程中剖宫产138例(21.2%),1次剖宫产史者621例(95.4%),2次及以上剖宫产史者30例(4.6%);两组患者产程中剖宫产比例以及次数构成差异有统计学意义(P=0.001)。多因素分析发现,产程中剖宫产是瘢痕妊娠和胎盘植入的独立保护因素(OR=0.61,P=0.019);≥2次剖宫产史是危险因素(OR=5.45,P<0.001)。结论产程中行剖宫产较非产程中行剖宫产可能是再次妊娠发生剖宫产瘢痕妊娠及胎盘植入的保护因素。Objective To study whether there is relationship between timing of cesarean section and cesarean scar pregnancy as well as placenta implantation.Methods From January 2010 to November 2015,total of 263 patients who got cesarean scar pregnancy or placental accreta after cesarean section of Peking University Third Hospital were selected as case group, while the total of the 651 patients who did not have placenta accreta after cesarean section were served as the control group, the clinical datas of the two groups of patients were collected, then whether there be differences in the timing of cesarean section between the two groups were compared.Results The average age in case group was 32.3±4.4,there were 33 cases of cesarean section in delivery process(12.5%),214 cases(81.4%)with one history of cesarean section,and 49 cases(18.6%)with two or more than two histories of cesarean section. The average age in control group was 32±4.3,there were 138 cases of cesarean section in delivery process(21.2%),621 cases(95.4%)with one history of cesarean section,and 30 cases(4.6%)with two or more than two histories of cesarean section. There was significant difference in the proportion of cesarean section and the number of cesarean section in the two groups,P=0.001.Multiple factors analysis found that cesarean section in labor was the protective factor of cesarean incision pregnancy and placenta implantation(OR=0.61,P=0.019);More than 2 times of cesarean section was a risk factor(OR=5.45,P<0.001).Conclusion Cesarean section in labor may be the protective factor of cesarean incision pregnancy and placenta implantation.

关 键 词：剖宫产时机 凶险性前置胎盘 剖宫产瘢痕妊娠 

分 类 号：R719.8[医药卫生—妇产科学]