剖宫产史对完全性前置胎盘妊娠结局及出血风险的影响：长达十年的回顾性分析。
Impact of Prior Cesarean Delivery on Pregnancy Outcomes and Hemorrhage Risks in Complete Placenta Previa: A Decade-Long Retrospective Analysis.
机构信息
Department of Obstetrics, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.
出版信息
Med Sci Monit. 2024 Nov 18;30:e944432. doi: 10.12659/MSM.944432.
BACKGROUND Complete placenta previa (CPP) is a life-threatening condition with increasing incidence worldwide. This retrospective study investigated the impact of prior cesarean delivery on pregnancy outcomes in women with CPP. MATERIAL AND METHODS The data of 476 patients with CPP who underwent cesarean delivery in a tertiary hospital in Shanghai, China, from January 2013 to December 2022 were retrospectively analyzed. Patients were divided into prior cesarean delivery and no-prior cesarean delivery groups. Diagnosis of CPP was confirmed by last preoperative ultrasound/MRI. Maternal characteristics, intrapartum conditions, maternal complications, and neonatal outcomes were compared between groups. Independent predictors of hemorrhage were analyzed by logistic regression analysis. RESULTS The prior cesarean delivery group had significantly higher maternal age (36 [3.7)] vs 34.2 [4.2)], P=0.012), rates of intraoperative bleeding (982.9 [202.9] vs 588.8 [134.2], P=0.001), hysterectomy (6.4% vs 0.9%, P=0.002), premature birth (60.9% vs 36.6%, P<0.001), and neonatal hospitalization (13.5% vs 6.3%, P=0.008). The no-prior cesarean delivery group had higher rates of assisted reproduction (30.0% vs 3.8%, P<0.001) and endometriosis history (14.1% vs 8.3%, P<0.001). Multivariate logistic regression showed a history of cesarean delivery (adjusted odds ratio (aOR) 1.67), 2 or more previous cesarean deliveries (aOR 5.22), anterior placenta (aOR 2.53), abnormal percreta (aOR 5.24), and antepartum bleeding (aOR 1.90) were strongly associated with massive hemorrhage (P<0.05). CONCLUSIONS Prior cesarean delivery increases risks of hemorrhage, hysterectomy, premature birth, and neonatal hospitalization in patients with CPP. Independent risk factors for hemorrhage in these patients include prior cesarean delivery (especially 2 or more), anterior placenta, abnormal placentation, and prenatal bleeding.
背景
完全性前置胎盘（CPP）是一种全球范围内发病率不断上升的危及生命的疾病。本回顾性研究旨在探讨既往剖宫产对 CPP 患者妊娠结局的影响。
材料与方法
回顾性分析 2013 年 1 月至 2022 年 12 月在中国上海一家三级医院行剖宫产术的 476 例 CPP 患者的临床资料。患者分为既往剖宫产组和无既往剖宫产组。CPP 的诊断由术前最后一次超声/磁共振成像（MRI）确认。比较两组产妇特征、产时情况、母体并发症和新生儿结局。采用 logistic 回归分析出血的独立预测因素。
结果
既往剖宫产组的产妇年龄明显更大[36（3.7）岁比 34.2（4.2）岁]，P=0.012）]，术中出血量更多[982.9（202.9）ml 比 588.8（134.2）ml]，P=0.001）]，子宫切除率更高[6.4%比 0.9%]，P=0.002）]，早产率更高[60.9%比 36.6%]，P<0.001）]，新生儿住院率更高[13.5%比 6.3%]，P=0.008）。无既往剖宫产组接受辅助生殖技术的比例更高[30.0%比 3.8%]，P<0.001）]，子宫内膜异位症病史的比例更高[14.1%比 8.3%]，P<0.001）]。多变量 logistic 回归分析显示，剖宫产史（调整优势比[aOR]1.67）]、2 次及以上剖宫产史[aOR 5.22）]、前位胎盘[aOR 2.53）]、异常胎盘植入[aOR 5.24）]和产前出血[aOR 1.90）]与大量出血密切相关（P<0.05）。
结论
既往剖宫产增加 CPP 患者出血、子宫切除、早产和新生儿住院的风险。这些患者出血的独立危险因素包括既往剖宫产史（尤其是 2 次及以上）、前位胎盘、异常胎盘植入和产前出血。
Zotero 插件