与其他子宫异常相比，哪种类型的子宫异常对妊娠结局有额外影响？一项对大型人群数据库的评估。
What type of uterine anomalies had an additional effect on pregnancy outcomes, compared to other uterine anomalies? An evaluation of a large population database.
作者信息
Kadour Peero Einav, Badeghiesh Ahmad, Baghlaf Haitham, Dahan Michael H
机构信息
Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, Montreal, Canada.
MUHC Reproductive Center, McGill University, Montreal, Canada.
出版信息
J Matern Fetal Neonatal Med. 2022 Dec;35(26):10494-10501. doi: 10.1080/14767058.2022.2130240. Epub 2022 Oct 10.
OBJECTIVE
To compare pregnancy risks between different congenital uterine anomalies utilizing other congenital anomalies as a control group in a large population database.
DESIGN, SETTING, AND SAMPLE: A retrospective population-based cohort study from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) included 3,846,342 births (2010-2014). Of them, 6195 deliveries were to women with bicornuate uteri, 798 with arcuate uteri, 2255 with didelphys uteri, 802 with unicornuate uteri and 1404 with septate uteri.
MAIN OUTCOME MEASURES AND RESULTS
After adjustment for confounders, women with bicornuate uteri were more likely to deliver vaginally (aOR 1.4, 95%CI: 1.1-1.9), = .01), less likely to deliver by cesarean (CD) and had lower risk of small for gestational age (SGA) (aOR 0.8, 95%CI: 0.7-0.9, = .03) when compared to the other anomalies (aOR 0.6, 95%CI: 0.5-0.6, = .0001). Pregnant women with arcuate uterus had lower risks of preterm delivery (PTD) (aOR 0.6, 95%CI: 0.5-0.8, = .0001), less chance of operative vaginal delivery (aOR 0.5, 95%CI: 0.2-0.9, = .04), and higher risk for CD (aOR 1.6, 95%CI: 1.4-2, = .0001). Pregnant women with didelphys uteri had higher risk of preterm premature rupture of membranes (PPROM) (aOR 1.6, 95%CI: 1.3-1.9, = .0001), PTD (aOR 1.5, 95%CI: 1.3-1.6, = .0001), CD (aOR 1.4, 95%CI: 1.2-1.5, = .0001) and wound complications (aOR 1.6, 95%CI: 1.1-2.4, = .02). Pregnant unicornuate uteri had increased risks of PTD (aOR 1.4, 95%CI: 1.1-1.6, = .0001), CD (aOR 2, 95%CI: 1.6-2.5, = .0001) and of SGA (aOR 1.8, 95%CI: 1.4-2.3, = .0001). Pregnant septate uteri had higher risk of chorioamnionitis (aOR 1.5, 95%CI: 1.1-2.1, = .048) and CD (aOR 1.4, 95%CI: 1.2-1.6, = .0001).
CONCLUSIONS
We demonstrated that there are different risks for certain adverse pregnancy and neonatal outcomes in diverse uterine anomalies as compared to the other anomalies.
目的
在一个大型人群数据库中，以其他先天性异常作为对照组，比较不同先天性子宫异常之间的妊娠风险。
设计、设置和样本：一项基于医疗成本和利用项目全国住院样本（HCUP-NIS）的回顾性队列研究，纳入了3846342例分娩（2010 - 2014年）。其中，双子宫女性分娩6195例，弓形子宫女性分娩798例，双子宫纵隔子宫女性分娩2255例，单角子宫女性分娩802例，纵隔子宫女性分娩1404例。
主要结局指标及结果
在对混杂因素进行调整后，与其他异常相比，双子宫女性经阴道分娩的可能性更高（调整后比值比[aOR]为1.4，95%置信区间[CI]：1.1 - 1.9，P = 0.01），剖宫产（CD）的可能性更低，且小于胎龄儿（SGA）风险更低（aOR为0.8，95%CI：0.7 - 0.9，P = 0.03）。弓形子宫孕妇早产（PTD）风险更低（aOR为0.6，95%CI：0.5 - 0.8，P = 0.0001），手术助产分娩的机会更少（aOR为0.5，95%CI：0.2 - 0.9，P = 0.04），CD风险更高（aOR为1.6，95%CI：1.4 - 2，P = 0.0001）。双子宫纵隔子宫孕妇胎膜早破（PPROM）风险更高（aOR为1.6，95%CI：1.3 - 1.9，P = 0.0001），PTD风险更高（aOR为1.5，95%CI：1.3 - 1.6，P = 0.0001），CD风险更高（aOR为1.4，95%CI：1.2 - 1.5，P = 0.0001）以及伤口并发症风险更高（aOR为1.6，95%CI：1.1 - 2.4，P = 0.02）。单角子宫孕妇PTD风险增加（aOR为1.4，95%CI：1.1 - 1.6，P = 0.0001），CD风险增加（aOR为2，95%CI：1.6 - 2.5，P = 0.0001）以及SGA风险增加（aOR为1.8，95%CI：1.4 - 2.3，P = 0.0001）。纵隔子宫孕妇绒毛膜羊膜炎风险更高（aOR为1.5，95%CI：1.1 - 2.1，P = 0.048）以及CD风险更高（aOR为1.4，95%CI：1.2 - 1.6，P = 0.0001）。
结论
我们证明，与其他异常相比，不同子宫异常在某些不良妊娠和新生儿结局方面存在不同风险。
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