中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2011年
3期
321-323
,共3页
瘢痕子宫%前置胎盘%再次妊娠%剖宫产%并发症
瘢痕子宮%前置胎盤%再次妊娠%剖宮產%併髮癥
반흔자궁%전치태반%재차임신%부궁산%병발증
Scar uterus%Placenta previa%Repeated pregnancy%Cesarean delivery%Complication
目的 探讨瘢痕子宫再次妊娠伴有前置胎盘再次行剖宫产的并发症及其防治.方法 收集分析2006年1月至2010年4月在我院行单胎再次剖宫产337例患者的临床资料,其中伴有前置胎盘者26例,同期单胎初次剖宫产6832例,其中伴有前置胎盘者201例.结果 瘢痕子宫再次妊娠的前置胎盘发生率为7.72%(26/337),明显高于初次剖宫产组的2.94%(201/6832),差异有统计学意义(x2=22.33,P＜0.01);且更易并发中央性前置胎盘(42.30%与0.00%,x2=0.43,P＜0.01).瘢痕子宫伴前置胎盘再次剖宫产组的子宫破裂率、胎盘植入率、产后出血率、子宫切除率分别为26.92%(7/26)、23.08%(6/26)、26.92%(7/26)、7.69%(2/26),而瘢痕子宫不伴前置胎盘组的以上发生率分别为2.57%(8/311)、0.32%(1/311)、1.29%(4/311)、0.00%(0/311),差异有统计学意义(x2值分别为27.97、50.41、42.16、12.79,P均＜0.01).结论 瘢痕子宫再次妊娠时前置胎盘发生率增加,且中央性比例增高,瘢痕子宫伴前置胎盘更易发生子宫破裂、胎盘植入、产后出血,甚至切除子宫,故降低剖宫产率、降低风险、提高产科质量非常重要.
目的 探討瘢痕子宮再次妊娠伴有前置胎盤再次行剖宮產的併髮癥及其防治.方法 收集分析2006年1月至2010年4月在我院行單胎再次剖宮產337例患者的臨床資料,其中伴有前置胎盤者26例,同期單胎初次剖宮產6832例,其中伴有前置胎盤者201例.結果 瘢痕子宮再次妊娠的前置胎盤髮生率為7.72%(26/337),明顯高于初次剖宮產組的2.94%(201/6832),差異有統計學意義(x2=22.33,P＜0.01);且更易併髮中央性前置胎盤(42.30%與0.00%,x2=0.43,P＜0.01).瘢痕子宮伴前置胎盤再次剖宮產組的子宮破裂率、胎盤植入率、產後齣血率、子宮切除率分彆為26.92%(7/26)、23.08%(6/26)、26.92%(7/26)、7.69%(2/26),而瘢痕子宮不伴前置胎盤組的以上髮生率分彆為2.57%(8/311)、0.32%(1/311)、1.29%(4/311)、0.00%(0/311),差異有統計學意義(x2值分彆為27.97、50.41、42.16、12.79,P均＜0.01).結論 瘢痕子宮再次妊娠時前置胎盤髮生率增加,且中央性比例增高,瘢痕子宮伴前置胎盤更易髮生子宮破裂、胎盤植入、產後齣血,甚至切除子宮,故降低剖宮產率、降低風險、提高產科質量非常重要.
목적 탐토반흔자궁재차임신반유전치태반재차행부궁산적병발증급기방치.방법 수집분석2006년1월지2010년4월재아원행단태재차부궁산337례환자적림상자료,기중반유전치태반자26례,동기단태초차부궁산6832례,기중반유전치태반자201례.결과 반흔자궁재차임신적전치태반발생솔위7.72%(26/337),명현고우초차부궁산조적2.94%(201/6832),차이유통계학의의(x2=22.33,P＜0.01);차경역병발중앙성전치태반(42.30%여0.00%,x2=0.43,P＜0.01).반흔자궁반전치태반재차부궁산조적자궁파렬솔、태반식입솔、산후출혈솔、자궁절제솔분별위26.92%(7/26)、23.08%(6/26)、26.92%(7/26)、7.69%(2/26),이반흔자궁불반전치태반조적이상발생솔분별위2.57%(8/311)、0.32%(1/311)、1.29%(4/311)、0.00%(0/311),차이유통계학의의(x2치분별위27.97、50.41、42.16、12.79,P균＜0.01).결론 반흔자궁재차임신시전치태반발생솔증가,차중앙성비례증고,반흔자궁반전치태반경역발생자궁파렬、태반식입、산후출혈,심지절제자궁,고강저부궁산솔、강저풍험、제고산과질량비상중요.
Objective To explore the complications and the treatments of repeated cesarean delivery in scar uterus pregnancy accompanied by the placenta praevia. Methods We performed a retrospective study in 6832 cases underwent first cesarean delivery,within which 201 cases were accompanied by the placenta praevia;and 337 cases underwent repeated cesarean deliver, within which 26 cases were accompanied by the placenta praevia. All subjects accepted cesarean delivery from January2006 toApril 2010 in our hospital. Results The occurrence rate of placenta previa was significantly higher in the repeated cesarean delivery than first-ever cesarean delivery (7. 72% vs 2. 94%, x2 = 22. 33, P ＜ 0. 01 ) , especially the occurrence of complete placenta previa (42. 30% vs 0. 00%, x2 = 80. 43, P ＜ 0. 01 ). The rates of uterus rupture, placenta accreta, postpartum hemorrhage and hysterectomy (r = 26. 92% ,23.08% ,26. 92% and 7. 69%, respectively) in repeated cesarean delivery in scar uterus pregnancy accompanied by the placenta praevia were significantly higher than those of the cases ( r = 2. 57% ,0. 32%, 1.29% and 0. 00%, respectively ) had repeated cesarean delivery in scar uterus pregnancy but no placenta previa ( x2 = 27.97,50. 41,42. 16,12. 79, respectively, Ps ＜ 0. 01 ). Conclusion The incidence of placenta previa increased in scar uterus pregnancy, especially the complete placental previa.Scar uterus pregnancy accompanied by the placenta praevia are more likely to occur uterus rupture,placenta accreta,postpartum hemorrhage and had hysterectomy. Obstetricians should give more effort to reduce the cesarean section rate,improve the quality of medical care.
