Lyu B, Chen M, Liu X X
Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu 610041, China.
Zhonghua Fu Chan Ke Za Zhi. 2016 Jul 25;51(7):498-502. doi: 10.3760/cma.j.issn.0529-567X.2016.07.004.
To investigate the risk factors of peripartum hysterectomy in placenta previa through retrospective study of 3 840 placenta previa cases.
The clinical data of 3 840 patients with placenta previa who delivered in West China Second University Hospital between Jan 2005 and June 2014 were analyzed retrospectively. The relationship of certain factors and peripartum hysterectomy was analyzed, including maternal age, residence place, parity, prior curettage, prior cesarean section, twin or multiple pregnancy, antenatal vaginal bleeding, type of placenta previa, suspected placenta accreta, antenatal level of hemoglobin and gestational age at delivery.
The prevalence of placenta previa was 4.84%(3 840/79 304)in West China Second University Hospital during the study period, and the incidence of preipartum hysterectomy in patients with placenta previa was 2.76%(106/3 840). One-factor analysis demonstrated that residence place, parity, times of prior curettage, prior cesarean section, prenatal vaginal bleeding, anterior placenta, type of placenta previa, placenta accreta, antenatal anemia and gestational age at delivery were potential risk factors for peripartum hysterectomy(P<0.01). Variables with P<0.1 in one-factor analysis were introduced to multi-factor logistic regression analysis, which suggested that one prior cesarean section(OR=12.9,95% CI:6.3-26.3), two or more prior cesarean sections(OR=14.4, 95%CI:3.9-53.2), anterior placenta(OR=4.8, 95%CI:2.1-10.7), complete placenta previa(OR=5.9, 95%CI: 1.8-42.5), placenta accreta(OR=11.2, 95%CI:6.8-18.6), antenatal hemoglobin<100 g/L(OR=1.7, 95%CI: 1.0-2.8)and delivery before 34 gestational weeks(OR=3.2, 95%CI: 1.6-6.3)were independent risk factors of peripartum hysterectomy in patients with placenta previa(P<0.05).
Prior cesarean section, anterior placenta, complete placenta previa, placenta accreta, antenatal anemia and delivery before 34 gestational weeks are high risk factors of peripartum hysterectomy in placenta previa patients. Perinatal care and risk evaluation before cesarean section are important to improve perinatal outcomes and reduce peripartum hysterectomy.
通过对3840例前置胎盘病例的回顾性研究，探讨前置胎盘患者围产期子宫切除术的危险因素。
回顾性分析2005年1月至2014年6月在四川大学华西第二医院分娩的3840例前置胎盘患者的临床资料。分析某些因素与围产期子宫切除术的关系，包括产妇年龄、居住地、产次、既往刮宫史、既往剖宫产史、双胎或多胎妊娠、产前阴道出血、前置胎盘类型、可疑胎盘植入、产前血红蛋白水平及分娩孕周。
研究期间，四川大学华西第二医院前置胎盘的发生率为4.84%（3840/79304），前置胎盘患者围产期子宫切除术的发生率为2.76%（106/3840）。单因素分析显示，居住地、产次、既往刮宫次数、既往剖宫产史、产前阴道出血、前壁胎盘、前置胎盘类型、胎盘植入、产前贫血及分娩孕周是围产期子宫切除术的潜在危险因素（P<0.01）。将单因素分析中P<0.1的变量纳入多因素logistic回归分析，结果显示，既往剖宫产1次（OR=12.9，95%CI：6.3-26.3）、既往剖宫产2次及以上（OR=14.4，95%CI：3.9-53.2）、前壁胎盘（OR=4.8，95%CI：2.1-10.7）、完全性前置胎盘（OR=5.9，95%CI：1.8-42.5）、胎盘植入（OR=11.2，95%CI：6.8-18.6）、产前血红蛋白<100 g/L（OR=1.7，95%CI：1.0-2.8）及孕34周前分娩（OR=3.2，95%CI：1.6-6.3）是前置胎盘患者围产期子宫切除术的独立危险因素（P<0.05）。
既往剖宫产史、前壁胎盘、完全性前置胎盘、胎盘植入、产前贫血及孕34周前分娩是前置胎盘患者围产期子宫切除术的高危因素。剖宫产术前的围产期护理和风险评估对改善围产期结局及减少围产期子宫切除术至关重要。
