瘢痕子宫再次妊娠分娩发生子宫破裂的危险因素分析  

Analysis of risk factors of uterine rupture during recurrent pregnancy and delivery of pregnant and parturient women with scarred uterus

作　　者：孙荣荣 金雅芳[1] 顾颖[1] 赵敏[1] 冯华萍[1] SUN Rongrong;JIN Yafang;GU Ying;ZHAO Min;FENG Huaping(Department of Gynecology and Obstetrics,Wuxi Municipal Maternity and Child Health Hospital Affiliated to Nanjing Medical University,Jiangsu Wuxi 21A000.China)

机构地区：[1]南京医科大学附属无锡市妇幼保健院妇产科,江苏无锡214000

出　　处：《中国妇幼健康研究》2021年第11期1553-1557,共5页Chinese Journal of Woman and Child Health Research

基　　金：2017年度江苏省妇幼健康科研项目(F201735)。

摘　　要：目的探讨瘢痕子宫再次妊娠分娩发生子宫破裂的危险因素。方法选取2009年1月至2020年10月在南京医科大学附属无锡市妇幼保健院妇产科就诊的33例瘢痕子宫再次妊娠发生子宫破裂者为子宫破裂组,47例瘢痕子宫再次妊娠未发生子宫破裂者为非子宫破裂组。回顾性收集所有产妇的临床病历资料,采用单因素分析和多因素Logistic回归分析瘢痕子宫再次妊娠分娩发生子宫破裂的危险因素。结果单因素分析结果显示,子宫破裂组产妇妊娠次数≥3次、生产次数>2次的比例明显高于非子宫破裂组(χ^(2)=11.10,P<0.01;χ^(2)=17.80,P<0.01);子宫破裂组产妇两次妊娠间隔时间≤3年、前次缝合方式为单层以及瘢痕厚度<0.3cm的比例均明显高于非子宫破裂组(χ^(2)值分别为11.99、11.31、17.45,P<0.01);子宫破裂组产妇分娩前Hb<100 g/L的比例明显高于非子宫破裂组(χ^(2)=11.05,P<0.01);多因素Logistic回归分析结果:妊娠次数≥3次、两次妊娠间隔时间≤3年的瘢痕子宫孕产妇再次妊娠发生子宫破裂的危险分别是妊娠次数<3次、间隔时间>3年孕产妇的1.24倍和1.58倍(95%CI:1.02~1.50,P=0.04;95%CI:1.35~4.85,P=0.04);前次缝合方式为单层、瘢痕厚度<0.3cm的瘢痕子宫孕产妇再次妊娠发生子宫破裂的风险分别是双层缝合、瘢痕厚度≥0.3cm的1.65倍和1.64倍(95%CI:1.17~4.16,P=0.03;95%CI:1.25~6.96,P<0.01)。结论妊娠次数≥3次、两次妊娠间隔时间≤3年、前次缝合方式为单层、瘢痕厚度<0.3cm是瘢痕子宫再次妊娠分娩时发生子宫破裂的危险因素,临床对于上述合并因素者应重点防御,进而降低子宫破裂的风险。Objective To explore risk factors of uterine rupture during recurrent pregnancy and delivery of pregnant and parturient women with scarred uterus.Methods From January 2009 to October 2020,a total of 33 patients with scarred uterus and had uterine rupture were classified as uterine rupture group,and the 47 patients with scarred uterus and without uterine rupture were classified as the non-uterine rupture group in the Department of Gynecology and Obstetrics,Wuxi Municipal Maternity and Child Health Hospital affiliated to Nanjing Medical University.The clinical medical records of all parturients were collected retrospectively,and single factor analysis and multivariate logistic regression analysis were used to analyze the risk factors of uterine rupture during recurrent pregnancy and delivery of pregnant and parturient women with scarred uterus.Results Univariate analysis showed that the proportions of the pregnant and parturient women with pregnancy frequency≥3 times and delivery requency>2 times in the uterine rupture group were significantly higher than those in the non-uterine rupture group(χ^(2)=11.10,P<0.01;χ^(2)=17.80,P<0.01);the proprtions of interval between two pregnancies≤3 years,previous monostratified(single-layer)suture history and the scar thickness<0.3 cm in the uterine rupture group were significantly higher than those in the non-uterine rupture group(χ^(2)=11.99,11.31 and 17.45 respectively,all P<0.01);the proportion of the pregnant and parturient women with hemoglobin(HB)<100 g/L before delivery in the uterine rupture group was significantly higher than that in the non-uterine rupture group(χ^(2)=11.05,P<0.01).Results of multivariate logistic regression analysis:the risk of uterine rupture in those pregnant women with scarred uterus and with more than 3 times of pregnancy and recurrent pregancy interval less than 3 years was 1.24 times and 1.58 times higher than that in those pregnant women with less than 3 times of pregnancy and recurrent pregancy interval more than 3 years,respectively(9

关 键 词：瘢痕妊娠 子宫破裂 缝合方式 危险因素 

分 类 号：R711.74[医药卫生—妇产科学]