[1]魏素梅,杨霄,金莹*,等.剖宫产术对妊娠并发胎盘植入程度的影响[J].中国计划生育和妇产科,2017,(8):61-64.
　WEI Su-mei,YANG Xiao,JIN Ying*,et al.Effect of cesarean section on placental implantation in pregnancy[J].Chinese Journal of Family Planning & Gynecotokology,2017,(8):61-64.
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剖宫产术对妊娠并发胎盘植入程度的影响
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《中国计划生育和妇产科》[ISSN:1674-4020/CN:51-1708/R]

卷:
期数:
2017年8期
页码:
61-64
栏目:
论著与临床
出版日期:
2017-08-25

文章信息/Info

Title:
Effect of cesarean section on placental implantation in pregnancy
作者:
魏素梅;  杨霄; 金莹*; 王琼; 熊雯
成都市妇女儿童中心医院妇产科
Author(s):
WEI Su-mei;  YANG Xiao;  JIN Ying*;  WANG Qiong;  XIONG Wen
Department of Obstetrics and Gynecology,Chengdu Women&Children’s Central Hospital,Chengdu Sichuan 61000,P.R.China
关键词:
剖宫产术; 胎盘植入; 瘢痕子宫
Keywords:
cesareans section;  placenta implantation;  scarred uterus
分类号:
R 719.8
摘要:
目的探讨剖宫产手术情况对下次妊娠并发胎盘植入(placenta implantation，PI)程度的影响。方法选择2012年5月至2016年5月在成都市妇女儿童中心医院分娩的瘢痕子宫（前次剖宫产术）11 025例为观察组（剖宫产组），同期经产妇（前次均为顺产）8 320例为对照组（阴道分娩组），比较不同分娩方式再次妊娠PI的发生率及植入程度，分析前次剖宫产是否伴有产后出血、是否为产程中转急诊手术以及前次剖宫产距离本次妊娠时间与PI程度的关系。结果剖宫产组再次妊娠时PI发生率高于阴道分娩组（25 % vs 18 %，P<0.05)，且植入型与穿透型PI发生率比阴道分娩组更高，差异有统计学意义（99 ‰ vs 66 ‰、58 ‰ vs 0.9 ‰，P均＜0.05）。剖宫产组中前次剖宫产伴产后出血，再次妊娠时PI发生率高于无产后出血组，尤其粘连型与植入型发生率更高，差异有统计学意义（146 ‰ vs 82 ‰、142 ‰ vs 87 ‰，P均＜005）；前次为产程中转剖宫产时，此次妊娠穿透型PI发生率高于非中转组（75 ‰ vs 45 ‰，P＜005）；前次剖宫产距离本次妊娠时间，与PI发生率及植入程度比较差异无统计学意义(P＞005)。结论前次剖宫产术，术后并发产后出血及产程中转剖宫产是再次妊娠发生PI的高危因素，应加强此类孕妇的孕期管理。
Abstract:
ObjectiveTo investigate the effect of cesarean section on the extent of placenta implantation(PI) in the next pregnancy. Methods11 025 patients pregnant again with the history of cesarean section from May 2012 to May 2016 in Chengdu Women&Children’s Central Hospital were included as the observation group(cesarean section group), while 8 320 patients with the history of virginal delivery from the same period were selected as the control group(virginal delivery group). The incidence and degree of PI were analyzed between the two groups. And whether the previous cesarean section was with postpartum hemorrhage, whether it’s the emergency operation for labor transit and pregnancy time from the previous cesarean section were related to the degree of placenta implantation were analyzed.ResultsThe incidence of PI was higher in cesarean section group than in vaginal delivery group（25 % vs 18 %，P＜005）. Moreover, incidence of placenta increta and placenta percreta were higher than that of vaginal delivery group.The differences were statistically significant(99 ‰vs 66 ‰, 58 ‰ vs 9 ‰,P＜ 005). Incidence of PI is obviously related to the accidence of postpartum hemorrhage in the last cesarean sections, which attend to higher incidence, especially placenta accrete and placenta increta (146 ‰ vs 82 ‰, 142 ‰ vs 87 ‰,P＜005). Accidence of placenta percreta was much higher when the patient were transferred from virginal deliver to cesareans section(75 ‰ vs 45 ‰，P＜005). There was no significant difference between the incidence and degree of PI and pregnancy time from the previous cesarean section(P＞005).ConclusionCesarean section surgery increased the risk of PI, which is associated with the accidence of postpartum hemorrhage and whether the patient was transferred from virginal deliver to cesareans section.So it is very important to strengthen the management of this kind of maternal during pregnancy.

参考文献/References:

［1］陈敦金,杨慧霞.胎盘植入诊治指南（2015）［J］.中华围产医学杂志,2015,7:481-485. ［2］ESHKOLI T, WEINTRAUB A Y, SERGIENKO R, et al. Placenta accreta: risk factors, perinatal outcomes, and consequences for subsequent births ［J］. American Journal of Obstetrics and Gynecology, 2013, 208(3): e1-e7. ［3］赵扬玉．剖宫产术后瘢痕部穿透性胎盘植入 ［J］．中国妇产科临床杂志，2009，10 （4）：245-247． ［4］SOLHEIM K N, ESAKOFF T F, LITTLE S E, et al. The effect of cesarean delivery rates on the future incidence of placenta previa, placenta accreta, and maternal mortality ［J］. The Journal of Maternal-fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 2011, 24(11): 1341-1346. ［5］KAMARA M, HENDERSON J J, DOHERTY D A, et al. The risk of placenta accreta following primary elective caesarean delivery: a case-control study ［J］. BJOG-An International Journal of Obstetrics and Gynaecology, 2013, 120 (7): 879-886. ［6］VAHANIAN S A, VINTZILEOS A M. Placental implantation abnormalities: a modern approach ［J］. Current Opinion in Obstetrics & Gynecology, 2016, 28(6): 477-484. ［7］陈运山，赵扬玉，王妍，等．影响胎盘植入凶险程度的临床高危因素分析 ［J］．实用妇产科杂志，2015，12 （31）：916-919． ［8］侯磊，李光辉，邹丽颖，等．全国剖宫产率及剖宫产指征构成比调查的多中心研究 ［J］．中华妇产科杂志，2014，49（10）：728-735．

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更新日期/Last Update: 2017-08-25