胎盘植入严重不良妊娠结局相关危险因素分析

目的探讨胎盘植入孕产妇发生严重不良妊娠结局的相关危险因素。方法回顾性分析广州医科大学附属第三医院2009年1月至2015年6月651例胎盘植入患者的临床资料。结果胎盘植入孕产妇严重不良妊娠结局的发生率为39.6%(258/651)。单因素分析显示,年龄、孕次、产次、流产次数、剖宫产次数、产前阴道出血次数、终止妊娠孕周、胎盘植入类型、未规律产前检查、合并内科疾病和合并前置胎盘是胎盘植入孕产妇发生严重不良妊娠结局的相关危险因素(P0.05);多因素logistic回归分析显示,剖宫产次数(OR=2.248,95%CI:1.590~3.177,P=0.000)、合并内科疾病(OR=1.604,95%CI:1.080~2.384,P=0.019)和合并前置胎盘(OR=1.877,95%CI:1.204~2.925,P=0.005)是胎盘植入孕产妇发生严重不良妊娠结局的独立危险因素。结论胎盘植入孕产妇发生严重不良妊娠结局的独立危险因素为剖宫产次数、合并内科疾病及前置胎盘。     

再次剖宫产高龄产妇产后出血危险因素分析

目的:分析再次剖宫产高龄产妇的产后出血(PPH)危险因素,为产后出血的防治提供参考。方法:回顾分析2013年1月至2017年12月在中国医科大学附属盛京医院再次剖宫产的1497例高龄产妇的临床资料。根据是否发生产后出血,将产妇分为产后出血组(131例)与非产后出血组(1366例),分析产妇的年龄、孕产史、胎盘等各类因素与产后出血的相关性,并通过多因素Logistic回归分析筛选出独立危险因素。结果:Logistic回归分析显示,胎盘附着位置(OR=2.15,95%CI为1.17～3.95,P=0.013)、前置胎盘(非前置胎盘:参考组;非完全性前置胎盘:OR=13.85,95%CI为6.22～30.84,P<0.001;完全性前置胎盘:OR=29.32,95%CI为16.32～52.67,P<0.001)和胎盘植入(OR=7.08,95%CI为3.60～13.92,P<0.001)为产后出血的独立危险因素。结论:胎盘附着位置、前置胎盘、胎盘植入为影响再次剖宫产的高龄产妇产后出血的独立危险因素。     

人工流产次数对剖宫产后再次妊娠母婴围产结局的影响

目的探究既往人工流产次数对于剖宫产术后再次妊娠母婴围产结局的影响。方法回顾分析广州医科大学附属第三医院等国内7省10家三级医院妇产科于2017年1月至2017年12月收治的剖宫产术后再次妊娠28周后分娩的孕妇,收集孕产妇的一般资料和本次妊娠情况,分析既往人工流产史对于剖宫产后再次妊娠的妊娠合并症及新生儿不良结局的影响。结果共纳入9468例孕妇,其中无流产史者5305例,有人工流产史者4163例,并根据人工流产次数分为人工流产1次组(2482例),人工流产2次组(1165例),人工流产≥3次组(516例)。4组孕妇的年龄、孕前体重、孕期增重、分娩孕周、产前出血、前置胎盘、胎盘植入、产后出血、新生儿转入NICU之间比较,差异有统计学意义(P<0.05)。二元logistic回归分析显示,与无流产史组相比,人工流产次数是剖宫产术后再次妊娠发生前置胎盘的独立危险因素(aOR11.44,95%CI为1.19~1.76;aOR22.18,95%CI为1.73~2.73,aOR33.65,95%CI为2.78~4.78);同时,人工流产史是产后出血的独立危险因素(aOR11.48,95%CI为1.10~1.98;aOR21.62,95%CI为1.12~2.36;aOR33.29,95%CI为2.20~4.93)。人工流产≥2次是胎盘植入的独立危险因素(aOR21.87,95%CI为1.39~2.50;aOR34.22,95%CI为3.08~5.77)。结论既往人工流产次数是瘢痕子宫再次妊娠孕妇发生前置胎盘、产后出血的独立危险因素。人工流产次数增加,可能会增加剖宫产后再次妊娠孕妇发生胎盘植入的风险。     

中央性前置胎盘合并胎盘植入产后大出血的相关因素分析

目的 探讨中央性前置胎盘合并胎盘植入孕妇产后大出血的相关因素及预防措施。方法 收集2005年4月至2019年6月浙江大学医学院附属妇产科医院收治的355例中央性前置胎盘合并胎盘植入孕妇的临床资料,根据患者剖宫产术中及术后24 h内阴道出血量将患者分成产后大出血组（出血量≥2 000 mL）和对照组（出血量<2 000 mL）,回顾性分析两组患者的一般资料、合并产前出血、妊娠合并症并发症、子宫畸形、胎盘位于子宫位置、分娩孕周、术中情况和手术操作等与产后大出血的关系。结果 影响中央性前置胎盘合并胎盘植入孕妇发生产后大出血的相关因素单因素分析显示,既往剖宫产次数、胎盘位于前壁、周围脏器浸润、子宫动脉结扎术、宫腔填塞术可能与产后大出血的发生相关（P <0.05）。进一步多因素logistic回归分析发现,周围脏器浸润（OR=28.821, 95%CI:3.741～222.033, P=0.001）、胎盘位于子宫前壁（OR=1.704, 95%CI:1.013～2.866,P=0.044）是中央性前置胎盘合并胎盘植入孕妇发生产后大出血的独立危险因素;子宫动脉结扎术（OR=0.593,...     

剖宫产术后再次妊娠合并前置胎盘孕妇胎盘植入的风险评估及不良结局预测全国多中心回顾性研究

目的探讨剖宫产术后再次妊娠合并前置胎盘孕妇的胎盘植入性疾病(PAS)影像学诊断及血管阻断方式对妊娠结局的影响。方法采用全国多中心回顾性研究, 于2018年1月1日至12月31日选取12家三级甲等医院的剖宫产术后再次妊娠合并前置胎盘的妊娠晚期单胎妊娠孕妇共747例。采用单因素及多因素logistic回归分析, 观察剖宫产术后再次妊娠合并前置胎盘孕妇严重不良结局(子宫切除、术中出血量≥1 000 ml、术中诊断PAS)的危险因素;观察产前超声和磁共振成像(MRI)检查在胎盘PAS及严重不良结局预测中的作用。根据是否行血管介入(子宫动脉栓塞术或腹主动脉球囊阻断术)分为阻断组(106例)与未阻断组(641例), 比较两组孕妇的母儿结局。结果 (1)一般情况:747例剖宫产术后再次妊娠合并前置胎盘孕妇的子宫切除率为10.4%(78/747), 术中出血量≥1 000 ml者占55.8%(417/747), 术中确诊PAS者占47.5%(355/747)。子宫破裂的发生率为0.8%(6/747)。(2)严重不良结局的危险因素:子宫切除的危险因素是血管阻断方式和术中出血量, 子宫动脉栓塞术者子宫切除...     

凶险性前置胎盘产妇发生弥散性血管内凝血和失血性休克及子宫切除的相关因素分析

目的:探讨凶险性前置胎盘产妇发生弥散性血管内凝血(DIC)、失血性休克、子宫切除不良妊娠结局的相关因素。方法:回顾性分析2012年1月1日至2016年12月31日于中国医科大学附属盛京医院行剖宫产终止妊娠的96例凶险性前置胎盘产妇的临床资料,对其发生DIC、失血性休克及子宫切除不良妊娠结局的有关因素行单因素和二项分类Logistic回归模型分析。结果:Logistic回归模型分析示:术中宫腔填塞纱布或球囊、行腹主动脉球囊阻滞是产妇发生DIC的保护性因素(OR1,P0.05);而伴有胎盘植入、人工流产次数多是发生DIC的独立危险因素(OR1,P0.05)。术中宫腔填塞纱布或球囊是产妇发生失血性休克的保护性因素(OR1,P0.05);而伴有胎盘植入、人工流产次数多是发生失血性休克的独立危险因素(OR1,P0.05)。术中行腹主动脉球囊阻断是切除子宫的保护性因素(OR1,P0.05);而伴有胎盘植入、孕次数越多是发生子宫切除的独立危险因素(OR1,P0.05)。结论:凶险性前置胎盘产妇孕次越多、人工流产次数越多、合并胎盘植入时,发生不良妊娠结局的风险越高。术中行宫腔填塞纱布或球囊压迫止血和行腹主动脉球囊阻断能降低不良妊娠结局的风险。     

65例胎盘植入患者的危险因素分析

目的:探讨胎盘植入患者的危险因素.方法:回顾分析2002年1月1日至2010年12月31日山西医科大学第二临床医学院妇产科收治的65例胎盘植入患者的临床资料,同时随机选取非胎盘植入孕妇65例为对照组.采用SPSS17.0统计软件中的单因素x2检验和Fisher精确概率法、多因素Logistic回归分析,比较两组患者的相关危险因素.结果:(1)胎盘植入患者占产科患者的0.86％;(2)单因素卡方分析:流产史(卡方P=0.012,趋势卡方P=0.003)、前置胎盘(卡方P＜0.001)、妊娠合并高血压疾病(卡方P=0.013)是胎盘植入的危险因素;(3)多因素Logistic回归分析:前置胎盘(OR=8.63,95％CI为2.25～33.11,P=0.002)、妊娠合并高血压疾病(OR=7.21,95％CI为1.65 ～31.57,P=0.009)、文化程度(OR=1.79,95％CI为1.00 ～3.18,P=0.049)是胎盘植入的独立危险因素.结论:胎盘植入的危险因素有流产史、前置胎盘和妊娠合并高血压疾病.前置胎盘、妊娠合并高血压疾病和文化程度是胎盘植入的独立危险因素.     

前置胎盘产前出血与妊娠结局关系研究

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。     

单、双胎妊娠并发子痫前期不良妊娠结局的荟萃分析

目的探讨单、双胎妊娠并发子痫前期的孕妇与围产儿不良结局发病率差异。 方法检索PubMed、Web of Science、中国生物医学文献数据库、中国学术文献总库、万方和维普中文数据库中2000年1月至2017年12月国内外发表的关于单、双胎妊娠并发子痫前期妊娠结局的研究。采用RevMan 5.3与Stata 12.0软件对资料进行荟萃分析,采用OR值及相应的95%CI评价不良结局与双胎妊娠并发子痫前期的相关性。 结果纳入10篇文献,共692例双胎妊娠合并子痫前期,3101例单胎妊娠合并子痫前期。双胎妊娠合并子痫前期组发病率高于单胎妊娠合并子痫前期：胎盘早剥OR＝2.16,95%CI为1.40～3.36;产后出血OR＝2.90, 95%CI为2.03～4.15;心功能衰竭OR＝3.73, 95%CI为2.10～6.63 ;肺水肿OR＝2.76, 95%CI为1.04～7.27;剖宫产OR＝2.27, 95%CI为1.58～3.26;胎膜早破OR＝2.99, 95%CI为1.64～5.47;早产OR＝6.24,95%CI为4.16～9.38,新生儿重症监护病房转入率OR＝2.33, 95%CI为1.66～3.26。 结论双胎妊娠合并子痫前期的不良妊娠结局包括胎盘早剥、产后出血、心功能衰竭、肺水肿、剖宫产、胎膜早破、早产和新生儿重症监护病房转入的发病率比单胎妊娠合并子痫前期高。     

辅助生殖技术单胎妊娠结局分析

目的:研究辅助生殖技术(ART)与自然受孕两种不同受孕方式单胎妊娠的妊娠结局。方法:回顾分析2009年1月1日至2017年12月31日在广州医科大学附属第三医院住院分娩的妊娠≥20周的单胎妊娠病例资料。按受孕方法分为ART组及自然妊娠组,分析两组母儿结局,再按是否为高龄妊娠,比较ART组及自然妊娠组的母儿结局。结果:ART组孕妇的平均年龄、初产妇、定期产检、非足月胎膜早破(PPROM)、羊水量异常、子痫前期、妊娠期高血压、妊娠合并血小板减少症、妊娠期糖尿病、糖尿病合并妊娠、前置胎盘、胎盘植入/粘连、产后出血、剖宫产分娩、产钳/吸引产助产、人工剥离胎盘、药物/机械性引产、流产、胎儿窘迫及胎儿为男性发生率均高于自然妊娠组,ART组的住院天数更长,分娩孕周更低,转诊重症监护病房(ICU)、急性器官衰竭发生风险较低,ART组围产儿平均体重高于自然受孕组。高龄妊娠孕妇中,ART组的妊娠期糖尿病、剖宫产分娩发生风险增加。非高龄妊娠孕妇中,ART组子痫前期、妊娠期高血压、妊娠期糖尿病、糖尿病合并妊娠、流产、PROM、羊水量异常、前置胎盘、胎盘植入/粘连、产后出血、胎儿窘迫、人工剥离胎盘、药物/机械性引产发生风险增加。ART组较自然妊娠组钳产/吸引产风险均增加,产妇转诊ICU及非规律产检发生风险均降低,差异均有统计学意义(均P<0.05)。结论:ART受孕单胎妊娠并发症及新生儿不良结局发生率高于自然妊娠组孕妇,但其更注重孕期产检;在非高龄妊娠孕妇中,ART组母儿不良结局风险增加,而高龄妊娠孕妇中,ART组母儿不良结局风险增加不明显。     

Obstetric history and the risk of placenta previa

OBJECTIVE: To evaluate secular trends in the occurrence of placenta previa and whether placenta previa is associated with the outcome of previous pregnancies, cesarean section, and sociodemographic factors. DESIGN: A cohort study based on the Medical Birth Registry of Norway. Placenta previa in the second pregnancy was investigated for associations with outcomes in the first pregnancy and sociodemographic factors. RESULTS: In birth orders 1 and 2 the occurrence of placenta previa was 1.2 and 2.2 per 1,000, respectively, with no secular trend. The occurrence increased with maternal age and was lowest in women aged 20-29 years. The recurrence rate was 23 per 1,000 (adjusted odds ratio (OR) of recurrence=9.7). In women with prior delivery at < or =25 gestational weeks the risk of placenta previa was 6.7 per 1,000 (adjusted OR=3.0). In women with prior placental abruption the risk was 5.8 per 1,000 (OR=2.6). In women with prior perinatal death the risk was 4.4 per 1,000 (adjusted OR= 1.8). No independent relationship emerged with socio-economic factors, previous birthweight, and a history of pregnancy induced hypertension. Cesarean section was associated with subsequent development of placenta previa (adjusted OR= 1.3). CONCLUSIONS: We found no secular trends in the occurrence of placenta previa. Placenta previa is associated with previously described risk factors for placental abruption. The increased risk of placenta previa subsequent to placental abruption supports the theory of a shared etiologic factor. However, placenta previa and placental abruption do not share a common etiology in relation to a history of pregnancy induced hypertension, fetal growth retardation, and socio-economic factors.     

胎盘植入及植入深浅对母婴的影响

目的:探讨胎盘植入及植入深浅对孕妇及胎儿的影响及其临床特点。方法:回顾分析2008年1月~2010年12月我院产科收治的266例单胎胎盘植入(病例组)及266例单胎非胎盘植入(对照组)患者的临床资料。将病例组再分为浅层侵入组(191例)和深层侵入组(75例)。深层侵入组由植入性胎盘和穿透性胎盘组成,浅层侵入组由粘连性胎盘组成。结果:病例组和对照组的输血治疗、产后出血、早产、新生儿窒息和入住NICU、胎儿死亡方面均差异显著(P0.05);但两组在有剖宫产史、实施剖宫产术终止妊娠、胎儿性别等方面则无显著差异(P0.05)。孕妇高龄、有剖宫产史、孕产次和流产次数增多与深层侵入的发生显著相关。与浅层侵入组比较,深层侵入组中孕妇行输血治疗、合并产后出血或前置胎盘、术后入住ICU治疗、新生儿出生体重2500g和入住NICU治疗等不良妊娠结局发生风险显著升高;在行剖宫产术终止妊娠、合并先露异常或胎膜早破等方面,深层侵入组与浅层侵入组无显著差异(P0.05)。结论:胎盘植入,尤其植入性胎盘和穿透性胎盘使母儿不良妊娠结局发生风险增高,与其相关的并发症与合并症亦可威胁母儿生命。     

超声胎盘血流检查在胎盘植入性疾病中的作用

胎盘植入性疾病是指胎盘绒毛侵入子宫肌层,达到或穿透子宫浆膜层,甚至累及膀胱和直肠,可导致严重产后出血、育龄妇女子宫切除,甚至孕产妇死亡。常见的高危因素有前置胎盘、剖宫产史、高龄等。近年来,随着剖宫产率的上升,胎盘植入性疾病的发病率不断升高,依靠超声征象及胎盘血流检查,判断胎盘植入的凶险程度,规范孕妇管理,减少胎盘植入并发症具有重要价值。     

Placenta previa accreta

OBJECTIVES: The purpose of our study was to assess the relationship between previous cesarean section and placenta previa accreta and to estimate the incidence of placenta accreta et previa accreta as the indication for peripartum hysterectomy. MATERIALS AND METHODS: The records of all patients delivered with the diagnosis of placenta previa accreta during the period from 1992-2002 at Hospital in Chojnice were reviewed. Statistical analyses were carried out to determine the relationship between previous cesarean section and subsequent development of placenta previa accreta. We conducted a retrospective analysis of indications for peripartum hysterectomy. RESULTS: From a total 28,177 women, who delivered at the Chojnice Hospital, 15(0.05%) patients had placenta accreta, 63(0.2%) placenta previa. Among placenta previa deliveries 22(34.9%) patients had previous cesarean section. Out of 15 patients with placenta accreta 10(66.7%) had placenta previa. Incidence of placenta accreta per case of placenta previa was 158.7 per 1000. The incidence of placenta previa accreta significantly increased in those with previous post cesarean scars. This incidence increased as the number of previous cesarean sections increased. The most common indication for peripartum hysterectomy was placenta accreta--48.4%, incidence of placenta previa accreta was accounts for 32.3% of all indications. CONCLUSIONS: The association between placenta previa accreta and prior cesarean section was confirmed. The incidence of placenta accreta increased as the number of previous cesarean sections increased. Patients with an antepartum diagnosis of placenta previa, who have had a previous cesarean section should be considered at high risk for developing placenta accreta. The most common indication for peripartum hysterectomy in this study was placenta previa accreta.     

Abnormal placentation: twenty-year analysis

OBJECTIVE: This study was undertaken to determine whether the rate of abnormal placentation is increasing in conjunction with the cesarean rate and to evaluate incidence, risk factors, and outcomes. STUDY DESIGN: Cases from 1982-2002 were identified by histopathologic or strong clinical criteria. Risk factors were assessed in a matched case-control study, and analyzed using conditional logistic regression models. RESULTS: There were 64,359 deliveries, with cesarean rates increasing from 12.5% (1982) to 23.5% (2002). The overall incidence of placenta accreta was 1 in 533. Significant risk factors for placenta accreta in our final analysis included advancing maternal age (odds ratio [OR] 1.13, 95% CI 1.089-1.194, P < .0001), 2 or more cesarean deliveries (OR 8.6, 95% CI 3.536-21.078, P < .0001), and previa (OR 51.4, 95% CI: 10.646-248.390, P < .0001). CONCLUSION: The rate of placenta accreta increased in conjunction with cesarean deliveries; the most important risk factors were previous cesarean delivery, previa, and advanced maternal age.     

Abnormal placentation

The term “morbidly adherent placenta” has recently been introduced to describe the spectrum of disorders including placenta accreta, increta and percreta. Due to excessive invasion of the placenta into the uterus there is associated significant maternal morbidity and mortality. Most significant risk factors for morbidly adherent placenta include history of prior cesarean delivery as well as placenta previa in the current pregnancy. Ultrasound remains the gold standard for antenatal diagnosis, however, in recent years MRI has assisted in identifying complex parametrial involvement. Optimizing maternal and neonatal outcomes involves early prenatal diagnosis, a multi-disciplinary team-based approach, and referral to an experienced center.     

Placenta previa/accreta and prior cesarean section

To assess the relationship between increasing numbers of previous cesarean sections and the subsequent development of placenta previa and placenta accreta, the records of all patients presenting to labor and delivery with the diagnosis of placenta previa between 1977 and 1983 were examined. Of a total of 97,799 patients, 292 (0.3%) had a placenta previa. The risk of placenta previa was 0.26% with an unscarred uterus and increased almost linearly with the number of prior cesarean sections to 10% in patients with four or more. The effect of advancing age and parity on the incidence of placenta previa was much less dramatic. Patients presenting with a placenta previa and an unscarred uterus had a 5% risk of clinical placenta accreta. With a placenta previa and one previous cesarean section, the risk of placenta accreta was 24%; this risk continued to increase to 67% (two of three) with a placenta previa and four or more cesarean sections. Possible mechanisms and clinical implications are discussed.     

Prediction of placenta accreta spectrum by a scoring system based on maternal characteristics combined with ultrasonographic features

ObjectiveIn order to create a comprehensive scoring system based on maternal characteristics and ultrasonographic features for predicting placenta accreta spectrum (PAS).Materials and methodsThis was a retrospective review of pregnant women who underwent routine ultrasound examination in the third trimester of pregnancy from January 2014 to November 2018 were used as a training set to establish the scoring system for PAS prediction while those who underwent examination from January 2019 to December 2019 served as a validation set.. Maternal characteristics including maternal age, parity, previous vaginal deliveries, previous curettage, previous cesarean section (CS), history of hypertension and diabetes mellitus, prenatal body mass index (BMI) were recorded. Ultrasonographic features including abnormal placental lacunae, subplacental hypervascularity, myometrial thinning, placental bulge, bladder wall interruption, location of placenta, placenta previa (yes or not) were recorded. Multivariate analysis was applied to analyze independent risk factors and assess the predictive power of selected parameters predicting PAS. Receiver operating characteristics (ROC) curve was used to evaluate the diagnosis power.ResultsParity, previous curettage and CS were independent risk factors. The best comprehensive scoring system was established as follow: the number of abnormal lacunae ≥3, 2 points; lacuna maximum dimension ≥2 cm, 5 points; subplacental hypervascularity (rich), 1 point; subplacental hypervascularity (extremely rich and disordered), 3 points; bladder wall interruption, 9 points; placental bulge, 9 points; placenta previa, 8 points; anterior placenta, 1 point; previous CS ≥ 1, 1 point; parity ≥ 4, 3 point; previous abortions ≥ 2, 1 point. The area under the ROC curve of the scoring system diagnosing PAS was 0.925. Sensitivity and specificity were 83.3% and 85.7%, respectively. Cross-validation for our model showed that sensitivity, specificity, positive predictive value and negative predictive value of the model in diagnosis of PAS were 82.6%, 81.8%, 82.6% and 81.8%, respectively. Diagnosis of 37 cases were consistent with the “gold standard”, and the coincidence rate was 82.2% (37/45).ConclusionThe comprehensive scoring system established in this study can effectively diagnose PAS.     

妊娠间隔对经产妇妊娠结局的影响多中心回顾性研究

目的探讨不同妊娠间隔(IPI)对经产妇妊娠结局的影响。方法基于全国14个省区市共21家医院开展多中心回顾性研究,通过查阅病历收集2011—2018年间两次妊娠均在同一家医院分娩的经产妇的年龄、身高、孕前体重、IPI、既往史、妊娠合并症和并发症、分娩孕周、分娩方式、妊娠结局等资料。根据不同IPI分为4组:<18个月组、18~23个月组、24~59个月组和≥60个月组,分析其临床特征和妊娠结局。根据WHO的推荐,以24~59个月组作为参照,比较各组经产妇的妊娠结局。进一步根据年龄、妊娠期糖尿病(GDM)史、巨大儿分娩史和早产史进行分层分析,探讨不同特征经产妇中IPI对其妊娠结局的影响。结果本研究共纳入经产妇8026例,其中<18个月组、18~23个月组、24~59个月组和≥60个月组分别为423、623、5512和1468例。(1)<18个月组、18~23个月组、24~59个月组和≥60个月组的妊娠年龄、本次妊娠前体质指数(BMI)、剖宫产史比例、GDM发生率、妊娠期高血压发生率以及剖宫产术分娩比例均逐渐增加,分别比较,差异均有统计学意义(P均<0.05)。(2)校正混杂因素后,与24~59个月组经产妇相比,≥60个月组经产妇的早产、胎膜早破和羊水过少的发生风险分别增加42%(OR=1.42,95%CI为1.07~1.88,P=0.015)、46%(OR=1.46,95%CI为1.13~1.88,P=0.004)和64%(OR=1.64,95%CI为1.13~2.38,P=0.009),其他组均未见不良妊娠结局的发生风险增加(P均>0.05)。(3)根据妊娠年龄分层,校正混杂因素后,与24~59个月组比较,高龄经产妇≥60个月组羊水过少的发生风险明显增加(OR=2.87,95%CI为1.41~5.83,P=0.004);非高龄经产妇<18个月组胎膜早破的发生风险明显增加(OR=1.59,95%CI为1.04~2.43,P=0.032),≥60个月组胎膜早破(OR=1.58,95%CI为1.18~2.13,P=0.002)和早产(OR=1.52,95%CI为1.07~2.17,P=0.020)的发生风险均显著增加。根据有无GDM史分层,校正混杂因素后,与24~59个月组比较,≥60个月组有GDM史经产妇产后出血的风险显著增加(OR=5.34,95%CI为1.45~19.70,P=0.012),无GDM史经产妇胎膜早破的发生风险显著增加(OR=1.44,95%CI为1.10~1.90,P=0.009)。根据有无巨大儿分娩史分层,校正混杂因素后,与24~59个月组比较,≥60个月组有巨大儿分娩史经产妇剖宫产术分娩的比例显著增加(OR=4.11,95%CI为1.18~14.27,P=0.026),无巨大儿分娩史经产妇胎膜早破的发生风险显著增加(OR=1.46,95%CI为1.12~1.89,P=0.005)。根据有无早产史分层,校正混杂因素后,与24~59个月组比较,≥60个月组无早产史经产妇胎膜早破的发生风险显著增加(OR=1.47,95%CI为1.13~1.92,P=0.004)。结论IPI≥60个月或<18个月均会造成经产妇不良妊娠结局的发生风险增加,应通过对育龄期妇女孕前咨询和产后保健的健康教育,指导育龄期妇女再次妊娠时保持适宜的IPI,以降低不良妊娠结局的发生风险。     

孕妇年龄与妊娠高危因素及妊娠结局的关系

目的:探讨孕妇年龄与妊娠高危因素、妊娠结局的关系。方法:通过对2015年1月1日至2016年10月31日期间,在南方医科大学珠江医院分娩的所有产妇作为研究分析对象,按年龄划分为4组,≤24岁组543例(13.76%)、25~29岁组1648例(41.18%)、30~34岁组1208例(30.61%)、≥35岁组547例(13.86%)。统计4组不同年龄孕妇妊娠合并症、并发症的发生率和妊娠结局,将25~29岁组设为对照组(OR=1),进行二元Logsitic回归分析年龄与妊娠合并症、并发症及妊娠结局等的相关性。结果:在年龄30岁孕妇中,不良孕产史、本次辅助生殖助孕妊娠、妊娠合并子宫肌瘤、妊娠期糖尿病、瘢痕子宫OR值均1,且随年龄组增加,OR值递增。前置胎盘、多胎妊娠、产后出血,分娩巨大儿、低体质量儿、早产儿,在年龄≥35岁组中OR值1。子痫前期中年龄≤24岁组、≥35岁组OR值均1。在30~34岁组出生缺陷儿的OR值1。结论:对不同年龄孕妇,要有针对性地采取围生期检查及保健工作,及时对高危孕妇进行干预,积极治疗相关合并症,预防并发症,适时选择最佳分娩方式,综合保障母婴健康。