子宫动脉栓塞术治疗产后出血对再次妊娠结局的影响  

Outcome of re-pregnancy in women with uterine artery embolization for postpartum hemorrhage

作　　者：林啸笑 孙待飞[1] 傅君[2] 钟惠珍[2] UN Xiaoxiao;SUN Daifei;FU Jun;ZHONG Huizhen(Department of Obstetrics,Ningbo Women and Children's Hospital,Mngbo 315012,Zhejiang Province,China;Department of Gynecology,Nlngbo Women and Children’s Hospital,Ningbo 315012,Zhejiang Province,China)

机构地区：[1]宁波市妇女儿童医院产科,浙江宁波315012 [2]宁波市妇女儿童医院妇科,浙江宁波315012

出　　处：《浙江大学学报（医学版）》2019年第5期540-545,共6页Journal of Zhejiang University(Medical Sciences)

基　　金：浙江省人口计划生育科研项目(2014KYB358)

摘　　要：目的:探讨子宫动脉栓塞术(UAE)治疗产后出血对再次妊娠结局的影响。方法:收集宁波市妇女儿童医院产科2010年1月至2016年1月收治的产后出血病例,选取再次妊娠的117例患者病例资料,根据之前是否行UAE治疗分为UAE组(40例)和对照组(未行UAE治疗,77例),比较两组再次妊娠和分娩情况并分析UAE治疗对再次妊娠和分娩的影响。结果:UAE组与对照组早孕人工流产和剖宫产瘢痕妊娠的发生率差异有统计学意义(P<0.05或P<0.01),再次妊娠分娩时UAE组子宫切除、复发产后出血、胎盘植入的比例高于对照组(P<0.01或P<0.05)。多因素回归分析结果显示,UAE后再次妊娠的患者发生剖宫产瘢痕妊娠的风险增加(P<0.05),发生胎盘植入及复发产后出血甚至子宫切除的风险增加(P<0.05或P<0.01)。结论:UAE后再妊娠产妇发生剖宫产瘢痕妊娠、胎盘植入及相关的产后出血甚至子宫切除的风险增大。Objective: To evaluate the outcome of re-pregnancy in women with uterine artery embolization(UAE)for postpartum hemorrhage(PPH). Methods: Clinical data of 117 pregnant women with previous PPH admitted in Ningbo Women and Children’s Hospital from January 2010 to January 2016 were retrospectively analyzed. Among them 40 cases were treated with UAE(UAE group) and 77 cases were not treated with UAE(control group). The outcomes of re-pregnancy were followed up and compared between two groups. Results: There were significant differences in the incidence of induced abortion in early pregnancy and cesarean scars pregnancy(CSP) between the two groups(P<0.05 or P<0.01). In the UAE group, the incidence of PPH, placental accretion and hysterectomy rate was significantly higher than that of control group(P<0.05 or P<0.01). Multivariate analysis showed that UAE was independent risk factor for CSP, placenta accretion, PPH and hystere-ctomy(P<0.05 or P<0.01).Conclusions: The overall fertility and re-pregnant outcomes in women with previous UAE for PPH are favorable. However, the risk of CSP, placenta accretion and associated recurrence of PPH and hysterectomy is higher in women receiving UAE during subsequent pregnancy.

关 键 词：产后出血/治疗 动脉 栓塞 治疗性 子宫/血液供给 妊娠结局 

分 类 号：R714.7[医药卫生—妇产科学]