瘢痕子宫不完全子宫破裂危险因素分析  

Risk factors of incomplete uterine rupture in scarred uterus

作　　者：刘超[1] 杨桦[1] 郝增平[1] LIU Chao;YANG Hua;HAO Zeng-ping(Department of Obstetrics and Gynecology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院妇产科

出　　处：《临床和实验医学杂志》2019年第15期1663-1667,共5页Journal of Clinical and Experimental Medicine

摘　　要：目的探讨剖宫产后瘢痕子宫再妊娠孕晚期发生不完全子宫破裂的危险因素。方法回顾性分析2015年1月至2017年12月首都医科大学附属北京友谊医院收治的142例剖宫产后瘢痕子宫再妊娠患者的病例资料,其中108例成功阴道分娩纳入对照组,34例发生不完全子宫破裂纳入病例组。分析患者前次剖宫产的手术时机、前次剖宫产与本次妊娠间隔时间、孕妇年龄及妊娠次数、流产次数、临床症状及超声情况与本次妊娠发生不完全子宫破裂之间的关系。结果病例组患者平均年龄为(36.24±3.66)岁,平均孕周为(38.53±1.29)周;对照组患者平均年龄为(32.82±3.25)岁,平均孕周为(39.14±1.08)周,两者差异均具有统计学意义(P<0.01);病例组临产剖宫产3例(8.8%),对照组临产剖宫产19例(17.6%),对照组临产剖宫产比率高于病例组,但两者差异无统计学意义(P=0.705);多因素Logistic回归分析发现,孕妇年龄和新生儿体重是瘢痕子宫再妊娠孕晚期发生不完全子宫破裂的独立影响因素(P<0.05),为瘢痕子宫再妊娠孕晚期发生不完全子宫破裂的危险因素,OR值(95%CI)分别为1.380(1.146~1.622)和1.002(1.000~1.003)。结论孕妇年龄、新生儿体重是瘢痕子宫孕晚期发生不完全子宫破裂的危险因素,前次剖宫产手术时机为临产后剖宫产可能是瘢痕子宫孕晚期发生不完全子宫破裂的保护性因素。Objective To investigate the risk factors of incomplete uterine rupture in the third trimester of pregnancy with scar uterus after cesarean section.Methods Retrospective study was conducted in 142 patients who are pregnant with scar uterus after cesarean section,including108 cases of successful vaginal delivery(as the control group),and 34 cases of incomplete uterine rupture(as the observationgroup).The timing of the previous cesarean section,duration between the previous cesarean section and this pregnancy,age of the pregnant woman,number of pregnancy,number of abortion,clinical symptoms and ultrasonic conditions as risk factors,the occurrence of incomplete uterine rupture in this pregnancy was analyzed.Results For patients in the observation group,average age was(36.24±3.66)years old,average gestational week was(38.53±1.28)weeks.And for patients in the control group,average age was(32.82±3.25)years old,average pregnant week was(39.14±1.08)weeks,these differences were statistically significant(P<0.01)between the two groups.For parturient cesarean section,there were 3 cases(8.8%)in the observation group,while 19 cases(17.6%)in the control group.The proportion of parturient cesarean section in the control group was higher than that in the observation group,but there was statistically insignificant difference between the two groups(P=0.705).Estimates from multivariate Logistic regression analysis indicated that both age and neonatal weight were independent risk factors for incomplete uterine rupture in the third trimester of pregnancy,with corresponding OR(95%CI)were 1.380(1.146~1.622)and 1.002(1.000~1.003),respectively.Conclusion Age of pregnant women and neonatal weight are the risk factors of incomplete uterine rupture in the third trimester of cicatricial uterine pregnancy with scar uterus after cesarean section.The timing of previous cesarean section might be the protective factor of incomplete uterine rupture in the third trimester of cicatricial uterine pregnancy.

关 键 词：瘢痕子宫 不完全子宫破裂 危险因素 剖宫产手术时机 

分 类 号：R719.8[医药卫生—妇产科学]