前置胎盘合并穿透性胎盘植入危险因素及妊娠结局分析  

Analysis of risk factors and pregnancy outcome of placenta previa combined with penetrating placenta implantation

作　　者：王瀚杰 杜凯玟 徐红兵[1] WANG Hanjie;DU Kaiwen;XU Hongbing(Department of Gynecology and Obstetrics,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院妇产科,重庆400016

出　　处：《现代医药卫生》2024年第17期2936-2941,共6页Journal of Modern Medicine & Health

摘　　要：目的探讨前置胎盘合并穿透性胎盘植入(PP)的危险因素和妊娠结局。方法选取2019年6月至2022年12月该院收治的经剖宫分娩的前置胎盘合并PP孕妇369例,根据胎盘植入临床分级分为未穿透组(297例)和穿透组(72例)。比较2组孕妇妊娠结局,采用logistic回归模型分析发生前置胎盘合并PP的危险因素。结果穿透组孕妇放置腹主动脉球囊、宫腔填塞(球囊/纱条)、子宫切除比例,以及术中出血量、产后并发症及新生儿不良结局发生率均明显高于未穿透组,差异均有统计学意义(P<0.05)。人工流产清宫术是胎盘植入合并PP的危险因素(优势比=2.421,95%可信区间1.107~5.296,P=0.027)。既往剖宫产次数大于或等于1次是前置胎盘合并PP的独立危险因素(优势比=3.314,95%可信区间1.525~7.203,P=0.002)。结论前置胎盘合并PP孕妇在围手术期积极采取预防出血措施后,其不良结局发生率仍较高。既往剖宫产次数大于或等于1次是前置胎盘合并PP的独立危险因素。Objective To explore the risk factors and pregnancy outcomes of placenta previa combined with penetrating placenta implantation(PP).Methods A total of 369 pregnant women with placenta previa combined with PP admitted to the hospital for delivery via cesarean section from June 2019 to December 2022 were selected and divided into the unperforated group(297 cases)and the perforated group(72 cases)according to the clinical grading of placenta implantation.The pregnancy outcomes of pregnant women in the two groups were compared,and the risk factors for the occurrence of placenta previa combined with PP were analyzed using logistic regression models.Results The percentage of pregnant women in the penetrated group with placement of abdominal aortic balloon,uterine tamponade(balloon/gauze),and hysterectomy,as well as the rates of intraoperative hemorrhage,post-partum complications,and adverse neonatal outcomes were significantly higher than those in the non-penetrated group,and the differences were all statistically significant(P<0.05).Induced abortion clearance was a risk factor for PP combined with placenta previa(OR=2.421,95%CI 1.107-5.296,P=0.027).The number of previous cesarean sections≥1 was an independent risk factor for PP combined with placenta previa(OR=3.314,95%CI 1.525-7.203,P=0.002).Conclusion The rate of adverse outcomes in pregnant women with placenta previa combined with PP was high despite more aggressive perioperative measures to prevent bleeding.The number of previous cesarean sections≥1 is an independent risk factor for PP with placenta previa.

关 键 词：前置胎盘 穿透性胎盘植入 危险因素 妊娠结局 

分 类 号：R714.25[医药卫生—妇产科学]