瘢痕子宫再次妊娠分娩方式及妊娠结局的临床分析
|
摘要
目的分析瘢痕子宫再次妊娠的分娩方式构成情况及妊娠结局,探讨瘢痕子宫再次妊娠阴道分娩的可行性与安全性。方法选取2016年1月至2016年12月安徽医科大学附属妇幼保健院(安徽省妇幼保健院)妇产科诊治的1680例瘢痕子宫再次妊娠产妇的临床资料作研究回顾性调查。比较经阴道分娩、有剖宫产指征行剖宫产手术、无剖宫产指征行剖宫产手术的构成情况,分析各组孕产期情况、妊娠合并症、妊娠结局等发生情况,为之后瘢痕子宫分娩方式合理选择提供指导。结果 1680例瘢痕子宫产妇中51例经阴道分娩3.04%、无指征行剖宫产手术者1302例(占77.50%)。经阴道分娩者宫颈评分、宫口开大等均高于剖宫产组,住院费用低于剖宫产组,差异具有统计学意义(P<0.05);剖宫产组患者中无手术指征亚组患者宫口开大低于无指征亚组,差异具有统计学意义(P<0.05)。妊娠并发症发生率排名前20的疾病类型中,盆腔粘连占比最高,依次为妊娠期糖尿病、胎膜早破、贫血等;妊娠期糖尿病、妊娠期贫血、脐带异常等10种并发症组间差异无统计学意义(P>0.05);妊娠结局方面产时出血量、新生儿体重和住院时间差异具有统计学意义(P<0.05)。结论瘢痕子宫产妇采用无指征行剖宫产手术者占比较高,并发症以盆腔粘连、胎膜早破等为主,经阴道分娩者入院时的宫口和宫颈情况好于剖宫产者,行剖宫产分娩方式产妇出血量较大,需加强贫血、产后感染等并发症的预防。
Objective To analyze the formation of delivery mode and pregnancy outcome in recurrent uterine scar pregnancy, in order to explore the feasibility and safety of the vaginal birth in recurrent uterine scar pregnancy. Methods Theclinical data of 1680 women with scar uterine pregnancy in our hospital from January 2016 to December 2016 was retrospectively analyzed. The proportions of vaginal delivery, caesarean section with caesarean section indications, and caesarean section withnon-caesarean section indications were studied and the occurrence ofpregnancy complications and pregnancy outcome in each group was analyzed to provide guidance for the rational choice of delivery mode. Results Among the 1680 cases, there were 51 cases(3.04%) of vaginal delivery and 1302 cases(77.50%) of caesarean section withnon-caesarean section indications. The cervical score of patients with vaginal delivery was higher than that of the caesarean section group, and the hospitalization cost was lower than that of the caesarean section group, with statistically significant differences(P<0.05). Among the top 20 diseases with high incidence, the highest was pelvic adhesion, followed by gestational diabetes mellitus, premature rupture of membranes, anemia and so on. There was no significant difference in the incidences of the following 10 complications such as gestational diabetes mellitus, gestational anemia and abnormal umbilical cord among the three groups(P>0.05), but there were statistically significant differences in maternal bleeding amount, neonatal weight and hospital stay(P<0.05).Conclusions The proportion of cesarean section without indication is high, with pelvic adhesions and premature rupture of membranes as the main complications. The uterine and cervix condition of women for vaginal delivery is better than that of patients performing caesarean section. Because of the large amount of blood loss in cesarean section, the prevention of complications such as anemia and postpartum infection should be strengthened.
Objective To analyze the formation of delivery mode and pregnancy outcome in recurrent uterine scar pregnancy, in order to explore the feasibility and safety of the vaginal birth in recurrent uterine scar pregnancy. Methods Theclinical data of 1680 women with scar uterine pregnancy in our hospital from January 2016 to December 2016 was retrospectively analyzed. The proportions of vaginal delivery, caesarean section with caesarean section indications, and caesarean section withnon-caesarean section indications were studied and the occurrence ofpregnancy complications and pregnancy outcome in each group was analyzed to provide guidance for the rational choice of delivery mode. Results Among the 1680 cases, there were 51 cases(3.04%) of vaginal delivery and 1302 cases(77.50%) of caesarean section withnon-caesarean section indications. The cervical score of patients with vaginal delivery was higher than that of the caesarean section group, and the hospitalization cost was lower than that of the caesarean section group, with statistically significant differences(P<0.05). Among the top 20 diseases with high incidence, the highest was pelvic adhesion, followed by gestational diabetes mellitus, premature rupture of membranes, anemia and so on. There was no significant difference in the incidences of the following 10 complications such as gestational diabetes mellitus, gestational anemia and abnormal umbilical cord among the three groups(P>0.05), but there were statistically significant differences in maternal bleeding amount, neonatal weight and hospital stay(P<0.05).Conclusions The proportion of cesarean section without indication is high, with pelvic adhesions and premature rupture of membranes as the main complications. The uterine and cervix condition of women for vaginal delivery is better than that of patients performing caesarean section. Because of the large amount of blood loss in cesarean section, the prevention of complications such as anemia and postpartum infection should be strengthened.
引文
[1] 梁玉萍.足月产妇选择性剖宫产的原因及并发症分析[J].临床医学研究与实践,2016,1(14):127-128.
[2] 钟菀杞,余艳萍,梁真娇,等.社会因素剖宫产母婴近期结局的回顾性队列研究[J].河北医学,2015,21(1):115-118.
[3] 胡健蓉.十年剖宫产率及其指征变化和围生儿病死率相关因素分析[J].中国妇幼卫生杂志,2016,7(4):24-27.
[4] 吴方银,张燕,肖兵,等.四川省非医学指征剖宫产现状分析[J].实用妇产科杂志,2012,28(3):187-190.
[5] 张智勤,胡继芬.无医学指征剖宫产相关因素Logistic回归分析[J].中国实用妇科与产科杂志,2010,26(11):859-862.
[6] 刘会玲.不同分娩方式妊娠结局及降低剖宫产率的干预措施[J].陕西医学杂志,2016,45(8):1051-1052.
[7] Villar J,Carroli G,Zavaleta N,et al.Maternal and neonatal individual risks and benefits associated with caesarean delivery:Multicentre prospective study [J].BMJ,2007,335(7 628):1025-1025.
[8] 曾荣春,廖亚玲,冉光琴.剖宫产术后瘢痕子宫足月分娩结局的影响因素分析[J].医学综述,2015,21(18):3432-3434.
[9] 刘礼.影响剖宫产术后瘢痕子宫足月分娩结局的相关因素分析[J].医学信息,2018,31(2):109-110.
[2] 钟菀杞,余艳萍,梁真娇,等.社会因素剖宫产母婴近期结局的回顾性队列研究[J].河北医学,2015,21(1):115-118.
[3] 胡健蓉.十年剖宫产率及其指征变化和围生儿病死率相关因素分析[J].中国妇幼卫生杂志,2016,7(4):24-27.
[4] 吴方银,张燕,肖兵,等.四川省非医学指征剖宫产现状分析[J].实用妇产科杂志,2012,28(3):187-190.
[5] 张智勤,胡继芬.无医学指征剖宫产相关因素Logistic回归分析[J].中国实用妇科与产科杂志,2010,26(11):859-862.
[6] 刘会玲.不同分娩方式妊娠结局及降低剖宫产率的干预措施[J].陕西医学杂志,2016,45(8):1051-1052.
[7] Villar J,Carroli G,Zavaleta N,et al.Maternal and neonatal individual risks and benefits associated with caesarean delivery:Multicentre prospective study [J].BMJ,2007,335(7 628):1025-1025.
[8] 曾荣春,廖亚玲,冉光琴.剖宫产术后瘢痕子宫足月分娩结局的影响因素分析[J].医学综述,2015,21(18):3432-3434.
[9] 刘礼.影响剖宫产术后瘢痕子宫足月分娩结局的相关因素分析[J].医学信息,2018,31(2):109-110.