不同生育政策时期子宫破裂的发生率、危险因素及母婴结局：中国的一项观察性研究。
The incidence, risk factors and maternal and foetal outcomes of uterine rupture during different birth policy periods: an observational study in China.
机构信息
National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, No. 17 Ren Min Nan Lu, Chengdu City, Sichuan Province, 610041, P. R. China.
National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
出版信息
BMC Pregnancy Childbirth. 2021 May 5;21(1):360. doi: 10.1186/s12884-021-03811-8.
BACKGROUND
Currently, there are no studies on changes in the incidence of uterine rupture or maternal and foetal outcomes in women with uterine rupture during different birth policy periods in China. Moreover, the results of association studies of maternal age, parity and previous caesarean section number with the risk of maternal and foetal outcomes in women with uterine rupture have not been consistent. This research aims to conduct and discuss the above two aspects.
METHODS
We included singleton pregnant women with no maternal complications other than uterine rupture from January 2012 to June 2019 in China's National Maternal Near Miss Surveillance System. The data in this study did not differentiate between complete and partial uterine rupture and uterine dehiscence. Through Poisson regression analysis with a robust variance estimator, we compared the incidences of uterine rupture and maternal and foetal outcomes in women with uterine rupture during different birth policy periods in China and determined the relationship between maternal age, parity or previous caesarean section number and uterine rupture or maternal and foetal outcomes in women with uterine rupture.
RESULTS
This study included 8,637,723 pregnant women. The total incidences of uterine rupture were 0.13% (12,934) overall, 0.05% during the one-child policy, 0.12% during the partial two-child policy (aRR = 1.96; 95% CI: 1.53-2.52) and 0.22% (aRR = 2.89; 95% CI: 1.94 4.29) during the universal two-child policy. The maternal near miss and stillbirth rates in women with uterine rupture were respectively 2.35% (aRR = 17.90; 95% CI: 11.81-27.13) and 2.12% (aRR = 4.10; 95% CI: 3.19 5.26) overall, 5.46 and 8.18% during the first policy, 1.72% (aRR = 0.60; 95% CI: 0.32-1.17) and 2.02% (aRR = 0.57; 95% CI: 0.37-0.83) during the second policy, and 1.99% (aRR = 0.90; 95% CI: 0.52-1.53) and 1.04% (aRR = 0.36; 95% CI: 0.24-0.54) during the third policy. The risk of uterine rupture increased with parity and previous caesarean section number.
CONCLUSION
The uterine rupture rate in China continues to increase among different birth policy periods, and the risk of maternal near miss among women with uterine rupture has not significantly improved. The Chinese government, obstetricians, and scholars should work together to reverse the rising rate of uterine rupture and improve the pregnancy outcomes in women with uterine rupture.
背景
目前，中国尚缺乏不同生育政策时期子宫破裂发生率和母婴结局变化的相关研究，且关于产妇年龄、产次和剖宫产史与子宫破裂母婴结局相关性的队列研究结果也不尽相同。本研究旨在对这两个方面进行探讨。
方法
我们纳入了 2012 年 1 月至 2019 年 6 月中国全国孕产妇危重症监测系统中除子宫破裂外无其他产科合并症的单胎妊娠孕妇。本研究数据未对完全性子宫破裂和不完全性子宫破裂及子宫破裂分别进行区分。采用稳健方差估计的 Poisson 回归分析，比较了中国不同生育政策时期子宫破裂的发生率和母婴结局，并确定了产妇年龄、产次或剖宫产史与子宫破裂或子宫破裂母婴结局的关系。
结果
本研究共纳入 8637723 名孕妇。子宫破裂总发生率为 0.13%（12934 例），其中一孩政策时期为 0.05%，二孩政策（部分）时期为 0.12%（调整相对危险度[aRR]为 1.96；95%CI：1.53-2.52），全面二孩政策时期为 0.22%（aRR 为 2.89；95%CI：1.94-4.29）。子宫破裂产妇的孕产妇危重症发生率和死胎率分别为 2.35%（aRR 为 17.90；95%CI：11.81-27.13）和 2.12%（aRR 为 4.10；95%CI：3.19-5.26），一孩政策时期为 5.46%和 8.18%，二孩政策（部分）时期为 1.72%（aRR 为 0.60；95%CI：0.32-1.17）和 2.02%（aRR 为 0.57；95%CI：0.37-0.83），全面二孩政策时期为 1.99%（aRR 为 0.90；95%CI：0.52-1.53）和 1.04%（aRR 为 0.36；95%CI：0.24-0.54）。子宫破裂的风险随着产次和剖宫产史的增加而增加。
结论
中国不同生育政策时期子宫破裂发生率持续上升，子宫破裂产妇的孕产妇危重症风险并未明显改善。中国政府、产科医生和学者应共同努力，扭转子宫破裂发生率上升的趋势，改善子宫破裂产妇的妊娠结局。
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