绒毛膜下血肿及其合并复发性流产患者妊娠结局的影响因素分析  

Analysis of influencing factors on pregnancy outcomes in patients with chorionic hematoma and recurrent miscarriage

作　　者：丁雪蕾[1] 李晓冬[2,3] 苍荣 何美娟 贾雪颖 Ding Xuelei;Li Xiaodong;Cang Rong;He Meijuan;Jia Xueying(Department of Obstetrics and Gynecology,Shijiazhuang Fourth Hospital,Hebei Province,Shijiazhuang 050000,China)

机构地区：[1]石家庄市第四医院妇产科,石家庄050000 [2]河北医科大学第二医院,石家庄050004 [3]河北医科大学第一医院

出　　处：《疑难病杂志》2024年第6期724-728,735,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：河北省医学科学研究重点课题(20201387)。

摘　　要：目的探讨绒毛膜下血肿(SCH)及其合并复发性流产(RSA)患者妊娠结局的影响因素。方法回顾性分析2019年6月—2021年6月就诊于石家庄市第四医院和河北医科大学第二医院的SCH患者204例,其中合并RSA 92例,单纯SCH 112例,通过对患者的年龄、BMI、诊断血肿时的孕龄、是否伴有阴道出血、孕产史、凝血指标[血小板聚集率(AA、ADP)、D-二聚体(D-D)]、有无复发性流产病史等因素分析,探讨其发生不良妊娠结局的高危因素。结果经Logistic分析发现,伴阴道出血(OR=3.443,95%CI 1.613~7.351,P=0.001)、复发性流产病史(OR=2.392,95%CI 1.136~5.035,P=0.022)、血小板聚集率ADP(OR=1.202,95%CI 1.118~1.292,P<0.001)是不良妊娠结局的危险因素,诊断血肿时的孕龄大(OR=0.963,95%CI 0.938~0.989,P=0.006)、既往活产次数多(OR=0.125,95%CI 0.047~0.330,P<0.001)是不良妊娠结局的保护因素。其中92例SCH合并RSA患者经Logistic分析发现,ADP(OR=1.171,95%CI 1.043~1.316,P=0.008)、D-D(OR=1.011,95%CI 1.002~1.020,P=0.020)高是不良妊娠结局的危险因素,既往活产次数多(OR=0.154,95%CI 0.061~0.392,P<0.001)是不良妊娠结局的保护因素。结论凝血功能异常(高凝状态)是单纯绒毛膜下血肿患者或者绒毛膜下血肿合并复发性流产患者不良妊娠结局的危险因素,需进行相应的抗凝治疗,以改善妊娠结局。Objective To investigate the influencing factors of pregnancy outcome in patients with subchorionic hematoma(SCH)and recurrent spontaneous abortion(RSA)combined with SCH,so as to formulate corresponding treatment strategies and improve pregnancy outcome.Methods A total of 204 patients with subchorionic hematoma admitted to the Fourth Hospital of Shijiazhuang and the Second Affiliated Hospital of Hebei Medical University from June 2019 to June 2021 were retrospectively analyzed.The high-risk factors of adverse pregnancy outcomes were analyzed by analyzing the patient's age,BMI,gestational age when SCH was diagnosed,whether accompanied by vaginal bleeding,pregnancy history,coagulation indicators(platelet aggregation rate AA,platelet aggregation rate ADP,D-dimer,homocysteine),and recurrent miscarriage history.Results A total of 204 SCH patients were included in the study.After controlling confounding factors,vaginal bleeding(OR=3.443,95%CI 1.613-7.351,P=0.001),the history of recurrent miscarriage(OR=2.392,95%CI 1.136-5.035,P=0.022),platelet aggregation rate(ADP)(OR=1.202,95%CI 1.118-1.292,P<0.001)were found that they were the risk factors for adverse pregnancy outcomes,and the number of gestational ages at diagnosis of hematoma(OR=0.963,95%CI 0.938-0.989,P=0.006)and previous live births(OR=0.125,95%CI 0.047-0.330,P<0.001)were the protective factors.After controlling confounding factors,platelet aggregation rate(ADP)(OR=1.171,95%CI 1.043-1.316,P=0.008)and D-dimer(OR=1.011,95%CI 1.002-1.020,P=0.020)were found to be risk factors for adverse pregnancy outcomes in 92 SCH patients with RSA,and the number of previous live births(OR=0.154,95%CI 0.061-0.392,P<0.001)was a protective factor for adverse pregnancy outcomes.Conclusion Abnormal coagulation(hypercoagulability)is a risk factor for adverse pregnancy outcomes in patients with subchorionic hematoma or subchorionic hematoma combined with recurrent spontaneous abortion.Patients with subchorionic hematoma complicated with recurrent abortion should pay more attention to mo

关 键 词：绒毛膜下血肿 复发性流产 妊娠结局 危险因素 

分 类 号：R714.25[医药卫生—妇产科学]