前置胎盘产前出血与妊娠结局关系研究
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摘要
目的探讨前置胎盘产前出血对妊娠结局的影响。方法分析2012年10月至2017年12月在南京医科大学第一附属医院住院分娩的404例前置胎盘病例,探讨产前出血的高危因素,并比较产前无出血组(n=254)及反复出血组(n=150)患者的妊娠结局差异。结果单因素Logistic回归分析结果提示:当孕妇既往孕次及宫腔操作史累计3次时,此次妊娠产前出血风险分别高于小于3次患者(OR=1.937,95%CI 1.054～3.562)、(OR=2.174,95%CI 1.050～4.504);孕28～<32周,产前出血风险最高,随着孕周增加,孕妇产前出血风险反而降低;前壁胎盘孕妇产前出血风险高于后壁胎盘患者(OR=3.978,95%CI 2.220～7.195);中央性前置胎盘孕妇产前出血风险高于边缘性及部分性前置胎盘患者(OR=3.346,95%CI 2.050～5.460)。多因素Logistic回归分析结果提示:与边缘性及部分性前置胎盘相比,中央性前置胎盘发生反复产前出血风险显著增加(OR=3.344,95%CI 1.955～5.722);前壁胎盘发生产前出血的风险高于后壁胎盘(OR=3.954,95%CI 2.196～7.387);孕周≥36周后产前出血风险显著降低,与其他孕周相比发生产前出血的风险显著降低(OR=0.086,95%CI 0.030～0.240)。产前反复出血组孕妇急诊手术风险显著增加(OR=252,95%CI 60.173～1055.359),血制品使用风险高于无出血组(OR=2.103,95%CI 1.394～3.171);产前反复出血孕妇与无产前出血孕妇相比,分娩低出生体重儿、新生儿轻度及重度窒息风险分别增加(OR=7.982,95%CI 2.410～26.426)、(OR=2.987,95%CI 1.529～5.837)、(OR=13.941,95%CI 1.690～114.626),同时新生儿重症病房收治风险增高(OR=3.379,95%CI 2.102～5.430)。结论孕次、宫腔操作史、妊娠终止孕周及前置胎盘类型及位置均是前置胎盘产前出血的高危因素,而中央性前置胎盘及前壁胎盘是增加产前出血的独立危险因素;反复出血组孕妇血制品使用风险增高,低出生体重儿出生风险、新生儿窒息、新生儿重症病房收住风险均明显增加。
Objective To study the effect of antepartum haemorrhage on pregnancy outcomes in placenta previa cases.Methods A total of 404 cases of placenta previa in the First Affiliated Hospital of Nanjing Medical University from Oc-tober 2012 to December 2017 were compared. The high-risk factors of prenatal hemorrhage were analyzed,and pregnan-cy outcomes were compared between no-bleeding group(n=254)and repeated-bleeding group(n=150).Results Uni-variate Logistic regression analysis suggested:when the number of gravidity and uterine cavity operation reached 3 times,prenatal bleeding risk was higher than those less than 3 times(OR=1.937,95%CI 1.054-3.562;OR=2.174,95%CI1.050-4.504),respectively.The risk of prenatal hemorrhage was the highest at 28-<32 weeks of gestation,and the riskof of prenatal bleeding decreased with the increase of gestational weeks.The risk of prenatal hemorrhage in patients withplacenta previa was higher than that in patients with posterior wall placenta(OR=3.978,95%CI 2.220-7.195).The riskof prenatal hemorrhage in women with central placenta previa was higher than that in women with marginal or partial pla-centa(OR=3.346,95%CI 2.050-5.460).Multivariate Logistic regression analysis suggested:the risk of recurrent prenatalbleeding in central placenta previa was higher than that in marginal and partial ones(OR=3.344,95%CI 1.955-5.722).The risk of prenatal bleeding in placenta previa was higher than that in posterior wall placenta(OR=3.954,95%CI 2.196-7.387).The risk of prenatal bleeding was significantly re-duced at ≥36 weeks of gestation,and the risk was signifi-cantly lower than that at other gestational weeks(OR=0.086,95% CI 0.030-0.240).The emergency operationrisk of pregnant women with repeated prenatal hemor-rhage was higher than that of those without prenatal hemorrhage(OR=252,95%CI 60.173-1055.359),and the risk of using blood products was higher than no-bleeding group(OR=2.103,95%CI 1.394-3.171).Compared with women in no-bleeding group,the risk of low birth weight,and mildand severe asphyxia of the newborn increased(OR=7.982,95%CI 2.410-26.426),(OR=2.987,95%CI 1.529-5.837)and(OR=13.941,95%CI 1.690-114.626),respectively,and the risk of admission and treatment in neonatal intensive careunit(NICU)was increased in repeated-bleeding group(OR=3.379,95%CI 2.102-5.430).Conclusion The risk factorsof prenatal haemorrhage of placenta previa are gravidity,uterine cavity operation,gestational weeks at termination ofpregnancy,and placental type and position;central placenta and anterior placenta are independent risk factors for in-creasing prenatal bleeding;repeated prenatal bleeding increases the risk of using blood products,low birth weight of thenewborn,neonatal asphyxia and neonatal NICU admission.
Objective To study the effect of antepartum haemorrhage on pregnancy outcomes in placenta previa cases.Methods A total of 404 cases of placenta previa in the First Affiliated Hospital of Nanjing Medical University from Oc-tober 2012 to December 2017 were compared. The high-risk factors of prenatal hemorrhage were analyzed,and pregnan-cy outcomes were compared between no-bleeding group(n=254)and repeated-bleeding group(n=150).Results Uni-variate Logistic regression analysis suggested:when the number of gravidity and uterine cavity operation reached 3 times,prenatal bleeding risk was higher than those less than 3 times(OR=1.937,95%CI 1.054-3.562;OR=2.174,95%CI1.050-4.504),respectively.The risk of prenatal hemorrhage was the highest at 28-<32 weeks of gestation,and the riskof of prenatal bleeding decreased with the increase of gestational weeks.The risk of prenatal hemorrhage in patients withplacenta previa was higher than that in patients with posterior wall placenta(OR=3.978,95%CI 2.220-7.195).The riskof prenatal hemorrhage in women with central placenta previa was higher than that in women with marginal or partial pla-centa(OR=3.346,95%CI 2.050-5.460).Multivariate Logistic regression analysis suggested:the risk of recurrent prenatalbleeding in central placenta previa was higher than that in marginal and partial ones(OR=3.344,95%CI 1.955-5.722).The risk of prenatal bleeding in placenta previa was higher than that in posterior wall placenta(OR=3.954,95%CI 2.196-7.387).The risk of prenatal bleeding was significantly re-duced at ≥36 weeks of gestation,and the risk was signifi-cantly lower than that at other gestational weeks(OR=0.086,95% CI 0.030-0.240).The emergency operationrisk of pregnant women with repeated prenatal hemor-rhage was higher than that of those without prenatal hemorrhage(OR=252,95%CI 60.173-1055.359),and the risk of using blood products was higher than no-bleeding group(OR=2.103,95%CI 1.394-3.171).Compared with women in no-bleeding group,the risk of low birth weight,and mildand severe asphyxia of the newborn increased(OR=7.982,95%CI 2.410-26.426),(OR=2.987,95%CI 1.529-5.837)and(OR=13.941,95%CI 1.690-114.626),respectively,and the risk of admission and treatment in neonatal intensive careunit(NICU)was increased in repeated-bleeding group(OR=3.379,95%CI 2.102-5.430).Conclusion The risk factorsof prenatal haemorrhage of placenta previa are gravidity,uterine cavity operation,gestational weeks at termination ofpregnancy,and placental type and position;central placenta and anterior placenta are independent risk factors for in-creasing prenatal bleeding;repeated prenatal bleeding increases the risk of using blood products,low birth weight of thenewborn,neonatal asphyxia and neonatal NICU admission.
引文
[1]丰有吉,沈铿.妇产科学[M].2版.北京:人民卫生出版社,2010:113-116.
[2]曹泽毅.中华妇产科学[M].2版.北京:人民卫生出版社,2005:422.
[3]Faiz AS,Ananth CV.Etiology and risk factors for placenta previa:an overview and meta-analysis of observational studies[J].JMatern Fetal Neonatal Med,2003,13(3):175-190.
[4]As?c?oglu O,?ahbaz A,Güng?rdük K,et al.Maternal and perinatal outcomes in women with placenta praevia and accreta in teaching hospitals in Western Turkey[J].J Obstet Gynaecol,2014,34(6):462-466.
[5]夏亚军,袁香梅,滕莉.89例前置胎盘患者临床结局的回顾性分析[J].中国实用妇科与产科杂志,2001,17(2):90-92.
[6]Silver RM.Abnormal placentation:placenta previa,vasa previa,and placenta accreta[J].Obstet Gynecol,2015,126(3):654-668.
[7]Chen LM,Du WJ,Dai J,et al.Effects of subclinical hypothyroid-?ism on maternal and perinatal outcomes during pregnancy:a single-center cohort study of a Chinese population[J].PLoS One,2014,9(10):e109364.
[8]孙丽洲,姜子燕.妊娠合并慢性淋巴细胞性甲状腺炎[J].中国实用妇科与产科杂志,2017,33(12):915-917.
[9]彭方亮,罗欣,漆洪波.瘢痕子宫再次妊娠并发前置胎盘197例临床分析[J].中国实用妇科与产科杂志,2016,32(8):788-791.
[10]徐虹,龚一女,吴明妍.中国儿童先天性肾积水早期管理专家共识[J].中国实用儿科杂志,2018,33(2):81-88
[11]肖农,陈艳妮.重视我国早产儿及危重新生儿的发育行为及心理评定[J].中国实用儿科杂志,2017,32(11):807-812.
[12]Ananth CV,Smulian JC,Vintzileos AM.The effect of placenta previa on neonatal mortality:a population-based study in the United States,1989 through 1997[J].Am J Obstet Gynecol,2003,188(5):1299-1304.
[13]Jung EJ,Cho HJ,Byun JM,et al.Placental pathologic changes and perinatal outcomes in placenta previa[J].Placenta,2018,63:15-20.(2018-09-23收稿2018-11-14修回)?
[2]曹泽毅.中华妇产科学[M].2版.北京:人民卫生出版社,2005:422.
[3]Faiz AS,Ananth CV.Etiology and risk factors for placenta previa:an overview and meta-analysis of observational studies[J].JMatern Fetal Neonatal Med,2003,13(3):175-190.
[4]As?c?oglu O,?ahbaz A,Güng?rdük K,et al.Maternal and perinatal outcomes in women with placenta praevia and accreta in teaching hospitals in Western Turkey[J].J Obstet Gynaecol,2014,34(6):462-466.
[5]夏亚军,袁香梅,滕莉.89例前置胎盘患者临床结局的回顾性分析[J].中国实用妇科与产科杂志,2001,17(2):90-92.
[6]Silver RM.Abnormal placentation:placenta previa,vasa previa,and placenta accreta[J].Obstet Gynecol,2015,126(3):654-668.
[7]Chen LM,Du WJ,Dai J,et al.Effects of subclinical hypothyroid-?ism on maternal and perinatal outcomes during pregnancy:a single-center cohort study of a Chinese population[J].PLoS One,2014,9(10):e109364.
[8]孙丽洲,姜子燕.妊娠合并慢性淋巴细胞性甲状腺炎[J].中国实用妇科与产科杂志,2017,33(12):915-917.
[9]彭方亮,罗欣,漆洪波.瘢痕子宫再次妊娠并发前置胎盘197例临床分析[J].中国实用妇科与产科杂志,2016,32(8):788-791.
[10]徐虹,龚一女,吴明妍.中国儿童先天性肾积水早期管理专家共识[J].中国实用儿科杂志,2018,33(2):81-88
[11]肖农,陈艳妮.重视我国早产儿及危重新生儿的发育行为及心理评定[J].中国实用儿科杂志,2017,32(11):807-812.
[12]Ananth CV,Smulian JC,Vintzileos AM.The effect of placenta previa on neonatal mortality:a population-based study in the United States,1989 through 1997[J].Am J Obstet Gynecol,2003,188(5):1299-1304.
[13]Jung EJ,Cho HJ,Byun JM,et al.Placental pathologic changes and perinatal outcomes in placenta previa[J].Placenta,2018,63:15-20.(2018-09-23收稿2018-11-14修回)?