稽留流产的危险因素：单中心回顾性分析。
Risk factors for missed abortion: retrospective analysis of a single institution's experience.
机构信息
Department of Gynaecology and Obstetrics, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No.1617 of Riyue Avenue, Qingyang District, Chengdu, 611731, China.
Department of Radiation Oncology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China.
出版信息
Reprod Biol Endocrinol. 2022 Aug 9;20(1):115. doi: 10.1186/s12958-022-00987-2.
OBJECTIVE
To explore the risk factors including the difference between mean gestational sac diameter and crown-rump length for missed abortion.
METHODS
Hospitalized patients with missed abortion and patients with continuing pregnancy to the second trimester from Chengdu Women's and Children's Central Hospital from June 2018 to June 2021 were retrospectively analyzed. The best cut-off value for age and difference between mean gestational sac diameter and crown-rump length (mGSD-CRL) were obtained by x-tile software. Univariate and multivariate logistic regression analysis were adopted to identify the possible risk factors for missed abortion.
RESULTS
Age, gravidity, parity, history of cesarean section, history of recurrent abortion (≥ 3 spontaneous abortions), history of ectopic pregnancy and overweight or obesity (BMI > 24 kg/m) were related to missed abortion in univariate analysis. However, only age (≥ 30 vs < 30 years: OR = 1.683, 95%CI = 1.017-2.785, P = 0.043, power = 54.4%), BMI (> 24 vs ≤ 24 kg/m: OR = 2.073, 95%CI = 1.056-4.068, P = 0.034, power = 81.3%) and mGSD-CRL (> 20.0vs ≤ 11.7 mm: OR = 2.960, 95% CI = 1.397-6.273, P = 0.005, power = 98.9%; 11.7 < mGSD-CRL ≤ 20.0vs > 20.0 mm: OR = 0.341, 95%CI = 0.172-0.676, P = 0.002, power = 84.8%) were identified as independent risk factors for missed abortion in multivariate analysis.
CONCLUSION
Patients with age ≥ 30 years, BMI > 24 kg/m or mGSD-CRL > 20 mm had increasing risk for missed abortion, who should be more closely monitored and facilitated with necessary interventions at first trimester or even before conception to reduce the occurrence of missed abortion to have better clinical outcomes.
目的
探讨包括平均孕囊直径与头臀长差值在内的导致稽留流产的相关危险因素。
方法
回顾性分析 2018 年 6 月至 2021 年 6 月于成都市妇女儿童中心医院因稽留流产住院的患者以及继续妊娠至孕中期的患者。采用 X-tile 软件获得年龄和平均孕囊直径与头臀长差值（mGSD-CRL）的最佳截断值。采用单因素和多因素 logistic 回归分析识别稽留流产的可能危险因素。
结果
单因素分析显示，年龄、孕次、产次、剖宫产史、复发性流产史（≥3 次自然流产）、异位妊娠史和超重或肥胖（BMI＞24 kg/m）与稽留流产有关。然而，仅年龄（≥30 岁比＜30 岁：OR＝1.683，95%CI＝1.017～2.785，P＝0.043，效能＝54.4%）、BMI（＞24 比≤24 kg/m：OR＝2.073，95%CI＝1.056～4.068，P＝0.034，效能＝81.3%）和 mGSD-CRL（＞20.0 比≤11.7 mm：OR＝2.960，95%CI＝1.397～6.273，P＝0.005，效能＝98.9%；11.7＜mGSD-CRL≤20.0 比＞20.0 mm：OR＝0.341，95%CI＝0.172～0.676，P＝0.002，效能＝84.8%）是稽留流产的独立危险因素。
结论
年龄≥30 岁、BMI＞24 kg/m 或 mGSD-CRL＞20 mm 的患者稽留流产风险增加，应在孕早期甚至孕前进行更密切的监测并给予必要的干预，以降低稽留流产的发生，获得更好的临床结局。
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