Wang Si, Hu Qing, Liao Hua, Wang Kana, Yu Haiyan
Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People's Republic of China.
Int J Womens Health. 2023 Sep 19;15:1453-1465. doi: 10.2147/IJWH.S422187. eCollection 2023.
Uterine scarring is risky for the pregnancy and is closely associated with adverse pregnancy outcomes. Here, we investigated risk factors and associated perinatal outcomes in singleton pregnant women with uterine scars.
This retrospective cohort study was conducted on singleton pregnant women who delivered at the West China Second University Hospital between January 1, 2021, and December 31, 2021.
The control group included 13,433 cases without uterine scars. The study group involved 2397 cases with one previous cesarean delivery (PCD), 163 cases with two PCDs, 12 cases with three PCDs, and 184 cases with non-cesarean uterine scars. The study group had a significantly higher incidence of placenta previa (6.4%), placenta percreta (5.3%), preterm delivery (10.3%), postpartum hemorrhage (3.4%), uterine rupture (9.4%), hysterectomy (0.18%), and bladder injury (0.4%) when compared with the control group ( <0.05). The scarred uterus cases with 1, 2, or 3 PCDs had significantly different complications, with the higher PCD frequency correlating with increased rates of placenta previa, placenta percreta, postpartum hemorrhage, uterine rupture, and uterine resection. Moreover, the hospitalization time, cesarean operation time, and intrapartum bleeding in the current pregnancy significantly increased with increasing PCD frequency ( <0.05). Analysis of the association between the duration of the interval between PCD and re-pregnancy and pregnancy complication revealed that the incidence of pernicious placenta previa was statistically higher in cases with intervals of <2 years or ≥5 years (4.7%) than in cases with 2 years ≤ interval time <5 years (2.5%) ( <0.05).
Pregnancies with uterine scars may experience higher rates of adverse perinatal outcomes. This calls for increased observation during pregnancy and delivery to reduce maternal and fetal complications.
子宫瘢痕对妊娠有风险，且与不良妊娠结局密切相关。在此，我们调查了单胎妊娠子宫瘢痕孕妇的危险因素及相关围产期结局。
本回顾性队列研究针对2021年1月1日至2021年12月31日在华西第二医院分娩的单胎妊娠孕妇进行。
对照组包括13433例无子宫瘢痕的病例。研究组包括2397例有一次剖宫产史（PCD）、163例有两次PCD、12例有三次PCD以及184例有非剖宫产子宫瘢痕的病例。与对照组相比，研究组前置胎盘（6.4%）、穿透性胎盘植入（5.3%）、早产（10.3%）、产后出血（3.4%）、子宫破裂（9.4%）、子宫切除术（0.18%）及膀胱损伤（0.4%）的发生率显著更高（P<0.05）。有1次、2次或3次PCD的瘢痕子宫病例并发症有显著差异，PCD次数越多，前置胎盘、穿透性胎盘植入、产后出血、子宫破裂及子宫切除术的发生率越高。此外，随着PCD次数增加，本次妊娠的住院时间、剖宫产手术时间及产时出血量显著增加（P<0.05）。分析PCD与再次妊娠间隔时间和妊娠并发症之间的关联发现，间隔时间<2年或≥5年的病例中凶险性前置胎盘的发生率（4.7%）在统计学上高于间隔时间2年≤间隔时间<5年的病例（2.5%）（P<0.05）。
有子宫瘢痕的妊娠可能出现更高的不良围产期结局发生率。这就要求在孕期和分娩期间加强观察，以减少母婴并发症。
