前置胎盘合并胎盘植入性疾病发生早产的影响因素分析  

Analysis of factors influencing premature birth in cases with placenta previa complicated by placenta accreta spectrum disorders

作　　者：王晶玉 贺艺 范翠芳[3] 熊国平[4] 孙国强[5] 王少帅 陈素华 乌剑利 邓东锐 冯玲 刘海意 党晓鹤 曾万江 WANG Jingyu;HE Yi;FAN Cuifang;XIONG Guoping;SUN Guoqiang;WANG Shaoshuai;CHEN Suhua;WU Jianli;DENG Dongrui;FENG Ling;LIU Haiyi;DANG Xiaohe;ZENG Wanjiang(Department of Obstetrics and Gynecology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,Hubei,China;不详)

机构地区：[1]华中科技大学同济医学院附属同济医院妇产科,湖北武汉430030 [2]咸宁市中心医院产科,陕西咸宁437000 [3]武汉大学人民医院产科,湖北武汉430030 [4]武汉市中心医院妇产科,湖北武汉430030 [5]湖北省妇幼保健院产科,湖北武汉430030 [6]西安交通大学第一附属医院妇产科,陕西西安710061

出　　处：《实用医学杂志》2024年第21期2982-2988,共7页The Journal of Practical Medicine

基　　金：国家重点研发计划项目(编号:2022YFC2704503)。

摘　　要：目的回顾性分析前置胎盘合并胎盘植入性疾病(placenta accreta spectrum,PAS)产妇早期早产(early preterm birth,EPB)和晚期早产(late preterm birth,LPB)的影响因素及母婴预后。方法纳入590例在2018年1月至2021年6月期间于武汉市及咸宁市共五家医院行剖宫产分娩的前置胎盘合并PAS产妇。根据分娩孕周将产妇分为EPB组、LPB组和足月分娩(term birth,TB)组。采用多项logistic回归模型分析发生EPB和LPB的危险因素,并分析早期母婴预后在组间的差异。结果590例前置胎盘合并PAS产妇EPB和LPB的比例为9.7%和54.4%。剖宫产术前使用宫缩抑制剂、术前阴道出血以及既往剖宫产次是EPB和LPB的危险因素。EPB组与LPB组产妇发生严重产后出血的比例相近,而EPB组的新生儿窒息、低出生体重儿及剖宫产术后24 h内转入NICU的比例均显著高于LPB组(P<0.001)。结论前置胎盘合并PAS主要发生LPB。既往剖宫产次、剖宫产术前子宫收缩与阴道出血与EPB和LPB显著相关。应在围产期严密监测下尽量延长产妇分娩孕周,减少早产的发生,改善母婴早期预后。Objective To retrospectively analyze of factors influencing early preterm birth(EPB)and late preterm birth(LPB)in pregnancy women with placenta previa complicated by placenta accreta spectrum disorders(PAS),and assess maternal and infant outcomes.Methods We included 590 cases of pregnancy women with placenta previa complicated by PAS who underwent cesarean sections at five hospitals in Wuhan and Xianning cities between January 2018 and June 2021.These patients were divided into three groups based on delivery gestational age:EPB,LPB,and term birth(TB).A multiple logistic regression model was employed to analyze the risk factors associated with EPB and LPB.Additionally,differences in early maternal and infant outcomes among these groups were examined.Results Among 590 pregnancy women with placenta previa complicated by PAS,the proportions of EPB and LPB were 9.7%and 54.4%.The use of uterine contraction inhibitors prior to cesarean section,vaginal bleeding,and previous cesarean sections history were identified as risk factors for both EPB and LPB.The proportion of severe postpartum hemorrhage was comparable between the EPB group and the LPB group;however,the incidence of neonatal asphyxia,low birth weight infants,and the rate of newborns transferred to the Neonatal Intensive Care Unit(NICU)within 24 hours after cesarean delivery were significantly higher in the EPB group compared to the LPB group.Conclusions Placenta previa complicated by PAS predominantly leads to LPB.The history of prior cesarean sections,uterine contractions,and vaginal bleeding prior to cesarean section,are significantly associated with both EPB and LPB.During the perinatal period,efforts should be made to extend gestational weeks under close monitoring to minimize the incidence of premature births and thereby improve early maternal and infant outcomes.

关 键 词：前置胎盘 胎盘植入性疾病 早期早产 晚期早产 

分 类 号：R714[医药卫生—妇产科学]