中期妊娠引产病理因素对引产后胎盘残留的影响  

Influences of pathological factors after induced labor in mid-pregnancy on placenta residue

作　　者：杨丽凌 刘晓燕 林开荣 胡宏媛 YANG Liling;LIU Xiaoyan;LIN Kairong;Hu Hongyuan(Department of Obstetrics,Wanning Municipal People's Hospital of Hainan Province,Hainan Wanning 571500,China)

机构地区：[1]海南省万宁市人民医院产科,海南万宁571500

出　　处：《中国妇幼健康研究》2023年第5期103-110,共8页Chinese Journal of Woman and Child Health Research

摘　　要：目的 探讨中期妊娠引产病理因素对患者引产后胎盘残留的影响。方法 回顾性选取2019年1月至2022年3月因病理性因素在万宁市人民医院实施中期妊娠引产患者80例为研究对象,根据术后有无胎盘残留分为胎盘残留组(40例)和无胎盘残留组(40例),比较两组患者一般资料和病理因素,应用多因素Logistic回归分析影响患者引产后胎盘残留的独立危险因素。应用卡方自动交互检测(CHAID)分类树算法构建患者引产后胎盘残留的风险预测模型,并用收益图和索引图评价模型的临床应用价值。结果 胎盘残留组的妊娠期高血压疾病、瘢痕子宫、胎盘前置、死胎和胎盘植入的发生率均明显高于无胎盘残留组,差异均有统计学意义(χ^(2)值分别为4.501、4.267、6.373、4.943、5.000,P<0.05)。多因素Logistic回归分析显示,胎盘前置(OR=4.736,95%CI:1.469~15.263)、胎盘植入(OR=18.651,95%CI:1.689~36.203)、瘢痕子宫(OR=4.383,95%CI:1.168~16.451)和死胎(OR=4.785,95%CI:1.385~17.157)均为患者中期妊娠引产后胎盘残留的独立危险因素(P<0.05)。分类树模型结果显示,模型共分3层,9个节点,其中包含5个终末节点。在胎盘前置、胎盘植入、瘢痕子宫和死胎4个解释变量中,胎盘前置对引产后胎盘残留的影响最大。模型第1层:有胎盘前置患者引产后发生胎盘残留的概率(67.74%)明显高于无胎盘前置者(38.78%),差异有统计学意义(χ^(2)=6.373,P=0.012)。模型第2层:存在胎盘前置时,有胎盘植入患者引产后发生胎盘残留的概率(83.33%)明显高于无胎盘植入者(32.00%),差异有统计学意义(χ^(2)=5.236,P=0.022);不存在胎盘前置时,有瘢痕子宫患者引产后发生胎盘残留的概率(71.43%)明显高于无瘢痕子宫者(34.29%),差异有统计学意义(χ^(2)=5.576,P=0.018)。模型第3层:当不存在胎盘前置且无瘢痕子宫时,有死胎患者引产后发生胎盘残留的概率(63.64%)明显高于无死胎者(23.08%),差�Objective To investigate influences of pathological factors after induced labor in the second trimester of pregnancy on placenta residue.Methods A retrospective study was conducted.80 patients who underwent mid-pregnancy induced labor due to pathological factors in our hospital from January 2019 to March 2022 were selected as study subjects.According to presence or absence of placenta residue after operation, the patients were divided into placenta residue group(40 cases) and non-placenta residue group(40 cases).The general data and pathological factors of the patients in the two groups were compared, and multivariate Logistic regression was used to analyze independent risk factors of placenta residue after induced labor.The risk prediction model of placenta residue after induced labor was constructed by using Chi-square automatic interactive detection(CHAID) classification tree algorithm, revenue diagram and index diagram were used to evaluate clinical application value of the model.Results The incidences of hypertensive disorder complicating pregnancy(HDCP),scarred uterus, placenta previa, placenta implantation and stillbirth in the placenta residue group were all significantly higher than those in the non-placenta residue group(χ^(2)=4.501,4.267,6.373,4.943 and 5.000,all P<0.05).Multivariate Logistic regression analysis showed that placenta previa(OR=4.736,95%CI:1.469-15.263), placenta implantation(OR=18.651,95%CI:1.689-36.203),scarred uterus(OR=4.383,95%CI:1.168-16.451) and stillbirth(OR=4.785,95%CI:1.385-17.157) were all independent risk factors for placenta residue after induced labor in mid-pregnancy(all P<0.05).The classification tree algorithm model included 3 layers and 9 nodes(including 5 final nodes).The results of the classification tree model showed that placenta previa had the greatest influence on placenta residue after induced labor among four variables such as placenta previa, scarred uterus, placenta implantation and stillbirth.The first layer of the model(Layer 1):The probability of placenta

关 键 词：中期妊娠 病理因素 分类树模型 胎盘残留 引产 

分 类 号：R173[医药卫生—妇幼卫生保健]