Yang Qiuying, Wen Shi Wu, Phillips Karen, Oppenheimer Lawrence, Black Douglas, Walker Mark C
OMNI Research Group, Clinical Epidemiology Program, Ottawa Health Research Institute, University of Ottawa, Ontario, Canada.
Am J Perinatol. 2009 Apr;26(4):279-86. doi: 10.1055/s-0028-1103156. Epub 2008 Nov 19.
The purpose of this study was to compare risk factors between placental abruption and placenta previa among primiparous and multiparous singleton pregnancies. We analyzed data from a population-based retrospective cohort with singleton pregnancies in the United States for 1995 to 2000. Maternal risk factors for placenta previa and placental abruption were examined using multiple logistic regressions. A total of 5,630,854 primiparous and 11,026,768 multiparous singleton pregnancies were available for final analyses after excluding subjects with missing information on outcomes or important exposures. Placental abruption was recorded in 4.8 per 1000 primiparous singleton births and 5.9 per 1000 multiparous singleton pregnancies. The occurrence of placenta previa was 1.9 per 1000 primiparous singleton pregnancies and 3.9 per 1000 multiparous singleton pregnancies. The effects of maternal age, race, parity, and previous cesarean section were stronger on placenta previa than on placental abruption, and the effects of cigarette smoking, alcohol drinking, and prenatal care were stronger on placental abruption than on placenta previa. A composite outcome of selected medical and pregnancy complications was related with placental abruption but not with placental previa. Placental abruption is more likely to be affected by conditions occurring during pregnancy, and placenta previa is more likely to be affected by conditions existing prior to pregnancy.
本研究的目的是比较初产妇和经产妇单胎妊娠中胎盘早剥和前置胎盘的风险因素。我们分析了1995年至2000年美国基于人群的单胎妊娠回顾性队列数据。使用多元逻辑回归分析前置胎盘和胎盘早剥的孕产妇风险因素。在排除结局或重要暴露信息缺失的受试者后,共有5,630,854例初产妇单胎妊娠和11,026,768例经产妇单胎妊娠可供最终分析。每1000例初产妇单胎分娩中有4.8例发生胎盘早剥,每1000例经产妇单胎妊娠中有5.9例发生胎盘早剥。前置胎盘的发生率为每1000例初产妇单胎妊娠中有1.9例,每1000例经产妇单胎妊娠中有3.9例。孕产妇年龄、种族、产次和既往剖宫产对前置胎盘的影响比对胎盘早剥的影响更强,而吸烟、饮酒和产前检查对胎盘早剥的影响比对前置胎盘的影响更强。选定的医疗和妊娠并发症的综合结局与胎盘早剥有关,但与前置胎盘无关。胎盘早剥更易受孕期发生的情况影响,而前置胎盘更易受妊娠前已存在的情况影响。